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

Clinical staff in the Emergency Department are often laser-focused on the biological side of recovery, such as getting the patient started on buprenorphine or managing withdrawal. However, as a peer, you know that a prescription is only one piece of the puzzle. If a patient leaves the ED with a script for Suboxone but has nowhere to sleep, no way to get to the pharmacy, and no phone to call a clinic, the medication is far less likely to be effective. These non-medical factors are known as Social Determinants of Health (SDoH).

What are SDoH?

Social Determinants of Health are the conditions in the environments where people are born, live, learn, work, and age. (source) For a person with Opioid Use Disorder (OUD), these factors are often the primary drivers of relapse. Key areas include:

• Housing Stability: Does the patient have a safe place to go? Stable housing is often a prerequisite for successful long-term recovery.
• Transportation: Can they get to their follow-up appointments? A lack of reliable transport is a major reason for no-show rates at recovery clinics.
• Food Security: It is difficult to focus on recovery when you are hungry. Access to nutritious food helps stabilize mood and energy levels.
• Economic Stability: Does the patient have a phone to receive appointment reminders? Do they have insurance to cover their medication costs?
• Social Support: Do they have a healthy network, or are they returning to an environment where everyone else is using substances?

In a care model that values the whole person, your role is to identify these barriers before the patient walks out the hospital doors. While the doctor is the expert on medical matters, you are the expert on logistics.

By conducting a simple SDoH screening during your conversation, you can catch the silent reasons a patient might fail. If they say, "I'm not sure I can make that Tuesday appointment," don't just encourage them to try harder. Instead, ask, "Do you have a ride, or would it help if we looked into a bus pass or a transport service?"

Recovery Capital

SDoH and the idea of Recovery Capital are significantly intertwined when thinking about patient health and intensity of services needed to help them recover. Recovery Capital is defined as the total breadth and depth of internal and external resources a person can draw upon to start and sustain their recovery. (source) Think of it as a patient's "recovery bank account"—the more capital they have, the more resilient they are against returning to use.

As a peer, you can directly influence three specific types of Recovery Capital while a patient is in the ED:

1. Personal Recovery Capital

This is split into two categories: what the patient has (physical) and who the patient is (human).

• Physical Capital: The tangible things a patient needs to survive. This includes physical health, financial assets, health insurance, safe shelter, clothing, food, and reliable transportation.
• Human Capital: The internal tools a person possesses. This includes their values, knowledge, job skills, problem-solving abilities, self-awareness, self-esteem, hopefulness, and interpersonal skills.

2. Family and Social Recovery Capital

This encompasses a patient's relationships and social networks, including their "family of choice."

• It is driven by having a supportive, sober social network, intimate partners willing to participate in treatment, and access to drug-free leisure activities.
• It also includes positive connections to mainstream community institutions like workplaces, schools, or faith communities.

3. Community & Cultural Recovery Capital

This is the environment surrounding the patient. It includes local attitudes, resources, and policies that make recovery easier or harder.

• Community Capital: Access to a full continuum of treatment resources, diverse recovery support institutions (like RCOs, clubhouses, and sober living), local recovery role models, and active efforts to reduce stigma.
• Cultural Capital: A subset of community capital that provides culturally-prescribed pathways of recovery that resonate with a patient's specific heritage or identity (such as the Native American "Red Road" or Afrocentric therapeutic models).

Recovery Capital is a framework for thinking about the barriers that contribute to a patient's return to use—like emotional distress, low motivation, and social pressure. By helping a patient solve an SDoH issue (like finding transportation or a safe shelter), you aren't just checking a box; you are actively building their Recovery Capital so they can build their resilience toward making a lasting change.

Addressing social needs alongside clinical care helps patients stay connected to treatment and build the resilience to sustain their recovery. The help of a peer is what makes this holistic approach possible.