Abstract
Introduction
Recent white papers from Norwegian authorities emphasize the importance of involving professionals with lived experiences in the mental health and addiction sectors through the employment of peer workers (“erfaringskonsulenter”/experts-by-experience) (Meld. St. 7 (2019–2020); Prop. 15 S (2015–2016)). While lived experience broadly refers to the personal knowledge gained through navigating mental health or addiction challenges, its formal integration into service provision is most evident in the role of peer workers. As employees who use their lived experience to support others, peer workers today represent a distinct category within Norwegian mental health and addiction services. By introducing lived experience embedded in the role of peer workers, policymakers aim to enhance individual and overall treatment efforts by integrating user perspectives (Andreassen, 2018; Blindheim-Hansen & Halvorsen, 2022; Larsen et al., 2022). The underlying premise is that individuals who have navigated addiction and recovery themselves can offer unique insights and empathetic engagement with service users.
Incorporating lived experience into clinical settings in Norway is not entirely new, but it has remained unexplored as a research topic until recently. Little is known about how peer workers navigate their roles, how lived experience is applied in practice, or how it affects service users. This study addresses these gaps by examining how professionals with lived experience—who have worked in peer worker roles in the past and later as trained professionals—navigate within Norwegian addiction treatment services. By exploring their perspectives, the study sheds light on the benefits and challenges of incorporating lived experience into professional practice. The findings contribute to ongoing discussions on role clarity, professional ethics, and the implications of formalizing lived experience within addiction treatment.
The paper begins by outlining the historical and policy background of peer support in Norway and the United States to provide context for the findings, highlighting differences in how lived experience is framed and applied in each country. The United States was chosen for detailed comparison due to its long-established peer support systems, the institutionalization of certification programs, and the strong emphasis on individual recovery journeys. Examining national differences offers insight into the opportunities and challenges of professionalizing lived experience across different systems. The study's aims and methods are described, followed by findings based on six qualitative interviews. The paper concludes with a discussion of key findings and their implications for policy and practice in Norway.
Historical and Contemporary Perspectives on Lived Experience in Addiction Treatment
In a Norwegian context, the term “addiction treatment” denotes a state-funded service focused on delivering a structured, professional approach to reduce or arrest patients’ substance use. This approach differs from strategies like harm reduction, drug policy advocacy, and other initiatives that aim to impact individual substance use, primarily due to its distinct understanding of treatment referring to structured, formalized interventions by professionals.
The use of lived experience embodied in peer support in addiction services has a longstanding history, originating in the United States in the mid-19th century, where peer support and the utilization of recovery narratives emerged within temperance campaigns (Crowley, 1999). Organized peer support was later reinvented through the establishment of Alcoholics Anonymous in 1937 (Augst, 2007; Blumberg & Pittman, 1991; Crowley & White, 2004; Griffin, 2000; White, 2003, 2004, 2014). Ideologically based treatment programs, such as therapeutic communities (Clark, 2017; de Leon, 2002), faith-based treatment (Hansen, 2018; Hood, 2011), and 12-step-based programs (Borkman et al., 2007; White, 2014), have long incorporated lived experience in the treatment regimes through peer support in many countries including Scandinavia (Bunt et al., 2008; Clark, 2017; Furuholmen & Andresen, 2007). These approaches aim to reshape the patient's identity associated with addiction and drug use, promoting abstinence and designating recovery as the subsequent identity-shifting process after achieving abstinence; using former patients as staffed role models is a common characteristic.
Several institutions were established in Norway from the 1970s till today by private entrepreneurs with lived experience, each grounded in an abstinence-based paradigm. In 2004, a treatment reform in Norway transferred responsibility for addressing addictive disorders from local municipalities to state-operated hospitals. Before the reform, individuals seeking assistance were classified as social clients, mainly receiving treatment as inpatients in one of the institutions mentioned above. Post-reform, treatment-seeking individuals began receiving psychiatric diagnoses under the ICD-10 classification, now recognized as patients with a formal right to treatment provided by qualified health specialists (Spesialisthelsetjenesteloven, 1999). The reform introduced regulations and frameworks for public and state-supported treatment institutions, requiring them to employ trained professionals, qualified psychotherapists, and medical specialists. Notably, the reform papers did not refer to the value or role of lived experience in treatment practices. In 2025, addiction treatment is a specialized part of Norway's universal healthcare system, allowing citizens to access free services. The welfare state employs a comprehensive social services system managed by the Norwegian Labour and Welfare Administration, which, among other services, supports individuals with substance use problems on a long-term basis. Addiction treatment services are state-regulated, promoting consistency and equity across regions. The primary staff coordinating these services are trained professionals versed in laws and regulations, system cooperation, patient rights, and established treatment approaches.
Utilizing Lived Experience in the United States and Norway
The following section explores how lived experience is utilized within peer work in the United States and Norway, emphasizing how peer work relies on and illuminates the use of lived experience, highlighting key similarities and differences between the two contexts.
