The Wounded Healer Paradox: Perceived Triggers of Drug Relapse and Recovery among Peer Supporters

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Despite extensive research on relapses, little attention has been given to those in recovery who support others while facing their setbacks. The study explores factors triggering relapses and the return to recovery, among men and women with histories of addiction and criminality who held peer support roles. Key findings reveal that disconnection from NA's 12-step program and recovering peers often initiated relapses, alongside early romantic relationships and insufficient recovery commitment. While empowering, the dual identity of peer supporters also exposes unresolved personal issues, leading to the "savior-rescuer paradox". However, lessons from relapses enhance resilience and deepen recovery commitment. The findings highlight relapses as a learning process rather than failure, emphasizing the role of social and recovery capital in sustaining long-term recovery. Rooted in the convict therapy perspective, the study advances the understanding of relapse dynamics and offers insights into relapse prevention strategies and peer support in the field of addiction recovery. Humanities/Health humanities Social science/Criminology Social science/Sociology wounded healer drug addiction recovery convict therapy 12-step program Alcoholics Anonymous (NA) Introduction The emerging concept of "wounded healers" is positioned between two significant ideas: peer-based intervention and Convict Therapy (Elisha, 2023 ). Peer-based interventions also referred to as peer support, peer mentoring, and peer work, are implemented in various therapeutic settings in prisons and the community. These initiatives aim to assist individuals seeking to change their way of life and recover by developing prosocial attitudes and behaviors, thereby increasing their chances for successful reintegration (Buck, 2021 ; Elisha, 2002; LeBel et al., 2015 ). Peer work encompasses roles such as mentoring, counseling, and guidance, utilizing reformed individuals' lived experiences to support others' rehabilitation efforts (Bellamy et al., 2012 ; White & Evans, 2013 ). This approach aligns with the developing concept of convict therapy (Elisha, 2023 ), which emphasizes the role of reformed former convicts and recovering individuals —referred to as wounded healers—in promoting rehabilitation and recovery processes based on their lived experiences. Convict Therapy draws on frameworks, including the wounded healer concept (LeBel et al., 2015 ), positive criminology (Ronel & Elisha, 2011 , 2020 ), and crime desistance theory (Laub & Sampson, 2001 , Maruna, 2002 ). The wounded healer notion is most exemplified in self-aid and mutual help groups for people with addiction problems, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), where recovering individuals provide support and guidance to newcomers while reinforcing their recovery (Perrin & Blagde, 2016; Ronel, 1998 ). Scholars in the field of desistance strongly support the role of peer support in promoting and enhancing change and rehabilitation processes. Indeed, studies worldwide highlight the numerous advantages of peer support, which are manifested in the development of strengths and a sense of competence, particularly among aid providers (e.g., Buck, 2018 ; Elisha & Shchaf-Friedman, 2023; LeBel et al., 2015 ; Woods, 2020 ). However, peer support is not without risks, particularly the potential for relapse (Elisha, 2022 ; Perrin, 2022 ; White & Kurtz, 2006 ). While much research has focused on relapse among recovering individuals in general, there remains a significant gap in understanding relapse experiences among wounded healers in the field of drug addiction. This study aims to fill that gap by exploring the perceived factors and triggers linked to relapses among recovering individuals who previously held peer support roles, and examining how they navigate their return to recovery. To our knowledge, this is the first study of its kind, and its findings could contribute significantly to relapse prevention strategies for individuals struggling with drug addiction. Relapses and recovery dynamics in substance abuse Relapses are commonly defined as the resumption of substance use after an attempt to stop or a period of abstinence (Guenzel & McChargue, 2020 ), often involving a return to previous levels of consumption (Moe et al., 2022 ). Relapses are a frequent occurrence in the recovery journey for individuals with substance use disorders. The National Institute on Drug Abuse (NIDA, 2023) reported high relapse rates ranging between 40% and 60% within the first year of treatment, emphasizing the chronic nature of addiction. Xie et al. ( 2005 ) found that after a ten-year follow-up, many clients achieved complete abstinence, although one-third experienced a relapse within the first year, with an additional one-third relapsing over the subsequent decade. Relapses are often viewed as a process that unfolds over time, rather than a distinct event (NIDA, 2023; DiClemente & Crisafulli, 2022 ). Its severity can range from a brief lapse to a full relapse, i.e., a complete return to previous levels and patterns of use. Essentially, relapses occur when the motivation to sustain recovery becomes secondary to drug cravings, making it difficult for the individual to maintain balance (Vafaie & Kober, 2022 ). Relapses among people with addiction problems are a complex phenomenon influenced by a multitude of factors. Drug craving, stress, trauma, exposure to drug-related cues, availability of substances, and social pressure can hinder recovery and lead to relapses (Hendershot et al., 2011 ; Marlatt & Donovan, 2005 ). Conversely, engagement in comprehensive treatment programs, adopting a healthy lifestyle, and developing strong social support networks (family, friends, and recovering peer groups) are associated with successful recovery (Vafaie & Kober, 2022 ). Developing effective coping strategies and identifying relapse triggers, also contribute to long-term recovery (Gauld et al., 2023 ). The "helper therapy" principle in NA groups and the 12-step approach The principle of helping others is a cornerstone of self-help and mutual aid groups for people with addictions such as NA. It is encapsulated in the "helper" therapy principle, introduced by Reissman ( 1965 ), which posits that individuals gain psychological and emotional benefits from assisting others. In NA, members evolve from "help-seekers" to "helpers," cultivating reciprocal relationships that encourage personal growth and resilience. Acts of service, such as sponsorship, are integral to NA's 12-step approach, providing a structured framework for peer support. This process strengthens social bonds but helps build recovery capital, essential for sustained recovery and reintegration (Best & Laudet, 2010 ; Best & Aston, 2015 ; Ronel, 1998 ). Research highlights significant benefits for aid providers and recipients in NA groups. Regular participation in NA significantly reduces relapses by providing ongoing peer support, greater community engagement, enhanced empowerment, and improved self-esteem (Vederhus & Kristensen, 2006 ). Helping others can also mitigate stigma and instill hope in both parties, reinforcing the belief that recovery is attainable (Pantridge et al., 2016 ; Turpin & Shier, 2017 ; Tracy & Wallace, 2016 ). Additionally, studies have shown that NA groups play a critical role in promoting recovery by fostering a strong sense of social connection that serves as a recovery-supportive network, reducing feelings of isolation, and increasing accountability (Moos, 2008 ). NA's 12-step program is also effective in enhancing recovery outcomes. Kelly & Yeterian ( 2011 ) emphasized that the structured nature of the 12-step encourages personal accountability and responsibility, both of which are crucial for sustained recovery. However, the peer support role is not without challenges. Over-involvement in helping roles can lead to burnout, and sponsorship dynamics may occasionally result in power imbalances. Moreover, individuals in the early stages of recovery often struggle to balance their personal needs with the demands of assisting others (Duvnjak et al., 2021 ; White & Kurtz, 2006 ; Elisha & Shchaf-Friedman, 2023). These challenges underscore the need for support and understanding in peer support roles. Peer supporters as wounded healers Given the recognized value of peer support in promoting recovery and rehabilitation efforts, peer-based programs for individuals with criminal, incarceration, and addiction backgrounds, have been developed globally over the past few decades, in both prison and community settings (Elisha, 2022 ). These programs are rooted in the notion of the "wounded healer", which refers to individuals who have experienced personal trauma and use their lived experiences to support others facing similar challenges (Sells et al., 2016 ). Elisha ( 2023 ) has integrated the theories and approaches behind this concept under the term "convict therapy" (for more details, see Elisha, 2023 ). Peer supporters leverage their personal experiences to build authentic, empathetic relationships with those they assist. These lived experiences serve a powerful tool in recovery, offering hope and motivation to those currently struggling (Elisha & Shchaf-Friedman, 2023; LeBel et al., 2015 ; Woods, 2020 ). Studies have indicated that peer support plays a crucial role in enhancing mental well-being and reducing recidivism among peer supporters (Kavanagh & Borrill, 2013 ; Sells et al., 2020). Peer work fosters personal and social transformation, both essential for recovery and reintegration (Buck, 2021 ; LeBel et al., 2015 ; Maruna, 2002 ). Peer support helps build resilience, instill purpose and agency, and shape a positive identity during recovery (Woods, 2020 ). A systematic review by Bassuk et al. ( 2016 ) confirms positive outcomes, including reduced substance use and recidivism. However, methodological limitations such as small sample sizes, lack of control groups, and varied peer role definitions hinder generalization. Peer support programs foster a dynamic of 'growth reciprocity,' where both the aid providers and the recipients experience mutual growth (Buck, 2021 ; Owen-DeSchryver et al., 2022 ). This reciprocal relationship creates an environment where both parties develop positive attributes that contribute to desistance, such as increased self-esteem, hope, faith, and prosocial attitudes (Buck, 2018 ; LeBel et al., 2015 ; Lopez-Humphreys & Teater, 2020 ). This concept aligns with 'generative activities' (Maruna, 2002 ), where peer supporters engage in actions that benefit themselves and those they assist. These activities include sharing experiences, providing guidance, and fostering a sense of community, reinforcing the belief that change is possible. Peer mentors serve as role models, demonstrating that individuals with similar backgrounds can successfully navigate the challenges of desistance. This visibility of success can inspire hope and motivation in mentees, further contributing to their recovery (Owen-DeSchryver et al., 2022 ; Nixon, 2020). These findings corroborate the assumptions of positive criminology (Ronel & Elisha, 2011 , 2020 ), which emphasize the ability of individuals to change and rehabilitate given the appropriate conditions. Developing strengths and learning from success cases are key aspects of this approach, as it reinforces the belief in the potential for recovery and the role of peer support in this process. Peer support as a means of social and capital recovery The primary advantages of peer support lie in the acquisition of social capital and recovery capital, both of which play a critical role in fostering recovery for peer supporters and recipients (Portes, 2000 ). Peer support programs highlight the importance of social capital by connecting individuals in recovery, and fostering strong social networks that provide the emotional, informational, and tangible support necessary for maintaining sobriety (Woods, 2020 ). Research by Best et al. ( 2011 ) indicates that peer support groups significantly enhance social capital, leading to improving mental health outcomes and reducing feelings of isolation. Laudet and White ( 2008 ) further demonstrate that individuals with strong social networks report higher rates of successful recovery, suggesting that social capital serves as a protective factor from relapse. As defined by Cloud and Granfield ( 2008 ), recovery capital encompasses the resources and support available to individuals in recovery, categorized into personal, social, community, and cultural dimensions. Personal recovery capital includes traits like resilience, motivation, and coping skills. Social recovery capital refers to the networks, relationships, and community ties that offer support and encouragement throughout recovery (Best & Laudet, 2010 ). Psychological resilience is a trait and a procedural ability to cope with stress and regulate emotions (Troy et al., 2023 ). Community recovery capital involves access to resources, services, and opportunities that facilitate recovery, such as healthcare, housing, and employment support. Lastly, cultural recovery capital includes the norms, values, and beliefs that reinforce and sustain recovery efforts (Cloud & Granfield, 2008 ). The concept of recovery capital is particularly relevant to NA where individuals accumulate both social and emotional resources through their involvement in peer support. These resources, including peer networks, act as both emotional support and practical guidance, helping members navigate the challenges in their recovery journey (Granfield & Cloud, 2001 ). According to Laudet and White ( 2008 ), individuals with diverse recovery capital are better equipped to manage mental health and substance use challenges. Peer supporters, as wounded healers, contribute significantly to both social and personal recovery capital by offering guidance and sharing their experiences, reinforcing the idea that recovery is achievable (Elisha, 2023 ). However, the role of the wounded healer comes with challenges that can jeopardize well-being and increase the risk of withdrawal. Peer supporters frequently face emotional strain and burnout due to their exposure to peers' suffering (Simpson et al., 2017 ). Additionally, issues such as professional conflicts, countertransference, and role confusion can disrupt their efforts, potentially leading to relapses (Elisha, 2022 ; White, 2000). The present study The role of peer support in the recovery of individuals with a criminal past and addiction issues presents both advantages and challenges. While peer support promotes recovery, builds social and recovery capital, and helps reduce stigma, it also carries risks such as vicarious trauma, and boundary issues. However, despite extensive research on relapses among recovering individuals, the experience of relapses among recovering wounded healers in the field of drug addiction has not been thoroughly examined. This study aims to address that gap by exploring this issue from the perspective of recovering wounded healers who have experienced relapses. The objective of the present study is to examine the perceived factors and triggers linked to relapses among recovering wounded healers and their subsequent return to the recovery journey. To the best of our knowledge, this is the first study of its kind, hence its novelty. The findings are expected to contribute to relapse prevention strategies and strengthen recovery efforts for individuals with addiction issues. Method The study utilizes a qualitative phenomenological approach, to gain an in-depth understanding of the