Substance Abuse and Mental Health Services Administration 

Executive Summary 

August 9-10, 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) hosted 

Recovery Now! Summit (RNS), bringing together nearly 200 in-person and virtual participants to collaboratively 

develop a national recovery agenda. Representatives included persons with lived experience of mental health or 

substance use challenges and recovery, substance use preventionists, harm reductionists, treatment and recovery 

support providers, researchers, staff of federal and state partners, and other allies.

This summit was designed to reflect and build upon the significant developments in recovery-related support, 

research, and advocacy since the first SAMHSA-sponsored recovery summits, which were held in the early 

2000s. The goals of the summit were to gather perspectives on the current strengths, opportunities, and 

aspirations of recovery movements and recovery work; gather perspectives on progress toward recoveryoriented systems over the past two decades, and on current strengths, opportunities, and challenges in 

operationalizing recovery-oriented systems; and identify key themes for new directions for SAMHSA’s 

recovery-related efforts in the 21st century. 

Across the two days, speakers in the five plenary sessions provided context, background information, and food 

for thought for participants to carry into the breakout sessions, in which they engaged in dialogue around four 

topics: (1) centering living experience in diverse settings, (2) promoting recovery-ready and recovery-rich 

communities; (3) preparing the workforce and workplace for integrating peers in diverse settings; and (4) 

addressing disparities and promoting equity and inclusion. 

Common Themes Across Dialogue Sessions

There were eight Common Themes Across Dialogue Sessions that emerged from the RNS: 

1. Specificity matters in thinking and talking about recovery-related concepts. Many of the conversations

during the RNS involved establishing common vocabularies. There were two concepts that participants

thought merited extended dialogue: the distinction between treatment, recovery, and recovery support

services; and defining lived experience.

2. Recovery happens in community. Throughout the RNS, participants noted that recovery happens

in community through interactions with persons with (similar) lived experience. Supportive interpersonal

relationships—that is, peers helping peers—foster recovery. RNS participants emphasized the importance of

recovery in community because of the continued pull of systems toward clinical/medical acute models of

care; the differences between the treatment and behavioral health systems-defined outcomes and

community-defined ones; and the fact that peer support has inherent value separate from clinical care.

3. Structural racism and classism impede recovery and recovery community-building. A growing body of

research indicates that structural discrimination resulting from the racial discourse of the War on Drugs is a

fundamental cause of mental health and substance use disorder disparities among Black, Indigenous, and

other people of color (BIPOC) and low-income persons. Participants noted that structural racism and

classism are built into our mental health and substance use care systems, and that structural violence has

both created oppressive conditions and established the terms by which individuals are pathologized,

criminalized, and alienated, leading to overtreatment for mental health conditions and undertreatment for

substance use disorders. Participants noted that these structural impediments/features are, in essence, stigma

enacted as policy. To address them requires intentional enactment of equity-focused policies and practices.

4. Lived experience should be at the center of helping systems—but centering is more than just adding

peers. Centering lived experience is an equity-focused practice that addresses implicit and structural bias in

care systems that are built around control. Although having peer workers on staff or engaging persons with

lived experience on an advisory council may be steps toward recovery-oriented systems of care (ROSCs),

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Substance Abuse and Mental Health Services Administration 

they are not sufficient for centering lived experience in policy and practice. To do so means dismantling the 

pathology paradigm and embracing the social and relational dimensions of recovery that exist before, 

during, after the medical treatment—and often in lieu of. 

5. Peer integration is only as effective as the organizational culture and infrastructure that supports the 

work. The integration of peers into diverse settings is only as effective as the organizational culture and 

infrastructure that supports the work. For peer work to be authentic and effective, organizations must, at 

minimum, align organizational policies and practices with peer principles and practice, develop specific 

roles and job descriptions that draw upon peer core competencies, provide supervision that is appropriate to 

peer work, and offer equitable pay to peer staff. 