Peer support in addiction treatment originated in the United States, where the 12-step movement played a pivotal role in shaping recovery narratives. In Norway, peer workers have been integrated into a state-driven welfare system, with recent inclusion in official treatment guidelines. Addiction treatment in the United States is characterized by fragmentation, with access and quality varying significantly based on insurance coverage, resulting in inconsistent treatment opportunities for individuals (Wolf, 2021). 12-step-based programs are standard (Bergman et al., 2024; Fletcher, 2013). The National Association for Alcoholism and Drug Abuse Counselors (NAADAC) represents addiction professionals, including counselors and peer specialists. Although the NAADAC standards do not apply across all states (Blash et al., 2015), they provide a framework for regulating the use of lived experience in peer worker roles. The NAADAC code of ethics clearly distinguishes between the roles of peer workers and counselors: peer workers offer support grounded in their personal experiences, while counselors apply their professional training, expertise, and clinical knowledge (NAADAC, 2021). While peer support workers might play a vital supportive role, they must maintain professional relationships with clients and are prohibited from accessing patient records, as their responsibilities explicitly exclude clinical treatment and medical oversight. To reinforce this distinction, the Code of Ethics for peer workers emphasizes clear professional boundaries, mandates supervisory guidance, and allows peer workers more flexibility to share personal experiences and discuss their recovery journeys, creating a framework that supports the value of lived experience within ethical limits. Various training programs and certifications are available for peer workers employed within professional services (Kaufman et al., 2016). According to the metareview by Bassuk et al. (2016), most peer workers in the United States are trained and certified.
In Norway, addiction treatment is provided by a multidisciplinary team, recently supplemented by peer workers to enhance support through lived experience. According to Norwegian studies and surveys, peer workers often take on the same responsibilities as trained professionals, including maintaining patient records and participating in treatment planning (Åkerblom et al., 2020; Erfaringssentrum, 2023).
The Health Personnel Act (Helsepersonelloven, 1999) sets out requirements for all employed in healthcare services, including peer workers. The legislation regulates professional conduct, emphasizing the need for confidentiality, accurate documentation, and the provision of sound, evidence-based healthcare. The ethical guidelines within the Act highlight employers’ responsibility to verify the qualifications of their staff and to prevent conflicts of interest, especially in situations where personal and professional relationships might become intertwined (Helsetilsynet, 2023). No explicit national framework exists for peer worker roles nor guidelines for integrating lived experience in health services. Hence, incorporating lived experience within Norwegian healthcare remains ambiguous in light of political aspirations to value personal insights professionally while adhering to The Health Personnel Act that enforces strict boundaries between private and professional spheres for all employees, including peer workers.
Qualified for Utilizing Lived Experience?
Effectively utilizing lived experience requires qualifications and training. With the proper education, peer workers may balance their personal experiences with professional knowledge, contributing to safe and targeted treatment (Eddie et al., 2019). Establishing training requires a professional framework that provides clear guidance on integrating personal experiences into practice, ensuring that these insights are applied appropriately and ethically within a structured professional setting. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines in the United States (2023), peer workers use their lived experience with addiction and recovery to build trust and reduce stigma in their relationships with clients. Hegedüs et al. (2021) and Turuba et al. (2023) emphasize the need for continuous, comprehensive training in boundary setting, self-care, and crisis response. According to Blash et al. (2015), peer worker training programs in the United States vary from 40 to 80 hours of instruction and include ethical training and guidance on professional boundaries. While some Norwegian municipalities and private organizations have recently introduced courses for peer workers, completing such a program is not required for employment. Moreover, these courses are not held to formal professional standards, as no such standards currently exist for peer workers. The sole qualification required for a peer worker position in Norway is lived experience with addiction or mental health challenges (Erfaringssentrum, 2022; Martinsen, 2019).
Norwegian Research on the Use of Lived Experience
Research on the professional use of lived experience gained momentum with the formal establishment of the peer worker role around 2008, with white papers explicitly endorsing lived experience as a foundational element in service delivery and positioning it as a central component of the care model. We identified three starting positions and allocations that align with historical and current perspectives.
Treatment institutions employing individuals—often former patients—as milieu therapists, encouraging them to share personal experiences with patients. Their lived experience with addiction and recovery is not only an essential qualification but also a central aspect of the therapeutic approach. This practice builds on a longstanding tradition in which former patients serve as role models, embodying the institution's values and guiding others through recovery in line with its selected therapeutic philosophy. This approach is documented in older literature on Norwegian therapeutic communities, which were the primary treatment model until the 2004 reform (Furuholmen & Andresen, 2007; Lohne, 1992; Thomassen, 2001). In fields such as nursing, social work, and psychotherapy, practitioners are typically advised to refrain from sharing personal experiences with addiction or mental health issues. This recommendation aligns with legal and ethical standards prioritizing professional boundaries, aiming to maintain therapeutic distance and safeguard the integrity of the client-provider relationship. However, some professionals selectively disclose lived experiences to foster therapeutic rapport and empathy. Studies from Norway's mental health sector reveal that while certain practitioners share their own mental health experiences with clients, they seldom discuss these insights in peer professional settings due to concerns over maintaining a professional role (Larsen & Moen, 2013; Siqveland & Jensen, 2022; Unhjem, 2019). Recent empirical studies have explored the perspectives of Norwegian peer workers and their clients in addiction treatment, using interviews to gain a deeper understanding of their experiences and insights (e.g., Åkerblom et al., 2020; Hordvik, 2022; Klevan et al., 2018; Ogundipe et al., 2019; Sjursæther & Lundberg, 2021; Sørly et al., 2022). The interviews indicate that peer workers draw on their personal histories, using a classic rock-bottom or awakening narrative to establish rapport and support clients. Peer workers often blur the lines between personal and professional interactions by engaging with service users outside work hours, including attending social events, participating in the same 12-step meetings as their patients, socializing as friends, sharing activities, and maintaining connections through social media. The Norwegian research indicates that peer workers often perform tasks similar to those of trained professionals, such as maintaining patient records and participating in treatment planning. Also, peer workers report receiving less structured guidance and support than their professionally trained colleagues, leading to uncertainty when managing complex situations and navigating role conflicts.