lived experiences and meaning associated with the phenomenon from the subjective perspective of the people who experienced it (Patton, 2002 ). In this case, the perspectives of recovering wounded healers who have experienced relapses. Through open-ended questions, the present study seeks to reveal the subjective insights of the participants. By implementing a thematic content analysis (Nowell et al., 2017 ), the research strives to identify the main themes that emerged from the interviews and propose new strategies for addressing the phenomenon under investigation. Participants Due to the sensitive nature of this study, which focuses on individuals with a history of drug addiction who recovered and then relapsed while formally employed in peer support roles within formal therapeutic settings, it was challenging to reach suitable interviewees. The research did not include individuals who volunteered as sponsors in NA's groups, but those formally employed. Therefore, we sought help from participants in our previous studies on peer support (Elisha & Shachaf-Friedman, 2023 , 2024 ), who referred us to appropriate candidates, allowing us to recruit additional interviewees using the "snowball" method which is a non-probability sampling technique mainly used when studying hard-to-reach or hidden populations (Patton, 2002 ). Ultimately, we interviewed 13 participants from Israel, which yielded sufficient data to achieve saturation, defined by the repetition of information in the responses (Glaser & Strauss, 2017 ). Of the 13 participants, 10 are men and 3 are women, all with a background of drug addiction, and some with alcohol addiction as well. Nearly all had criminal records, including arrests and prison terms for various offenses such as drug-related crimes, theft, fraud, and violence. Their ages range from 40 to 70 years (average: 53). Among them, seven are divorced, five are married and one is single. All but two have children, and some also have grandchildren. Their formal education ranges from 6 to 12 years; however, all have received professional training relevant to their peer-support practice in one or more of the following areas: group facilitation, addiction treatment, the 12-step program, and psychotherapy. Most of the participants reported being active members in NA's 12-step groups. Regarding relapses, participants reported that their "fall" occurred after one to 14 years of recovery and sobriety while formally employed in peer support roles in addiction therapeutic settings, either in prison or community (e.g., therapeutic community, hostel, addiction unit center). Some returned to the recovery path a relatively short time after that relapse (six months to a year), while others experienced much longer periods of relapse, with the longest lasting 15 years. All participants identified as recovering from drug addictions, with current recovery periods ranging from several months to 32 years. Some still held peer support roles, while others transitioned to different fields. A few mentioned running private clinics where they also treat individuals with addiction problems. Materials Based on the research objectives, we developed an interview guide consisting of open-ended, broad questions, to conduct semi-structured, in-depth interviews with the participants. Examples include: 1. Describe your attempts at recovery over the years, including your most recent relapse. 2. In your view, what were the factors that led to your recent relapse while working as a peer supporter? 3. What happened to you afterward, and what led you back to the path of recovery? 4. Reflecting on your recovery journey, what lessons have you learned about relapses and maintaining recovery? Procedure The study received approval from the ethics committee of the first author's institutional IBR. With help from participants in our previous studies on peer support (Elisha & Shachaf-Friedman, 2023 ; 2024 ), we were referred to appropriate candidates, who further helped us to recruit more interviewees using the "snowball" method (Patton, 2002 ). Both authors conducted interviews during the period between November 2023 and May 2023. The participants were initially contacted to assess suitability and responsiveness. If they agreed, a Zoom meeting was scheduled according to their preference. Before the interviews, participants were asked to sign an informed consent form. At the beginning of each interview, participants expressed their consent to be interviewed and authorized the researchers to record the session, so any identifying information would be omitted. The interviews began with general questions about the participant's background, followed by open-ended questions about the addiction and their journey into peer support, their relapse, their struggles, and their path to recovery. The interviews lasted an average of about an hour. An external company then transcribed the recorded interviews. The researchers conducted a thematic content analysis of the transcribed interview (Nowell et al, 2017 ), to identify key themes that emerged from the interviews, through repeated readings of the transcripts. Data Analysis This study employed thematic content analysis (Nowell et al., 2017 ). The primary objective of this methodological framework is to systematically identify and interpret key patterns within the data set, offering a structured approach to understanding the phenomenon under investigation. Thematic analysis is noted for producing contextually relevant, interpretative, and substantively rich outcomes, which enhance the credibility and impact of the research (Nowell et al., 2017 ). In this study, the researchers carefully read and re-read the interview transcripts to identify recurring themes across all the interviews. The coding process and theme development were conducted manually, with an effort to preserve the participants’ original wording. The theme names were derived directly from participants' narratives while the order and connections between themes were structured according to participants' reasoning. Ethical Considerations This study adhered to rigorous ethical standards, obtaining approval from the Institutional Review Board (IRB) Ethical Committee at Max Stern Yezreel Valley College, Israel. Measures were implemented to ensure participant confidentiality and informed consent. Participants were informed of the voluntary nature of their participation and their right to withdraw at any time without providing a reason. Assurances were provided regarding the omission of any directly or indirectly identifying information. Interview transcriptions were handled by an external service provider under a strict confidentiality agreement. All audio recordings were securely stored in an encrypted folder, with access limited exclusively to the research team. Findings The findings derived from the participants' narratives revealed two central themes. The first theme revolves around efforts to reason and explain their relapses, while the second emphasizes reinforcing the cumulative value of recovery and the lessons learned from past experiences. Participants' explanations for the "fall" revealed several interconnected sub-themes addressing the slippery slope that begins with disconnection from NA's 12-step program and recovering peers, which undermines the support system critical to recovery. Other reasons related to role confusion and false self-perception of "savior-rescuer"; entering intimate relationships too early; and the reluctance to give up the thrill associated with crime and drug use. The second theme, focusing on the cumulative value of recovery and lessons learned, highlights the importance of vigilance and self-awareness. Participants emphasized the need to recognize warning signs that may precede a relapse. They also discussed the understanding that recovery requires ongoing maintenance by consistently applying NA’s pillars of recovery. A key realization shared by many was that recovery has no cumulative value; it is "Just for today," and there are no guarantees for the future. Below is an in-depth description of the findings, accompanied by direct quotes from the respondents, under pseudonyms to protect their anonymity. As a general background, most participants reported growing up with an addicted parent or sibling and being exposed to drugs at a young age in their neighborhood. Additionally, they experienced abandonment, parental neglect, or sexual abuse during childhood. However, their decision to pursue recovery—both during previous recovery attempts and after their most recent relapse while engaged in peer work—was often inspired by an encounter with a recovering peer who gave them hope and the belief that recovery was possible for them as well. Explanations for relapses This theme relates to the respondents' accounts for their relapse while formally holding a peer-support position ("wounded healer). The main factor pointed out by the respondents that led to their "fall", was disconnecting from the NA group members. Participants indicated that renouncing this central core value of the 12-step program led to further concessions that ultimately resulted in a complete disconnection from the recovery path and a return to previous negative patterns (e.g., dishonesty, manipulation, arrogance, selfishness), including drug use and often criminality. They also noted that many of their acquaintances abandoned the principles of the NA, and either relapsed or died (usually from an overdose) as a result. Notably, no differences were found in the respondents' accounts based on their length of recovery. Slippery slope: Disconnecting from NA's 12-step program and recovering peers Participants marked the disconnecting from NA members, that is, recovering peers, as the first step on the slippery slope toward relapses. Paradoxically, they attributed this to the success they experienced in their professional and personal lives at the time, which fostered a false sense of competence ("I can manage on my own"). Quotes: I had financial success, got married, had children, and rehabilitated myself. From the outside it's like I got it all, I fulfilled a dream, and I thought it wouldn't happen to me. My deterioration began when I financially succeeded. I stopped going to NA meetings, I stopped being in contact with clean addicts, and I stopped wording the 12-step. Then there was a crisis at home with the children, it was hard for me to contain it, and then I fell back into drugs. (Orna) I stopped working on the program. I felt strong and self-confident; I was earning money, I was independent, I had succeeded, and I was no longer a user. This was the illusion. If you don't work the program, you forget that it's not about drugs at all, it's about a life problem, our bad patterns. The problem was that I got disconnected from the program. Pretty soon, I began to feel lonely and once again not connected to the world, and these existential questions about the meaning of life arose once more. So that's what happened: I moved away, fell apart, and then the drugs came. (Alex) Arnon described this downhill spiral, explaining that when a recovering individual abandons the basic principles of recovery, namely, those of the 12-step program, relapses are almost guaranteed. This deterioration manifested itself in socializing with fellow drug users, which soon led to a return to his return to drugs: Once you start giving up on some things, you gradually begin to give up on others. You stop going to NA, stop connecting with peers, start hanging out with active drug users, and go to problematic places. Thinking that because you've been clean for 20 years, you can afford all these things, and then boom! you find yourself using drugs. (Arnon) Role confusion: False self-perception of "savior-rescuer" Another explanation for relapses, as described by several respondents, involves developing a "savior-rescuer" self-perception. Participants linked this to unresolved character flaws such as self-centeredness, dishonesty, arrogance, and manipulation, which ultimately fostered a false sense of omnipotence that contributed to their downfall . This can be viewed as role confusion, steaming from their double identity of recovering individuals with a problematic past, who serve as peer supporters, a powerful role that may lead them to feel superior and unmanageable. For example, Alina described her insights and awareness of her unresolved issues, which manifested in an omnipotent false perception of a "savior-rescuer" while engaging in peer work, ultimately leading to her relapse: Not being a savior-rescuer is imperative for me, because I need to surrender. I feel outside of myself when I'm assisting others; it keeps me out of my head. There's nothing better than seeing them come in and maintain their recovery. It's like watching a miracle happen. But you must be careful about where you are and what mode am I in - Am I in teacher mode? Am I in savior mode? I was so unaware of parts of me that were unhealed, and I probably put myself in a situation I shouldn't have and won’t do again. (Alina) Entering intimate relationships too early Some participants stated that entering new romantic relationships may form an additional risk factor for relapses, especially for new recovery, that is, those with less than two years of recovery. According to them, this is mainly due to unresolved personal issues that may worsen in the face of new intimate relationships and sabotage the recovery process. I've seen over the years people who get clean and sober start a relationship too early and relapsed. This is not something I recommend. It's maybe one in ten that it works, but otherwise, they relapse. They are not ready to have an intimate relationship with a woman just after six months clean. Sorry to say it, but they need at least a couple of years. (Dan) Another explanation is related to the sexual insecurity of a recovering addict, who may use drugs to meet his partner's expectations in relation to his virility, as Yossi noted: Others may be ashamed to say it, but many fall back on drugs mainly because of girls. Why? Because an addict can't do what he needs to do as a man without the drugs. You know what I mean? He feels insecure without the drug, so when he is with a girl and wants to function properly, he will take drugs beforehand to feel like a man. (Yossi) Reluctance to give up the thrill of crime and drugs Several participants attributed their relapses also to a lack of genuine willingness to recover, stemming from the benefits and thrills they derive from drug use and a life of crime, along with the difficulty of maintaining a lifestyle free from action and risk. The truth is that I didn't want to be 'clean'. I don't like the cleanliness. There was something missing in the excitement - the activity of searching for things in other people's drawers and closets. I really missed the action. I felt like an idiot getting up in the morning, going to work, coming back from work, and going to sleep in bed at night. I missed the variety, the action. (Amir) According to them, it takes a certain mental maturity, as well as "hitting rock bottom", for an addict to truly want to recover and change his way of life. I was not ready to stay 'clean'. I had no willingness to give up drugs because getting clean involves a lot of concessions. It means giving up a certain lifestyle and giving up an easy solution. After all, what's good about drugs? I could control what I felt. If I want to feel 'high', I take this; if I want to feel "down", I take that. You must reach a kind of maturity, a deep bottom, for this to happen. (David) The cumulative value of recovery: Lessons learned from the past When the respondents were asked whether there is added value to their