ASHLAND – A winding staircase leads to Lorie McLaughlin’s office on the second floor of the Ashland County Council on Alcoholism and Drug Abuse building.
A few items hang on her office’s wood-paneled walls: paintings of flowers, McLaughlin’s education certificates, a calendar featuring images of animals each month — in April, an elephant standing amid lush greenery.
Pinned to the calendar is a recent picture of McLaughlin and her significant other. Behind that picture is another of the couple, circa 2014, shortly before they were arrested on drug charges and committed to recovery from their respective addictions.
McLaughlin pointed out the differences in their physical attributes between the two pictures. In the earlier image, taken around Christmas time at the height of their addictions, their gaunt faces and sunken eyes with dark circles are a sharp contrast to their facial fullness and comparatively youthful complexions in the recent image.
“So my story started a long, long time ago,” McLaughlin explained. “I think I was 12 years old and I could drink my own six pack.”
McLaughlin grew up in Ashland County. Today, she serves that community as the addiction treatment center ACCADA’s certified peer support person, using her experience with addiction to help others enter and stick with the recovery lifestyle.
ACCADA’s peer supporter before her, Traci Kiliany, helped her do the same.
As a child, McLaughlin suffered sexual abuse from her caregivers, which she said led to poor self esteem that she masked by drinking alcohol. She began smoking marijuana at age 16 and by 29 had started using hard drugs regularly. Compounded by harmful relationships later in life, McLaughlin sank deeper into substance abuse, developing a dependency on methamphetamine.
“I thought I was going to die without meth,” she said. “The truth of it was, I was dying with it.”
In 2015, police arrested McLaughlin and her significant other on drug charges. McLaughlin took a plea deal, but her significant other still has two years left on his sentence. Their expectations of each other now are clear — if either resorts to drugs, they will be kicked to the curb.
Today, McLaughlin is seven years clean from drug and alcohol use.
As a peer supporter, McLaughlin provides people with support that the professional boundaries counselors must follow do not allow.
“If they want to go to the doctor but they’re afraid, I can go into the doctor’s office with them,” McLaughlin said as an example, adding that she advocates for them at appointments to teach them how to eventually do so for themselves.
McLaughlin also often provides transportation, such as to the grocery store, shopping for an outfit for a job interview, or Alcoholics Anonymous and Narcotics Anonymous meetings. She helps her peers build skills including time management and budgeting, as well as scheduling activities outside recovery — to the movies, meditation classes and cooking classes, for example.
“Some people, like myself, don’t know what to do when drugs aren’t a part of your life,” she explained.
McLaughlin can relate to the people she serves in ways people who have no experience with the substance and mental health issues can’t, because she has been there herself.
“I give them my story and they automatically get comfortable with me and start telling me their story,” McLaughlin said.
Overall, McLaughlin supports people as needed in their recovery journey, but she is conscious of the ethical parameters of her work. She points people to counseling when needed. When she is unsure if an activity is permissible, she checks with the ACCADA staff.
Peer support is part of treatment plans at ACCADA, not a substitute to counseling and other recovery services. It is also not crisis care. Rather, it is support for daily living and the prevention of crises.
McLaughlin is currently the only certified peer supporter at ACCADA and working in Ashland County, to the knowledge of the county’s substance use and mental health agencies.
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McLaughlin received counseling at ACCADA for five years before undergoing certification to become a peer supporter, a role she began in 2020. ACCADA has had a certified peer supporter on staff since 2016, with one on staff at a given time, ACCADA’s director Rick Ford said.
McLaughlin is ACCADA’s third certified peer supporter. Those who preceded her either retired or are still doing peer support work in another area, Ford said.
This spring, McLaughlin is working with nine peers — five who are required to see her as they reside in ACCADA’s recovery housing, as well as four others who chose to continue peer support.
Peer support is an evidence-based practice recognized by the Substance Abuse and Mental Health Services Administration and Mental Health America, among other organizations.
Overall, quantitative and qualitative evidence points to links between peer support and higher quality of life, increased engagement with recovery services and improved whole health and self-management. Further, peer support work has been shown to reduce hospitalization and in-patient stays, as well as decrease substance use and depression.
In Ohio, the peer support certification process requires various trainings, ranging from ethics to trauma-informed care, as well as agreeing to a code of ethics and passing an exam and background check. People cannot receive certification if they have certain disqualifying offenses, including physical and sexual violence.