These findings highlight the varied and sometimes conflicting ways lived experience is incorporated and researched in Norwegian addiction treatment. The first perspective—where treatment institutions employ former patients as milieu therapists—illustrates a longstanding tradition of using lived experience as a key therapeutic tool within specific treatment philosophies. The second perspective—where trained professionals in nursing, social work, and psychotherapy generally avoid self-disclosure—reflects adherence to ethical and legal boundaries, prioritizing professional distance. The third perspective—where peer workers extensively use personal narratives, experience role ambiguity, and receive limited structured guidance—underscores the challenges of integrating lived experience in professional roles.
When Lived Experience Becomes Part of the Job
During the interviews in this study, two participants, Sissel and Erik, held positions as trained professionals who occasionally shared their personal experiences with patients, exercising professional discretion. This practice aligns with self-disclosure in healthcare, where professionals share personal information to build rapport and enhance therapeutic relationships (Cleary & Armour, 2022; Ziv-Beiman et al., 2017). Additionally, two participants, Viggo and Olaug, described a unique work role in which they were employed as trained professionals while also being expected to share their lived experiences with addiction and recovery as part of their professional duties. To our knowledge, no studies have examined similar dual roles in Scandinavia or internationally, but some mental health researchers advocate for professionals to use their lived experience more explicitly in clinical work (Cleary & Armour, 2022; Oates et al., 2017; Sinclair et al., 2023b). We hypothesize that the blurred roles, the absence of a defined framework for integrating lived experience into professional work, and the expectation that some trained professionals utilize their lived experience may be a uniquely Norwegian phenomenon.
Aims of the Study
The primary aim of this study was to explore how professionals utilize their lived experiences with addiction and recovery across their various roles, past and present, and how their perspectives on the use of lived experience evolved through formal training and vocational experience. The secondary aim is to investigate how the participants utilize their lived experience within professional frameworks and organizational expectations. The research is grounded in interviews with six professionals who hold formal qualifications in nursing, social work, and teaching, along with personal histories of addiction, treatment, and recovery, as well as vocational experience in peer worker roles.
Two research questions will guide our investigation:
What insights into the use of lived experience in Norwegian addiction treatment can be gained by examining how participants utilize their lived experiences in their work roles as peer workers in the past and as trained professionals today? How do participants perceive and navigate the impact of the national framework for health personnel and professional ethics in their current use of lived experience?
Research Approach
This study's research approach is inspired by Richard Swedberg's principles of exploratory research, which emphasize theory development through inductive reasoning in the social sciences (Swedberg, 2014, 2020). Swedberg advocates deriving new concepts and theoretical connections from empirical evidence rather than conforming data to pre-existing theories. Building on Swedberg's insights and grounded theory, Aksel Tjora (2018, 2021) has provided extensive guidance on methodological processes for concept and theory generation. This research methodology was selected due to the limited theoretical framework and the lack of well-defined concepts in the emerging field of peer workers and formally trained professionals who incorporate lived experiences in the Norwegian context. The study aims to identify emerging elements and perspectives within our data that can inform new research questions and deepen our understanding of the role of lived experience in addiction services.
Selection of Participants
Participants for an initial study were initially identified through personal and academic networks and later recruited using a snowball sampling technique (Parker et al., 2019). The information provided to potential participants specified that “eligibility for participation required employment in the addiction field, relevant professional qualifications, and personal lived experience with addiction and treatment.” We reached out to twenty potential participants for the initial study, ten of whom accepted the invitation and participated in individual, semi-structured, comprehensive interviews (Tjora, 2021) throughout 2022. At the time of the interviews, all participants had at least 1 year of experience in their current professional roles, with some having over 5 years of experience. The interviews occurred in various locations such as university premises, other neutral settings, participants’ residences, or online video platforms. Most were audio-captured, while a few were video-recorded. Participants could choose the venue and time of the interview. The interviews varied in length from 40 minutes to 2 hours. The guiding framework for these discussions covered three main areas. (a) A narrative overview of each participant's current and past work roles, educational and personal backgrounds, and motivations for entering the addiction sector. (b) Their current and previous workplaces’ approaches to utilizing lived experience, experiences collaborating with peer worker colleagues, and their perspectives on the organizational ethos, including perceived managerial and collegial expectations. (c) Reflections on the interactions and dynamics between patients, themselves, and other staff members. Participants shared insights from both their past and present roles and their journeys with addiction, treatment, and recovery. The interviewer employed open-ended questions to encourage reflection beyond the structured topics. Six participants had experience with peer worker roles before undertaking formal professional training, while the remaining four had no experience in peer support roles. With this opportunity to compare participants’ experiences in peer worker roles and roles as qualified professionals, as well as to explore how formal education might influence perspectives on using lived experience, we exclusively used and reanalyzed coded data from the six participants with backgrounds in peer support, which serve as the foundation for this paper. The six participants, drawn from various regions of Norway, bring diverse academic backgrounds in social sciences, health sciences, and pedagogy.
