To access a read-only link to this infographic, click here.

References and Resources
Adult ADHD: What it Feels Like to Have It - Psycom
Prefrontal Cortex - Science of Psychotherapy
Our Current Understanding of Adult ADHD - Innovations in Clinical Neuroscience
​ADHD Resources on Benefits.gov

​To become a certified behavioral health peer support specialist (CBHPSS), you must be diagnosed with a mental illness and/or substance use disorder.  You also have to have been in recovery for over two years (typically, this is shown by not being admitted to a hospital or rehab center for behavioral health issues, maintaining sobriety and wellness, and not being charged with a crime or serving jail time for two or more years).  If a person meets these requirements, then they may go through specialized training in order to support individuals in the community that are currently struggling with mental illness and/or addiction. ​

After this process, peer support specialists submit an application and fee to the state that they reside in.  To maintain their certification in Montana, peer support specialists must complete 20 continuing education units per year, as well as having supervision from a licensed behavioral health professional (such as a licensed clinical social worker, licensed professional counselor, licensed addiction counselor, or psychologist).  They are required to have one hour of supervision for every 20 hours of direct peer support work. They must also be aware of how to write appropriate documentation for each peer support session.  Peer support specialists must uphold the code of ethics and refrain from unethical decisions when working with individuals in the community.  

Here is a link to an infographic that takes a broader look at peer support across the nation, and contains information about Nationally Certified Peer Specialists (NCPSs). ​

Sure, we have therapists, psychologists, psychiatrists, and licensed addiction counselors-- so why add an extra person to the mix?  Well, peer support is a wonderful addition to mental health and addiction treatment in many ways.  

Peer support is a recovery and wellness-based profession​. 
What does that mean?  Well, therapists, psychiatrists, etc. often use a medical or treatment-based model.  They diagnose and treat mental illness, addiction, or co-occurring disorders.  While this is highly useful and necessary for many individuals, peer support specialists take a different approach. Part of the work we do is telling our stories of recovery and what that means to us, which can communicate to those we work with that they are not alone, that others have some of the same experiences as them, and that there is hope.  We see recovery as a process that is continual, because people should not feel as though something is inherently wrong with them that needs to be "cured".  We work with wellness and recovery models to identify what motivates an individual and what areas of life that they need most support in to reach their goals.  Then-- we give them support!  We can also connect them to community resources, social programs, and other wraparound services.  

Peer support provides additional social connection and support
Many studies have shown that social isolation is a factor in addiction and choices that may negatively affect an individual's mental and physical health.  This has been famously studied in rats, like in this study where rats chose spending time with fellow rats over ingesting drugs such as methamphetamine and heroin.  When individuals are given an option to engage in positive social connection, drug/alcohol abuse and self-destructive behaviors can be greatly reduced.  This is where peer support specialists come in.  Being a peer support doesn't require a fancy degree; it just requires being a person in recovery!  Therefore, individuals at times may feel more comfortable spending time with a peer support specialist.  They may be closer in age, socioeconomic status, gender, or education-level to their peer.  This can foster authenticity, openness, and a positive connection.  Sometimes, peer support specialists can even meet their peers in their communities, making peer support even more accessible and giving the peer a chance to be in a safe space, or take risks and go on a hike, to the gym, to coffee, or to other fun places!

Peer support specialists can relate to individuals with behavioral health difficulties in a way that clinicians can't due to the nature of their jobs
Although I am a peer support specialist, I am also working on my master's degree in counseling and expressive arts therapy.  As a counselor, there are more limitations on what we can share with clients.  Though much of the stigma has reduced in recent years, it is still somewhat stigmatized for therapists and counselors to have histories of mental illness and substance abuse.  Some self-disclosure is okay, but the main focus of therapy is on the client and the treatment methods that will best help them!  Though peer support specialists are coached to disclose in appropriate and positive ways, there is less restriction on self-disclosure, because disclosure is part of the profession! Though therapy, psychiatry, and addictions counseling are vital to the treatment process, peer supports simply have an advantage in this way.  Peer supports can also model healthy self-disclosure, so that clients can learn how to share their own stories without affecting their relationships or their feelings of safety in a variety of settings.    