Peer supporters must have direct lived experience with substance use and/or mental health issues, meaning they must be in recovery. People with family or friends in recovery do not qualify to become peer supporters certified by the state.
Executive director of the Ashland County Mental Health and Recovery Board David Ross said the board has no formal way to measure the effectiveness of peer support services at this time, which is not unique to Ashland.
“Basically, success is what the person says success is,” Ross said. “So every person that goes into — whether it’s substance use or mental health — one of the first things the counseling staff will do is ask them, ‘tell us what success will look like for you.’ And that, obviously, looks very different for different people.”
Overall, it’s difficult to track outcomes for mental health and substance use, Ross explained.
“We can track appointments, we can track how long people are in, we can track what they call process outcomes, but it’s really hard to actually track individual successes in terms of ‘I came to the agency and I got all of my needs met that I wanted,’ ” Ross said.
More broadly, the board has collect aggregated data through an annual outcomes and satisfaction survey since 2011. The latest, administered in the summer of 2021, included 88 responses across agencies indicating moderate to moderately high levels of satisfaction, outcomes, access, involvement and staff sensitivity.
Aside from ACCADA, other programs in Ashland County hope to add certified peer supporters to their staff, including Pathways Peer Support, a program that is part of Catholic Charities Ashland County. Currently, Pathways provides recovery-oriented programming that promotes positive relationships and coping skills, under the direction of program administrator Deborah Brookshire and her staff.
Pathways’ programs are open to anyone over the age of 18 who thinks they can benefit. People who attend do not have to be referred or have a diagnosis, a difference from ACCADA where people have to be ACCADA clients. Pathways programming is free and also more generalized in that it does not have diagnostic labels.
Brookshire said seven people have expressed interest and/or have begun the steps to become certified peer support people for Pathways, including Michelle Simons, a participant at Pathways who said she decided to pursue peer support certification after Pathways workers showed her the importance of her story.
“I’m hoping, come fall, we’ll have one of the live trainings,” Brookshire said, adding that pathways intends to partner with other nearby organizations, such as MOCA House in Wooster.
Having peer supporters at Pathways would open up possibilities for partnerships with others in the community, such as hospitals and police departments, to improve quality of life for people who have substance use and mental health issues, but to also limit institutionalization and save money for the community, Brookshire said.
“But, before I try marketing the program to those (places such as hospitals), I need certified peer supporters,” Brookshire said.
Another long term goal Brookshire has for Pathways is staffing a warm line, where people can call in a few hours each day in the evenings to speak with peer supporters before situations escalate to crisis.
“It’s ‘I’ve walked this road before,’ not ‘I’m a professional and do it my way because I know best,’” Brookshire said of peer support. “Not that all professionals want to do it that way, I mean I am one, but we do. We have the preconceived, prescribed ‘this is what you need to do to make it better’ and that’s not necessarily always practical in each person’s life because you don’t truly understand.”
While Pathways does not currently employ certified peer supporters, the organization approaches all programming with a peer-to-peer mindset, which has become apparent to co-facilitator and social worker Lainy Allen, who started working at Pathways in the fall of 2020.
Pathways staff has taught her that listening means listening to people as individuals, and not for diagnostic criteria, Allen said.
“We expect clients to tell us the worst parts of their lives or people’s struggles, and yet sometimes clinicians fail to show up as a person,” Allen said. “And as a peer, you get to be a person, a real person with your own scars and your own story, and I think that brings a lot of trust already to the table.”
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Ashland County has some mental health-specific peer support services in place, including a Hearing Voices Network affiliated support group that Stacey Roberts began in 2018 with support from Appleseed Community Health Center and the Mental Health and Recovery Board of Ashland County.
HVN is a national charity that raises awareness of and challenges negative stereotypes about people who hear voices and see visions. Roberts decided to start the support group — Celebrate Your Mind — after HVN helped her heal.
Roberts began hearing voices and seeing visions at 19 years old. From age 19 to 44, her identity had been her diagnosis as a paranoid schizophrenic, she said.
She did not look past that clinical label until she attended a conference with HVN representatives, Ron Coleman and Karen Taylor from England, who saw her as a peer and not a diagnosis. Rather than asking her “What’s wrong with you?” they asked “What happened to you?”
Roberts, now 49, said she considers herself a few years into recovery. Roberts continues to run Celebrate Your Mind support groups every Tuesday, attendance for which she said grew from two people initially to about eight regular attendees today.