Coding
We initially recorded and transcribed all 10 interviews word-for-word. During this process, personal details, including gender, names, educational background, relationships, and locations, were anonymized to protect participants` privacy. The transcribed data were analyzed using MAXQDA software, which allowed us to apply multiple coding schemes to examine the content. The stepwise-deductive-induction (SDI) model developed by Tjora (2018) guided the data coding approach, and the methodology directly emphasizes the emergence of coding processes and category formation from empirical data. Consequently, the coding of interview transcriptions went beyond statements and language, probing into the emotions, word choice, and reflections that were either explicitly expressed or otherwise present. Following the method, the coding, consisting of 96 different codes, was compiled into eight categories, each described with empirical-analytical reference notes pointing to emerging themes. Three of the eight categories from the chosen six participants’ interviews were considered relevant for this article. We labelled the first category “early experiences” and included participants’ descriptions of their early approach to patients informed only by their own treatment experiences in a peer worker role. The second category focused on the participant's perception of organizational expectations and was named “role expectations.” The third category was labelled “changes” and included quotes about the participant's personal and professional transformation through vocational experience and professional training. The third category included descriptions of how the participants use their lived experience today as trained professionals.
Ethics
Approval was obtained from the Norwegian Social Science Data Services (Reference number: 202461). Ethical research guidelines were adhered to, with participants providing written informed consent. To maintain participants’ anonymity, the article deliberately excludes further identifying details about the participants, acknowledging the small community of peer workers in Norwegian addiction treatment and the importance of protecting their privacy within this context.
Findings
The following presentations fall into three parts. The first part illustrates participants’ reflections on their evolving perspectives on personal experiences and their treatment approaches. The second part highlights participants’ experiences with organizational work roles, and the third part provides examples of how they use lived experience today as trained professionals. The first section presents quotes related to the first and third coding categories, pointing to coding for “early experiences” and “changes,” including excerpts from the participants’ accounts of using lived experience as peer workers and expressions of transformed perspectives following professional training. All six participants were employed in the past as peer workers shortly after completing their treatment and prior to receiving professional training.
My Recovery was the Gold Standard
In her own words, Hedda struggled with opioid and amphetamine addiction for years before becoming drug-free in a residential facility, where the manager offered her a job as a peer worker shortly after her graduation. Today, she works as a trained social worker specializing in treating patients with dual diagnoses. She recalls her initial time as a peer worker, her first job ever. Hedda: “When it [the job offer] was first brought up, it seemed incredibly appealing. I was in a phase of fresh realization, feeling as if I had experienced an epiphany. The clarity of mind was overwhelming (chuckles), and I felt that my path to recovery was the gold standard, so I was ready to share this revelation with the patients.”
When Hedda started as a peer worker without training or vocational experience, she was enthusiastic about using her personal experience to connect with and support patients. She was confident that sharing her recovery journey could inspire and help others facing similar challenges. Hedda: “When they hired me [….] I had not attended any courses, I didn’t have any vocational experience. They just wanted to give me the job because I had done well as a patient.”
Her employer failed to provide Hedda with additional training, but the manager stepped in to offer occasional guidance whenever Hedda took the initiative. Today, as a trained social worker, she realizes that just sharing her lived experience may not be the best approach to treatment. Hedda: “Working as a peer worker… it has to be based on more than just one's personal experience. Becoming drug-free is a fantastic achievement… but it is not enough. I am the expert on my own recovery, but that doesn’t make me an expert on someone else's.”
As Hedda transitioned into her current position as a trained social worker, her perspective on helping shifted. In this context, her chuckle in the first quote can be seen as a subtle expression of humor, marked by a touch of irony, reflecting her changed perspective. Interviewer: «Ok, so you don’t share your lived experience with the patients in your current job?» Hedda: «It hasn’t felt natural until now. My patients are very sick […] they have multiple psychiatric issues in addition to abusing drugs. It's more important for me to establish a therapeutic position.»
Hedda has chosen not to share her personal experiences out of consideration for patients she perceives as highly vulnerable. Instead, she focuses on being present and building therapeutic relationships. However, she remains open to drawing on her lived experience if it naturally emerges in conversation.
I Used to Think That the 12-Step Program was the Solution for Everyone
After overcoming addiction and achieving recovery through a 12-step program, Olaug began working as a peer worker. Eventually, she advanced her career by pursuing a formal nursing education. Looking back on her recovery journey within 12-step groups, she now acknowledges that there are multiple paths to recovery and sees the 12-step approach as just one of many possible options. Olaug: “I used to think the 12-step program was the right solution for everyone. It worked for me, but I now see that it doesn’t work for everyone. Before I achieved professional training, I was very uncritical about it. I thought Narcotics Anonymous was the answer to everything. [….]. I now realize, especially in the first two years [as a peer worker], that I wasn’t really giving the patients anything useful. I didn’t show them alternatives to Narcotics Anonymous either.”
Through professional training and evidence-based knowledge, Olaug has come to recognize that her experience with the 12 steps represents only a fraction of the support options available to patients. She now believes that merely sharing her own recovery story and directing patients to Narcotics Anonymous meetings was insufficient. Looking back, she feels she should have been more aware of alternative recovery pathways. This realization has been problematic and introspective, marked by internal conflicts. Olaug: « I actually came into conflict with myself when I started college… concerning [my involvement in] Narcotics Anonymous, like, “Shit, is this what I need?” or, “What have I been doing?” But I’ve figured it out, and I have found a much better… a nicer balance.”
