Addiction Messenger Featured Article - July 2023
Moving beyond “spaghetti suppers” to fund peer support services
By Tyler W. Myroniuk, assistant professor, Department of Public Health, University of Missouri
Without organizations in the ecosystem of recovery engaging in peer recovery work, treating substance use disorder is unattainable at the population level. But those organizations—mostly non-profits—need funding to retain staff, increase programming, and simply pay rent for their community spaces; the money must come from somewhere. Even though the Biden administration has provided an unprecedented amount of funding to tackle substance use disorder (the President’s 2022 State of the Union speech highlighted this), many organizations do not feel the impact of this policy change.
Our recently released report, titled “Barriers to Acquiring Funding for Organizations in the Ecosystem of Recovery,” summarizes Quality Improvement (QI) work that we undertook in 2022 to identify the largest perceived barriers in these efforts and convey policy recommendations largely directed at federal and state government agencies. The leaders of over 200 organizations across the US participated in a survey and 85 leaders participated in one of 16 focus groups. To our knowledge, no prior substance use disorder work has engaged such a large number of organizations in the ecosystem of recovery. In the process, we generated a sample list of over 500 organizations in the ecosystem of recovery, which was an important task itself because no single comprehensive list exists. This QI study was motivated by a prior needs assessment of how to build and strengthen the capacity of the peer recovery community and is the first comprehensive empirical examination of the thought processes and struggles that lead organizations in the ecosystem of recovery to pursue funding or not.
Watch this explainer video, narrated by Tyler W. Myroniuk, about the ORF report.
Through a mixed-methods analysis of the quantitative and qualitative data, we identified four major themes that leaders of organizations in the ecosystem of recovery collectively depicted:
- “‘They are so overwhelming:’ Grant Applications and the Need for Training;”
- “‘No amount of spaghetti suppers are going to raise $20 grand for an audit:’ Calls for Fundamental Changes to Funding Peer Recovery Services;”
- “‘My community is not invited to be a part of the conversation:’ The Need for Culturally Inclusive Funding Approaches;” and
- “‘Keep the lights on:’ Diversifying Funding to Sustain.”
We offer policy recommendations for each of these themes in the report. The Substance Abuse and Mental Health Services Administration (SAMHSA, within the federal Department of Health and Human Services) who funded this work (but was not involved in shaping it) is receptive to these recommendations and this work is being disseminated nationwide. We believe that a “new dawn” of access to peer recovery funding is on the horizon.
Our study team continues to pursue more analyses from the troves of data collected in 2022. We have unfortunately found evidence that barriers to acquiring funding are heavily racialized. Sadly, this should not come as a surprise because of systemic inequalities that the BIPOC community has faced throughout American history. The survey data indicate that organizations whose community members are comprised of at least 50% BIPOC individuals appear to be less likely to pursue federal funding, partner with other organizations, and have access to as many streams of funding as organizations whose members are predominantly non-Hispanic White (the official census term for what we think of as White).
The struggles to acquire funding and apparent systemic differences in funding access were confirmed—in great detail—by leaders of such organizations in focus groups. Though the opioid epidemic has disproportionately affected White Americans, that is only a recent element of larger substance use disorder prevalence by racial/ethnic identity (see James and Jordan, 2018; Drake et al., 2020; Gollust and Haselswerdt, 2021). We will soon be submitting this to the scientific community for peer review, to widen our reach and message of the need for accessible and equitable funding for peer recovery services.
The results of our QI work are not revelations to leaders of organizations in the ecosystem of recovery. Compiling this evidence and convincing stakeholders of the pervasiveness of organizations’ struggles to combat substance use disorder—including funding restrictions on basic things like paying staff members—is the true value of our work. We believe that this work will spur action among leaders of organizations in the ecosystem of recovery and government and private funders. These groups have the same ultimate goal when ear-marking funding for peer recovery work: help those suffering from substance use disorder.
Now it is up to people like me to convey the importance of this work to the scientific community while continuing to partner with—and build trust with—those in the peer recovery community; we have momentum and SAMHSA is listening. Further, leaders of organizations in the ecosystem of recovery can use our report to make it clear to local, state, and federal agencies that there is clear evidence of fundamental issues to accessing peer recovery operational and programmatic funding. Striving for health equity ought to be an essential societal goal and funding equity for peer recovery is crucial if we want to achieve this.
Drake, J., Charles, C., Bourgeois, J. W., Daniel, E. S., & Kwende, M. (2020). Exploring the impact of the opioid epidemic in Black and Hispanic communities in the United States. Drug Science, Policy and Law, 6.
James, K., & Jordan, A. (2018). The opioid crisis in black communities. Journal of Law, Medicine & Ethics, 46(2), 404-421.
Gollust, S. E., & Haselswerdt, J. (2021). A crisis in my community? Local-level awareness of the opioid epidemic and political consequences. Social Science & Medicine, 291, 114497.
Dr. Tyler W. Myroniuk’s public health research agenda is rooted in his formal training in sociology and demography but is also influenced by theoretical perspectives and empirical considerations from anthropology, economics, and medicine.
His most recent public health work includes examinations of immunological outcomes, behavioral responses, and attitudes pertaining to the COVID-19 pandemic; marriage and mental health outcomes of older adults; understanding HIV stigma through community-based participatory research; quality improvement and precision health data considerations in medicine; work-family balance and self-rated health; and the links between social capital and mental and physical health.
Dr. Myroniuk’s published work is set in Canada, Europe, India, Malawi, South Africa, India, and the U.S.