Peer support may be more culturally appropriate for some individuals
Some individuals may have grown up in a culture that stigmatizes going to a therapist or psychiatrist.  These individuals may feel more comfortable going to alternative professionals or traditional healers.  Though peer support specialists are associated with the behavioral health profession, some individuals may feel more comfortable with a peer support specialist than a therapist due to the associated stigma of "needing therapy" or going to a "shrink".  These individuals still deserve and need care, and it's possible that a peer support specialist with a similar background could reach them in a way that others cannot.  

It is also important to note the diversity present in the peer support profession itself.  As opposed to therapists, who, as a whole, are made up of 74% white individuals (Zippia, 2023), peer support specialists in the US have slightly more diversity, being made up of 67% white individuals (Zippia, 2023).  This makes the peer support specialist profession actually MORE racially diverse than the United States as a whole (~76% white). 

As people of color are over-represented in areas such as incarceration, especially for substance-related crimes, (Black individuals represent up to 5 times the amount of white individuals in jails and prisons, and more in some states), this number is significant.  Studies have also shown that "56% of state prisoners, 45% of federal prisoners, and 64% of jail inmates were determined to have a mental health problem" (Geller, 2020).  Therefore, because peer support specialists are more diverse, they can better serve the previously-incarcerated population and prevent recidivism by giving individuals culturally appropriate support and reducing the systemic barriers that prevent people of color from accessing care and funnel them back into the prison system. 

Organizational influences
A study noted that organizational influences can be a barrier to peer support.  Organizations that are based on a more hierarchical structure, such as acute units that favor nurses and psychiatrists over mental health workers, tend to do more poorly in organizing and maintaining peer support specialists as part of their workforce.  Organizations that fully accept the roles of peer supports as part of their system or peer-led organizations tend to function much better!  (This is not to say that hierarchical organizations can't learn a thing or two!)

Legislature
In Montana, efforts to create a credentialing process (similar to a license) for peer support was tabled.  This is just one example of how progress in the peer support profession can be stalled or halted by legislative processes.  Legislators may table bills for a number of reasons, including what they believe it will cost the state.  Many peer support specialists are part of the advocacy process, down to drafting bills themselves!  Reach out to your local behavioral health advisory committee or peer support committee for more information on this process.

Role confusion
An important part of the workplace is having a clearly defined role.  Organizations that give peer support workers unclear instructions or overload them with responsibilities function poorly.  Due the potentially distressing nature of their job, peer support specialists need jobs that have good work-life balances, that teach healthy boundaries, and that clearly state their roles and give them appropriate training.  This includes training on patient confidentiality and appropriate disclosure

​Working with others
In larger organizations, some people are prejudiced towards peer support specialists (shown in this study), and therefore may be resistant to hiring them or working with them.  That is why it is so important to teach about peer support so we can reduce stigma.  Though we can't change everyone's minds, by creating a more well-informed public overall, we can influence policies and enact change.  

Socioeconomic factors
​Some larger organizations may not pay peer support specialists as much as some might argue that they should get paid!  In part, this is due to the fact that some states have restrictions on what type or organizations can hire and bill for peer support services.  In Montana, mental health centers (MHCs), licensed substance use disorder clinics, Indian Health Services and other organizations listed here can bill for peer support through Medicaid.  When searching for a job as a peer support specialist, make sure that you are satisfied with the pay you will be receiving.  It is up to us to advocate for better pay as a whole!  

Some peer support specialists, once certified, can work as independent contractors, and therefore may have some part in negotiating their own pay.  However, know that you must have a supervisor either within that organization or on your own, as well as being able to complete the appropriate documentation, and regularly pay income taxes quarterly or annually.  You must also have your own liability insurance.  You may be required to license yourself as an LLC (which, depending on the state, is surprisingly affordable).  If you want to pursue this path, do plenty of research, and be sure to have people on your side to help inform you about your financial and legal obligations!

People with mental illness and substance use disorders so often face stigma and discrimination in the workplace.  However, in the peer support profession, our experiences are actually appreciated and rewarded, and can be utilized to help others that are at different spots in their recovery or are in the same dark places that we've had to claw our way out of ourselves. 

