Expand Community Support for Impacted Families

Introductory Paragraph

The entire family feels the effects of substance use disorder. There are many ways a community can expand current supports for family members who are coping with a loved one’s substance use disorder, whether they are in treatment, transition, or recovery. In many cases, families can be part of the foundation for recovery, and their needs must be taken into consideration when a loved one is affected. In short: when the whole family is supported, the outcomes improve for each person in the family. Families recover too.

Key Information

Types of Programs That Support Families

Community support is a powerful wellness tool. Communities can provide support to a variety of systems which help families, especially in ensuring that families know what’s available for them in the community. Whether it’s a state, local, or federal government resource or a nonprofit organization, family support covers a wide spectrum of assistance for substance use, recovery, mental health, and harm reduction. Special programs are designed for all age groups, as offerings are specifically focused on issues affecting active-duty military, military families, non-denominational groups, LGBTQI+, parent only, spouse or partner only, as well as a cultural focus for a wide variety of ethnic and/or racial groups. The following programs are examples of family support. (NOTE: any references to a particular type of program or support group does not imply an endorsement or a referral.)

• 12-Step Programs may be a family member’s first introduction to getting support when coping with a family member’s substance use disorder. These meetings are essentially fellowship programs that work on a peer-to-peer basis. Members help each other by practicing the Twelve Steps of Alcoholics Anonymous (or Narcotics Anonymous). They welcome and give comfort to family members, as well as encouragement and support to the person with substance use disorder. The assurance of anonymity is essential to 12-Step programs to help more families and friends. There are an estimated 14,000 Al-Anon Family Groups meetings every week throughout the US and Canada.

• In-Person Support Groups (not 12-Step). Not everyone feels comfortable with a Twelve-Step framework, so families may want to be supported in other ways. There are many peer-to-peer alternatives that may appeal to those who would prefer a more secular, cognitive-behavioral (i.e., scientifically informed) strategy instead of a spiritual model. Other options for support meetings include Smart Recovery, Secular Organizations for Sobriety (SOS Sobriety), Because I Love You (BILY), Learn2Cope, Parents of Addicted Loved Ones, GRASP (Grief Recovery After a Substance Passing), and many others.

• Grief Support. Because of stigma about substance use disorder, families often deal with shame in addition to their grief. From 1999 to 2017, more than 702,000 people died from a drug overdose. When the existing addiction epidemic intersected with the onset of the Covid pandemic in 2020, the results were tragic – as both fatal and nonfatal overdoses surged in the early months of the pandemic and continued. From April 2020 to April 2021, over 100,000 Americans lost their lives to overdoses. Opioids continue to be the driving cause of those deaths. Synthetic opioids, primarily Fentanyl, caused nearly two-thirds (64%) of all drug overdose deaths in the 12-month period ending April 2021, up 49% from the prior year. The ripple effect of those losses continues to affect families, friends, and caregivers.

• Collegiate Recovery Programs (CRPs) offer college students a connection to other students in recovery, as well as access to a supportive and confidential community. There are approximately 200 CRPs throughout the country that provide college students with the tools and support they need to succeed in the lifelong journey of recovery. These include as substance-free housing, counseling, substance-free events, and safe drop-in spaces. CRPs also provide collegiate institutions with the knowledge and solutions necessary to effectively support students who are in or seeking recovery from substance use disorder.

• Faith-Based Support. Churches, synagogues, mosques, and other faith groups can be a valuable bridge to the community when discussing substance use and the impact of the opioid epidemic. Faith-based organizations have a vested interest in their congregations and communities, and they can often reach people who may be reluctant to share information with anyone but their religious leaders. Houses of worship are generally open to sharing their spaces, whether it’s hosting a recovery group or a 12-step program. For example, the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, Ohio, created a Faith-based Outreach Committee. Officials contracted with five faith-based programs to participate in the initiative. By incorporating spirituality in the recovery process, congregations can increase awareness and education within their congregations. Additionally, State Opioid Response (SOR) grant funds can be used to the provision of substance use disorder services by faith-based organizations. Community leaders may find faith-based communities open to hosting a town hall to help educate their own members on the science of addiction, medication-assisted treatment, or Naloxone training. Faith-based leaders also have a weekly audience where they can grow compassion within the community, while also supporting families in recovery.

