“If It Wasn’t for Him, I Wouldn’t Have Talked to Them”: Qualitative Study of Addiction Peer Mentorship in the Hospital
Hospitalizations related to substance use disorders (SUD) are skyrocketing. Hospital providers commonly feel unprepared to care for patients with SUD and patients with SUD commonly feel discriminated against by hospital staff. This tension can lead to provider burnout and poor patient outcomes. Research in ambulatory settings suggests that peer mentors (PMs) can improve substance use outcomes and patient experience. However, no study has examined the role of peer mentorship for patients with SUD in hospitals.
Understand how peer mentorship affects care for hospitalized patients with SUD, and how working in a hospital affects PMs’ sense of professional identity.
Qualitative study utilizing participant observation, individual interviews, and focus groups related to the PM component of the Improving Addiction Care Team (IMPACT), a hospital-based interprofessional addiction medicine consult service.
IMPACT providers, patients seen by IMPACT, PMs, and a PM supervisor.
Qualitative thematic analysis.
PMs occupy a unique space in the hospital and are able to form meaningful relationships with hospitalized patients based on trust and shared lived experiences. PMs facilitate patient care by contextualizing patient experiences to teams and providers. Reciprocally, PMs “translate” provider recommendations to patients in ways that patients can hear. Respondents described PMs as “cultural brokers” who have the potential to transfer trust that they have earned with patients to providers and systems who may otherwise be viewed as untrustworthy. While PMs felt their role led to professional and personal development, the intensity of the role in the hospital setting also put them at risk for emotional drain and stress.
While integrating PMs into hospital care presents substantial challenges, PMs may act as a “secret weapon” to engage often marginalized hospitalized patients with SUD and improve patient and provider experience.
KEY WORDSsubstance-related disorders qualitative research peer recovery hospital physician-patient relations
Authors would like to acknowledge O’Nesha Cochran, Chris Colasurdo, Kim Brandt, Meg Devoe, Richard Gil, Melissa Weimer, Daren Ford, Stacey Mahoney, Jessica Brown, Claire Dorfman, and the entire IMPACT clinical team. The IMPACT is supported by OHSU and CareOregon.
This work was supported by the Oregon Clinical and Translational Research Institute (OCTRI) grant UL1TR0023693.
Compliance with Ethical Standards
Study protocol was approved by the Oregon Health & Science University institutional review board.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 3.Englander H, Collins D, Perry SP, Rabinowitz M, Phoutrides E, Nicolaidis C. “We’ve learned it’s a medical illness, not a moral choice”: qualitative study of the effects of a multicomponent addiction intervention on hospital providers’ attitudes and experiences. J Hosp Med. 2018;13:752–8.Google Scholar
- 5.McGillion J, Wanigaratne S, Feinmann C, Godden T, Byrne A. GPs’ attitudes towards the treatment of drug misusers. Br J Gen Pract. 2000;50:385–6.Google Scholar
- 7.Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users: the keys to the “narc” cabinet. J Gen Intern Med. 2002;17:327–33.Google Scholar
- 9.Sleeper J, Bochain S. Stigmatization by nurses as perceived by substance abuse patients: a phenomenological study. J Nurs Educ Pract. 2013;3:8.Google Scholar
- 15.Watson E. The mechanisms underpinning peer support: a literature review. J Ment Health. 2017;1–12.Google Scholar
- 20.Englander H, Brandt K, Mahoney S, Brown J, Nydahl A, Weimer M, Gregg J. Tools to support hospital-based addiction care: core components, values, and activities of the Improving Addiction Care Team (IMPACT). J Addict Med. https://doi.org/10.1097/ADM.0000000000000487.
- 21.Englander H, Gregg J, Gullickson J, et al. Recommendations for integrating peer mentors in hospital-based addiction care (in press). Subst Abus. https://doi.org/10.1080/08897077.2019.1635968.