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Abstract

Background:

Peer support workers (PSWs) play a critical role in addressing the substance use crisis, and PSWs’ training experiences may influence important occupational outcomes such as job stress and burnout. This cross-sectional study examined associations between PSWs’ training experiences, job stress, and 2 dimensions that contribute to burnout – a lack of personal achievement and emotional exhaustion – in a sample of 25 PSWs (M_age = 49.3, SD = 12.9; 64% cisgender women; 80% white) from South Carolina.

Methods:

Participants completed the Subjective Stress Scale and the Abbreviated Maslach Burnout Inventory. While burnout is typically characterized by 3 dimensions, this study was only able to measure personal achievement and emotional exhaustion due to low reliability of the depersonalization scale. Participants also reported the total number of training hours they received prior to becoming a PSW and what topics they received training in, which were categorized as knowledge-based, skill-based, or value-based. Sum counts for each topic category were calculated.

Results:

Adjusted-regression analyses revealed that total number of training hours was not associated with personal achievement or emotional exhaustion (p’s > .131) but was positively associated with job stress (B = 0.031, SE = 0.014, 95% CI [0.001, 0.060], p = .042, ηp² = .200). Total number of training topics was not associated with job stress or emotional exhaustion (p’s > .248) but was positively associated with personal achievement (B = 0.577, SE = 0.245, 95% CI [0.065, 1.090], p = .029, ηp² = .226). Having received more knowledge-based training (B = 1.494, SE = 0.592, 95% CI [0.254, 2.734], p = .021, ηp² = .270) and value-based training (B = 1.627, SE = 0.722, 95% CI [0.116, 3.138], p = .036, ηp² = .211), but not skill-based training, was associated with greater personal achievement.

Conclusions:

High-quality training curricula that cover a range of topics, particularly knowledge- and value-based topics, may enhance PSWs’ sense of personal accomplishment. Improving content and quality over quantity may also reduce PSWs’ job stress. These efforts can support positive work experiences and engagement among PSWs in the substance use disorder recovery field.

Keywords

peer support workers education burnout training job stress substance use disorder

Highlights

Peer support workers play a significant role in supporting the recovery of individuals with substance use disorders (SUDs).

This study found that a greater number of training hours was associated with greater job stress, while more training in a range of topics – specifically knowledge-based and value-based trainings – was associated with a stronger sense of personal achievement at work.

These findings underscore the importance of improving training content and quality over quantity to increase positive work experiences and sustained engagement among the peer support workforce in the SUD recovery field.

Introduction

Peer support workers (PSWs), also known as peer support specialists or recovery coaches, are an important workforce in addressing the substance use crisis. Leveraging their lived experiences in their professional role, PSWs perform a range of responsibilities, including providing individual and group-based recovery services, facilitating linkage to services, engaging in harm reduction efforts, and delivering other recovery-oriented programming, which play a significant role in the prevention and treatment of substance use disorders (SUDs).^1,2 However, PSWs’ strong personal connections to their professional role, coupled with work-related challenges, may result in high job stress and burnout.^3,4 Job stress refers to the day-to-day perceived stress at work,⁵ whereas burnout involves emotional exhaustion, depersonalization, and lack of personal accomplishment and achievement after prolonged exposure to workplace stressors.^6,7 Both are common among health care providers and are indicators of occupational well-being.⁸ Greater burnout is associated with lower quality of care and patient satisfaction, as well as increased suicidal ideation and occupational turnover.^9-12 Though burnout is well-studied among physicians and nurses, less research has focused on PSWs. Challenges related to difficulty maintaining personal and professional boundaries, lack of role clarity, and limited organizational support may contribute to PSW burnout.^13,14 Other factors such as working in a rural community and longer tenure have also been associated with burnout via emotional exhaustion.¹⁵ As such, systemic efforts are needed to mitigate job stress and burnout to create and sustain a well-supported PSW workforce.

