Reframing Peer Support as a Health Equity and Reentry Infrastructure Strategy
Abstract
Peer support has historically been positioned as a supplemental or supportive service within behavioral health and reentry systems. However, emerging evidence and implementation models suggest that peer-led interventions are more accurately understood as critical infrastructure for advancing health equity, improving continuity of care, and transforming engagement among populations disproportionately impacted by incarceration, homelessness, substance use disorders, and systemic exclusion. Drawing upon implementation practice, systems leadership, evidence-based literature, and community-based reentry initiatives, this paper examines how Peer Recovery Support Navigators (PRSNs) and Community Health Workers (CHWs) with lived experience can function as catalysts for systems transformation. Attention is given to Black, and Indigenous People of Color (BIPOC) communities and justice-impacted populations historically underserved by institutional systems. The paper further explores how community engagement, culturally responsive care, and lived experience leadership contribute to improved treatment participation, healthcare engagement, and long-term recovery outcomes.
Introduction
The intersection of opioid use disorder (OUD), homelessness, behavioral health instability, incarceration, and structural inequity represents one of the most urgent public health challenges in the United States. Over the past two decades, overdose deaths involving opioids have increased dramatically, with synthetic opioids such as fentanyl driving unprecedented mortality rates across communities nationwide (Centers for Disease Control and Prevention [CDC], 2023).
While the opioid epidemic affects populations across racial and socioeconomic groups, BIPOC communities and justice-impacted populations continue to experience some of the greatest disparities in treatment access, continuity of care, and recovery outcomes.
Historically, healthcare and criminal legal systems have approached substance use through fragmented and often punitive frameworks that failed to address the broader structural conditions shaping health outcomes. Individuals returning from incarceration frequently reenter communities facing unstable housing, untreated behavioral health conditions, limited employment opportunities, disrupted healthcare coverage, and heightened overdose risk.
Research demonstrates that the immediate post-release period is associated with dramatically elevated mortality rates, particularly due to overdose and untreated chronic illness (Binswanger et al., 2007).
Through my work developing peer support infrastructure, reentry initiatives, and community-based leadership models within Los Angeles County’s Alternatives to Incarceration (ATI) movement, it became increasingly evident that institutional systems often fail to engage the very populations most impacted by structural inequity. In practice settings serving justice-impacted populations, treatment disengagement is rarely the result of individual unwillingness alone. More often, it reflects longstanding experiences of institutional mistrust, criminalization, fragmented care, and systemic exclusion.
These observations reinforce a growing body of evidence demonstrating that treatment engagement is fundamentally relational. Systems designed primarily around compliance, surveillance, or institutional authority frequently struggle to establish meaningful engagement among populations historically harmed by healthcare and criminal legal systems. Sustainable engagement instead requires approaches grounded in trust, continuity, cultural responsiveness, and lived experience leadership.
This paper argues that Peer Recovery Support Navigators (PRSNs) and Community Health Workers (CHWs) with lived experience represent a critical but underutilized infrastructure strategy for advancing health equity, improving treatment engagement, and transforming behavioral health and reentry systems.
The Evolution of Peer Support: From Mutual Aid to Systems Strategy
Peer support emerged historically from grassroots mutual-aid movements grounded in shared experience, recovery, and community accountability. Early recovery communities recognized that individuals with lived experience possessed a unique ability to establish trust, model hope, and support behavioral change among others navigating similar struggles. Over time, peer support evolved from informal community practice into increasingly formalized behavioral health and recovery support interventions.
Despite this evolution, lived experience leadership has often remained structurally marginalized within institutional systems. Traditional healthcare environments frequently position experiential knowledge as secondary to formal clinical training, reinforcing hierarchical distinctions between “professional expertise” and “lived expertise.” However, implementation experience increasingly demonstrates that this distinction fails to account for the realities of engaging populations historically underserved by institutional systems.
Through my work facilitating peer support and leadership development initiatives within the ATI (Alternatives to Incarceration) Incubation Academy, it became increasingly clear that the tension between traditional professional models and lived experience-based support systems is often rooted in differing assumptions about trust, authority, and engagement. Traditional systems frequently prioritize formal credentials, fixed roles, and uni-directional accountability structures, while peer support models emphasize mutuality, experiential credibility, flexible engagement, and relationship-centered care.
Rather than viewing these approaches as competing frameworks, implementation practice suggests that effective behavioral health and reentry systems require integration of both clinical expertise and lived experience leadership.
One principle consistently reinforced throughout my ATI implementation work was the understanding that “people closest to the problem are closer to the solution.” Individuals directly impacted by incarceration, homelessness, behavioral health instability, and substance use disorders possess forms of systems knowledge that institutional structures frequently overlook. Their lived experience provides critical insight into barriers to care, institutional mistrust, engagement strategies, and practical pathways toward continuity of care.
“People closest to the problem are closer to the solution.” – Troy F. Vaughn
Structural Vulnerability and the Reentry Crisis
The reentry period following incarceration represents one of the most structurally vulnerable transitions within public systems. Individuals leaving correctional settings frequently encounter fragmented healthcare access, unstable housing, unemployment, untreated trauma, and limited continuity of care. These structural conditions significantly increase risks for overdose, hospitalization, recidivism, and mortality.