Olaug relied on her experience as a member of Narcotics Anonymous as the primary tool in her previous role as a peer worker. Achieving professional and evidence-based knowledge about addiction and treatment created a personal crisis and fostered regrets regarding her former attitude and advice to patients. Today, Olaug works as a trained nurse at an inpatient facility, and her role includes using her lived experience. Olaug faces new challenges, merging the nursing role with her lived experience, which affects her collaboration with colleagues and patients. Olaug: “It is difficult to balance how much of my professional expertise and how much of my lived experience I should use in collaboration with my colleagues. […] you get confused, you know… sometimes you can use a lot of your lived experience, and it's good in one meeting, and then suddenly… you try the same in the next, and then it's like, now you need to be professional, right? Then you’ve forgotten to be professional. And vice versa. No, now you are too professional. Now, it's important to remember the path you’ve walked yourself.” Interviewer: “I think what you describe being employed as a trained nurse and using lived experience may be complicated”. Olaug: “I struggle with it today as well [comparing to the time before becoming a nurse]… even I have learned… ethics and… laws and regulations and everything, navigating the boundaries is very complicated, really.” Interviewer: “Which boundaries are you considering? Are you thinking about how much personal information to share? “. Olaug: “Yes, how personal I should be, how close I should get with patients”.
Olaug combines her professional skills and personal experiences in her clinical work and collaboration with colleagues. She strives to navigate legal framework, nursing ethics, and the use of lived experience, carefully considering where to draw boundaries between her personal life and her role as a nurse. This balance is further complicated in team settings, where distinguishing between speaking as a professional or sharing lived experience can be challenging. She also notes an inconsistency in workplace rules, which adds to her confusion. At one meeting, professional knowledge is relevant; utilizing the same knowledge is criticized at the next meeting, where she is encouraged to draw on her own experiences. Also, the quote “I struggle with it today as well, even I have learned ethics, laws, and regulations and everything” reveals by the phrase “today” that Olaug, in her previous role as a peer worker, was not aware of laws and regulations, although all health personnel including peer workers is required to know and respect the basic legal framework outlined in The Health Personnel Act. The difference is that she now has obtained her nursing license, which could be at risk if someone reports boundary violations to the Health Supervisory Authority.
Nothing Makes Sense Anymore
Before he quit drugs and enrolled in professional training, Viggo, in his own words, struggled with severe drug addiction and underwent multiple treatment attempts. After overcoming addiction and completing inpatient treatment across several institutions with the support of 12-step groups, he took on a job as a peer worker, motivated by a desire to support others facing similar struggles. Viggo: “ When I became drug-free and realized that I needed a job [….] I thought, “Oh my God, everyone should have this opportunity.” So I want to give recovery to everyone, and it's great that there's no doubt about what works, like.. (laughs a little). And then I became a professional teacher and realized, “Okay, more things are going on and it's not that simple… now nothing makes sense anymore.”
As Viggo advanced in his professional training, he noticed a shift in his approach. His academic and practical experiences provided him with a deeper and more nuanced perspective on addiction treatment, expanding his understanding beyond personal experience alone. The new insights into the complexity of treatment created personal crises, expressed in the phrase “nothing makes sense.” The conversation between the interviewer and Viggo explored the therapeutic methods he employed with patients during his initial role as a peer worker. Viggo: “Erm… when I started [as a peer worker] in addiction treatment, I was kind of… influenced by the type of treatment I had received and the follow-up care I was in, which was very confrontational and tough… sort of tough love, in a way. It was very much about breaking down and then building up… stressing a strong sense of discipline, and if you didn’t do things right, then YOU were wrong. […] I didn’t see at the time that it wasn’t working, but I now realize that a different approach works much, much better.”
Viggo reflects on his time as a peer worker, noting that he leaned heavily on his personal treatment journey when working with patients in the past. He expresses another understanding today that the approach he once considered valuable—essentially passing on his personal recovery experiences and use of tough love—was not necessarily beneficial to those he aimed to help. Viggo shares that he now prefers not to discuss personal matters at work, protecting his privacy by frequently changing workplaces. One reason is that colleagues in peer support roles often seek his professional advice and personal support, placing additional demands on him. Interviewer: “What do your peer worker colleagues want to talk to you about?” Viggo: “Well, it may concern their interactions with patients and their reactions to things. How they have handled certain situations. Seeking confirmation that something is okay or not, or… eh… general insecurity. And I feel bad if I get annoyed not being a caring supporter, you know. However, when engaging with colleagues’ needs, I feel guilty neglecting the patients.”
Viggo explains that his peer worker colleagues need support, guidance, and affirmation. While he wants to provide this support, he acknowledges that doing so takes away time from patient work. The tension between supporting colleagues and helping patients has taken a toll on Viggo, leading to what he describes as emotional burnout. When asked if he envisions solutions beyond changing workplaces, Viggo suggests that structured support and guidance are essential for employees expected to incorporate their lived experience into work roles.
Becoming a Trained Professional
In their early stages as peer workers without formal qualifications or training, Hedda, Olaug, and Viggo relied solely on using lived experience to treat and support patients. After professional training, they reflected on their previous roles and recognized that knowledge and professional skills are essential for addressing various treatment-related challenges. Initially, they believed that a single approach—whether sharing their own recovery stories, participating in 12-step programs, or applying tough love—was the correct method. Now, they emphasize the need for flexibility in addressing the complexities of addiction recovery and the patients` diversity of problems and situations. Olaug and Viggo share that gaining formal knowledge led to personal crises and regrets about how they advised patients in the past. Olaug and Viggo also address organizational issues when they talk about how they are expected to combine lived experience into roles as a nurse and a teacher. Olaug feels uncertain about her undefined role and is puzzled by the seemingly shifting expectations. She is also trying to understand how to integrate her lived experience within nursing practice's ethical and legal boundaries. Viggo resists compensating for the organization's lack of support and supervision provided to his peer worker colleagues. Through their acquired professional knowledge and vocational experience, Olaug, Viggo, and Hedda now identify issues they did not recognize in their former roles as peer workers.