recovery, considering their lived experience that includes addiction, recovery, relapse, and re-recovery, most answered in the affirmative. The cumulative value reported includes a better ability to avoid and overcome risks for relapse by recognizing "warning signs", through the active application of the four pillars of recovery in NA These pillars include the daily practice of the spiritual principles of the 12-step program, attending NA meetings, supporting and being supported by peers, and engaging in service, i.e., voluntary actions for the benefit of the community. Recognizing 'warning signs' One of the key lessons from past experiences that the respondents pointed out was the importance of recognizing 'warning signs' and avoiding the risk factors that led to their downfall. They specifically reflected on their character flaws (e.g., selfishness, self-pity), which made them feel superior to NA members and led them to disassociate themselves from them. This awareness manifested in their realization of the need for continuous support from others, as well as the necessity of engaging in ongoing self-work through the application of the 12-step principles. This is how Alina described her difficulty in speaking openly in NA group meetings, recognizing her tendency to fall into self-pity and manipulation, and her way of overcoming this through her awareness of the importance of openness and honesty: Sometimes I don't want to be in a meeting. My anxiety is very high, and I feel uncomfortable with a lot of things. But the more I do them, the less uncomfortable I become. So now, if I feel myself going into that area of pity and manipulations, you know, I stand a much better chance of catching myself in time. Well, we know where this lead. (Alina) Aviram, too, explains the need to attend NA meetings, as a means of receiving social and emotional support to overcome the destructive parts of himself and avoid relapses: In addicts, the destructive part is very large, and our defense mechanisms are looser, and fluid. I mean, if I don't do these actions of recovery, then my dark side comes out, the shadow takes over, and it starts living my life, instead of me living my life. I once left the program because I didn't want to be with those 'whiners' in groups. Today, they are an example for me, like a warning sign. (Aviram) No expiration date: the application of the NA's four pillars of recovery As part of the lessons learned from their last relapse while practicing peer work, all participants expressed a strong commitment to the four pillars of recovery in NA, which include, according to them, attending NA meetings, practicing spirituality through the 12-step, supporting and being supported by peers, and serving others. There are four steps that you must follow in the program. One, practice the steps Every day as much as possible; two, attend NA meetings in a regular home group; three, do service, like mentoring peers; and four, God. Today, I have a faith in God, a permanent NA group, I'm doing service, and I support peer members of NA These are the four pillars. If you do them regularly, cleanliness is guaranteed. (Arnon) Betty emphasizes that there is no expiration date for recovery and that these actions have become a routine for her, stemming from an awareness of their importance for maintaining long-term recovery: Going to NA groups, supporting and being supported, are very important for Recovery and it has no expiration date. This means that even at the age of 100, I will go to groups, contribute my part, and do service with love and everything that is needed. It's a way of life. It's part of my life. Like I get up in the morning and brush my teeth. If I don't do it, I feel like I'm missing something. (Betty) No accumulating value: "just for today", no guarantees for the future Some respondents, however, expressed a skeptical position, stating that there is no actual cumulative value since the achievement of recovery is merely temporary ("just for today"). Asher, who fell back into drugs after 12 years of cleanness while formally engaged in peer work, describes this experience as if he had returned to the same starting point of his addiction: For 12 years, I managed to avoid something I really liked, drugs, so now a monster's hunger has arisen. The problem is when you return to use, you pick up from the same point where you stopped; no new world opens. So, it's as if I had regressed; I returned to being the same 27-year-old boy, completely idiot, as if I learned nothing. (Asher) Several respondents compared drug addiction recovery to weight management, emphasizing that individuals must follow a strict daily routine. They observed that even a minor deviation from this routine can lead to immediate weight gain. Likewise, in the realm of drug addiction, they highlighted that regardless of the number of years a person has been in recovery, any lapse from the recovery program can lead to a relapse. This program only works for 24 hours, every day anew. No matter how many years you've been 'clean', there's no guarantee for anyone. I know some individuals who have 'fallen' even after 20 or 30 years of sobriety. It can be frustrating, but it's like with a diet: one can maintain one's weight for many months, but as soon as he eats more than is allowed, he will immediately gain weight. (Shimi) However, this insight involves learning from the past, hence its cumulative value. That is, the recognition of the transience of "just for today" and the need to constantly be alert, as frustrating as it may be, sharpens the necessity for daily maintenance of recovery, as emphasized by NA's 12-step program. Discussion Grounded in the context of peer supporters as wounded healers in the field of drug addiction recovery, this study examined the perceived factors and triggers leading to relapses among recovering wounded healers, as well as their subsequent return to the recovery path. Participants were men and women with histories of drug addiction and criminality who experienced relapses while serving in formal peer support roles. Their accounts revealed relapse durations ranged from brief episodes (less than one year) to extended periods lasting many years before they resumed their recovery. Some participants remain formally employed in peer support roles, while others have shifted to different fields. Regardless of their professional status, all participants emphasized their ongoing informal support and engagement with recovering peers through NA groups. The participants' narratives reveal two central themes. The first centered on the triggers and factors leading to relapse. The second highlighted the cumulative value of recovery and its enduring impact. Notably, participants credited encounters with recovering as pivotal in their decision to recommit recovery. This finding underscores the convict therapy perspective (Elisha, 2023 ), emphasizing the critical role of individuals with lived experience of addiction and incarceration - those possessing street and carceral capital (Buck, 2018 ; Perrin, 2022 ) - in fostering processes of change and rehabilitation among peers. Relapses as a learning process Participants identified disengagement from NA group members and the 12-step program as a significant trigger for relapse. This disconnect often sets off a downhill spiral, leading to harmful behaviors, substance use, and sometimes criminal activity. Paradoxically, participants were aware that these actions violated the principles of the program that had previously supported their recovery. Many attributed their disconnection to professional success in peer support roles, which fostered a false sense of self-sufficiency. Believing they could manage their recovery independently, ultimately undermined their progress. Peer support, a cornerstone of the 12-step program and recovery literature, thrives on reciprocal relationships where individuals offer and receive support. Disengagement weakened these connections, eroding external validation and internal motivation to maintain recovery (Kelly & Yeterian, 2011 ; Ronel, 1998 ). Strong social bonds and supportive relationships, as emphasized by Sampson and Laub's (1993) life-course perspective, are critical in sustaining recovery. Maruna ( 2002 ) highlights the importance of developing a positive identity and narrative in achieving successful desistance, while the concept of recovery capital underscores the cumulative value of personal, social, and community resources in supporting recovery (Granfield & Cloud, 2001 ). Desistance literature emphasizes the importance of social connections and supportive relationships in maintaining desistance from substance use and criminal behavior (McNeill & Weaver, 2010 ). Patton and Best ( 2024 ) pointed out that mutual aid groups were identified as key sources of social capital for those in recovery. However, if individuals distance themselves from these recovery-promoting social circles, the positive effects may not be strong enough to sustain their progress. Positive criminology (Ronel & Elisha, 2011 ) further explains recovery by emphasizing meaningful engagement, spirituality, and altruism. NA integrates these principles, providing a spiritual and communal foundation to help individuals navigate the recovery challenges. When participants disconnected from these anchors, they diminished their recovery capital, increasing their vulnerability to relapse. These ideas align with convict therapy and lived experience theory (Elisha, 2023 ), highlighting the value of peer support in fostering resilience and commitment to recovery. Some participants noted that new romantic relationships pose a significant risk factor for relapses, especially within the first two years of recovery. Individuals in the early stages of recovery often face emotional regulation and self-esteem, making them particularly susceptible to the pressures of intimate relationships (Fleming et al., 2010 ; Permut et al., 2018 ). While romantic and family support can enhance resilience and stability, they also pose risks, especially when pursued as an escape from emotional distress or as a substitute for heights of substance use (Permut et al., 2018 ). The emotional fluctuations of these relationships can act as relapse triggers and foster co-dependence, with mutual relapses posing an increased risk when both partners are in recovery (Wallace et al., 2020 ). Another explanation for past relapses, cited by participants, was a lack of genuine willingness to recover, fueled by the psychological rewards and thrills of drug use and criminal behavior. This ambivalence—being torn between the desire to heal and the allure of harmful behaviors—complicates the recovery journey (Miller & Rolnick, 2012). Crime desistance theory emphasizes resolving such internal conflicts as essential to transitioning from criminal behavior to a law-abiding lifestyle (LeBel et al., 2015 ; Maruna, 2002 ). Participants’ experiences also align with Prochaska and DiClemente's (1983) stages of change model, which conceptualizes recovery as a cyclical process involving relapse, growth, and renewed commitment. In the pre-contemplation stage, individuals often fail to recognize the need for change, clinging to the perceived rewards of addiction or criminal lifestyles. During the contemplation stage, they began weighing the benefits of recovery against the comfort of familiar behaviors. Motivation played a pivotal role in the preparation and action stages, as participants actively engaged in recovery practices such as attending NA meetings, working through the 12-step, and seeking peer support. Relapses, while challenging, were reframed not as failures but as opportunities for learning and growth. Participants described how relapses helped them identify triggers, refine coping strategies, and build resilience. They emphasized the importance of NA's four pillars—spiritual practices, regular meeting attendance, mutual peer support, and community service—in sustaining recovery. These practices align with the maintenance stage of the change model, in which the focus shifts to prevent regression and consolidate progress. This cyclical understanding of relapses underscores its integral role in the recovery process, offering opportunities for reflection, personal growth, and renewed commitment to long-term change. The savior-rescuer paradox of the wounded healer Some participants attributed their relapse to adopting a "savior-rescuer" self-image, which they associated with unresolved character flaws, such as self-centeredness, dishonesty, arrogance, and manipulation. This dynamic created a false sense of omnipotence and role confusion (White, 2000) as they navigated their dual identities as recovering individuals and peer supporters. Their newfound authority as peer supporters and sense of efficacy further complicated this tension. The wounded healer role offers both empowering opportunities and significant risks. While helping others can provide a sense of purpose and bolster personal recovery, over-identification with the helper role can obscure unresolved vulnerabilities. This "savior-rescuer" paradox, as observed in some participants, led to an inflated sense of control and a distancing from essential support networks, such as NA group members. This highlights the delicate balance required to reconcile the dual identities of recovering individuals and peer supporters (White & Evans, 2013 ). From the perspective of convict therapy (Elisha, 2023 ), engaging in peer support allows individuals to transform their criminal past into a source of strength, using their experiences with crime and addiction to assist others. This process fosters emotional healing, enhances empathy and forgiveness, and provides a sense of purpose and self-worth, consistent with the wounded healer concept (Elisha & Shachaf-Friedman, 2024 ). However, unresolved tensions between the "convict" and "recovering" identities, particularly among those who have not fully addressed their past behaviors, can create a fragile sense of self. This fragility may undermine their commitment to recovery and contribute to relapses, as reported by participants. Moreover, this tension often hindered participants’ ability to seek help and renew their recovery journey. They perceived relapse as a personal failure—a “fall.” This sense of failure was particularly acute for those in leadership roles within the recovery community, who felt they "should have known better." Participants attributed their relapse to character flaws that led them to disregard the lessons they had learned—and even taught—during their recovery. Beneath these accounts lay a pervasive sense of shame, self-blame, remorse, and guilt. These emotions led many participants to believe they should have acted differently, yet paradoxically inhibited their capacity to practice self-forgiveness or seek support (Griffin et al., 2016 ; Braithwaite et al., 2018 ). Research on shame suggests that it can foster antisocial behaviors (Griffin et al., 2016 ; Leach, 2017 ; Snoek et al., 2021 ) and lead to disintegrative actions (Benau, 2022 ; Etherson, 2023 ). However, studies also indicate that reintegration is possible when shame is addressed constructively, self-forgiveness is cultivated, and social support is accessible (Etherson, 2023 ; Snoek et al., 2021 ). The cumulative value of recovery Most respondents emphasized that their recovery journey holds significant added value, rooted in the lessons learned from past experiences. These include recognizing relapse risk factors—“warning signs”—and proactively avoiding them by consistently applying NS's four pillars of recovery: daily spiritual practices, participation in NA meetings, engaging in mutual peer support, and community service. This