Lived Experience and Rural Barriers: A Qualitative Analysis of Peer Leadership in Recovery Community Centers

Background: Peer workers in the substance use and recovery field draw from their lived experience in recovery to provide services to individuals seeking treatment for substance use disorder. Little is known about the benefits and challenges of peer work in rural settings and in leadership positions. This study explores how lived experience shapes the perceptions and actions of directors of recovery community centers (RCCs) in rural areas, focusing on the link between lived experience and stigma, client challenges, and attitudes toward medications for opioid use disorder (MOUD). Methods: We conducted semi-structured interviews with 11 directors at RCCs in rural Georgia, United States, from August to November 2024 to understand their lived experience, community stigma, client challenges, and attitudes toward MOUD. Thematic analysis was employed to develop themes related to lived experience and service delivery. Results: Themes included links between lived experience and reducing rural community stigma by recovering out loud, forming partnerships to overcome client challenges, facilitating community awareness of the RCC, and connecting to clients through empathy. Regarding MOUD attitudes, directors generally expressed positive sentiments toward this recovery pathway, but some interviewees shared negative perceptions and complex MOUD-related lived experiences. Both lived experience and education/training shaped these attitudes. Conclusions: Peer leaders can enhance recovery support services in rural areas through their lived experience representation, though this approach may introduce challenges. Recovery services should consider these peers an asset while providing them with education and training on evidence-based practices.