Lived Experience is not a Fixed Narrative
The participants’ reflections on their past assumptions and actions illuminate that the interpretation and dissemination of past life events are dynamic processes, evolving within changing temporal and contextual frameworks. As this study demonstrates, with shifts in context and personal circumstances—such as the passage of time, accumulation of vocational experience, and not least, acquisition of professional training, ethical guidelines, and evidence-based knowledge—the narratives that mirror their lived experiences also transform. Personal narratives present flexible, responsive, and adaptable reflections of past events rather than fixed, unchanging retellings. We will pursue this line of thought by examining the participants’ reflections on using lived experiences conveyed through the genre of recovery narratives.
The Recovery Narrative
Within the Norwegian vision, peer workers—and, by extension, those employed based on their background in lived experience—are expected to represent the voices of service users and contribute to improving treatment services. This dual role encompasses political and therapeutic tasks, leading to ambiguity about their exact function in the treatment regimes (Johansen, 2016; Odden et al., 2015). Unclear and missing national frameworks guiding the use of lived experience, peer workers’ roles, qualifications, and professional ethics add to the confusion. Norwegian studies reflect uncertainty about what qualifies as lived experience and how personal experiences should be communicated to patients and colleagues (e.g., Åkerblom et al., 2020; Sjursæther & Lundberg, 2021), indicating that service providers expect peer workers to convey their “well-processed experiences” with thoughtfulness, providing a reflective and intentional account of their recovery journey (Åkerblom & Mohn-Haugen, 2022; Blindheim-Hansen & Halvorsen, 2022; Martinsen, 2019; Odden et al., 2015). For example, a peer worker in Kroksjø's study (2021, p. 37) recalls their job start: “The first thing a team member asked me was if I could tell my story. I was quite put out and dared nothing but share. It felt bizarre.”
However, research has not yet examined how these and similar expectations are operationalized and implemented in clinical work. It is unclear how “well-processed” experiences should be defined and what criteria can be applied to decide if lived experiences are articulated and interpreted as well-processed. One possibility is that specific recovery genres would be accepted as well-processed and representative, as Woods et al. (2019) suggest. In the following section, the participants share their experiences of utilizing recovery narratives in a professional setting. The second section incorporates quotes from the second coding category, focusing on participants’ perceptions of the service provider's expectations.
Matching the Institution's Beliefs
After gaining vocational experience in several addiction treatment centers, Olaug was hired by a treatment institution with the expectation that she would integrate her lived experiences with her professional expertise in her role as a nurse. Here, she recounts how her employer prescribed the narratives she should convey to patients. Olaug: “Regarding personal experiences, there are limits on what's acceptable to share. It's all good if it matches the [institution’s] beliefs. However, when it doesn’t, you’re restricted. There was a time I became tired and disillusioned with [self-help groups], yet I couldn’t relay that sentiment to the patients. They were to remain under the impression that using [self-help groups] was the only correct approach. You’re given such guidelines to follow.”
Olaug's account highlights a discrepancy between her personal experiences and professional role expectations regarding endorsing institutionally preferred treatment guidelines, such as participation in self-help groups. As a role model, her narratives were meant to validate and support institutional philosophy for the patients. However, this expectation remained even when her personal experiences differed from these guidelines, resulting in a form of self-censorship. In this context, Olaug was implicitly expected to align her expressions of experience with the institution's approach, effectively framing its philosophy as her own authentic perspective. This illustrates a broader institutional mechanism in which personal narratives are molded to reinforce the therapeutic framework, potentially compromising the authenticity of lived experience.
A Dramatic Tale
After qualifying as a high school teacher, Viggo worked at several addiction treatment institutions. One manager encouraged him to integrate his personal experiences with his professional expertise when working with patients. However, he felt he had little control over the personal information he disclosed. Viggo: “I feel that [….], there's an expectation that I should share my story of becoming drug-free, as it Interviewer: “How do you feel about that?” Viggo: “I do it less now, but I feel… it's draining (laughs a bit)… For one, it feels a lot like self-affirmation all the time, you know. Who am I sharing this for? For myself, or to help them? […] I don't think it benefits the patients much. And it certainly doesn't help me, either. Because then I'm always living in the past.”
Viggo's reflections underscore a complex ethical tension surrounding the use of personal experience. He is aware of a subtle expectation from his employer and colleagues—that his role is most effective when he recounts specific, emotive aspects of his recovery journey. This focus is perceived to hold “therapeutic value” for patients, adding a layer of authority and authenticity to his guidance. However, Viggo's hesitation, highlighted by his repeated use of “I feel” and his nervous laughter, suggests a disconnect between this expectation and his understanding of therapeutic efficacy. He grapples with questions of purpose and self-identity, openly wondering whether sharing these experiences aids the patients or only serves as a self-validation within a work environment that values personal recovery stories. Viggo's reflections reveal his sense that continually recounting his past is psychologically taxing, effectively binding him to an identity he feels may no longer serve him or the therapeutic goals. This dilemma points to significant ethical concerns regarding the authenticity of narratives and the impact of institutional expectations on an individual's well-being. The prescriptive use of personal stories in treatment settings risks depleting the individual and may limit the scope of therapeutic engagement by prioritizing specific types of recovery narratives over more varied, patient-centered approaches.
How Should Lived Experience be Communicated?
The second section of the findings offers insight into the complexities and challenges involved in combining lived experience with professional roles. The participants’ accounts reveal encounters with expectations regarding how their lived experiences should be shared, framed, and presented. The absence of clear role descriptions, ethical guidelines, and established criteria for using and defining a “well-processed” lived experience places professionals in a precarious position, requiring them to navigate subjective interpretations of their experiences by employers and colleagues. These findings highlight the need to reassess recovery narrative expectations, develop guidelines that honor the professional's autonomy, and ensure that shared experiences benefit patients.