approach reflects a heightened commitment to long-term recovery, aligning with the positive criminology perspective, suggesting that individuals can grow from adversity (Ronel & Elisha, 2011 ). It also resonates with the desistance theory, which emphasizes self-reflection and personal development as essential for moving away from criminal behavior (Maruna, 2002 ). Convict therapy (Elisha, 2023 ) emphasizes the pivotal role of peer support in building accountability and resilience. Through meaningful connections and participation in recovery-oriented activities, individuals build social and recovery capital, which enhances their ability to sustain long-term recovery (Best et al., 2011 ; Laudet & White, 2008 ; Woods, 2020 ). These supportive relationships and community engagement further bolster resilience, empowering individuals to overcome challenges and maintain their recovery. This perspective aligns with lived experience theory, which underscores the significance of personal narratives and the subjective understanding of one's experiences in shaping the recovery journey (Sells et al., 2016 ). The respondents acknowledged that their relapse experiences contributed to a deeper understanding of their addiction and recovery journey. This acknowledgment aligns with the concept of "recovery capital" (Granfield & Cloud, 2001 ), which suggests that individuals in recovery accumulate resources—social, personal, and community-based—that enhance their ability to sustain recovery over time. Research supports the notion that relapses, while challenging, can serve as a learning experience, helping individuals identify personal triggers and refine coping strategies (Best & Laudet, 2010 ; DiClemente & Crisafulli, 2022 ). Lessons learned from relapses, such as recognizing warning signs and appreciating the necessity of ongoing peer support, reflect an increase in recovery capital (Best et al., 2011 ). These insights often lead to stronger commitments to the recovery process and adherence to the values of the 12-step program, which emphasizes personal growth, accountability, and sustained engagement in peer-based support networks (Kelly & Yeterian, 2011 ). However, some participants argued that recovery holds no cumulative value, as achievements are temporary, and daily effort is required to maintain progress. This perspective reflects NA’s “just for today” philosophy, framing recovery as an ongoing process that necessitates daily commitment (Alcoholics Anonymous, 2001 ). This perspective fosters humility and vigilance, encouraging individuals to remain alert to potential triggers while cultivating gratitude. The 12-step framework underscores this mindset, warning against complacency and promoting deeper engagement with recovery principles to build resilience against setbacks (White & Kurtz, 2006 ). As respondents noted, embracing NA’s philosophy provides a reliable foundation for ongoing recovery and long-term success. Conclusions and practical implications This research contributes significantly to the field of drug recovery by deepening our understanding of the triggers and pathways leading to relapses and re-recovery among peer supporters, also known as wounded healers. By integrating Prochaska and DiClemente's (1983) stages of change with frameworks such as positive criminology, desistance theory, and convict therapy, the study provides valuable insights into the dynamic processes of recovery and relapse. The findings emphasize the vital role of internal motivation, social connections, and resilience in navigating the complexities of recovery. Addressing the diverse challenges faced by recovering individuals can enhance the effectiveness of recovery programs, ultimately promoting sustained change and personal growth. The study highlights the need for structured interventions tailored to the stages of change, especially for peer supporters managing the complexities of the wounded healer role. Peer supporters in recovery should receive continuous training and support to strengthen their resilience. Such training should focus on self-care, boundary-setting, recognizing personal triggers, and developing emotional skills to process past failures. These strategies will help peer supporters stay committed to their recovery while effectively assisting others (Beales & Wilson, 2015 ). By reframing failure as an opportunity for growth, recovery programs can focus on fostering factors that sustain long-term recovery. Furthermore, integrating insights from convict therapy (Elisha, 2023 ) into peer support training can deepen the understanding of the emotional and psychological aspects of relapse. Recovery programs should include therapeutic interventions that address unresolved issues related to individuals' criminal pasts, as these conflicts can significantly impact recovery outcomes. By addressing these challenges, recovery programs can better equip peer supporters to navigate their dual roles, ultimately enhancing their ability to support both their recovery and that of recipients. Limitations and directions for future research Several limitations of this study should be acknowledged. The participants were recruited through a snowball, non-probability sampling technique, which carries inherent risks of bias. In this case, participants were primarily connected through their involvement in the NA community, which may have influenced the prominence of the 12-step worldview and terminology in their accounts. The reliance on this network may have excluded perspectives from individuals outside this specific recovery framework, potentially limiting the diversity of viewpoints. Moreover, reliance on self-reported data introduces potential risks of recall bias and social desirability bias. Future research should consider adopting longitudinal designs to capture the dynamics and evolving nature of recovery and relapse over time. Expanding the sample to encompass individuals from diverse cultural, socioeconomic, and gender backgrounds would enhance the generalizability of the findings. Comparative studies between peer supporters and non-peer supporters could offer valuable insights into the unique challenges of the wounded healer role. Additionally, exploring the influence of digital platforms, spirituality, and strategies for preventing burnout offers promising directions for further investigation. Declarations Ethical Approval The study received approval from the Ethics Committee of the Max Stern Yezreel Valley College IBR (the first author's institutional affiliation). Approval number: 2024-1 YVC EMEK Date of approval: 15 October 2023. Scope of approval: 4 years. Informed Consent We confirm that all research was carried out in accordance with the IBR's ethical regulations, including signing the participants on an informed consent form before the interviews, and omitting any identifying or personal information of research participants, to maintain their anonymity and confidentiality References Alcoholics Anonymous (2001). The big book . Hardback. https://www.aa.org/the-big-book Beales, A. & Wilson, J. (2015). Peer support - the what, why, who, how and now. 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Peer-based interventions also referred to as peer support, peer mentoring, and peer work, are implemented in various therapeutic settings in prisons and the community. These initiatives aim to assist individuals seeking to change their way of life and recover by developing prosocial attitudes and behaviors, thereby increasing their chances for successful reintegration (Buck, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Elisha, 2002; LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePeer work encompasses roles such as mentoring, counseling, and guidance, utilizing reformed individuals' lived experiences to support others' rehabilitation efforts (Bellamy et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; White \u0026amp; Evans, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This approach aligns with the developing concept of convict therapy (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which emphasizes the role of reformed former convicts and recovering individuals \u0026mdash;referred to as wounded healers\u0026mdash;in promoting rehabilitation and recovery processes based on their lived experiences. Convict Therapy draws on frameworks, including the wounded healer concept (LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), positive criminology (Ronel \u0026amp; Elisha, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and crime desistance theory (Laub \u0026amp; Sampson, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2001\u003c/span\u003e, Maruna, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe wounded healer notion is most exemplified in self-aid and mutual help groups for people with addiction problems, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), where recovering individuals provide support and guidance to newcomers while reinforcing their recovery (Perrin \u0026amp; Blagde, 2016; Ronel, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Scholars in the field of desistance strongly support the role of peer support in promoting and enhancing change and rehabilitation processes. Indeed, studies worldwide highlight the numerous advantages of peer support, which are manifested in the development of strengths and a sense of competence, particularly among aid providers (e.g., Buck, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Elisha \u0026amp; Shchaf-Friedman, 2023; LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Woods, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, peer support is not without risks, particularly the potential for relapse (Elisha, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Perrin, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; White \u0026amp; Kurtz, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). While much research has focused on relapse among recovering individuals in general, there remains a significant gap in understanding relapse experiences among wounded healers in the field of drug addiction. This study aims to fill that gap by exploring the perceived factors and triggers linked to relapses among recovering individuals who previously held peer support roles, and examining how they navigate their return to recovery. To our knowledge, this is the first study of its kind, and its findings could contribute significantly to relapse prevention strategies for individuals struggling with drug addiction.\u003c/p\u003e\n\u003ch3\u003eRelapses and recovery dynamics in substance abuse\u003c/h3\u003e\n\u003cp\u003eRelapses are commonly defined as the resumption of substance use after an attempt to stop or a period of abstinence (Guenzel \u0026amp; McChargue, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), often involving a return to previous levels of consumption (Moe et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Relapses are a frequent occurrence in the recovery journey for individuals with substance use disorders. The National Institute on Drug Abuse (NIDA, 2023) reported high relapse rates ranging between 40% and 60% within the first year of treatment, emphasizing the chronic nature of addiction. Xie et al. (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) found that after a ten-year follow-up, many clients achieved complete abstinence, although one-third experienced a relapse within the first year, with an additional one-third relapsing over the subsequent decade.\u003c/p\u003e \u003cp\u003eRelapses are often viewed as a process that unfolds over time, rather than a distinct event (NIDA, 2023; DiClemente \u0026amp; Crisafulli, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Its severity can range from a brief lapse to a full relapse, i.e., a complete return to previous levels and patterns of use. Essentially, relapses occur when the motivation to sustain recovery becomes secondary to drug cravings, making it difficult for the individual to maintain balance (Vafaie \u0026amp; Kober, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRelapses among people with addiction problems are a complex phenomenon influenced by a multitude of factors. Drug craving, stress, trauma, exposure to drug-related cues, availability of substances, and social pressure can hinder recovery and lead to relapses (Hendershot et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Marlatt \u0026amp; Donovan, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Conversely, engagement in comprehensive treatment programs, adopting a healthy lifestyle, and developing strong social support networks (family, friends, and recovering peer groups) are associated with successful recovery (Vafaie \u0026amp; Kober, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Developing effective coping strategies and identifying relapse triggers, also contribute to long-term recovery (Gauld et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe \"helper therapy\" principle in NA groups and the 12-step approach\u003c/h2\u003e \u003cp\u003eThe principle of helping others is a cornerstone of self-help and mutual aid groups for people with addictions such as NA. It is encapsulated in the \"helper\" therapy principle, introduced by Reissman (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e1965\u003c/span\u003e), which posits that individuals gain psychological and emotional benefits from assisting others. In NA, members evolve from \"help-seekers\" to \"helpers,\" cultivating reciprocal relationships that encourage personal growth and resilience. Acts of service, such as sponsorship, are integral to NA's 12-step approach, providing a structured framework for peer support. This process strengthens social bonds but helps build recovery capital, essential for sustained recovery and reintegration (Best \u0026amp; Laudet, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Best \u0026amp; Aston, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ronel, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1998\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch highlights significant benefits for aid providers and recipients in NA groups. Regular participation in NA significantly reduces relapses by providing ongoing peer support, greater community engagement, enhanced empowerment, and improved self-esteem (Vederhus \u0026amp; Kristensen, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Helping others can also mitigate stigma and instill hope in both parties, reinforcing the belief that recovery is attainable (Pantridge et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Turpin \u0026amp; Shier, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Tracy \u0026amp; Wallace, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Additionally, studies have shown that NA groups play a critical role in promoting recovery by fostering a strong sense of social connection that serves as a recovery-supportive network, reducing feelings of isolation, and increasing accountability (Moos, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). NA's 12-step program is also effective in enhancing recovery outcomes. Kelly \u0026amp; Yeterian (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) emphasized that the structured nature of the 12-step encourages personal accountability and responsibility, both of which are crucial for sustained recovery.\u003c/p\u003e \u003cp\u003eHowever, the peer support role is not without challenges. Over-involvement in helping roles can lead to burnout, and sponsorship dynamics may occasionally result in power imbalances. Moreover, individuals in the early stages of recovery often struggle to balance their personal needs with the demands of assisting others (Duvnjak et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; White \u0026amp; Kurtz, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Elisha \u0026amp; Shchaf-Friedman, 2023). These challenges underscore the need for support and understanding in peer support roles.