Peer support specialists have amazing communities amongst themselves.  In fact, I recently attended a webinar with Montana's Peer Network, made some new connections, and again got to be a part of the wonderful, vulnerable, and resilient spaces that peer support specialists create wherever they go! 

​If you have experienced mental illness, trauma, or addiction and are in a place of recovery (or are getting there!), I highly recommend thinking about becoming a peer support specialist.  There are so many opportunities, and not just as a peer support!  You can be a public speaker, a writer, an advocate, and a peer educator.  There are endless possibilities!  If you choose this path, you will meet some amazing people along the way, and have many opportunities to grow as a person and be exposed to a community filled with love, hope, and empowerment.  

This post talks about eating disorders, dieting, suicidal ideation, and childhood trauma.  If you are suffering from an eating disorder and need to talk to someone, contact the NEDA Helpline here, and if you are struggling with suicidal thoughts and need someone to talk to, dial 988 to reach the National Suicide Prevention Lifeline.  

About six months ago, I was on the keto diet (again).  I have always been very good at keeping to diets. Sometimes, I would reserve my minuscule carbohydrate allowance for a treat-- one Hershey's kiss, a cracker, even a fruit (how I missed apples!).  Other times, I would be measuring out sour cream, choking down dry keto "bread", and eating spoonfuls of sugar-free peanut butter because I craved sugar and carbs so much. ​

At the same time, I was looking into fillers for my ever-present under eye hollows.  I could finally afford it-- I had saved my tax return, more hefty than usual from being enrolled in grad school (thank you, Lifetime Learning Credit).  This was something I'd only dreamed of as a teenager, the daughter of a single mother, always adorned as I was in secondhand clothing and cheap makeup.  Breathlessly, I made the appointment.  On the day of, I wore huge, dark sunglasses.  I strolled into the glitzy waiting room, and waited. When I finally got into the chair, my heart was hammering.  Then came the needles in my face... it wasn't a fun experience, to say the least.  And afterwards, when I finally looked into the mirror-- I saw no difference. I still looked just as tired, just as "ugly".  As I left, I heard someone at the front desk ask what I was in for, like we were in a women's prison.  And my injector (the traitor,​ I thought): "Oh, an eye thing."  I walked through the pretentious front lobby and pushed through the double doors, tears stinging my eyes and blood rising in my cheeks.  I felt ashamed, disappointed, and hopeless.  If I couldn't be cured by fillers, what hope was there for me?  When would I be beautiful?  I remember sobbing into my mother's shoulder: "it wasn't enough. Nothing changed. Nothing changed." I didn't know it yet, but this was an extremely significant moment.  Because, as I realized later on, nothing would ever have changed; the problem wasn't me.  ​There was never anything wrong with me.  ​

I felt as thought nothing could touch me, as if it were only a force of will that kept my feet from lifting from the ground. But somewhere along the line, that feeling disappeared.  At some point, my body and everything about it became the enemy. ​

I felt as though I had caused the trauma, simply by having a body; therefore, my body was wrong, and I was ashamed of it.  At the same time, I began to form the rather conflicting idea that my body was only worthy if it was desirable to others.  Altogether, it was a recipe for disaster.​

I started skipping meals, relishing the weakness and the strung-out feeling-- evidence that I was, in fact, wasting away. And, as starving yourself sometimes does, it worked.  I lost almost forty pounds in a few months. ​​

In the morning, the psychiatrist subtly blamed me for being honest about my suicidal thoughts, diagnosed me with adjustment disorder, and sent me back out into the world.  I moved towns to be closer to my family, and my eating disorder got under control, but only just.  I went to a few different therapists, but nothing really fit.  I talked about my trauma, worked out a million ways to interpret it, and tried not to blame myself for what had happened to me.  I got better, but I was still just existing; I wasn't really living​.  And I was still dieting.​​

I read about weight discrimination, and how individuals in larger bodies are paid less, more likely to be convicted in a court of law, and suffer a host of other horrible injustices.  I started hearing microaggressions and microinsults being thrown out towards people in larger bodies as casually as saying "bless you" when someone sneezes.  