Foundational and ongoing training is integral to ensure that PSWs are equipped to perform their jobs effectively. Though PSWs bring valuable knowledge to their work, they do not typically receive the extensive formal education required of licensed health care providers. At the same time, PSWs often perform a broad array of tasks (eg, advocacy, case management, direct service provision), each demanding specific competencies and knowledge bases.¹ As such, PSWs generally complete trainings for state certification, though requirements vary significantly by organization, state, or other contexts.^16,17 This suggests a high degree of heterogeneity in training content, quality, and duration, with little research examining optimal training, specifically how training influences outcomes such as job stress and burnout. Some studies suggest that training improves PSWs’ self-efficacy and job satisfaction and reduces job stress and burnout by building individuals’ capacity to handle high-stress work demand.^3,18,19 Also, some training topics, such as self-care, may be particularly crucial for sustainment in the field.^3,20 Taken together, examining the relationships between training, job stress, and burnout among PSWs may be helpful in improving training and workforce development efforts.

This study sought to examine the associations between training experiences, job stress, and burnout among PSWs from South Carolina working in the SUD recovery field. To become a certified peer support specialist or certified peer recovery support specialist in South Carolina, individuals are required to complete 46 hours of classroom training, pass an examination, and complete 100 or 500 hours of PSW work.²¹ Peer recovery support specialists must also pass the International Certification & Reciprocity Consortium examination.²¹ Training sites must receive approval from Addiction Professionals of South Carolina (APSC), and trainers follow a standardized training curriculum that covers topics including human behavior, signs and symptoms of SUD, recovery service techniques, continuum of care, and federal/state guidelines. Sites may add to this curriculum but may not subtract from it.²¹ In this study, training experiences were characterized by the total number of self-reported training hours PSWs received and by the self-reported topics they had received training in, which were categorized as knowledge-based, skill-based, or value-based trainings. It was hypothesized that greater hours of training and greater number of topics would be associated with less job stress and less burnout through lower emotional exhaustion, lower depersonalization, and a greater sense of personal accomplishment.

Methods

Participants

The sample included 25 PSWs (M_age = 49.3 years, SD = 12.9) working in the recovery field in South Carolina who identified as cisgender women (n = 16, 64%) or men (n = 9, 36%). PSWs self-identified their race as white (n = 20, 80%), Black/African American (n = 3, 12%), or biracial white and Native American/Alaskan Native (n = 2, 8%). Education attainment included a high school diploma and/or general education development (n = 2, 8%), some college (n = 8, 32%), an associate’s (n = 6, 24%), bachelor’s (n = 6, 24%), master’s (n = 1, 4%), and doctoral degree (n = 2, 8%). All PSWs (n = 25) were certified in the state. On average, participants worked as a PSW for 3.2 years (SD = 2.3, range: 1-10), reported being in recovery for 12.5 years (SD = 9.6), and served 39 clients (SD = 30.9) per month. PSWs were paid full-time employees (n = 21, 84%), paid part-time employees (n = 3, 12%), and a part-time volunteer (n = 1, 4%).

Procedures

Participants were recruited via flyers distributed to SUD recovery organizations in South Carolina. Eligible participants had to be >18 years old and PSWs for at least 3 months. PSWs were required to have been in their role for at least 3 months to ensure that they had some job experiences prior to participating in this study. Flyers included a link to a digital consent form. Data for the present study were collected in February and March of 2023. Consenting participants completed a battery of measures. They also completed semi-structured interviews, which are described elsewhere but not the focus of this study. Participants were eligible to receive a $50 incentive. All study procedures were approved by the Institutional Review Board of the University of South Carolina.

Measures

Participants reported on their age, gender, race, education level, and professional experiences as a PSW. Participants reported how many hours of formal training they received to prepare themselves for being a PSW and selected what topics they had received training in from a list of 18 topics. Per APSC guidelines, training hours could include virtual or in-person workshops/activities.²¹ Topics were generated from training competencies and topics outlined by SUD agencies;^16,22 the list was reviewed by a PSW consultant and was categorized into knowledge-based (n = 6), skill-based (n = 6), and value-based trainings (n = 6). The overall and category-specific counts were calculated.

Job stress was measured using a 4-item Subjective Stress Scale.²³ Participants responded to items (eg, “I feel a great deal of stress because of my job.”; 1 = Strongly Disagree to 7 = Strongly Agree) that were summed (α = .77), with higher scores indicating greater job stress.