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePeer supporters as wounded healers\u003c/h3\u003e\n\u003cp\u003eGiven the recognized value of peer support in promoting recovery and rehabilitation efforts, peer-based programs for individuals with criminal, incarceration, and addiction backgrounds, have been developed globally over the past few decades, in both prison and community settings (Elisha, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These programs are rooted in the notion of the \"wounded healer\", which refers to individuals who have experienced personal trauma and use their lived experiences to support others facing similar challenges (Sells et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Elisha (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) has integrated the theories and approaches behind this concept under the term \"convict therapy\" (for more details, see Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Peer supporters leverage their personal experiences to build authentic, empathetic relationships with those they assist. These lived experiences serve a powerful tool in recovery, offering hope and motivation to those currently struggling (Elisha \u0026amp; Shchaf-Friedman, 2023; LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Woods, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies have indicated that peer support plays a crucial role in enhancing mental well-being and reducing recidivism among peer supporters (Kavanagh \u0026amp; Borrill, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Sells et al., 2020). Peer work fosters personal and social transformation, both essential for recovery and reintegration (Buck, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Maruna, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Peer support helps build resilience, instill purpose and agency, and shape a positive identity during recovery (Woods, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A systematic review by Bassuk et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) confirms positive outcomes, including reduced substance use and recidivism. However, methodological limitations such as small sample sizes, lack of control groups, and varied peer role definitions hinder generalization.\u003c/p\u003e \u003cp\u003ePeer support programs foster a dynamic of 'growth reciprocity,' where both the aid providers and the recipients experience mutual growth (Buck, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Owen-DeSchryver et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This reciprocal relationship creates an environment where both parties develop positive attributes that contribute to desistance, such as increased self-esteem, hope, faith, and prosocial attitudes (Buck, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Lopez-Humphreys \u0026amp; Teater, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This concept aligns with 'generative activities' (Maruna, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), where peer supporters engage in actions that benefit themselves and those they assist. These activities include sharing experiences, providing guidance, and fostering a sense of community, reinforcing the belief that change is possible. Peer mentors serve as role models, demonstrating that individuals with similar backgrounds can successfully navigate the challenges of desistance. This visibility of success can inspire hope and motivation in mentees, further contributing to their recovery (Owen-DeSchryver et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Nixon, 2020).\u003c/p\u003e \u003cp\u003eThese findings corroborate the assumptions of positive criminology (Ronel \u0026amp; Elisha, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which emphasize the ability of individuals to change and rehabilitate given the appropriate conditions. Developing strengths and learning from success cases are key aspects of this approach, as it reinforces the belief in the potential for recovery and the role of peer support in this process.\u003c/p\u003e\n\u003ch3\u003ePeer support as a means of social and capital recovery\u003c/h3\u003e\n\u003cp\u003eThe primary advantages of peer support lie in the acquisition of social capital and recovery capital, both of which play a critical role in fostering recovery for peer supporters and recipients (Portes, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Peer support programs highlight the importance of social capital by connecting individuals in recovery, and fostering strong social networks that provide the emotional, informational, and tangible support necessary for maintaining sobriety (Woods, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Research by Best et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) indicates that peer support groups significantly enhance social capital, leading to improving mental health outcomes and reducing feelings of isolation. Laudet and White (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) further demonstrate that individuals with strong social networks report higher rates of successful recovery, suggesting that social capital serves as a protective factor from relapse.\u003c/p\u003e \u003cp\u003eAs defined by Cloud and Granfield (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), recovery capital encompasses the resources and support available to individuals in recovery, categorized into personal, social, community, and cultural dimensions. \u003cem\u003ePersonal recovery capital\u003c/em\u003e includes traits like resilience, motivation, and coping skills. \u003cem\u003eSocial recovery capital\u003c/em\u003e refers to the networks, relationships, and community ties that offer support and encouragement throughout recovery (Best \u0026amp; Laudet, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Psychological resilience is a trait and a procedural ability to cope with stress and regulate emotions (Troy et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). \u003cem\u003eCommunity recovery capital\u003c/em\u003e involves access to resources, services, and opportunities that facilitate recovery, such as healthcare, housing, and employment support. Lastly, \u003cem\u003ecultural recovery capital\u003c/em\u003e includes the norms, values, and beliefs that reinforce and sustain recovery efforts (Cloud \u0026amp; Granfield, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe concept of recovery capital is particularly relevant to NA where individuals accumulate both social and emotional resources through their involvement in peer support. These resources, including peer networks, act as both emotional support and practical guidance, helping members navigate the challenges in their recovery journey (Granfield \u0026amp; Cloud, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Laudet and White (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), individuals with diverse recovery capital are better equipped to manage mental health and substance use challenges. Peer supporters, as wounded healers, contribute significantly to both social and personal recovery capital by offering guidance and sharing their experiences, reinforcing the idea that recovery is achievable (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, the role of the wounded healer comes with challenges that can jeopardize well-being and increase the risk of withdrawal. Peer supporters frequently face emotional strain and burnout due to their exposure to peers' suffering (Simpson et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, issues such as professional conflicts, countertransference, and role confusion can disrupt their efforts, potentially leading to relapses (Elisha, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; White, 2000).\u003c/p\u003e\n\u003ch3\u003eThe present study\u003c/h3\u003e\n\u003cp\u003eThe role of peer support in the recovery of individuals with a criminal past and addiction issues presents both advantages and challenges. While peer support promotes recovery, builds social and recovery capital, and helps reduce stigma, it also carries risks such as vicarious trauma, and boundary issues. However, despite extensive research on relapses among recovering individuals, the experience of relapses among recovering wounded healers in the field of drug addiction has not been thoroughly examined. This study aims to address that gap by exploring this issue from the perspective of recovering wounded healers who have experienced relapses.\u003c/p\u003e \u003cp\u003eThe objective of the present study is to examine the perceived factors and triggers linked to relapses among recovering wounded healers and their subsequent return to the recovery journey. To the best of our knowledge, this is the first study of its kind, hence its novelty. The findings are expected to contribute to relapse prevention strategies and strengthen recovery efforts for individuals with addiction issues.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe study utilizes a qualitative phenomenological approach, to gain an in-depth understanding of the lived experiences and meaning associated with the phenomenon from the subjective perspective of the people who experienced it (Patton, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). In this case, the perspectives of recovering wounded healers who have experienced relapses. Through open-ended questions, the present study seeks to reveal the subjective insights of the participants. By implementing a thematic content analysis (Nowell et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), the research strives to identify the main themes that emerged from the interviews and propose new strategies for addressing the phenomenon under investigation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eDue to the sensitive nature of this study, which focuses on individuals with a history of drug addiction who recovered and then relapsed while formally employed in peer support roles within formal therapeutic settings, it was challenging to reach suitable interviewees. The research did not include individuals who volunteered as sponsors in NA's groups, but those formally employed. Therefore, we sought help from participants in our previous studies on peer support (Elisha \u0026amp; Shachaf-Friedman, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who referred us to appropriate candidates, allowing us to recruit additional interviewees using the \"snowball\" method which is a non-probability sampling technique mainly used when studying hard-to-reach or hidden populations (Patton, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Ultimately, we interviewed 13 participants from Israel, which yielded sufficient data to achieve saturation, defined by the repetition of information in the responses (Glaser \u0026amp; Strauss, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the 13 participants, 10 are men and 3 are women, all with a background of drug addiction, and some with alcohol addiction as well. Nearly all had criminal records, including arrests and prison terms for various offenses such as drug-related crimes, theft, fraud, and violence. Their ages range from 40 to 70 years (average: 53). Among them, seven are divorced, five are married and one is single. All but two have children, and some also have grandchildren. Their formal education ranges from 6 to 12 years; however, all have received professional training relevant to their peer-support practice in one or more of the following areas: group facilitation, addiction treatment, the 12-step program, and psychotherapy. Most of the participants reported being active members in NA's 12-step groups.\u003c/p\u003e \u003cp\u003eRegarding relapses, participants reported that their \"fall\" occurred after one to 14 years of recovery and sobriety while formally employed in peer support roles in addiction therapeutic settings, either in prison or community (e.g., therapeutic community, hostel, addiction unit center). Some returned to the recovery path a relatively short time after that relapse (six months to a year), while others experienced much longer periods of relapse, with the longest lasting 15 years.\u003c/p\u003e \u003cp\u003eAll participants identified as recovering from drug addictions, with current recovery periods ranging from several months to 32 years. Some still held peer support roles, while others transitioned to different fields. A few mentioned running private clinics where they also treat individuals with addiction problems.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMaterials\u003c/h3\u003e\n\u003cp\u003eBased on the research objectives, we developed an interview guide consisting of open-ended, broad questions, to conduct semi-structured, in-depth interviews with the participants. Examples include: \u003cem\u003e1. Describe your attempts at recovery over the years, including your most recent relapse. 2. In your view, what were the factors that led to your recent relapse while working as a peer supporter? 3. What happened to you afterward, and what led you back to the path of recovery? 4. Reflecting on your recovery journey, what lessons have you learned about relapses and maintaining recovery?\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003e The study received approval from the ethics committee of the first author's institutional IBR. With help from participants in our previous studies on peer support (Elisha \u0026amp; Shachaf-Friedman, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), we were referred to appropriate candidates, who further helped us to recruit more interviewees using the \"snowball\" method (Patton, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Both authors conducted interviews during the period between November 2023 and May 2023. The participants were initially contacted to assess suitability and responsiveness. If they agreed, a Zoom meeting was scheduled according to their preference. Before the interviews, participants were asked to sign an informed consent form. At the beginning of each interview, participants expressed their consent to be interviewed and authorized the researchers to record the session, so any identifying information would be omitted. The interviews began with general questions about the participant's background, followed by open-ended questions about the addiction and their journey into peer support, their relapse, their struggles, and their path to recovery. The interviews lasted an average of about an hour. An external company then transcribed the recorded interviews. The researchers conducted a thematic content analysis of the transcribed interview (Nowell et al, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), to identify key themes that emerged from the interviews, through repeated readings of the transcripts.