Abstract: Utilization of Peer Recovery Coach in Emergency Department Among People with Substance Use Disorder (Society for Social Work and Research 30th Annual Conference Anniversary)

Schedule:

Friday, January 16, 2026

Marquis BR 10, ML 2 (Marriott Marquis Washington DC)

* noted as presenting author

Yali Deng, MSW, PhD Candidate, University of Maryland at Baltimore, Baltimore, MD

Jay Unick, PhD, Professor, University of Maryland at Baltimore, Baltimore, MD

Jon Gilgoff, PhD, Clinical Research Specialist, University of Maryland at Baltimore, MD

Background and Purpose:

Peer recovery coaches (PRCs)—individuals with lived experience of substance use disorder (SUD) recovery and specialized training—are increasingly integrated into hospital emergency departments (EDs). A common model connects ED-based substance use screening with referrals to PRCs, who then provide motivational interviewing, service navigation, and linkage to care based on patients’ stage of change. However, little is known about PRC service utilization, patient characteristics, or associated outcomes. This study aims to: (1) describe individuals referred to PRCs, and (2) examine differences between those who completed a PRC evaluation (“completion group”) and those who did not (“non-completion group”).

Methods:

Data were collected from a Baltimore ED and included 5,003 referrals linked to 3,564 unique patients referred to PRCs for alcohol or substance use disorder between September 1, 2022, and May 31, 2024. Patients whose only reported substance was cannabis or SUD treatment medication were excluded. The final sample included 2,051 individuals who reported alcohol, heroin/fentanyl, cocaine, or other drug use. Baseline characteristics were described, and bivariate analyses (Chi-square and t-tests) were conducted to compare completion and non-completion groups. Key variables included substance use status, stage of change (precontemplation to maintenance), and outcomes such as treatment referral, 30- and 90-day ED readmission, and time to revisit. The Benjamini-Hochberg False Discovery Rate adjustment and effect sizes were applied.

Results:

Most participants were male (67%), non-Hispanic Black (65%), aged 50 or older (43%), and on Medicaid (71%). Common substances included heroin/fentanyl (42%), cocaine (38%), alcohol (37%), and cannabis (23%). One in five participants were readmitted during the study period (7% within 30 days, 12% within 90 days). Of the 2,051 participants, 58% completed a PRC interview. The completion group was more likely to be male and report alcohol, cocaine, or heroin/fentanyl use. They were also more likely to be in contemplation (36%) or preparation to maintenance stages (37%) compared to 16% in the non-completion group (Φ = 0.34). Treatment referrals were significantly more common in the completion group (26% vs. 1%; Φ = 0.33). However, they also had a slightly higher 90-day readmission rate (14% vs. 10%; Φ = 0.06). No significant differences were found for 30-day readmission or time to revisit.

Conclusion:

A substantial proportion (42%) of high-risk ED patients referred to PRCs did not complete an evaluation. Motivation to change appears to be a key factor in engagement. Patients who completed PRC services had higher substance use risk, greater readiness to change, and higher referral rates, but also slightly higher long-term readmissions. These findings suggest PRCs play a critical role in connecting ED patients—particularly those in the contemplation stage—to treatment. Additional research is needed to evaluate long-term outcomes of PRC interventions.