Impact of the Overdose Crisis on Peer Workers’ Well-Being

01/06/2023

Working in the human services field is hard work, but working with at-risk and underserved populations, such as those living with substance use or other mental health disorders, reaches another level of difficulty. Peer workers, like myself, experience an array of traumatizing events through our daily work, such as losing participants/clients to overdose. A recent study suggests, that “even a single exposure to a fatal or non-fatal overdose can lead to considerable stress, burnout, and overdose-related compassion fatigue (Mamdani, et al, 2021).” As peer workers, we are exposed to traumatic events such as overdose on an ongoing basis, which creates the perfect environment for compassion fatigue & burnout to occur.
As a peer worker, the following are just a few examples of what I experience through my work; a participant overdosed twice in just 6 days. Another woman I am working with lost custody of her children, she is, of course, devastated. There are several individuals living outside (in New England in January, nonetheless), and all we, (outreach/peer workers) can do is offer food, warm clothing, supplies, and of course, linkage to community resources & support(s) when/if the need is identified by the individual.
Now, consider the impact(s) on police officers, paramedics, and other frontline workers who respond to the ever-increasing opioid overdoses, witnessing people overdose, some fatal, sometimes multiple times in a single shift. Not only that but the frustration peer workers experience hitting barrier after barrier while trying to link individuals to opioid use disorder (OUD) services and very limited treatment options. Additionally, there is absolute heartbreak when we are confronted with knowing there is nowhere to send individuals coming to us seeking housing resources.
Quite frankly, for many folks, living outside [exposed to the elements] is a more appealing & safer bet than going to a shelter or asking for help because of the stigma, shame, & judgment they fear they will face, and from my experience, they are not wrong to worry about such things. If you recall in my last blog, I told a few participants’ accounts of facing judgment, shame, & discrimination while trying to access services in local emergency departments for their opioid use disorder. There are hundreds more stories such as these of individuals trying to access housing resources.

Self-Care is Key

As an empath, this all weighs on me as I am sure it weighs on all of us doing this hard [at times, impossible] work, which I have been doing for almost 10 years now and luckily got some sound advice during that time that has stuck with me throughout the years. And, of course, there were some lessons I just had to learn the hard way, through my own mistakes. Learning to care for my own well-being [FIRST]was imperative to my ability to continue doing this incredibly rewarding, but often, painful work. Peer workers must ensure they take intentional steps to ensure they care for their emotional, spiritual, physical, and mental well-being before they can effectively help anyone else.

Key Components of Compassion Fatigue (CF)

According to Ontario HIV Treatment Network (2019), there are 3 main components of experienced among service providers addressing substance use include “emotional exhaustion (feeling drained of all emotional capacity), depersonalization (experiencing cynicism, helplessness, and detachment), and lowered sense of personal accomplishment (a belief that one’s work is not significant).” Working with victims of violence and trauma changes the worldview of service providers (peer workers) and puts individuals and organizations at risk for a range of negative consequences (Bell, et al., 1990).” Organizations have a significant impact on a peer worker’s risk for experiencing CF, including “a reduction in the workforce, inadequate training & development opportunities for peer workers, and the lack of an appropriate venue to express feelings (Dougherty & Horowitz, 2021).”

Sources

The following are well-known sources of burnout among peer workers; unreasonable client caseloads, the balance of work/home/community commitments, a negative work environment (including inequitable pay compared to non-peer colleagues), and lack of colleague support/recognition (whether only perceived or reality). The Peer Recovery Center for Excellence stated, “unaddressed secondary trauma often leads to compassion fatigue, and if left unaddressed, CF may result in burnout, that according to many studies, may not be reversible (Dougherty & Horowitz, 2021).

Implications

Vicarious trauma also referred to as secondary stress trauma (SST) can have far-reaching impacts which include, higher staff turnover rates, poorer job performance, and, unfortunately, some peer workers may even return to using substances due to this work-related stress. Lack of self-care, boundaries and proper supervision are also contributing factors.

Interventions
More research needs to be done surrounding the impact CF & BO has on peer workers, however, with the implementation of policies, procedures, practices, and programs, vicarious trauma-informed organizations can be created, according to the Vicarious Trauma Institute (2015). The Peer Recovery Center for Excellence provides examples of how to reduce your likelihood of CF & BO from occurring, in their 2021 Online training titled, “The Impact of Compassion Fatigue in Peer Support Work.” The training lists “building compassion satisfaction, as well as building blocks of empathy and healthy detachment” as ways to reduce your risk of experiencing CF or BO (Dougherty & Horowitz, 2021). Compassion satisfaction & compassion fatigue can be looked at as the positive & negative consequences of doing peer support work.

My Plan to Reduce Peer Worker’s Risk of CF

I have found that I best process the trauma, grief, & loss I experience in this work by talking about it with my fellow peers. It is beyond reassuring to know that the person you are sharing your experience with can empathize with the feelings you are experiencing through their own lived experiences. Peer support work is evidence that representation and lived experience, matters! We can create as many vicarious trauma-informed policies as we want, but if peer workers do not have a seat at the [planning] table, the future success of said policies is questionable at best. That is why I have decided, with the support of PPI’s leadership team’s support to create a Peer Worker Alliance group (not settled on the name yet, lol). The group will provide a safe space for peers to connect with their peers who are doing similar work in the surrounding area to discuss, process, and support each other through the myriad of issues that arise in this work, including secondary traumatic stress, compassion fatigue, & burnout. My hope is to eventually provide training and workforce development opportunities through this group as well.
Stay tuned for more information surrounding this new endeavor! I am very excited to get started and will provide you with more information as soon as I am able. As always, if you or someone you know is living with substance use disorder and are in need of treatment services, recovery support(s), or harm reduction supplies, including Naloxone, please feel free to call/text me, Jess, @ 860-336-9412!

Key Terms
Peer Workers “Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD), according to BMC Psychiatry (2022).”
Compassion is “a feeling of deep sympathy and sorrow for another who is stricken by suffering a misfortune, accompanied by a strong desire to alleviate the pain or remove its cause, according to the Peer Recovery Center of Excellence (Dougherty & Horowitz, 2021).”
Fatigue is “extreme tiredness, typically resulting from mental or physical exertion or illness (Dougherty & Horowitz, 2021).”
Compassion fatigue (CF) is “the physical, emotional, and psychological impact of helping others, often through traumatic or stressful life events, according to WebMD (2020).”
Compassion satisfaction (CS) is defined as “the pleasure we derive from being able to do the work we do. The compassion we experience in doing our work provides a sense of satisfaction (Dougherty & Horowitz, 2021).”
Burnout (BO) is defined by the World Health Organization (WHO) as “physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment (WHO, 2019).”
Vicarious trauma (VT) is “the exposure to the trauma experiences of others” (Peer Support, 2003), and is reportedly an occupational challenge for peer workers and many other professions.
Self-care “is an essential social work survival skill and refers to activities and practices that we can engage in on a regular basis to reduce stress and maintain and enhance our short- and longer-term health and well-being. (University at Buffalo, 2023).”

References
Compassion Fatigue: Symptoms To Look For (webmd.com)
The Bell Tolls for Thee & Thine: Compassion Fatigue & the Overdose Epidemic – ScienceDirect
https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00449-1
PowerPoint Presentation (peerrecoverynow.org)
Introduction to Self-Care – University at Buffalo School of Social Work – University at Buffalo