LINCS UP: A Randomized Clinical Trial Evaluating Peer Recovery Coaches in Patients With Substance Use Disorders in the Emergency Department and Hospital

Peer recovery coaches (PRC) are increasingly deployed in emergency department and inpatient hospital settings to assist people with substance use disorders (SUD) in navigating their recovery. From a window of lived experience, peer coaches provide motivational interviewing and linkage to a broad array of resources. Despite PRCs’ increasing presence nationwide, high-quality prospective data on their impact on patient-oriented outcomes is lacking.

We conducted a 3-arm single site randomized controlled trial enrolling adult ED and hospital patients who scored 3 or higher on the Drug Abuse Screening Test-10. Prisoners and medically/psychiatrically unstable patients were excluded. Participants were randomized 1:1:1 to in-person PRC, virtual PRC using a tablet, and usual care. PRCs followed participants until discharge providing referrals to a wide range of resources and were available for follow up. The primary outcome was successful linkage to a SUD recovery organization. We collected follow up data at 7, 30, and 90 days. For adequate power, we collapsed the in-person and virtual PRC groups into a single intervention arm for analysis. We performed mixed effects linear and Poisson regressions. We present standardized mean differences (SMD), rate ratios (RR), and 95% confidence intervals.

We enrolled 144 participants: 49 usual care, 47 in-person PRC, 48 virtual PRC. Median age was 44 years (range 20-71); 71% were male; 77% identified as black, 17% white. Participants in the intervention arms reported similar engagement with recovery organizations at 7, 30, and 90 days when compared to usual care (7 day RR 2.29 95% CI 0.91-5.76; 30 day 1.16, 0.49-2.74, 90 day 1.06, 0.44-2.53). Participants in the PRC groups scored higher on the Brief Assessment of Recovery Capital (SMD 0.62, 95% CI 0.13-1.10) and reported fewer days of drug use (RR 0.55, 95% CI 0.39-0.77) at 90 days compared to usual care. Results for these secondary outcomes were nonsignificant at 7 and 30 days.

In this RCT of ED and hospital patients with SUD, we did not find an increase in recovery organization engagement for patients seen by a peer coach. Results, however, did suggest an increase in recovery capital and decrease in drug use in the PRC arms.