Engaging Family Members and Other Concerned Significant Others in Recovery Services
Write-up by IRIS team member: Yali Deng
Substance use disorder (SUD) greatly impacts not only those struggling with addiction, but also their families and loved ones. Family members often experience chronic and intense stress, stigma, family strain, social isolation, and fear of losing their loved ones to overdose (Slocum et al., 2024). At the same time, family members and other concerned significant others (CSO) are important recovery supports for people with SUD. A meta-analysis showed that SUD treatment involving significant others had an increased effect in reducing substance use above and beyond individually-based therapies or usual care delivered in a one-on-one setting (Ariss & Fairbairn, 2020). Findings from an IRIS fellow’s study of crisis response calls received by peers showed a higher percentage of those referred by family and other CSOs (CSOs) initiated treatment than those who were self-referred (48.8% vs. 33.8%; Hamm & Frey, 2023). These results indicate the importance of engaging family members and CSOs in recovery services.
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Despite clear benefits, interventions that leverage CSOs involvement to improve treatment engagement and outcomes are underutilized and understudied. To address this need, National Institute on Drug Abuse (NIDA; 2024) posted an approved concept clearance calling for studies that facilitate the engagement of support persons (their term for CSOs). This proposed initiative focuses on studies evaluating interventions or service delivery frameworks that reduce stigma or provide care navigation assistance for support persons, leverage support persons as lay interventionists, or enhance their well-being and coping skills.
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In this write-up, we summarize two articles that discussed strategies or interventions related to family involvement. The first described a conceptual framework and strategies for using telehealth to increase family engagement in opioid use disorder (OUD) recovery for youth. The second study presents findings from an online support group for affected family members.
Article 1
"Conceptual Framework for Telehealth Strategies to Increase Family Involvement in Treatment and Recovery for Youth Opioid Use Disorder"
Hogue, A., Bobek, M., Levy, S., Henderson, C. E., Fishman, M., Becker, S. J., Dauber, S., Porter, N., & Wenzel, K. (2021). Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder. Journal of Marital and Family Therapy, 47(2), 501–514. https://doi.org/10.1111/jmft.12499
In this paper, Hogue and colleagues discussed strategies within telehealth to enhance family engagement in youth OUD services in order to improve engagement and outcomes. This framework highlights that families can be involved in a continuum of youth OUD services across four stages including treatment preparation, treatment initiation, treatment stabilization, and OUD Recovery (seen Figure 1).
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During treatment preparation (stage 1), assertive family outreach can be used to support engagement. Providers can utilize text, phone calls, and video calls to discuss the roles that family members can play, and message family members about the essential role of medication in recovery. A quick phone call to family members to thank them for their time and affirm their willingness to enroll, and to confirm appointment details, can be powerful. After treatment initiation (stage 2), families can be integrated into treatment activities through collaboration and goal-setting interventions such as building therapeutic alliances and conveying the importance of family support in overcoming OUD. Two exemplar interventions were highlighted in the article, including Youth Opioid Recovery Support intervention and Community Reinforcement and Family Training, which offer training for CSO to better communicate with substance-using loved ones and motivate them into treatment. During the treatment stabilization stage (stage 3), family psychoeducation can be used to enhance treatment outcomes by educating families about OUD and its symptoms, impacts, and treatment options. Also, service providers can teach families coping, problem-solving, and communication skills to improve family relationships, including through family systems therapy. During OUD recovery stage (stage 4), families can be engaged in ongoing post-treatment care to maintain treatment gains. This stage emphasizes quality-of-life interventions including vocational training and positive leisure engagement.
FIGURE 1 Conceptual framework for using telehealth to increase family involvement across the youth OUD services continuum
This article also described synchronous and asynchronous direct-to-family tele-support that can supplement provider-delivered interventions. Synchronous tele-support includes helplines, peer-to-peer coaching, and networking forums. Asynchronous tele-support can include automated text messaging, self-directed internet courses, and social media support. For example, automated messages can be provided to families who are not ready for in-person contact. The message often includes communication strategies, resource links, and encouragement and validation messages.
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In conclusion, this framework paper proposed the adoption of family-focused interventions and integration of telehealth into in-office care. Fully implementing this framework would require professional education in the utilization of telehealth, time and resources for service coordination across various platforms, and incorporation with other specialists. Though this would necessitate investments of time and financial resources, family-focused interventions through telehealth offer unique opportunities to engage family members who otherwise may not be able to participate due to lack of time, living apart, or other logistic barriers.
Article 2
"Online Peer-Led Support Program for Affected Family Members of People Living With Addiction: A Mixed Methods Study"
Peart, A., Horn, F., Grigg, J., Manning, V., Campbell, R., & Lubman, D. I. (2023). Online peer-led support program for affected family members of people living with addiction: A mixed methods study. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-023-01082-2
In this article, we introduce an intervention that taps into multiple domains of interest within NIDA’s concept on engaging loved ones, including leveraging support persons as interventionists and enhancing their well-being. This study evaluates an online, peer-led support group intervention for family members of people experiencing substance use addiction. The word “peer” as used here means people who have lived experience as an affected family member. This study used a one-group mixed-method approach, with the quantitative part examining change in participant outcomes (i.e., self-efficacy, personal well-being and social connectedness) through pre-post tests, and qualitative interviews exploring their experience and perceived impact.
This support group was a subsequent intervention for affected family members who attended an online psychoeducation program called BreakThrough in Australia. The group’s aim was to expand educational content of Breakthrough sessions and provide a platform for family members to connect as well as share experiences and coping strategies. The intervention consisted of 18 one-hour sessions and was held weekly through Zoom.
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A total of 31 participants attended one or more support group sessions and 23 completed both baseline and exit surveys. Quantitative results showed that participants showed improvement in general self-efficacy (i.e., feel more confident dealing with difficulties in their life), but no significant improvement in personal well-being and social connectedness. Qualitative results indicated that through this online support group, participants were able to connect with people who share the same world; learn strategies from each other and normalize their experience; and feel more positive about their current situation. They also stressed the importance of a facilitator who shared similar lived experiences, which created a safe and supportive atmosphere. Participants stated that the online format made the support more accessible.
In conclusion, this peer-led online support group, which used affected family members as facilitators and a telehealth approach, showed promising results. The group brought together affected family members and created a platform to learn coping strategies and access support. Service providers may also consider leveraging active family members as lay interventionists and take advantage of online platforms to increase access to services for family members.
References
Ariss, T., & Fairbairn, C. E. (2020). The effect of significant other involvement in treatment for substance use disorders: A meta-analysis. Journal of Consulting and Clinical Psychology, 88(6), 526–540. https://doi.org/10.1037/ccp0000495
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Hamm, R., & Frey, J. (2023). Take the hand that reaches out: Examining the relationship between referral source and treatment admission within peer-delivered mobile crisis services. IRIS Recovery Research Fellowship. https://www.iris.ssw.umaryland.edu/_files/ugd/557311_5b2a76e0461f445387c16ca5276219e6.pdf
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National Institute on Drug Abuse. (2024). National Advisory Council on Drug Abuse (NACDA) approved concept clearances. National Institute on Drug Abuse. Retrieved August 15, 2024 from https://nida.nih.gov/about-nida/advisory-boards-groups/national-advisory-council-drug-abuse-nacda/national-advisory-council-drug-abuse-nacda-approved-concept-clearances
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Slocum, S., Carrington, C., & Pollini, R. A. (2024). “Living in a chronic state of panic”: Family members’ experiences with opioid use disorder. Journal of Social Work Practice in the Addictions, 1–17. https://doi.org/10.1080/1533256X.2024.2378687