Justin S. Bell ¹ Dennis Watson ^1* Tina Griffin ² Sierra Castedo De Martell ¹ Emma Sophia Kay ³ Mary Hawk ⁴ Bradley Ray ⁵ Michelle Hudson ¹

• ¹ Chestnut Health Systems, Bloomington, United States
• ² University of Illinois Chicago, Chicago, Illinois, United States
• ³ University of Alabama at Birmingham, Birmingham, Alabama, United States
• ⁴ University of Pittsburgh, Pittsburgh, Pennsylvania, United States
• ⁵ RTI International, Durham, North Carolina, United States

Introduction: Peer recovery support services (PRSS), an expanding component in SUD treatment, are delivered by individuals with lived experience of substance use disorder (SUD). Despite the growing importance of these peers and the unique challenges they face in a developing health profession, limited research has focused on their workforce outcomes. This review aims to map the literature on a) workforce outcomes among peers and b) the individual and organizational contributors to these outcomes. Materials and Methods: We conducted a scoping review of empirical literature from January 1, 1999 to January 26, 2023 on APA PsycINFO ® , Embase ® , CINAHL ® , Web of Science™, and Google Scholar. We also conducted a search of grey literature on institutional websites to locate additional articles. Search strategies targeted terms related to peers (e.g., peer specialist, people with lived experience), workforce outcomes (e.g., burnout, compassion fatigue), and organizational environments (e.g., workplace, volunteer). The review was preregistered with Open Science Framework (https://doi.org/10.17605/OSF.IO/C9YNR). Results: Of the 16,361 total articles retrieved, 20 were included after screening, consisting of 9 quantitative, 9 qualitative, and 2 mixed-methods studies. Cross-sectional survey was the most common study design (n = 9). Organizational factors, such as supervisory support and professional development opportunities, were linked to increased job satisfaction and retention while factors such as inadequate compensation and stigma were barriers to workforce sustainability. Individual challenges, including boundaries with clients and a lack of self-care, were associated with burnout and decreased job satisfaction. Conclusions: Results highlight challenges faced by peers in SUD services which limit their ability to sustain well-being and achieve career longevity. Research gaps include the need for longitudinal studies, a clearer understanding of work settings, and an exploration of mediating or moderating factors affecting workforce outcomes. Future efforts to foster a sustainable peer workforce should focus on improving peer workers' well-being through organizational support, professional development, and targeted interventions based on occupational health theories.