Most recently, on May 5, Roberts started a new support group for people with dissociated parts because of trauma. Dissociation is a way the mind copes with stress, such as a traumatic event.
Roberts decided to start the new group — “Part of Me” — after she personally and at least three other people she knows locally had searched for support for dissociation and could not find resources.
“It is very much a need that is not being met in the community, let alone, probably state or nationwide,” Roberts said of dissociated parts support services.
Roberts is nearing completion of her Ohio peer supporter certification. While she is also a licensed social worker of 28 years, she does not approach her work with these support groups as a clinician.
“We don’t focus on psychosis or delusions or hallucinations,” Roberts said. “We try not to use clinical language.”
While Roberts’ support groups have set times, her support of peers is not limited to these sessions. Peer support is about meeting people where they are, which sometimes means talking over coffee or texting until the early hours of the morning, Roberts said.
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People who work in addiction and mental health services in Ashland have mixed feelings about the professionalization of peer support.
Trish Risser has been involved with peer support for more than 20 years but has not and does not intend to become certified through the state. Risser began doing peer support when and as it was initially conceived — similar to Alcoholics Anonymous where it is fundamentally about peers helping peers, with no cost or agency tied to it.
Risser does not want to be attached to an agency because she does not want to be bound to only helping people during business hours.
“I want to be available to people when they need me, not because I’m on a schedule,” Risser said.
McLaughlin with ACCADA, for example, has set work hours. While she is technically off-the-clock on evenings and weekends, she said she often still answers calls.
Brookshire of Pathways said she also questioned the state’s requirement for certified peer supporters to have a high school diploma, or pass the General Educational Development test.
“Part of being a peer supporter is having lived experience, right, well sometimes because of their lived experiences, things got in the way,” Brookshire said.
This was the case for McLaughlin, who got her GED to receive her peer support certification.
The professionalization of peer support is something David Ross, with the county mental health and recovery board, has seen increase throughout his nearly two decades of board involvement.
The board ended an earlier version of Pathways, known as Lifeworx, in 2017 because it decided the peer support program needed more professional oversight to ensure safety and positive outcomes. As a result, the board funded Pathways under Catholic Charities — the structure that exists today.
While Ross said the county learned through experience that it needed the peer support program itself to be more structured, he sees both benefits and drawbacks to the overall trend of professionalizing peer support.
“I get it — taxpayer dollars, if we’re going to bill insurance or bill Medicaid, Medicare, then I get it — they have every right to expect that these people are trained, that there are controls in place to make sure it protects the person receiving the service, it protects the agency, you know, it protects everybody, so I get all that,” Ross said.
“But when you do that, it changes who may want to do it. That’s our dilemma.”
Ross does not think certified peer support and uncertified peer support are mutually exclusive.
“It would be like saying, ‘Should we have outpatient services at ACCADA for people that are struggling with substance use, or should we have AA?’ Well, I want to have both, right? Because some people benefit by one or the other, or they benefit by both,” Ross explained.
“So, to me, the professional peers and the folks that are just doing it more naturally without (certification), I think they both have value and my hope is that we can continue with both.”
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McLaughlin has her eye on the future. She and her significant other have plans to start a farm once he is out of prison. She said they are compatible on every level.
“We like to have bonfires, we like to garden, we like animals, we like to work, we like to help people.”
But, addiction continues to grip her family.
McLaughlin has three children. Her oldest, 38, is currently struggling with substance use, alcohol use and mental-health issues, which McLaughlin attributes to her and her ex-husband raising him in an abusive environment.
“I wish I could change it up, and I have changed it up, but it just wasn’t in time for them to have the benefits,” she said of her children.
Her youngest died from an overdose in January 2021. She was 33 years old.
“That was a punch in the gut,” she said, “and I was in shock for three weeks. I couldn’t even grasp it.”
While McLaughlin has seen peers she has worked with through ACCADA commit to recovery, she said when it comes to dealing with addiction within the family, she is too close to the situation.
“All I could tell her was, you need, you need, you need, and bossing her around,” McLaughlin said of her late daughter’s struggles with substance use issues.
She eventually decided to share her daughter’s death with her peers. At times, it has been challenging for her to balance her focus on her own recovery with focusing on supporting her peers.
Recovery has no end.
“I have to keep myself in check every day,” she said, but now she knows her signs and when she needs to ask for help.
“I’ve made mistakes,” McLaughlin said. “The only mistake that is going to really get you is the one you don’t want to own, the one you don’t want to take responsibility for.”
