Mapping and realist evaluation of Lived Experience Recovery Organisations as part of the drug and alcohol treatment and recovery System in England (LEROS)
Around 50 Lived Experience Recovery Organisations (LEROs) across England are already delivering peer support for people recovering from drug and alcohol addiction, but no one knows how well they work or how they fit into the wider treatment system. This matters because recovery from substance use disorder is a long-term process—it involves not just stopping drug use but also securing housing, finding employment, and rebuilding social networks. Since 2012, local authorities have been responsible for commissioning treatment services, and the government now requires them to build recovery-oriented systems of care. LEROs could play a key role, but commissioners have no evidence base to guide decisions about funding them. This study will map all LEROs in England, then conduct in-depth case studies of six diverse organisations. Researchers will interview staff, clients, and stakeholders to understand what works, for whom, and in what circumstances. They will also co-produce a standard set of outcomes that LEROs can realistically measure. If successful, the project will give commissioners a practical framework for deciding whether and how to invest in peer recovery support. That could lead to better recovery outcomes for individuals and reduce the societal harms of addiction—without requiring new treatments, just better use of existing community resources.
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Background Substance use disorder (SUD) causes significant harm to individuals, families and society, and is a major driver of health inequalities. Recovery is often a long-term process that involves not only gaining control over substance use but also tackling broader psychosocial issues that help sustain recovery, such as securing stable housing, education, employment, addressing underlying mental health challenges and rebuilding social networks. Since 2012, local authorities (LA) have been responsible for commissioning treatment services in England. The latest government drug strategy and commissioning quality standards for drug and alcohol services require each LA to commission a recovery-orientated system of care (ROSC), combining acute treatment and longer-term recovery support. Around 50 known Lived Experience Recovery Organisations (LEROs) operate in England delivering/co-ordinating community-based peer recovery support interventions (P-RSI), and have the potential to add value to ROSCs. However, little is known about the extent they are currently commissioned, there is no agreed way to measure their impact, and there is no direct evidence about how they best work within the system to inform evidence-based commissioning. Methods This study will use a realist approach to explore how LEROs operate within the drug and alcohol treatment and recovery system. There will be four work packages (WP). WP1 will map existing LEROs across England, describe their commissioning arrangements, identify diversity in characteristics and explore any existing data collection. WP2 will involve a rapid realist review to synthesise evidence on P-RSIs to inform an initial programme theory. In WP3, we will conduct in-depth case studies of six LEROs, purposively selected to reflect diversity in size, setting, structure, and client populations. We will collect qualitative and quantitative data through for example interviews, questionnaires and documentary analysis with staff, clients, and key stakeholders. Analysis will identify Context-Mechanism-Outcome (CMO) configurations and we will finalise the programme theory. This WP will also generate a long list of potential outcomes that LEROs can impact that will feed into WP4. Finally, in WP4 we will co-produce an outcome framework through DELPHI methods with relevance to recovery that is feasible to collection. Anticipated impact and dissemination This study will address critical evidence gaps about the role of LEROs within ROSCs in England. It will describe the extent to which they are already commissioned as part of the system, and develop programme theory to understand what works, for whom, in what contexts, and why. The work will also result in a co-produced core outcome set to capture their impact. These findings and outputs will support commissioners to make evidence-based decisions and will lay the foundation for future research and routine data collection to capture the impact of LEROs within the system. By improving recovery support systems, this work will contribute to better outcomes for individuals in recovery, and reduce societal harms associated with SUD in line with current government policy. Findings will be shared through academic conferences and publications, guidance documents, policy briefings, blog and social media posts, and engagement events with key stakeholders to maximise the reach and impact of the work across the system.
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