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThis study employed thematic content analysis (Nowell et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The primary objective of this methodological framework is to systematically identify and interpret key patterns within the data set, offering a structured approach to understanding the phenomenon under investigation. Thematic analysis is noted for producing contextually relevant, interpretative, and substantively rich outcomes, which enhance the credibility and impact of the research (Nowell et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the researchers carefully read and re-read the interview transcripts to identify recurring themes across all the interviews. The coding process and theme development were conducted manually, with an effort to preserve the participants’ original wording. The theme names were derived directly from participants' narratives while the order and connections between themes were structured according to participants' reasoning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e This study adhered to rigorous ethical standards, obtaining approval from the Institutional Review Board (IRB) Ethical Committee at Max Stern Yezreel Valley College, Israel. Measures were implemented to ensure participant confidentiality and informed consent. Participants were informed of the voluntary nature of their participation and their right to withdraw at any time without providing a reason. Assurances were provided regarding the omission of any directly or indirectly identifying information. Interview transcriptions were handled by an external service provider under a strict confidentiality agreement. All audio recordings were securely stored in an encrypted folder, with access limited exclusively to the research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003cdiv id=\"Sec23\" class=\"Section4\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e\n\n \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003cdiv id=\"Sec31\" class=\"Section4\"\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e\n\n \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003cdiv id=\"Sec35\" class=\"Section3\"\u003e \u003cdiv id=\"Sec36\" class=\"Section4\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eThe findings derived from the participants\u0026apos; narratives revealed two central themes. The first theme revolves around efforts to reason and explain their relapses, while the second emphasizes reinforcing the cumulative value of recovery and the lessons learned from past experiences. Participants\u0026apos; explanations for the \u0026quot;fall\u0026quot; revealed several interconnected sub-themes addressing the slippery slope that begins with disconnection from NA\u0026apos;s 12-step program and recovering peers, which undermines the support system critical to recovery. Other reasons related to role confusion and false self-perception of \u0026quot;savior-rescuer\u0026quot;; entering intimate relationships too early; and the reluctance to give up the thrill associated with crime and drug use.\u003c/p\u003e\n\u003cp\u003eThe second theme, focusing on the cumulative value of recovery and lessons learned, highlights the importance of vigilance and self-awareness. Participants emphasized the need to recognize warning signs that may precede a relapse. They also discussed the understanding that recovery requires ongoing maintenance by consistently applying NA\u0026rsquo;s pillars of recovery. A key realization shared by many was that recovery has no cumulative value; it is \u0026quot;Just for today,\u0026quot; and there are no guarantees for the future. Below is an in-depth description of the findings, accompanied by direct quotes from the respondents, under pseudonyms to protect their anonymity.\u003c/p\u003e\n\u003cp\u003eAs a general background, most participants reported growing up with an addicted parent or sibling and being exposed to drugs at a young age in their neighborhood. Additionally, they experienced abandonment, parental neglect, or sexual abuse during childhood. However, their decision to pursue recovery\u0026mdash;both during previous recovery attempts and after their most recent relapse while engaged in peer work\u0026mdash;was often inspired by an encounter with a recovering peer who gave them hope and the belief that recovery was possible for them as well.\u003c/p\u003e\n\u003cp\u003eExplanations for relapses\u003c/p\u003e\n\u003cp\u003eThis theme relates to the respondents\u0026apos; accounts for their relapse while formally holding a peer-support position (\u0026quot;wounded healer). The main factor pointed out by the respondents that led to their \u0026quot;fall\u0026quot;, was disconnecting from the NA group members. Participants indicated that renouncing this central core value of the 12-step program led to further concessions that ultimately resulted in a complete disconnection from the recovery path and a return to previous negative patterns (e.g., dishonesty, manipulation, arrogance, selfishness), including drug use and often criminality. They also noted that many of their acquaintances abandoned the principles of the NA, and either relapsed or died (usually from an overdose) as a result. Notably, no differences were found in the respondents\u0026apos; accounts based on their length of recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSlippery slope: Disconnecting from NA\u0026apos;s 12-step program and recovering peers\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants marked the disconnecting from NA members, that is, recovering peers, as the first step on the slippery slope toward relapses. Paradoxically, they attributed this to the success they experienced in their professional and personal lives at the time, which fostered a false sense of competence (\u0026quot;I can manage on my own\u0026quot;).\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eQuotes:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI had financial success, got married, had children, and rehabilitated myself. From the outside it\u0026apos;s like I got it all, I fulfilled a dream, and I thought it wouldn\u0026apos;t happen to me. My deterioration began when I financially succeeded. I stopped going to NA meetings, I stopped being in contact with clean addicts, and I stopped wording the 12-step. Then there was a crisis at home with the children, it was hard for me to contain it, and then I fell back into drugs. (Orna)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI stopped working on the program. I felt strong and self-confident; I was earning money, I was independent, I had succeeded, and I was no longer a user. This was the illusion. If you don\u0026apos;t work the program, you forget that it\u0026apos;s not about drugs at all, it\u0026apos;s about a life problem, our bad patterns. The problem was that I got disconnected from the program. Pretty soon, I began to feel lonely and once again not connected to the world, and these existential questions about the meaning of life arose once more. So that\u0026apos;s what happened: I moved away, fell apart, and then the drugs came. (Alex)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eArnon described this downhill spiral, explaining that when a recovering individual abandons the basic principles of recovery, namely, those of the 12-step program, relapses are almost guaranteed. This deterioration manifested itself in socializing with fellow drug users, which soon led to a return to his return to drugs:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOnce you start giving up on some things, you gradually begin to give up on others. You stop going to NA, stop connecting with peers, start hanging out with active drug users, and go to problematic places. Thinking that because you\u0026apos;ve been clean for 20 years, you can afford all these things, and then boom! you find yourself using drugs. (Arnon)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRole confusion: False self-perception of \u0026quot;savior-rescuer\u0026quot;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother explanation for relapses, as described by several respondents, involves developing a \u0026quot;savior-rescuer\u0026quot; self-perception. Participants linked this to unresolved character flaws such as self-centeredness, dishonesty, arrogance, and manipulation, which ultimately fostered a false sense of omnipotence that contributed to their downfall\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e This can be viewed as role confusion, steaming from their double identity of recovering individuals with a problematic past, who serve as peer supporters, a powerful role that may lead them to feel superior and unmanageable.\u003c/p\u003e\n\u003cp\u003eFor example, Alina described her insights and awareness of her unresolved issues, which manifested in an omnipotent false perception of a \u0026quot;savior-rescuer\u0026quot; while engaging in peer work, ultimately leading to her relapse:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot being a savior-rescuer is imperative for me, because I need to surrender. I\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003efeel outside of myself when I\u0026apos;m assisting others; it keeps me out of my head.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere\u0026apos;s nothing better than seeing them come in and maintain their recovery.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIt\u0026apos;s like watching a miracle happen. But you must be careful about where you\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eare and what mode am I in - Am I in teacher mode? Am I in savior mode? I was\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eso unaware of parts of me that were unhealed, and I probably put myself in a\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003esituation I shouldn\u0026apos;t have and won\u0026rsquo;t do again. (Alina)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEntering intimate relationships too early\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants stated that entering new romantic relationships may form an additional risk factor for relapses, especially for new recovery, that is, those with less than two years of recovery. According to them, this is mainly due to unresolved personal issues that may worsen in the face of new intimate relationships and sabotage the recovery process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI\u0026apos;ve seen over the years people who get clean and sober start a relationship too\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eearly and relapsed. This is not something I recommend. It\u0026apos;s maybe one in ten\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ethat it works, but otherwise, they relapse. They are not ready to have an intimate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003erelationship with a woman just after six months clean. Sorry to say it, but they\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eneed at least a couple of years. (Dan)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother explanation is related to the sexual insecurity of a recovering addict, who may use drugs to meet his partner\u0026apos;s expectations in relation to his virility, as Yossi noted:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOthers may be ashamed to say it, but many fall back on drugs mainly because\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eof girls. Why? Because an addict can\u0026apos;t do what he needs to do as a man without\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ethe drugs. You know what I mean? He feels insecure without the drug, so when\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ehe is with a girl and wants to function properly, he will take drugs beforehand\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eto feel like a man. (Yossi)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReluctance to give up the thrill of crime and drugs\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants attributed their relapses also to a lack of genuine willingness to recover, stemming from the benefits and thrills they derive from drug use and a life of crime, along with the difficulty of maintaining a lifestyle free from action and risk.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe truth is that I didn\u0026apos;t want to be \u0026apos;clean\u0026apos;. I don\u0026apos;t like the cleanliness. There\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ewas something missing in the excitement - the activity of searching for things in\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eother people\u0026apos;s drawers and closets. I really missed the action. I felt like an idiot\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003egetting up in the morning, going to work, coming back from work, and going to\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003esleep in bed at night. I missed the variety, the action. (Amir)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to them, it takes a certain mental maturity, as well as \u0026quot;hitting rock bottom\u0026quot;, for an addict to truly want to recover and change his way of life.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI was not ready to stay \u0026apos;clean\u0026apos;. I had no willingness to give up drugs because\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003egetting clean involves a lot of concessions. It means giving up a certain lifestyle\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eand giving up an easy solution. After all, what\u0026apos;s good about drugs? I could\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003econtrol what I felt. If I want to feel \u0026apos;high\u0026apos;, I take this; if I want to feel \u0026quot;down\u0026quot;, I\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003etake that. You must reach a kind of maturity, a deep bottom, for this to\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ehappen. (David)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe cumulative value of recovery: Lessons learned from the past\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen the respondents were asked whether there is added value to their recovery, considering their lived experience that includes addiction, recovery, relapse, and re-recovery, most answered in the affirmative. The cumulative value reported includes a better ability to avoid and overcome risks for relapse by recognizing \u0026quot;warning signs\u0026quot;, through the active application of the four pillars of recovery in NA These pillars include the daily practice of the spiritual principles of the 12-step program, attending NA meetings, supporting and being supported by peers, and engaging in service, i.e., voluntary actions for the benefit of the community.