Discovering the Use of Lived Experience
The third and final section builds on the third coding category labeled “changes,” focusing on descriptions of how the participants use their lived experiences at the time of the interviews as trained professionals. As Olaug, Viggo, and Hedda noted, their recovery stories once played a central role in their professional approach, and they explain how, in their roles as peer workers, they found themselves repeatedly sharing their personal recovery narratives and endorsing the familiar methods they had personally encountered. During the interviews, they expressed hesitation in incorporating recovery narratives into their clinical work today. Nevertheless, their skepticism does not mean they have ceased drawing on these experiences. Instead, as trained professionals, they seek to use professional judgment to determine how, when, and what to share, as demonstrated by Sissel in the next section.
Identifying the Grind
Sissel, a trained nurse working with homeless patients struggling with substance abuse, describes her past with addiction, including multiple inpatient treatments and previous roles as a peer worker. In this conversation, she reveals that she found little meaning in the peer worker role, which eventually motivated her to pursue formal training as a nurse. While studying, she continued working as a peer worker—an increasingly challenging role. Sissel: “I found it awkward and fake to go around presenting myself as a peer worker [to the patients and the colleques]… because.. there's an expecta.. (searching for words)” Interviewer: “An expectation that you should share your lived experiences?” Sissel: «You and I are different people, we have different lives, […] but there is this idea that the peer worker might offer a solution.. and a sense of hope.. but I started to feel that it.. it was quite cruel, because the hope of “if I can, so can you”… it's a kind of imposition.. it's just not true.. it's just not true. Some people don't want [to listen to solutions at all], and some have incredibly complex lives, where.. where it's not simply.. like.. to decide to make a change.. I found that [working as a peer worker] became…[impossible]».
Sissel's reflections illustrate a critical tension in the peer worker role, highlighting the ethical and emotional complexity of using personal recovery narratives. Her discomfort stems from the expectation that her lived experience could—or should—serve as a motivational tool, embodying the message that recovery is universally achievable. Sissel's description of this role as “awkward and fake” signals her resistance to such expectations, particularly given her awareness of her patients’ diverse and sometimes insurmountable challenges. This discomfort aligns with academic critiques, such as those by Woods et al. (2019) and Mattingly (2010), who explore how hope, though often framed as an essential therapeutic tool, can inadvertently place undue pressure on individuals. When recovery narratives are positioned as a template for success, they may imply that failure to recover mirrors a lack of will rather than structural or situational barriers. Sissel's perception that this hope can feel “cruel” reflects her empathy for patients whose complex circumstances may render such aspirations unrealistic. Her experience underscores the ethical ambivalence surrounding the deployment of hope in clinical settings: while it can foster resilience for some, it risks alienating others by oversimplifying the nature of recovery. Sissel's transition to formal nursing, driven by a desire for a role that allows for a broader approach, further highlights her limitations in the peer worker role. Her narrative challenges the field to consider alternative, more nuanced ways of fostering hope that respects each individual's unique situation without resorting to a one-size-fits-all recovery story. Today Sissel is reluctant to share her personal experiences with clients or coworkers. Still, her challenging treatment experiences have fostered greater empathy and a deeper understanding of patients’ situations. Sissel: “I understand…. eh.. especially when I am working with older patients, what sorts of treatment journeys they might have been on. If you’re fifty, you’ve likely been through both [institution A] and perhaps [institution B] and so on…
Despite her reluctance to share her story directly, Sissel values her lived experience as a source of empathy and insight. Her background enables her to recognize the “grind” of long-term treatment patients may have endured, fostering a deeper, more compassionate connection. In this way, her lived experience becomes a form of unspoken understanding, allowing her to engage with patients authentically without explicitly drawing on her own story.
Lived Experience is a Qualification
Sissel's professional role allows her to choose independently whether and how to draw upon her personal experiences within her work framework. This selective integration aligns with studies examining how and why trained professionals may use personal experiences in mental health care to build rapport and understanding with patients (Larsen & Moen, 2013; Siqveland & Jensen, 2022; Unhjem, 2019). Rather than replacing formal training, Sissel's lived experience deepens her expertise and enriches her empathetic understanding of her patients’ challenges. In the international literature, a study by Ham et al. (2013) indicated that professionals with lived experience engaged in self-disclosure more frequently early in their careers but later adapted their approach, becoming more selective. Many transitioned from sharing “long war stories” about their addiction to employing self-disclosure intentionally and strategically as a therapeutic tool. Ham et al. conclude that self-disclosure should be used cautiously and tailored to the client's needs to avoid potential negative consequences. In another study from the mental health sector, the interviewed nurses used their own experiences to better understand and empathize with their patients. This “use of self” was described as a powerful tool for supporting and understanding patients (Oates et al., 2017). A scoping review from Ødegård (2022) reviewed mental health professionals’ challenges when drawing on their lived experience, particularly how this practice can blur the traditional “us-and-them” boundary between providers and patients, raising concerns about role clarity. While lived experience can deepen empathy, it may also risk compromising objectivity. Given the limited guidelines for incorporating personal experience into clinical practice, Ødegård highlights the need for structured support and transparent policies to ensure that lived experience is applied responsibly within healthcare settings.