6. Lived experience-based jobs/roles have expanded, but stigma keeps them from being fully valued. The 

range and type of settings in which peer work is happening has expanded greatly over the past 2 decades— 

and there is an increasing body of research that demonstrates the value of peer support. Yet, peer labor is 

still undervalued for a variety of reasons the RNS participants discussed, which include settings that are not 

designed nor trained to value, know, and utilize the principles and values that ground peer support; peer 

workers being hired for entry-level, ancillary tasks; workplaces placing greater value in higher levels of 

formal education or professional credentials, and the primacy of the medical/clinical model itself. These 

three factors translate into low wages and meager employee benefits for lived experience-based jobs. 

7. Structural racism, classism, and stigma impede the growth of community-based, peer-run, peer-led 

organizations. All things being equal, peer-led/peer-run/peer-governed organizations would have the 

resources they need to fulfill their role as the gold standard of recovery support services. RNS participants 

noted that the current funding system is unequal, leading to chronic underfunding and underinvestment in 

these community-based programs. The factors that affect their funding are structural, connected to the same 

equity issues and stigma noted previously for individuals. Instead of “fitting a square peg into a round hole,” 

new visions for alternative funding models are needed. 

8. Systems transformation is an incomplete, never-ending process. Participants noted that, much like 

recovery, system transformation is an ongoing process not a destination. Although progress has been made 

toward ROSCs, significant issues persist. For systems to become and remain recovery-oriented, it is a neverending process of mapping recovery resources and assets; developing leadership and other roles for persons 

with lived experience; developing and updating policies that support a recovery-orientation; creating and 

refreshing networks of recovery-centered services; developing sustainable funding mechanisms; and 

evaluating outcomes and impacts. 

Thinking Beyond What Currently Exists 

If systems transformation is the aim, and if recovery happens in community through interactions with persons 

with lived experience, then a logical question is: How do we create environments that maximize the 

opportunities for both to occur? Recovery-ready environments and recovery-rich communities are two concepts 

that focus on communities as the sites of healing, which build upon the earlier conceptualizations of recoveryoriented systems of care. Both require the creation of policies that shift our perspective from services and 

supports in an acute care delivery model to a model that fosters quality of life and wellness across people’s 

recovery journeys. They encourage “thinking beyond” what currently exists, to better connect individual 

recovery (personal transformation) to recovery-oriented systems of care (institutional transformation) to 

recovery-rich communities (community transformation). 

Participants defined and described both concepts. They noted that to create them will require a concentrated 

focus on diversity, equity, inclusion, and social justice; adequate funding must be available for recoverycentered programs (not just programs that focus on crisis, disease/symptoms, and pathology); and fully 

funded/resourced alternatives to institutionalization in health care and criminal justice settings. 

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Substance Abuse and Mental Health Services Administration 

Toward a R ecovery Agenda: Fostering Recovery-Centered Systems and 

Healthy Recovery Ecosystems in Recovery-Rich Communities 

The outcome of the RNS resulted in an updated national recovery agenda. Across the 2-day summit, participants 

offered their thoughts and observations on how the Office of Recovery can promote recovery-centeredness 

across SAMHSA and can work with and in communities to transform systems to support recovery in the 21st 

century. Ten focus areas were identified as critical to this work, along with suggested approaches: (1) 

acknowledging structural harms and working to dismantle them; (2) engaging diverse lived experience, 

intentional inclusion, and meaningful representation for MH and SUD recovery leaders in policy setting; (3) 

addressing disparities and promoting equity; (4) collecting recovery-related data and measuring recovery 

outcomes; (5) prioritizing community-based, peer-run recovery supports and alternatives to clinical services in 

grantmaking; (6) building the capacity of community-based, peer-run organizations; (7) supporting the lived 

experience (peer) workforce; (8) collaborating with other federal agencies to promulgate a recovery agenda; (9) 

providing guidance to states on systems transformation; and (10) providing guidance to the field. 

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