CENTENNIAL, Colo. \u2014 Sarah Wright stops by her peer support specialist\u2019s hotel room-turned-office in this Denver suburb several times a day.<\/p>\n

But her visit on a Wednesday morning in mid-October was one of her first with teeth.<\/p>\n

The specialist, Donna Norton, had pushed Wright to go to the dentist years after homelessness and addiction had taken a toll on her health, down to the jawbone.<\/p>\n

Wright was still getting used to her dentures. \u201cI haven\u2019t had teeth in 12\u00bd, 13 years,\u201d she said, adding that they made her feel like a horse.<\/p>\n

A new smile was Wright\u2019s latest milestone as she works to rebuild her life, and Norton has been there for each step: opening a bank account, getting a job, developing a sense of her own worth.<\/p>\n

Wright\u2019s voice started to waver when she talked about Norton\u2019s role in her life during the past few months. Norton wrapped her arms, adorned with tattoos of flames, spiderwebs, and a zombie Johnny Cash, around Wright.<\/p>\n

\u201cOh, muffin,\u201d she said. \u201cI\u2019m so proud of you.\u201d<\/p>\n

Norton, 54, is a Harley-riding, bulldog-loving, eight-years-sober grandmother and, professionally, \u201ca cheerleader for the people that look bad on paper.\u201d<\/p>\n

People like her. \u201cIf you were to look me up on paper, you wouldn\u2019t be in this room with me,\u201d Norton said. \u201cYou would not let me near your house.\u201d<\/p>\n

If she were a therapist or social worker, hugging and sharing her experiences with drugs and the law might be considered a breach of professional boundaries. But as a peer support specialist, that\u2019s often part of the job.<\/p>\n

\u201cI have no boundaries,\u201d Norton said. \u201cF\u2014 off,\u201d she said, \u201cis a term of endearment here.\u201d<\/p>\n