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRecognizing \u0026apos;warning signs\u0026apos;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the key lessons from past experiences that the respondents pointed out was the importance of recognizing \u0026apos;warning signs\u0026apos; and avoiding the risk factors that led to their downfall. They specifically reflected on their character flaws (e.g., selfishness, self-pity), which made them feel superior to NA members and led them to disassociate themselves from them. This awareness manifested in their realization of the need for continuous support from others, as well as the necessity of engaging in ongoing self-work through the application of the 12-step principles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis is how Alina described her difficulty in speaking openly in NA group meetings, recognizing her tendency to fall into self-pity and manipulation, and her way of overcoming this through her awareness of the importance of openness and honesty:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSometimes I don\u0026apos;t want to be in a meeting. My anxiety is very high, and I feel\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003euncomfortable with a lot of things. But the more I do them, the less\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003euncomfortable I become. So now, if I feel myself going into that area of pity and\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003emanipulations, you know, I stand a much better chance of catching myself in\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003etime. Well, we know where this lead. (Alina)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAviram, too, explains the need to attend NA meetings, as a means of receiving social and emotional support to overcome the destructive parts of himself and avoid relapses:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIn addicts, the destructive part is very large, and our defense mechanisms are\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003elooser, and fluid. I mean, if I don\u0026apos;t do these actions of recovery, then my dark side\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ecomes out, the shadow takes over, and it starts living my life, instead of me living\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003emy life. I once left the program because I didn\u0026apos;t want to be with those \u0026apos;whiners\u0026apos;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ein groups. Today, they are an example for me, like a warning sign. (Aviram)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo expiration date: the application of the NA\u0026apos;s four pillars of recovery\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs part of the lessons learned from their last relapse while practicing peer work, all participants expressed a strong commitment to the four pillars of recovery in NA, which include, according to them, attending NA meetings, practicing spirituality through the 12-step, supporting and being supported by peers, and serving others.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are four steps that you must follow in the program. One, practice the steps\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEvery day as much as possible; two, attend NA meetings in a regular home\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003egroup; three, do service, like mentoring peers; and four, God. Today, I have a\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003efaith in God, a permanent NA group, I\u0026apos;m doing service, and I support peer\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003emembers of NA These are the four pillars. If you do them regularly, cleanliness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eis guaranteed. (Arnon)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBetty emphasizes that there is no expiration date for recovery and that these actions have become a routine for her, stemming from an awareness of their importance for maintaining long-term recovery:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGoing to NA groups, supporting and being supported, are very important for\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRecovery and it has no expiration date. This means that even at the age of 100,\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI will go to groups, contribute my part, and do service with love and everything\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ethat is needed. It\u0026apos;s a way of life. It\u0026apos;s part of my life. Like I get up in the morning\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eand brush my teeth. If I don\u0026apos;t do it, I feel like I\u0026apos;m missing something. (Betty)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo accumulating value: \u0026quot;just for today\u0026quot;, no guarantees for the future\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome respondents, however, expressed a skeptical position, stating that there is no actual cumulative value since the achievement of recovery is merely temporary (\u0026quot;just for today\u0026quot;). Asher, who fell back into drugs after 12 years of cleanness while formally engaged in peer work, describes this experience as if he had returned to the same starting point of his addiction:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFor 12 years, I managed to avoid something I really liked, drugs, so now a\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003emonster\u0026apos;s hunger has arisen. The problem is when you return to use, you pick\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eup from the same point where you stopped; no new world opens. So, it\u0026apos;s\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eas if I had regressed; I returned to being the same 27-year-old boy, completely\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eidiot, as if I learned nothing. (Asher)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral respondents compared drug addiction recovery to weight management, emphasizing that individuals must follow a strict daily routine. They observed that even a minor deviation from this routine can lead to immediate weight gain. Likewise, in the realm of drug addiction, they highlighted that regardless of the number of years a person has been in recovery, any lapse from the recovery program can lead to a relapse.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis program only works for 24 hours, every day anew. No matter how many\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eyears you\u0026apos;ve been \u0026apos;clean\u0026apos;, there\u0026apos;s no guarantee for anyone. I know some\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eindividuals who have \u0026apos;fallen\u0026apos; even after 20 or 30 years of sobriety. It can be\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003efrustrating, but it\u0026apos;s like with a diet: one can maintain one\u0026apos;s weight for many months,\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ebut as soon as he eats more than is allowed, he will immediately gain weight.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(Shimi)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHowever, this insight involves learning from the past, hence its cumulative value. That is, the recognition of the transience of \u0026quot;just for today\u0026quot; and the need to constantly be alert, as frustrating as it may be, sharpens the necessity for daily maintenance of recovery, as emphasized by NA\u0026apos;s 12-step program.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGrounded in the context of peer supporters as wounded healers in the field of drug addiction recovery, this study examined the perceived factors and triggers leading to relapses among recovering wounded healers, as well as their subsequent return to the recovery path. Participants were men and women with histories of drug addiction and criminality who experienced relapses while serving in formal peer support roles. Their accounts revealed relapse durations ranged from brief episodes (less than one year) to extended periods lasting many years before they resumed their recovery. Some participants remain formally employed in peer support roles, while others have shifted to different fields. Regardless of their professional status, all participants emphasized their ongoing informal support and engagement with recovering peers through NA groups.\u003c/p\u003e \u003cp\u003eThe participants' narratives reveal two central themes. The first centered on the triggers and factors leading to relapse. The second highlighted the cumulative value of recovery and its enduring impact. Notably, participants credited encounters with recovering as pivotal in their decision to recommit recovery. This finding underscores the convict therapy perspective (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), emphasizing the critical role of individuals with lived experience of addiction and incarceration - those possessing street and carceral capital (Buck, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Perrin, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) - in fostering processes of change and rehabilitation among peers.\u003c/p\u003e\n\u003ch3\u003eRelapses as a learning process\u003c/h3\u003e\n\u003cp\u003eParticipants identified disengagement from NA group members and the 12-step program as a significant trigger for relapse. This disconnect often sets off a downhill spiral, leading to harmful behaviors, substance use, and sometimes criminal activity. Paradoxically, participants were aware that these actions violated the principles of the program that had previously supported their recovery. Many attributed their disconnection to professional success in peer support roles, which fostered a false sense of self-sufficiency. Believing they could manage their recovery independently, ultimately undermined their progress.\u003c/p\u003e \u003cp\u003ePeer support, a cornerstone of the 12-step program and recovery literature, thrives on reciprocal relationships where individuals offer and receive support. Disengagement weakened these connections, eroding external validation and internal motivation to maintain recovery (Kelly \u0026amp; Yeterian, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Ronel, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Strong social bonds and supportive relationships, as emphasized by Sampson and Laub's (1993) life-course perspective, are critical in sustaining recovery. Maruna (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) highlights the importance of developing a positive identity and narrative in achieving successful desistance, while the concept of recovery capital underscores the cumulative value of personal, social, and community resources in supporting recovery (Granfield \u0026amp; Cloud, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDesistance literature emphasizes the importance of social connections and supportive relationships in maintaining desistance from substance use and criminal behavior (McNeill \u0026amp; Weaver, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Patton and Best (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) pointed out that mutual aid groups were identified as key sources of social capital for those in recovery. However, if individuals distance themselves from these recovery-promoting social circles, the positive effects may not be strong enough to sustain their progress. Positive criminology (Ronel \u0026amp; Elisha, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) further explains recovery by emphasizing meaningful engagement, spirituality, and altruism. NA integrates these principles, providing a spiritual and communal foundation to help individuals navigate the recovery challenges. When participants disconnected from these anchors, they diminished their recovery capital, increasing their vulnerability to relapse. These ideas align with convict therapy and lived experience theory (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), highlighting the value of peer support in fostering resilience and commitment to recovery.\u003c/p\u003e \u003cp\u003eSome participants noted that new romantic relationships pose a significant risk factor for relapses, especially within the first two years of recovery. Individuals in the early stages of recovery often face emotional regulation and self-esteem, making them particularly susceptible to the pressures of intimate relationships (Fleming et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Permut et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). While romantic and family support can enhance resilience and stability, they also pose risks, especially when pursued as an escape from emotional distress or as a substitute for heights of substance use (Permut et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The emotional fluctuations of these relationships can act as relapse triggers and foster co-dependence, with mutual relapses posing an increased risk when both partners are in recovery (Wallace et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother explanation for past relapses, cited by participants, was a lack of genuine willingness to recover, fueled by the psychological rewards and thrills of drug use and criminal behavior. This ambivalence\u0026mdash;being torn between the desire to heal and the allure of harmful behaviors\u0026mdash;complicates the recovery journey (Miller \u0026amp; Rolnick, 2012). Crime desistance theory emphasizes resolving such internal conflicts as essential to transitioning from criminal behavior to a law-abiding lifestyle (LeBel et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Maruna, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; experiences also align with Prochaska and DiClemente's (1983) stages of change model, which conceptualizes recovery as a cyclical process involving relapse, growth, and renewed commitment. In the pre-contemplation stage, individuals often fail to recognize the need for change, clinging to the perceived rewards of addiction or criminal lifestyles. During the contemplation stage, they began weighing the benefits of recovery against the comfort of familiar behaviors. Motivation played a pivotal role in the preparation and action stages, as participants actively engaged in recovery practices such as attending NA meetings, working through the 12-step, and seeking peer support.\u003c/p\u003e \u003cp\u003eRelapses, while challenging, were reframed not as failures but as opportunities for learning and growth. Participants described how relapses helped them identify triggers, refine coping strategies, and build resilience. They emphasized the importance of NA's four pillars\u0026mdash;spiritual practices, regular meeting attendance, mutual peer support, and community service\u0026mdash;in sustaining recovery. These practices align with the maintenance stage of the change model, in which the focus shifts to prevent regression and consolidate progress. This cyclical understanding of relapses underscores its integral role in the recovery process, offering opportunities for reflection, personal growth, and renewed commitment to long-term change.\u003c/p\u003e\n\u003ch3\u003eThe savior-rescuer paradox of the wounded healer\u003c/h3\u003e\n\u003cp\u003eSome participants attributed their relapse to adopting a \"savior-rescuer\" self-image, which they associated with unresolved character flaws, such as self-centeredness, dishonesty, arrogance, and manipulation. This dynamic created a false sense of omnipotence and role confusion (White, 2000) as they navigated their dual identities as recovering individuals and peer supporters. Their newfound authority as peer supporters and sense of efficacy further complicated this tension.\u003c/p\u003e \u003cp\u003eThe wounded healer role offers both empowering opportunities and significant risks. While helping others can provide a sense of purpose and bolster personal recovery, over-identification with the helper role can obscure unresolved vulnerabilities. This \"savior-rescuer\" paradox, as observed in some participants, led to an inflated sense of control and a distancing from essential support networks, such as NA group members. This highlights the delicate balance required to reconcile the dual identities of recovering individuals and peer supporters (White \u0026amp; Evans, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom the perspective of convict therapy (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), engaging in peer support allows individuals to transform their criminal past into a source of strength, using their experiences with crime and addiction to assist others. This process fosters emotional healing, enhances empathy and forgiveness, and provides a sense of purpose and self-worth, consistent with the wounded healer concept (Elisha \u0026amp; Shachaf-Friedman, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, unresolved tensions between the \"convict\" and \"recovering\" identities, particularly among those who have not fully addressed their past behaviors, can create a fragile sense of self. This fragility may undermine their commitment to recovery and contribute to relapses, as reported by participants.