Through my work within ATI initiatives and countywide reentry collaboratives, it became increasingly evident that successful reentry outcomes are inseparable from broader structural conditions including housing stability, employment access, integrated healthcare, civic engagement, faith-based support, and policy advocacy. Reentry systems that isolate behavioral health treatment from these broader determinants often struggle to sustain long-term recovery outcomes.
Structural vulnerability theory further supports this understanding by recognizing that social, political, and economic systems produce unequal exposure to health risks (Metzl & Hansen, 2014). Justice-impacted individuals often experience overlapping forms of structural exclusion that compound barriers to treatment engagement. In practice settings serving reentry populations, these barriers commonly include delayed Medicaid activation, transportation limitations, housing discrimination, employment restrictions, healthcare mistrust, and fragmented coordination between correctional and community-based systems.
Importantly, many traditional systems continue to operate from assumptions that treatment failure is primarily the result of individual noncompliance rather than structural instability. Such approaches frequently overlook the realities facing individuals attempting to navigate recovery while simultaneously addressing housing insecurity, financial instability, unresolved trauma, and systemic exclusion.
Peer Recovery Support Navigators help address these gaps by functioning as continuity-of-care specialists capable of translating institutional systems into accessible, relationship-centered pathways for participants.
Community Engagement and Health Equity
Improving treatment engagement among Black communities disproportionately impacted by opioid use disorder requires approaches grounded in trust, cultural responsiveness, and authentic community partnership. Historically marginalized populations often approach institutional systems with understandable skepticism shaped by prior experiences of criminalization, discrimination, and exclusion.
My work developing peer leadership initiatives and community engagement strategies within ATI and reentry systems reinforced that organizations incorporating individuals with lived experience are often better positioned to create services that are culturally responsive, integrated, effective, and sustainable. Community engagement is not merely outreach. Effective engagement requires systems to demonstrate trustworthiness through accessibility, dignity, shared decision-making, and relational credibility.
The LEADERS Training Academy model I developed at the Los Angeles Regional Reentry Partnership (LARRP) further demonstrates that lived experience leadership can extend beyond direct services into workforce development, advocacy, policy engagement, civic participation, and systems transformation. These implementation experiences reinforced that sustainable recovery is strengthened not only through treatment access, but through leadership development, economic mobility, social connection, and civic engagement.
Trusted messengers, including Peer Recovery Support Navigators, Community Health Workers, faith leaders, and grassroots community organizations, often play a critical role in helping participants transition from institutional skepticism to sustained engagement in care.
Conclusion
The opioid crisis, reentry instability, and behavioral health inequities confronting Black communities and justice-impacted populations cannot be addressed through fragmented or institution-centered systems alone. Sustainable engagement requires approaches grounded in trust, continuity, cultural responsiveness, and lived experience leadership.
Through implementation work within LARRP, ATI initiatives, reentry collaboratives, peer leadership development programs, and community-based behavioral health systems, it became increasingly evident that lived experience leadership is not ancillary to systems reform it is foundational to it.
Peer Recovery Support Navigators and Community Health Workers represent more than supplemental support staff. They are essential infrastructure within emerging models of equitable healthcare and reentry systems. Evidence-based frameworks such as the Transitions Clinic Network demonstrate that integrating lived experience into care systems improves engagement, strengthens continuity of care, and advances health equity outcomes.
Ultimately, systems transformation requires moving beyond models that treat impacted communities as passive recipients of services and toward frameworks that recognize lived experience as a form of expertise capable of reshaping healthcare, behavioral health, and reentry systems from the inside out.
References
Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115
Centers for Disease Control and Prevention. (2023). Drug overdose deaths in the United States, 2002–2023. U.S. Department of Health and Human Services. https://www.cdc.gov/drugoverdose/deaths/index.html
Hollander, M. A. G., Chang, C. H., Douaihy, A. B., & Hulsey, E. G. (2021). Racial inequity in medication treatment for opioid use disorder. Journal of Addiction Medicine, 15(6), 496–505. https://doi.org/10.1097/ADM.0000000000000805
Johnson, N. L., et al. (2025). Embracing anti-racism: Co-creating recommendations with Black communities to improve addiction treatment. Social Science & Medicine, 365, 117539. https://doi.org/10.1016/j.socscimed.2024.117539
Mauer, M., & Chesney-Lind, M. (2002). Invisible punishment: The collateral consequences of mass incarceration. The New Press.
Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126–133. https://doi.org/10.1016/j.socscimed.2013.06.032
National Institute on Drug Abuse. (2023). Medications to treat opioid use disorder research report. National Institutes of Health. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction
Substance Abuse and Mental Health Services Administration. (2020). Treatment Improvement Protocol (TIP) 63: Medications for opioid use disorder. U.S. Department of Health and Human Services. https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder/PEP21-02-01-002
Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154. https://doi.org/10.2147/SAR.S81535
Wang, E. A., Hong, C. S., Shavit, S., Sanders, R., Kessell, E., & Kushel, M. B. (2012). Engaging individuals recently released from prison into primary care: A randomized trial. American Journal of Public Health, 102(9), e22–e29. https://doi.org/10.2105/AJPH.2012.300894
Be First to Comment