A 2012 study also showed that obesity and weight gain aren't necessarily predictors of mortality.  In the study, by adding only four healthy habits-- drinking in moderation, not smoking, eating healthy, and exercising-- the risk of death of an "obese" person became almost exactly the same as someone who is considered to have a "normal" BMI.  
​
All of this made me, for lack of a better word, angry.  I was angry at myself. I was angry because I realized that I was never going to look like a model; I would never be as petite as Zoe Kravitz.  I was never going to meet my own standards for how I thought I should look.  And I was angry because I was so blinded by society's standards that I thought that that was the only acceptable way to look.  That I had to be at a weight that is only achievable if I'm weak, tired, and starving.  And that so many people, especially women but also people of all genders, are expected to starve themselves to be acceptable, lovable, and worthy.  Angry isn't really the right word.  I was livid.  ​

That brings us to that elusive ~3% of people who actually lose weight and keep it off.  It turns out, those people are the ones who do just that-- they find joy in healthy eating and movement.  They also score high on measures of "intuitive eating"-- essentially, eating when they are hungry and stopping when they are full, and eating a wide variety of foods and nutrients.  I had lost touch with my body in the pursuit of weight loss, in the pursuit of what I thought would make me happy and worthy; in the process, I was actively working against what I wanted.  And I was so sorry.

​I was sorry to the five-year old girl whose bodily rights had been violated, and to the twelve year old who was starving herself, and the high school girl who felt pressured and the 18-year old college student who should have found her voice living in the big city but couldn't.  ​ I felt the need to apologize to all the versions of myself I'd been before that still wept and cowered in my heart.  But the only way I could do that would be to break free of the the vice grip of diet culture, to relinquish the image of a body that I would never and could never have, and to learn to love the body I did have.  

Read
Intuitive Eating by Evelyn Tribole and Elyse Resch
Big Girl: How I Gave Up Dieting and Got a Life by Kelsey Miller
Health At Every Size: The Surprising Truth About Your Weight by Lindo Bacon
The Anti-Diet Project by Kelsey Miller (Refinery29)

Watch
Why Dieting Doesn't Usually Work - Sandra Aamodt (TEDx)
Behind the Before and After: Non Diet, Intuitive Eating and Body Image Documentary - The Body Love Society (YouTube)
Why Biggest Loser Winners Often Regain Weight - ABC News (YouTube)
The Exercise Happiness Project - Chris Wharton (TEDx)
How To Get Healthy Without Dieting - Darya Rose (TEDx)
Our Bodies are Not an Image | Mary Jelkovsky | TEDxCherryCreekWomen
Living without shame: How we can empower ourselves | Whitney Thore | TEDxGreensboro
​

This identity tug-of-war is a tool of colonialism, that insidious force that is still trying first and foremost to eradicate Native peoples and turn us against each other.  That is why we are given "blood quantum", a percentage of "Indian" blood, like prize dogs in a competition.  Many individuals anecdotally state that the so-called "percentage" is purposefully miscalculated to prevent Native people and their children from getting enrolled in their tribe, so that their children's identities are forgotten and lost to time.  It is a bureaucratic extermination: less paperwork, less benefits to give to those in need, less justice to be paid.  Less people to carry on the cultures and ways of life that directly oppose capitalism, the ownership of land, and the destruction of nature.  Some call it a "paper genocide"-- a way to reduce the number of enrolled individuals in a tribal nation, until, eventually, it dies out.
​

Then there were "Indian" boarding schools, when young Native children were forced to attend Christian schools and stripped of their culture: their long hair cropped short, their languages and traditional ways of knowing banned, and their will destroyed through physical, sexual, and emotional abuse that occurred very often in these institutions, sometimes resulting in death.  All of these deliberate and horrific acts of what can only be described as human rights violations and war crimes resulted in something known as intergenerational trauma, which is a phenomenon in whichtrauma mutates the genes, which is passed down through generations, increasing the likelihood for many diseases and mental illnesses.  This accounts for the major health disparities that are seen in tribal populations.