A big part of Donna Norton\u2019s job as a peer support specialist with the Hornbuckle Foundation is building relationships with people in the early stages of recovery from substance use disorders. Norton draws from her own history with addiction, homelessness, and the justice system to help them get back on their feet.(Rae Ellen Bichell \/ KHN)<\/span><\/figcaption><\/figure>\n
Norton works for the Hornbuckle Foundation, which provides peer support to participants in the SAFER Opportunities Initiative<\/a>. SAFER provides short-term shelter in the hotel for people in Arapahoe County who are homeless and have mental health or substance use disorders.<\/p>\n
Peer support specialists are themselves in recovery and are employed to help others. As billions of dollars in opioid settlement funds roll out to states and localities, local leaders are deciding what to do with the money. Supporting and training peer specialists, whose certification requirements vary by state<\/a>, are among the options.<\/p>\n
States, counties, municipalities, and tribes filed thousands of lawsuits against drug companies and wholesalers that are accused of fueling the opioid crisis. Many of those cases were lumped together into one mega-lawsuit. This year, four companies settled out of court, agreeing to pay $26 billion over 18 years. Participating states must follow guidelines for how the money can be spent.<\/p>\n
In Colorado, hundreds of millions of dollars<\/a> from that settlement (and a few others) will go to local governments and regional groups, several of which submitted plans<\/a> to use some of the money for peer support services.<\/p>\n
David Eddie, a clinical psychologist and a research scientist at the Recovery Research Institute at Massachusetts General Hospital, said peer recovery support services have \u201cbeen gaining a lot of traction in recent years.\u201d<\/p>\n
According to the Substance Abuse and Mental Health Services Administration, \u201cmounting evidence\u201d shows<\/a> that working with a peer specialist can result in better recovery outcomes, from greater housing stability to reduced rates of relapse and hospitalization. A report<\/a> by the U.S. Government Accountability Office identified peer support services as a promising practice in treating adults with substance use disorders. In many states, peer specialists are reimbursed through Medicaid.<\/p>\n
\u201cThey can plug a really important gap,\u201d Eddie said. \u201cThey can do things that we as clinicians can\u2019t do.\u201d<\/p>\n
They can, for example, help navigate the bureaucracy of the child protective services system, about which clinicians might have little knowledge, or take someone out to coffee to build a relationship. If a person stops showing up to therapy, Eddie said, a peer support specialist \u201ccan physically go and look for somebody and bring them back to treatment \u2014 help them reengage, reduce their shame, destigmatize addiction.\u201d<\/p>\n
Norton has, for instance, picked up a client who called her from an alley after being discharged from a hospital stay for an overdose.<\/p>\n
\u201cSome people will tell you, \u2018I decided I was going to get in recovery, and I never had to drink, drug, or use again.\u2019 That\u2019s not my experience. It took me 20 years to get my first year clean and sober. And that was trying every day,\u201d said Norton from her office, her Vans planted just inches from a basket that lives under her desk: It contains three opioid overdose reversal kits stocked with Narcan.<\/p>\n
Her office, warmed by the sunlight coming through a south-facing window and the nearly constant rotation of people plopping onto the couch, contains a shelf of essential items. There are tampons, for whoever needs them \u2014 Norton will \u201cnever forget\u201d the time she got a ticket for stealing tampons from a grocery store while she was homeless \u2014 and urine analysis kits, for determining whether someone is high versus experiencing psychosis.<\/p>\n
She teaches \u201cstop, drop, and roll\u201d as a coping mechanism for when people are feeling lost and thinking about using substances again. \u201cIf you\u2019re on fire, what do you do?\u201d Norton said. \u201cYou stop immediately, you lay on the ground, you roll and get yourself out. So I\u2019m like, \u2018Go to bed. Just go to sleep.\u2019 People are like, \u2018That\u2019s not a wellness tool.\u2019\u201d<\/p>\n
\u201cIt is,\u201d Audrey Salazar chimed in. Once, when Salazar was close to relapsing, she stayed with Norton for a weekend. \u201cI literally just slept,\u201d Salazar said. The two rested and ate Cocoa Puffs and Cheez-Its by the box.<\/p>\n
\u201cIt was so bad,\u201d Norton said of the junk food binge. But the weekend got Salazar back on track. Working with a peer support specialist who has \u201cwalked the same walk,\u201d Salazar said, \u201cholds you accountable in a very loving way.\u201d<\/p>\n
That October day, Norton pivoted from nagging one person to make a doctor\u2019s appointment, to getting someone else set up with a food pantry, to figuring out how to respond to the bank that told a third client that an account couldn\u2019t be opened without a residential address. She also worked on lowering the defenses of a newcomer, a sharply dressed man who seemed skeptical of the program.<\/p>\n
$\"A$
Donna Norton meets with Ian Dereus and his dog, Lola, at the hotel in Centennial, Colorado, where Norton helps people recovering from mental health and substance use disorders. Dereus is now considered a graduate and is living in his own apartment.(Rae Ellen Bichell \/ KHN)<\/span><\/figcaption><\/figure>\n
Some people come to Norton after being released from the county jail, others by word of mouth. And Norton has recruited people in parks and the street. The newcomer applied after hearing about the program in a homeless shelter.<\/p>\n
Norton decided that sharing a little about herself was the way to go with him.<\/p>\n
\u201c\u2018My experience is jails and hospitals and institutions. I\u2019ve got an old number,\u2019 meaning a convict number. \u2018And I have eight years drug-free,\u2019\u201d she recalled telling him. \u201c\u2018My office is down the hall. Let\u2019s get some paperwork done. Let\u2019s do this.\u2019\u201d<\/p>\n
Norton is one of seven peers on staff with the Hornbuckle Foundation, which estimates that it costs about $24,000 a month to provide peer services to this group of residents, with peer specialists working full time make about $3,000 a month plus $25 an hour per client. Norton\u2019s office is the hub of activity for a floor in one hotel where about 25 people participating in the SAFER Opportunities Initiative live while recovering from substance use disorders until they \u201cgraduate\u201d to another hotel, located next door. From there, they\u2019ll move on to their own housing, which staffers often help them find.<\/p>\n
While in the program, residents meet at least once a week with a case manager, a therapist, and a peer support specialist, in addition to attending group meetings, which take place every day except Sundays and are all run by peers.<\/p>\n
Kyle Brewer, based in Arkansas, is the peer specialist program manager for NAADAC, the Association for Addiction Professionals (formerly the National Association for Alcoholism and Drug Abuse Counselors). Brewer, who said his life derailed after he started using prescription opioids to manage the pain from a wisdom tooth removal, said opioid settlement funds present an opportunity to support the people who work on the ground.<\/p>\n
\u201cWhen we\u2019re working and talking and troubleshooting different approaches to solve the opioid crisis, we should have the people that have been directly affected by those issues in the room, guiding those conversations,\u201d he said.<\/p>\n
Toward the end of the day, Norton ran into the new guy in the hallway again, this time on his way back from the ice machine.<\/p>\n
\u201cEight years clean. My hat goes off to you,\u201d he said.<\/p>\n
\u201cI started with one day,\u201d said Norton.<\/p>\n
\u201cWell, I\u2019ll start with one hour,\u201d said the new guy.<\/p>\n
He said he needed to clean out his car, where he\u2019d been living. He said he has trouble putting his jeans on in the morning after losing a thumb to frostbite. He wanted to find a part-time job. He has trauma to work through in therapy. His mother died about a year and a half ago.<\/p>\n
\u201cFriday night, we\u2019re going to the movies,\u201d said Norton.<\/p>\n
\u201cOh, cool,\u201d he said. \u201cI want to see \u2018Top Gun,\u2019 the new one.\u201d<\/p>\n
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