Written by Elizabeth Cairns, Mobilize Recovery Special Projects, and reviewed by Code Recover Peer Advisors, August 2026

Peer recovery support specialist Spencer Costello talks about his experience building a peer program within the ERs of Las Vegas, NV

The Emergency Department is designed for acute stabilization. It is where you put out the fire, but it is not where you rebuild the house. If a patient leaves the ED with a prescription for MOUD but returns to the same isolated environment, their risk of recurrence remains incredibly high. To build lasting recovery capital, patients need to be tethered to a community that understands them. This is where Recovery Community Organizations (RCOs) become your most valuable partners.

What is an RCO?

A Recovery Community Organization is an independent, non-profit organization led and governed by representatives of local communities of recovery. (source) Unlike clinical treatment centers or methadone clinics, RCOs do not typically provide medical care. Instead, they provide the scaffolding for a new life:

• Peer Support Groups: Alternatives or additions to traditional 12-step models, such as SMART Recovery or All Recovery meetings.
• Resource Navigation: Help with job placement, housing applications, and navigating the legal system.
• Social Connection: Substance-free social events, volunteer opportunities, and a safe physical space to exist without judgment.

Substance use thrives in isolation. When patients leave the chaos of active use, they often find themselves facing a profound void. Their previous social circle was likely intertwined with obtaining and using drugs. As a peer navigator, you can help them fill that void with positive connections before loneliness leads to relapse. RCOs provide immediate, welcoming social networks that prove recovery is not just about stopping use; it is about starting to live.

Making the Connection

Connecting a patient to an RCO requires more than just handing them a flyer. It requires active linking:

1. Know Your Local Landscape: You should personally know the directors and lead peers at the RCOs in your hospital's area. Tour their facilities so you can describe them accurately to your patients. You may need to create a MOU (Memorandum of Understanding) between the hospital and RCO to designate a path of patient referral.
2. Make the Call Together: While the patient is still in the ED, call the RCO. Say, "I have someone sitting with me who is getting discharged today and could use a place to go tomorrow. Can I introduce you?"
3. Bridge the Gap: If the RCO offers peer transport or street outreach, coordinate with them to pick the patient up from the hospital or meet them at their first outpatient clinic appointment.

By connecting the clinical intervention (MOUD initiated in the ED) to long-term community support (the RCO), you provide the tools to create a long term safety net. You change the narrative from "Don't use today" to "Here is a community that will help you build the life you want to live."