\u003c/p\u003e \u003cp\u003eMoreover, this tension often hindered participants\u0026rsquo; ability to seek help and renew their recovery journey. They perceived relapse as a personal failure\u0026mdash;a \u0026ldquo;fall.\u0026rdquo; This sense of failure was particularly acute for those in leadership roles within the recovery community, who felt they \"should have known better.\" Participants attributed their relapse to character flaws that led them to disregard the lessons they had learned\u0026mdash;and even taught\u0026mdash;during their recovery.\u003c/p\u003e \u003cp\u003eBeneath these accounts lay a pervasive sense of shame, self-blame, remorse, and guilt. These emotions led many participants to believe they should have acted differently, yet paradoxically inhibited their capacity to practice self-forgiveness or seek support (Griffin et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Braithwaite et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Research on shame suggests that it can foster antisocial behaviors (Griffin et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Leach, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Snoek et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and lead to disintegrative actions (Benau, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Etherson, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, studies also indicate that reintegration is possible when shame is addressed constructively, self-forgiveness is cultivated, and social support is accessible (Etherson, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Snoek et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eThe cumulative value of recovery\u003c/h3\u003e\n\u003cp\u003eMost respondents emphasized that their recovery journey holds significant added value, rooted in the lessons learned from past experiences. These include recognizing relapse risk factors\u0026mdash;\u0026ldquo;warning signs\u0026rdquo;\u0026mdash;and proactively avoiding them by consistently applying NS's four pillars of recovery: daily spiritual practices, participation in NA meetings, engaging in mutual peer support, and community service. This approach reflects a heightened commitment to long-term recovery, aligning with the positive criminology perspective, suggesting that individuals can grow from adversity (Ronel \u0026amp; Elisha, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). It also resonates with the desistance theory, which emphasizes self-reflection and personal development as essential for moving away from criminal behavior (Maruna, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConvict therapy (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) emphasizes the pivotal role of peer support in building accountability and resilience. Through meaningful connections and participation in recovery-oriented activities, individuals build social and recovery capital, which enhances their ability to sustain long-term recovery (Best et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Laudet \u0026amp; White, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Woods, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These supportive relationships and community engagement further bolster resilience, empowering individuals to overcome challenges and maintain their recovery. This perspective aligns with lived experience theory, which underscores the significance of personal narratives and the subjective understanding of one's experiences in shaping the recovery journey (Sells et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe respondents acknowledged that their relapse experiences contributed to a deeper understanding of their addiction and recovery journey. This acknowledgment aligns with the concept of \"recovery capital\" (Granfield \u0026amp; Cloud, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), which suggests that individuals in recovery accumulate resources\u0026mdash;social, personal, and community-based\u0026mdash;that enhance their ability to sustain recovery over time. Research supports the notion that relapses, while challenging, can serve as a learning experience, helping individuals identify personal triggers and refine coping strategies (Best \u0026amp; Laudet, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; DiClemente \u0026amp; Crisafulli, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Lessons learned from relapses, such as recognizing warning signs and appreciating the necessity of ongoing peer support, reflect an increase in recovery capital (Best et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). These insights often lead to stronger commitments to the recovery process and adherence to the values of the 12-step program, which emphasizes personal growth, accountability, and sustained engagement in peer-based support networks (Kelly \u0026amp; Yeterian, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, some participants argued that recovery holds no cumulative value, as achievements are temporary, and daily effort is required to maintain progress. This perspective reflects NA\u0026rsquo;s \u0026ldquo;just for today\u0026rdquo; philosophy, framing recovery as an ongoing process that necessitates daily commitment (Alcoholics Anonymous, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). This perspective fosters humility and vigilance, encouraging individuals to remain alert to potential triggers while cultivating gratitude. The 12-step framework underscores this mindset, warning against complacency and promoting deeper engagement with recovery principles to build resilience against setbacks (White \u0026amp; Kurtz, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). As respondents noted, embracing NA\u0026rsquo;s philosophy provides a reliable foundation for ongoing recovery and long-term success.\u003c/p\u003e"},{"header":"Conclusions and practical implications","content":"\u003cp\u003eThis research contributes significantly to the field of drug recovery by deepening our understanding of the triggers and pathways leading to relapses and re-recovery among peer supporters, also known as wounded healers. By integrating Prochaska and DiClemente's (1983) stages of change with frameworks such as positive criminology, desistance theory, and convict therapy, the study provides valuable insights into the dynamic processes of recovery and relapse. The findings emphasize the vital role of internal motivation, social connections, and resilience in navigating the complexities of recovery. Addressing the diverse challenges faced by recovering individuals can enhance the effectiveness of recovery programs, ultimately promoting sustained change and personal growth.\u003c/p\u003e \u003cp\u003eThe study highlights the need for structured interventions tailored to the stages of change, especially for peer supporters managing the complexities of the wounded healer role. Peer supporters in recovery should receive continuous training and support to strengthen their resilience. Such training should focus on self-care, boundary-setting, recognizing personal triggers, and developing emotional skills to process past failures. These strategies will help peer supporters stay committed to their recovery while effectively assisting others (Beales \u0026amp; Wilson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). By reframing failure as an opportunity for growth, recovery programs can focus on fostering factors that sustain long-term recovery.\u003c/p\u003e \u003cp\u003eFurthermore, integrating insights from convict therapy (Elisha, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) into peer support training can deepen the understanding of the emotional and psychological aspects of relapse. Recovery programs should include therapeutic interventions that address unresolved issues related to individuals' criminal pasts, as these conflicts can significantly impact recovery outcomes. By addressing these challenges, recovery programs can better equip peer supporters to navigate their dual roles, ultimately enhancing their ability to support both their recovery and that of recipients.\u003c/p\u003e"},{"header":"Limitations and directions for future research","content":"\u003cp\u003eSeveral limitations of this study should be acknowledged. The participants were recruited through a snowball, non-probability sampling technique, which carries inherent risks of bias. In this case, participants were primarily connected through their involvement in the NA community, which may have influenced the prominence of the 12-step worldview and terminology in their accounts. The reliance on this network may have excluded perspectives from individuals outside this specific recovery framework, potentially limiting the diversity of viewpoints. Moreover, reliance on self-reported data introduces potential risks of recall bias and social desirability bias.\u003c/p\u003e \u003cp\u003eFuture research should consider adopting longitudinal designs to capture the dynamics and evolving nature of recovery and relapse over time. Expanding the sample to encompass individuals from diverse cultural, socioeconomic, and gender backgrounds would enhance the generalizability of the findings. Comparative studies between peer supporters and non-peer supporters could offer valuable insights into the unique challenges of the wounded healer role. Additionally, exploring the influence of digital platforms, spirituality, and strategies for preventing burnout offers promising directions for further investigation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthical Approval\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe study received approval from the Ethics Committee of the Max Stern Yezreel Valley College IBR (the first author\u0026apos;s institutional affiliation).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eApproval number: \u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e2024-1\u003c/span\u003e YVC EMEK\u003c/strong\u003e \u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eDate of approval: \u003cstrong\u003e15 October 2023.\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eScope of approval: \u003cstrong\u003e4 years.\u003c/strong\u003e\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eInformed Consent\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWe confirm that all research was carried out in accordance with the IBR\u0026apos;s ethical regulations, including signing the participants on an informed consent form before the interviews, and omitting any identifying or personal information of research participants, to maintain their anonymity and confidentiality\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlcoholics Anonymous (2001). \u003cem\u003eThe big book\u003c/em\u003e. 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The varieties of recovery experience: A primer for addiction treatment professionals and recovery advocates. \u003cem\u003eInternational Journal of Self Help and Self Care\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1\u0026ndash;2), 21\u0026ndash;61. https://doi.org/10.2190/911r-mtq5-vj1h-75cu\u003c/li\u003e\n\u003cli\u003eWoods, M. (2020). \u0026ldquo;Helping others and helping myself\u0026rdquo;: Wounded healers as peer workers. \u003cem\u003eIrish Probation Journal, 17,\u003c/em\u003e 191\u0026ndash;211.\u003c/li\u003e\n\u003cli\u003eXie, H., McHugo, G. J., Fox, M.B., \u0026amp; Drake, R.E. (2005). Special section on relapse prevention: Substance abuse relapse in a ten-year prospective follow-up of clients with mental and substance use disorders. Psychiatric Services, 56(10), 1282\u0026ndash;1287. https://doi.org/10.1176/appi.ps.56.10.1282 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"wounded healer, drug addiction, recovery, convict therapy, 12-step program, Alcoholics Anonymous (NA)","lastPublishedDoi":"10.21203/rs.3.rs-6517733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6517733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe present study examined the experiences of relapses among peer supporters, known as wounded healers, in recovery from drug addiction. Despite extensive research on relapses, little attention has been given to those in recovery who support others while facing their setbacks. The study explores factors triggering relapses and the return to recovery, among men and women with histories of addiction and criminality who held peer support roles. Key findings reveal that disconnection from NA's 12-step program and recovering peers often initiated relapses, alongside early romantic relationships and insufficient recovery commitment. While empowering, the dual identity of peer supporters also exposes unresolved personal issues, leading to the \"savior-rescuer paradox\". However, lessons from relapses enhance resilience and deepen recovery commitment. The findings highlight relapses as a learning process rather than failure, emphasizing the role of social and recovery capital in sustaining long-term recovery. Rooted in the convict therapy perspective, the study advances the understanding of relapse dynamics and offers insights into relapse prevention strategies and peer support in the field of addiction recovery.\u003c/p\u003e","manuscriptTitle":"The Wounded Healer Paradox: Perceived Triggers of Drug Relapse and Recovery among Peer Supporters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 10:03:54","doi":"10.21203/rs.3.rs-6517733/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-19T18:19:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-09T09:25:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-05T18:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215553581293344994990613372122168805112","date":"2025-12-22T15:56:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260304882120728741139371613150172439599","date":"2025-12-19T15:46:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T15:04:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68968408253859100084737022672239425878","date":"2025-12-19T10:51:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324723293731792257518396358506069741605","date":"2025-12-17T21:32:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180850364475056017654115472470681376110","date":"2025-12-17T19:36:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-06T09:49:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-14T09:57:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-14T09:55:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-14T09:55:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-04-24T06:36:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d54a1503-e24c-4fca-9ad7-4f592fddd036","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":49738546,"name":"Humanities/Health humanities"},{"id":49738547,"name":"Social science/Criminology"},{"id":49738548,"name":"Social science/Sociology"}],"tags":[],"updatedAt":"2026-04-07T16:01:59+00:00","versionOfRecord":{"articleIdentity":"rs-6517733","link":"https://doi.org/10.1057/s41599-026-07089-z","journal":{"identity":"humanities-and-social-sciences-communications","isVorOnly":false,"title":"Humanities and Social Sciences Communications"},"publishedOn":"2026-04-01 15:58:31","publishedOnDateReadable":"April 1st, 2026"},"versionCreatedAt":"2025-06-09 10:03:54","video":"","vorDoi":"10.1057/s41599-026-07089-z","vorDoiUrl":"https://doi.org/10.1057/s41599-026-07089-z","workflowStages":[]},"version":"v1","identity":"rs-6517733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6517733","identity":"rs-6517733","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}