Discussion and Conclusion
An analysis of Norwegian working conditions reveals a notable difference in the use of lived experience, particularly in contrast to the United States, where professional and ethical frameworks govern the incorporation of lived experience in peer worker roles, systematically embedding it within clinical practice. In contrast, frameworks regarding the use of lived experience remain absent in Norway, bearing significant implications. Untrained peer workers like Hedda, Olaug, and Viggo were hired to assume roles in addiction treatment typically reserved for professionals. These findings correspond with Norwegian studies that show peer workers often do the same job as trained professionals, including case management and reading and writing in patients’ records (Åkerblom et al., 2020; Clausen, 2022; Karlsdottir & Storm, 2021; Øygard & Håvarstein, 2023). Employed without training in peer worker roles, Hedda, Olaugh, and Viggo lacked the knowledge to comprehend and adhere to the legal framework in the Health Personnel Act (Helsepersonelloven, 1999), leaving them to navigate complex environments, putting them at risk of sanctions for violating ethical boundaries unknown to them. However, for Viggo and Olaug, even professional training did not ensure adherence to professional ethics when their lived experience was expected to be used in their professional capacity. Viggo and Olaug risk losing their jobs if they do not comply with their employer's demands; however, if they comply, they could face sanctions from their professional organizations and the Board of Health Supervision (Statens Helsetilsyn, 2012). In Norway, service providers are responsible for ensuring that employees are qualified for their roles; the participants’ experiences cast doubt on whether this responsibility is consistently fulfilled. Employed as peer workers, Hedda, Viggo, and Olaug relied on familiar methods and ideologies without critical examination. When they gained evidence-based knowledge as a part of their professional training, they reevaluated their previous approaches, realizing that their treatment methods and approaches might have been risky for patients. International research on lived experience in mental health discusses challenges related to inclusion, assimilation, and co-optation of employees with lived experience (Penney & Prescott, 2016; Sinclair et al., 2023a). In this context, tokenism refers to the practice of including individuals from marginalized groups, such as those with lived experience, in roles or activities to create an appearance of inclusivity without granting them meaningful influence or support. The extent to which Hedda, Olaug, and Viggo felt they could influence the treatment regimes within the institutions where they worked as peer workers remains unclear, as they seemed to adhere closely to the institutions’ established methods and ideologies. Hedda, Olaug, and Viggo questioned practices and work roles only after receiving professional training. Given these perspectives, one might question if employing untrained peer workers aligns with the political intention to enhance and renew professional practice through lived experience embedded in a peer worker role. This is especially pertinent when a service provider hires a former patient. Hedda worked as a peer in the very institution where she had recently been a patient, making it reasonable to assume that, as an employee, she might feel pressured not to challenge treatment protocols or disagree with colleagues who had recently been her counselors and caregivers.
This study also questions how lived experience should be conveyed. The construction and use of recovery narratives is a developing research area in mental health and addiction services (Duff Gordon & Willig, 2021; Pienaar & Dilkes-Frayne, 2017; Woods et al., 2019; Yeo et al., 2022). The participants’ cautious approach toward articulating lived experiences today differs from their past use and the views expressed by peer workers in Norwegian studies, where statements emphasize the merit of sharing recovery narratives with patients (see Åkerblom et al., 2020; Borg et al., 2017; Klevan et al., 2018; Sørly et al., 2022). Sharing one's own story “in a way that creates hope” is integrated into peer worker courses in Norway (Kydland & Biringer, 2022), even though no contemporary official Norwegian guideline recommends that peer workers share their recovery stories. However, as Trond and Viggo in this study reveal, service providers may expect peer workers to communicate well-processed experiences, a concept also noted in several Norwegian studies on peer work (Clausen, 2022; Hordvik, 2022; Martinsen, 2019). Whether these allegedly well-processed experiences conform to the classic rock-bottom narrative or constitute a distinct genre remains an open empirical question (Liveng et al., 2018; Subhani et al., 2022; Woods et al., 2019).
Trained professionals who use their lived experiences as a supplemental tool might bring a distinct depth to patient care. According to findings in this study and the international literature, professionals—who have undergone formal training alongside personal recovery journeys—believe their lived experiences can enhance empathy and rapport with patients without overshadowing their professional expertise. They utilize personal insights, tailoring disclosures to the context and patient needs, which allows them to maintain a therapeutic focus while building trust and credibility. These professionals often perceive their lived experience as an extra resource rather than the core of their therapeutic approach, emphasizing that professional discretion is critical. The Norwegian Health Personnel Act (Helsepersonelloven, 1999) requires professionals to maintain clear role awareness and avoid blending private and professional roles. These rules apply universally to all healthcare professionals and are designed to protect the patient's and the professional's integrity. When lived experience is brought into therapeutic contexts—whether in the role of a trained professional or a peer worker—challenges related to role clarity and boundary management inevitably arise. The political ambition to incorporate lived experience in addiction services highlights a pressing need for research on integrating such experiences within the existing framework and defining the role of a peer worker. Further studies are essential to explore how lived experience narratives generate benefits in clinical settings and how they can be shared in ethically responsible ways. This need is relevant for trained professionals who bring lived experience into their roles and peer workers hired explicitly for their personal recovery journeys.
Limitations
A methodological limitation of the study is the use of qualitative interviews with a small sample of participants. While this approach provides in-depth insights into how participants perceive and utilize their personal experiences in professional contexts, it limits the generalizability of the findings. The experiences and reflections of individual participants may be heavily influenced by their specific workplaces and personal backgrounds, meaning the results may not represent broader populations of professionals or peer workers in other contexts.
Footnotes
Declaration of Conflicting Interests
Funding
ORCID iD