This is why there must be visibility-- because visibility forces people to bear witness and hold accountable those that would continue to silently kill off our people and culture.  Visibility can be promoted through the use of the term BIPOC (black and indigenous people of color), representation in media and mainstream culture, promotion of indigenous artwork (film, poetry, visual arts, music), diversity and inclusion training in healthcare and mental healthcare, the acknowledgement of occupation of Native lands (for example, in Helena, MT, we are occupying Salish and Blackfoot / Niitsítapi ᖹᐟᒧᐧᒣᑯ land), the de-exoticization of Native cultures, and the inclusion of the "2S" in LGBTQIA2S+.

Focus Plant relies on the same concept, except it uses cute plants as motivation.  The longer you set the timer to focus, the more "raindrops" you get to plant new plants and water them with-- and the higher the level they become.  You collect little dinosaur gardeners that you can level up, which raises the amount of raindrops you can receive for each focus session.  There's also a social feature, where you can join or make a group and plant trees.  

Altogether, we think it's adorable, fun, and makes focusing a breeze.  It's super motivating to see the raindrops add up, discover new worlds, acquire new gardeners, and collect all those weird little plants.  

Find it on Google Play and iOS.  ​

It doesn't push you to suddenly start doing CrossFit or go on a juice cleanse.  Instead, it recognizes that habits are formed little by little.  By taking on what you can handle, even if it's just doing five pushups or eating one fruit a day, or even mental health habits such as "avoid negatively labeling [yourself]", you can start yourself on a much longer, much more lasting journey to health and self-discovery. 

It also allows you to share your daily intentions or gratitude and send and receive anonymous virtual cards from other members of the Tri(be), which can help you feel validated and supported.  

​The most important thing that Fresh Tri does (in our opinion) is take the shame out of wanting to become healthy.  Bye, fatphobia and unrealistic body standards! Hello body appreciation and self-love.  ​

CBT helps you recognize that these thoughts aren't completely true, and sometimes they're just utter nonsense.  With CBT, you gain awareness of your "cognitive distortions", and use specific methods to re-work them into something that's more realistic and more self-compassionate.  

CBT is a great form of therapy-- but it's easy to get caught up in the chaos of daily life and forget how to decode your thoughts. We can't carry around our therapist in our pocket, but we almost always have our phones! That's why we like CBT Companion.  With the free version, you can use their "challenge your automatic thought" tool to write down your negative thought, identify the cognitive distortion, and challenge it.  It also has useful tools like a journal to record your day-to-day emotions, moods, and thoughts.   It has mindfulness tools, breathing exercises, a sleeping log, and plenty of educational videos if you want to learn more about CBT.  It also has "SMART" goal building, which is a method to make specific, achievable goals.

Add it to your home page if CBT is something that works with you-- or talk to your therapist about trying it if you haven't yet!  

Check it out for Android and iPhone.​

My Possible Self is sort of an all-in-one, with a mood tracker, podcasts, journal, logs for sleep, drinks, and food, mindfulness audios/videos, articles, physical exercise and yoga/stretching videos, recipes, quizzes,  therapeutic tools for anxiety, depression, and alcohol use, breathing tools, and guided series like "overcoming your anxiety".  If you need help holding yourself accountable, it includes a "risky places" feature, which will monitor if you're close to a place that will trigger drinking or gambling behaviors.  It's got pretty much everything-- including a "crisis" button that will dial 911 for you or direct you mental health helplines, such as NAMI, Mental Health America, the National Suicide Prevention Lifeline, The Addiction Center, and SAMHSA treatment referral helpline.  (Just make sure to click the "USA" button. )

We're so grateful to the creators of My Possible Self for making mental health tools so accessible! ​

Many people with OCD often get little to no understanding and empathy from those around them, and can even have their struggles turned into a joke (due to a lot of negative media portrayals and stereotypes).  That's why the nOCD app can be so powerful!  nOCD is basically a mix between a message board/social platform and a therapy app. 

​It not only allows you to reach out to others who share your experiences-- nOCD can allow you to get help from a certified OCD specialist (which is covered by Blue Cross Blue Shield, UnitedHealthcare, Cigna, Kaiser Nor-Cal, Aetna and others). They provide a free 15-minute call to get more information.

​If your insurance doesn't cover therapy, there are still options for you! Feel free to use the self guided Exposure and Response Prevention Therapy and SOS tools, post to the community, and read others' inspiring stories of recovery.  ​