Peer support workers are becoming a more visible part of services for people who use drugs and alcohol, bringing something that conventional clinical teams cannot easily reproduce: direct, personal knowledge of addiction, recovery and the systems surrounding both. A new qualitative study suggests that whether this expertise strengthens care may depend heavily on what happens behind the scenes, in supervision sessions intended to support the workers themselves. The research found that peer workers valued supervision when it offered emotional safety, opportunities for reflection, clear boundaries and recognition of lived experience as a legitimate form of expertise. They described it as far less useful when it became mainly an administrative exercise, was shaped too narrowly by clinical models or failed to reflect the realities of peer work. The findings place supervision—not simply recruitment or training—at the centre of efforts to build durable, recovery-oriented substance-use services.

Peer support workers are distinct from clinicians because their authority is rooted primarily in lived experience rather than professional qualifications. They may have personal experience of substance use, treatment, recovery, homelessness, criminal justice systems or other challenges shared by the people they support. That experience can help workers establish trust, communicate hope and make treatment systems feel less alien to service users. It can also create demanding psychological and professional situations. A peer worker may recognize aspects of their own past in a service user’s story, encounter stigma about their history or feel pressure to prove that lived experience belongs in a formal healthcare environment. Supervision is the structured process through which staff can examine such experiences, consider risks, develop practice and receive support. In this context, it must do more than check whether paperwork is complete or targets have been met: it must help workers understand how to use personal experience without being consumed by it.

Daryl Mahon, the study’s sole author, interviewed 12 peer support workers employed in substance-use services. The interviews were conducted online, and the resulting accounts were examined with thematic analysis using a hybrid inductive-deductive approach. In qualitative research, thematic analysis is used to identify recurring patterns of meaning across participants’ descriptions rather than to calculate the frequency of predetermined variables. An inductive element allows themes to emerge from what participants say, while a deductive element uses existing concepts or research questions to guide interpretation. This combination can be useful when a field has an established theoretical vocabulary but remains underexplored in a particular setting. The study did not attempt to estimate the prevalence of particular supervision experiences across the entire peer workforce, and its sensitive data were not made publicly available because of confidentiality concerns. Its purpose was instead to provide a detailed account of how supervision is experienced by workers whose roles often sit between personal testimony, social support and professional service delivery.

The first theme portrayed supervision as a form of emotional containment. Substance-use services routinely involve crisis, relapse, grief, trauma, overdose risk and uncertainty. Peer workers can encounter these pressures while drawing on memories of their own lives, making emotional responses particularly complex. Containment does not mean suppressing feelings or treating them as evidence of weakness. In supervision, it refers to creating a reliable relationship and setting in which difficult emotions can be acknowledged, thought about and placed in context before they spill into practice or personal life. A supervisor may help a worker distinguish empathy from over-identification, recognize signs of stress and decide when a situation requires additional support. This reflective function is technically different from simply offering advice: it supports the worker’s capacity to process an event, understand its significance and choose a proportionate response. Participants considered supervision safer and more valuable when it provided that kind of protected space.

The second theme concerned role clarification. Peer workers often operate within organizations designed around professional hierarchies, clinical documentation and formal accountability. Their responsibilities may overlap with those of counselors, case managers or support staff, yet their contribution is not identical to any of these roles. Unclear boundaries can expose workers to conflicting expectations: they may be asked to share personal experiences, but not know how much disclosure is appropriate; to advocate for service users, but also to follow organizational procedures; or to build informal trust while maintaining confidentiality and professional limits. Supervision can make these tensions explicit. By discussing what a peer worker is—and is not—responsible for, it can reduce role ambiguity, support ethical decision-making and prevent personal relationships from becoming unsafe or unsustainable. In implementation terms, this matters because a job title alone does not establish a functioning role. The surrounding routines, authority structures and feedback systems determine how that role operates in practice.

A third theme captured what the study calls the negotiation of peer identity within professional systems. Bringing lived experience into a service can challenge assumptions about who counts as an expert. At the same time, peer workers may feel pressure to distance themselves from their histories in order to be accepted by colleagues, or to perform a simplified version of recovery that reassures the institution. Professionalization can bring greater recognition, stable employment and clearer standards, but it can also unintentionally strip lived experience of its distinctive value if peer workers are expected to behave exactly like every other staff member. The interviews indicated that supervision could either help navigate or intensify this tension. When supervisors recognized peer work as a specialized practice, workers could reflect on their identity without treating it as a problem to be hidden. When supervision was framed only through conventional clinical assumptions, participants found it disconnected from the knowledge and relationships central to their work.

That distinction is important because supervision has several functions that are sometimes collapsed into one. A managerial meeting may review caseloads, attendance, performance indicators and organizational policies. A clinical supervision session may focus on assessment, diagnosis, treatment planning or therapeutic technique. A restorative conversation may address stress, emotional impact and professional resilience. These functions can overlap, but the study suggests that peer workers need supervision designed specifically around their role rather than a generic version imported from another profession. Peer-informed supervision might include supervisors with knowledge of lived-experience practice, structured discussion of boundaries and disclosure, attention to stigma and power, and a clear understanding of recovery-oriented language. It might also incorporate peer workers’ perspectives into the design of supervision itself. The point is not to exempt peer workers from accountability, but to ensure that accountability does not erase the practice they were hired to provide.

The fourth theme therefore focused on the need for peer-informed and organizationally embedded supervision. “Embedded” means that support is built into the institution’s ordinary infrastructure instead of relying on an individual supervisor’s goodwill or a worker’s ability to request help during a crisis. For supervision to protect role integrity, organizations would need to allocate time for it, define its purpose, train supervisors and make clear how concerns are escalated. They would also need to acknowledge that supervision cannot compensate for structural problems such as inadequate staffing, insecure employment, discriminatory attitudes or poorly designed peer roles. A supportive conversation may help someone manage a difficult encounter, but it cannot by itself repair an organization that treats lived experience as symbolic rather than substantive. Mahon’s findings consequently frame supervision as an implementation mechanism: one of the processes that determines whether a new workforce model is faithfully integrated into services or gradually absorbed into older professional patterns.

The study’s implications extend beyond the 12 people interviewed. Peer support is increasingly incorporated into responses to substance-use disorders because connection, credibility and hope can influence whether people engage with care. Yet the benefits associated with peer work cannot be separated from working conditions. A role that repeatedly exposes workers to distress without adequate reflection may produce burnout, withdrawal or turnover; a role with unclear boundaries may create risks for both staff and service users. Supervision cannot guarantee positive outcomes, and this study did not measure treatment success, worker retention or changes in service-user health. It also does not establish that one supervision model will work in every country or organization. Its contribution is more precise: it shows why the design of supervision deserves the same attention as the design of peer roles themselves. Future research could test peer-informed supervision models, examine how workers from different backgrounds experience them and connect supervision practices with measurable workforce and service outcomes.

For now, the message is straightforward but consequential. Employing people with lived experience does not automatically make a substance-use service recovery-oriented. The organization must also create conditions in which that experience can be used safely, ethically and without being forced into a purely clinical template. Supervision is where many of those conditions become visible: whether workers can discuss emotional strain, whether boundaries are negotiated rather than assumed, whether their expertise is respected and whether managers understand the difference between support and surveillance. Mahon’s study suggests that supervision should be treated as core infrastructure, not as a box to tick after recruitment. If peer workers are expected to sustain hope and connection for people facing addiction, the systems around them must provide the same qualities of safety, recognition and reliable support.