Burnout was measured using the 9-item Abbreviated Maslach Burnout Inventory.²⁴ The inventory measures emotional exhaustion (eg, “I feel fatigued when I get up in the morning and have to face another day on the job.”), depersonalization (eg, “I have become more callous toward people since taking this job.”), and personal achievement (eg, “I feel that I am positively influencing other people’s lives.”), which is consistent with the World Health Organization’s (WHO) definition of burnout.²⁵ Each dimension is summed (0 = Never to 6 = Everyday). Higher scores indicated more burnout except for personal achievement, where higher scores indicated less. In this study, emotional exhaustion (α = .85) and personal achievement (α = .87) demonstrated good internal consistency. Depersonalization (α = .20) demonstrated poor reliability, and we decided as an authorship team to exclude it from our analyses, focusing on emotional exhaustion and personal achievement. Because we were unable to analyze all 3 dimensions that typically characterize burnout, we refer to these constructs individually rather than using the term burnout hereinafter. We also address this in Limitations.

Data Analyses

Descriptive and correlational analyses were conducted on primary variables. Three linear regressions were conducted to examine whether total training hours was associated with job stress, emotional exhaustion, and lack of personal achievement. Three linear regressions were conducted to examine whether total training topics was associated with the same outcomes; if statistically significant (ie, p < .05), post hoc analyses were conducted to examine whether total knowledge-, skill-, and value-based trainings predicted job stress, emotional exhaustion, and lack of personal achievement. Covariates included age, gender, years of work experience, and clients served per month. Individual parameter estimates and effect sizes (ηp²) were examined to determine effect size (small = 0.01-0.059; medium = 0.06-0.13; large ≥ 0.14). There were no missing data. All analyses were conducted in SPSS.

Results

On average, PSWs received 112.12 (SD = 87.92) total hours of training to prepare themselves for their role and were trained in 14.00 (SD = 3.66) topics. Table 1 shows training topics by category. Across topics, skill-based training on mental health interventions and self-care were endorsed by all PSWs (n = 25, 100%). Knowledge-based trainings on local resources and medication for opioid use disorder, and value-based trainings on recovery concepts, cultural competency/humility, and harm reduction were endorsed by 88% (n = 22). PSWs reported average levels of job stress (M = 15.60, SD = 5.52, possible range: 0-28). Using cutoffs,²⁶ PSWs had “low” emotional exhaustion (M = 4.88; SD = 3.13) and “high” personal achievement (M = 15.08; SD = 4.16).

Table 1.

Frequency of Training Topics Endorsed by PSWs (N = 25).

Training topics	N	%
Knowledge-based trainings
Local resources (eg, understanding the resources and the requirements of each facility, matching resources to individual needs)	22	88
Medication for opioid use disorder (eg, buprenorphine, methadone, naltrexone)	22	88
Medication for other substance use disorders	18	72
Contextual factors (eg, family dynamics, community, spirituality, impacts of social determinants of health such as employment and housing)	17	68
Health care management (eg, obstacles to remaining on medications, navigating insurance companies, government grants and subsidies, resources like GoodRx)	13	52
Policy, legislation, advocacy, and rights protection (eg, navigating government organizations such as the department of social services)	10	40
Skill-based trainings
Traditional mental health intervention (eg, motivational interviewing, cognitive behavioral therapy, mindfulness, relaxation)	25	100
Self-care as a peer support worker	25	100
Relationship/social skills (eg, interpersonal skills, active listening)	22	88
Crisis support (eg, risk assessment, de-escalation, crisis planning)	21	84
Group facilitation	19	76
Family support (eg, how to work with peers’ family members)	13	52
Value-based trainings
Recovery concepts (eg, stages of recovery, stages of change, writing a recovery plan)	22	88
Cultural competency/humility	22	88
Harm reduction approach	22	88
Person/patient first language	19	76
Strength-based or holistic approach (eg, disease model vs positive psychology; mind, body and soul)	19	76
Trauma-informed care	19	76

Abbreviation: PSW, Peer support worker.

Table 2 shows descriptives and Pearson correlations. Total hours of training was not correlated with any variable, p’s > .225. Total number of topics trained in was positively correlated with personal achievement (r = .50, p = .011) but not emotional exhaustion. Total number of knowledge-based trainings (M = 4.08; SD = 1.53, r = .52, P = .008) and value-based trainings (M = 4.92; SD = 1.32, r = .46, p = .022) were both positively correlated with personal achievement. Total number of skill-based trainings was not correlated with personal achievement.

Table 2.

Descriptive and Correlational Analyses.

