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Research has found that experientially similar others—people experienced with the same or similar condition—can provide valuable forms of support that significant others—individuals who are close but have not experienced the same condition—are unable to provide. Providing such support can also have a positive effect on the helper’s well-being and sense of self. While helping similar others is central to mutual support groups, such as 12-Step programs, there is a dearth of literature examining patterns of help and potential benefits (or challenges) for helpers in recovery from a substance use disorder. This study examines how a group of people with a history of opioid use and addiction discuss their efforts to help and provide support to others struggling with addiction. Individuals with a history of incarceration or who were involved with 12-Step programs reported more public forms of helping others, often centered on public disclosures. Most interviewees, however, described helping similar others in more informal, individualized manners. Many of these interviewees were in relationships with other recovering drug users, which blurred their roles as both a similar and significant other and created risks previous literature on social support has not discussed. Finally, I introduce the concept of entrepreneur ex’s to describe a small number of men who sought novel means of helping others outside of a formalized treatment setting, which resulted in favorable contact with powerful, high-status figures. Altogether, this study advances literature on social support in the context of stigmatized illness by illustrating different patterns of social support in relation to similar and significant others, as well as notable differences in both the benefits and risks faced by helpers.