Opinion

Workers with lived and living experience have a long history in the alcohol and other drug (AOD) field. Some of the earliest and best-known AOD support services are organised and staffed by those with lived experience, and countless lives have been improved due to the efforts of this segment of the workforce. Recent years have seen increasing recognition of the value of lived and living experience in providing client care, and a concomitant increase in the number of designated peer worker roles.

Peer workers operate in defined positions within the workforce and draw on their experiential knowledge to assist others to engage in treatment and achieve their goals. Peer workers can be found in a range of positions, including in treatment, prevention, and harm-reduction services (such as needle/syringe exchange programs and opioid overdose programs). A growing body of research has identified the benefits that peer workers can bring for clients (1, 2), but also the challenges they can face in their work. These include stigma and discrimination, role ambiguity, work/life conflict, low pay and power imbalances (3, 4). There are frequent calls for greater support and legitimisation of peer workers in the AOD field, and these are certainly important priorities for the sector. However, workforce development efforts are needed that extend beyond this group alone.

Our recent study of 1506 AOD workers across Australia indicates that the prevalence of lived and living experience among the workforce is far higher than the number of designated peer roles would suggest. Of the 986 workers we surveyed in direct client service roles, just 2% were in a defined peer worker position. However, more than 67% reported some form of lived or living experience (35% personal lived experience; 32% family/other lived experience). Among these workers, approximately a third had not disclosed their lived experience to their workplace, and a quarter of these stated that didn’t disclose specifically to avoid judgement or stigma.

There are two key messages to take away from these data. Firstly, if workforce support and development efforts focus exclusively on workers in designated peer roles, the majority of workers with lived and living experience are unlikely to benefit. Secondly, the perceived risk of judgement and stigma for disclosing lived and living experience remains significant.

More in-depth research is needed to examine this issue further. Unfortunately, studies of the Australian AOD workforce (including peer workers and those with lived and living experience) are hampered by a lack of nationally representative data. The definition of “peer worker” in the Australian AOD sector is also inconsistent, further impeding our understanding of the size and nature of this workforce. If we as a sector want to do better in supporting peer workers and those with lived and living experience, we need to have a clearer understanding of their social and employment demographics, as well as their work experiences and ambitions.

While challenging, establishing regular processes for collecting representative data on the AOD workforce will provide key information to inform not only better quality research, but also workforce planning, support and development initiatives. We are currently exploring how such data collection processes could potentially be implemented within the sector, and this will be a topic for further conversations.

A better understanding of how and why peer workers and those with lived and living experience stigma and discrimination is also imperative. For example, we need to know more about the origins of stigma within organisations, the ways it is experienced and who is most impacted. Efforts to address stigma at a social, organisational and individual level have already been ongoing in many spheres and will continue to require concerted effort going forward. Broader public campaigns may form an important component of these efforts; successful initiatives in reducing stigma related to mental health may provide useful models.

In the meantime, consideration needs to be given to how both peer workers and workers with lived and living experience can best be supported in their personal wellbeing and professional development, while still protecting privacy, anonymity, and autonomy. Significant progress has already been made in the AOD field to recognise and promote peer workers and those with lived and living experience; as a sector we should continue to strive for a safe and rewarding environment for all workers and clients.