Variable	M (SD)	Range	1	2	3	4	5	6	7
1. Training hours	112.12 (87.92)	24-333	—
2. Training topics	14.00 (3.66)	5-18	.16	—
3. Knowledge-based	4.08 (1.53)	1-6	.09	.96^a	—
4. Skill-based	5.00 (1.19)	2-6	.09	.87^a	.78^a	—
5. Value-based	4.92 (1.32)	1-6	.25	.89^a	.79^a	.61^b	—
6. Job stress	15.60 (5.52)	6-27	.14	−.01	.05	−.01	−.09	—
7. Emotional exhaustion	4.88 (3.13)	0-12	.03	.23	.24	.19	.20	.52^b	—
8. Personal achievement	15.09 (4.16)	0-18	.12	.50^c	.52^b	.36	.46^c	.14	.40^c

Abbreviation: SD, Standard deviation.

p < .001; ^b p < .01; ^c p < .05.

Table 3 shows regression estimates. Total number of training hours was not associated with emotional exhaustion or personal achievement, p’s > .131. However, total number of hours was significantly and positively associated with job stress (B = 0.031, SE = 0.014, 95% CI [0.001, 0.060], p = .042), and this effect was large (ηp² = .200). Total topics trained in was not associated with job stress or emotional exhaustion, p’s > .248. However, total training topics was significantly and positively associated with personal achievement (B = 0.577, SE = 0.245, 95% CI [0.065, 1.090], p = .029), and this effect was large (ηp² = .226). More knowledge-based training (B = 1.494, SE = 0.592, 95% CI [0.254, 2.734], p = .021) and value-based training (B = 1.627, SE = 0.722, 95% CI [0.116, 3.138], p = .036), but not skill-based training, were associated with greater sense of personal achievement and indicated large effects (ηp² = .270 and ηp² = .211, respectively).

Table 3.

Linear Regression Analyses.

Dependent variable/predictor	B	SE	95% CI	t	P	ηp²
Job stress
Total training hours	0.031	0.014	0.001, 0.060	2.177	.042	.200
Total training topics	−0.108	0.325	−0.788, 0.571	−0.334	.742	.006
Emotional exhaustion
Total training hours	0.013	0.008	−0.004, 0.031	1.579	.131	.116
Total training topics	0.209	0.176	−0.158, 0.577	1.193	.248	.070
Personal achievement
Total training hours	0.003	0.014	−0.025, 0.032	0.244	.810	.003
Total training topics	0.577	0.245	0.065, 1.090	2.357	.029	.226
Knowledge-based training topics	1.494	0.592	0.254, 2.735	2.522	.021	.251
Skill-based training topics	1.160	0.758	−0.427, 2.747	1.530	.142	.110
Value-based training topics	1.627	0.722	0.116, 3.138	2.254	.036	.211

Regression analyses involving knowledge-based, skill-based, and value-based trainings were follow-up analyses (ie, not included in the same model as total training topics) and were conducted individually (ie, 3 separate analyses).

Discussion

This study examined how training experiences relate to job stress, emotional exhaustion, and sense of personal achievement among PSWs in the SUD recovery field. Regression analyses were performed on self-report survey data. Results demonstrate nuanced findings.

Contrary to our hypothesis, total number of training hours was positively associated with job stress. One theory that may explain this finding is the job resource-demands theory.²⁷ Specifically, the theory postulates that high job demands can lead to negative employee well-being outcomes, and job resources can buffer this negative relationship.²⁷ However, existing research acknowledges individual and organizational factors that can undermine this buffering effects.^27,28 For instance, while training as a resource can fuel learning, growth, and confidence in achieving work goals, PSWs may not perceive all trainings as useful²⁹ or not be able to apply trainings to address work demands due to a variety of reasons (eg, lack of control or autonomy), leading to greater job stress.^27,28 Increased training may also induce job stress via intra-role conflict/ambiguity. One study found that formal training was associated with increased job stress but only among counselors with a substance use history; authors indicated that these counselors may experience stress about performing job studies when their knowledge about performing job duties from formal training and from lived experiences do not align.³⁰ Others have highlighted the important role of engaged organizational leaders who can facilitate access to additional resources such as a supportive climate, coaching, and feedback, which may be needed in order for training to reduce stress.^27,31 Future research should further investigate these relationships. Relatedly, while this study did not collect information about the nature of these training hours (eg, virtual vs in-person, supervised trainings hours), future research may examine whether and how the characteristics of training hours affect job stress.

This study yielded a novel finding – more training across a range of topics, particularly in knowledge and values, was associated with higher personal achievement. Training on SUD treatments, contextual factors, and systems navigation may equip PSWs to successfully address the diverse needs of their peers. Humanistic person-centered training experiences may affirm PSWs’ values in their work, as prior research has shown that greater personal-work values alignment and stronger professional identity are linked to higher personal achievement.^32,33 Skill-based trainings were not associated with personal achievement. These trainings may require resources such as supervision to yield effects on PSWs’ personal achievement. Future research should explore what knowledge- and value-related topics may be of most interest and most useful to PSWs.

Emotional exhaustion was not significantly associated with training experiences, and poor reliability for depersonalization precluded analysis. Our sample reported low emotional exhaustion and almost no depersonalization, consistent with prior research among PSWs.^34,35 This low variance may have limited statistical power. However, other factors such as job fairness and balanced work demands predict lower emotional exhaustion among PSWs;^34,35 thus, future research may investigate other organizational resources, such as strong workplace relationships, and workplace autonomy/flexibility,³⁶ that may reduce emotional exhaustion.

This study has several limitations. It was conducted with a small sample of PSWs from a single US state that was predominantly white and cisgender women, limiting the generalizability of results to samples beyond the demographics represented. Future research may be conducted in more diverse samples. Training topics were also determined through PSW self-report rather than reviewing specific training curricula. PSWs may have recalled topics from more recent trainings as opposed to topics from their formal training, which may affect the accuracy of reported topics. Future research could leverage actual training curricula from certifying organizations to understand PSW training. In addition, given the timing of data collection, it is likely that the COVID-19 pandemic impacted training experiences, including the amount and modality (ie, virtual or in-person) of training. These factors should be examined in future work.³⁷ Other variables that could potentially affect the associations, such as type of educational degree, whether trainings were received preparatory or for continuing education, and other prior work experiences, were not examined in this study and point to further research needed in this area. Due to the poor reliability of the depersonalization scale, we also were unable to measure burnout using the tri-dimensional operationalization defined by the WHO (high emotional exhaustion, high depersonalization, low personal achievement).²⁵ Because we focused only on 2 of the 3 individual dimensions, these findings may not fully capture PSWs’ experiences of burnout. Moreover, the sample had low prevalence of high job stress, limiting generalizability to more distressed PSWs. Finally, the present study did not examine outcomes such as compassion fatigue and secondary traumatic stress, which are experiences that can arise from working with individuals who have experienced trauma and may present similarly to burnout.³⁸ Future research could examine the impacts of training on these outcomes.

Despite these limitations, this study’s findings offer insights that can inform how PSW training can better support positive work experiences. Because number of total training hours was positively associated with job stress, organizations and credential boards should not assume that increasing training hours is inherently beneficial to positive work responses. Considering that training in a diversity of topics, particularly in knowledge-based and value-based topics, was associated with higher personal achievement, ensuring that training aligns with the demands of PSWs’ roles can support PSWs’ sense of accomplishment and achievement at work. Together, these efforts can maximize the quality and impact of PSW training.

Conclusion

PSWs are a crucial part of the recovery workforce and play a unique role in efforts to combat the US substance use crisis. Despite this, research on how the training of PSWs relates to their well-being and sustainability in the workforce remains limited. This study serves as an important steppingstone toward better understanding how training may impact PSWs’ experiences and sustained engagement in their work.

Footnotes

ORCID iDs

Wendy Chu

Eleanor G. Wu

Sarah J. Miller

Magdalena Moskal

Sarah Grace Frary

Sayward E. Harrison

Ethical Considerations

This study was approved for exempt review by the University of South Carolina IRB. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

Consent to Participate

All participants provided written informed consent.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data may be available upon request by contacting the corresponding author.*

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Associations between Training Experiences,Job Stress,Personal Achievement,and Emotional Exhaustion among Peer Support Workers in the Substance Use Disorder Recovery Field

Abstract

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Highlights

Introduction

Methods

Participants

Procedures

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Data Analyses

Results

Discussion

Conclusion

Footnotes

ORCID iDs

Ethical Considerations

Consent to Participate

Funding

Declaration of Conflicting Interests

Data Availability Statement

References