• Grand Families/Kinship. One tragic consequence of the opioid epidemic is the marked increase in children living with their grandparents. Grand families have unique challenges that may not fit neatly into family programs in a given community. Those who have taken in grandchildren after losing their sons or daughters to overdoses may struggle with shame and grief. Those same grandparents may be retired, on a fixed income, or living below the poverty line. A 2018 study from Generations United reported that "grand families are often not given access to the same supports and services that traditional unrelated foster families receive." Communities can offer updated parenting skills classes, provide specialized support groups, and help to navigate the school system and other community resources. West Virginia State University created an initiative, Healthy Grand families, to support grandparents now raising a family for the second time. The program provides everything a “new” parent needs to learn again: nutrition, social media and teens, stress management, and the new “normal” for their family. After completing the series, a licensed clinical social worker consults with them for three months to navigate community and advocacy services.

• Family Coaching Programs & Peer Navigators Many parents feel lost when navigating their child’s substance use issues. By speaking with someone who has been there, parents can learn how to stay connected to their loved one and get the support and encouragement they need and deserve. Communities can directly help parents by creating peer-to-peer programs such as the Partnership to End Addiction Parent Coaching program. This model pairs parents seeking help with a specially trained parent volunteer who has traveled the same path, dealing with a child’s substance use. Parent Coaching includes the benefits of shared experience and evidence-based techniques centered on motivating change. Consider building a community parent coaching program for families in crisis.

• Peer Navigators (Kinship or Family). Navigators provide critical information and referral services to grandparents and other relatives raising children who are outside the child welfare system. Without these family members, many of the children would likely wind up in the foster care system. Kinship navigators can help families navigate their loved ones into treatment. One example is Arizona Kinship Support Services which provides help in a variety of ways, from completing guardianship packets and benefit applications to assisting families who wish to become guardians or adoptive parents. Their family testimonials offer compelling reasons for why this is critical support. New York state funds regional Family Support Navigators to provide help throughout the recovery process and connect families to vital resources.

Inform, Educate, and Create

It’s not enough to simply have various types of family support available in your community. Families have to know it’s available.

• Inform Your Community about Available Family Support. Whether it’s an online directory, distributing flyers, social media, community events, or an email blast, community leaders are often the best positioned to get information directly to families of those with substance use disorder. There’s another benefit to openly promoting all that your community has available to help families -- it will help families by reducing the stigma surrounding substance use disorder, treatment, and recovery. That helps both families and their loved ones in treatment and recovery.

• Educate Your Community about the Impact on Children. The opioid crisis has amplified the significant and multifaceted impacts of substance use on child and family health and well-being. As more families affected by parental substance use around the country face child welfare involvement, it is more important than ever to support family-centered treatment-focused approaches, from supporting children in foster care to aiding children with Neonatal Abstinence Syndrome. Your community can engage clinics, pediatricians, schools, and child care providers with the help of the American Academy of Pediatrics’ fact sheets. Each sheet includes a state-by-state breakdown of the opioid epidemic, child welfare systems, and child health. They also recommend policy solutions that can support vulnerable children and families at the state and federal levels.

• Create a Family-Friendly Guide from Treatment to Recovery. Families affected by substance use need help navigating the disease and the systems set up to assist those looking for help. Many states and local communities have set up websites with links to multiple forms of support and service. As an example, the state of New Hampshire created a robust website to assist and support families to help them navigate everything from active addiction to recovery. It is an easy-to-follow guide that provides an extensive array of content, walking families through every step of the recovery process. The family-friendly format includes a variety of topics, as well as links to New Hampshire’s “Doorways” -- assistance with accessing every level of treatment and 211 support.

Relevant Research

• SAMHSA has updated Treatment Improvement Protocol (TIP) 39, titled "Substance Abuse Treatment and Family Therapy." This TIP, first published in 2004, has been revised to reflect new research. It helps providers and administrators better understand how to include families in the complex and often difficult treatment of substance use disorder. This research report documents how involving family members or significant others in treatment and/or therapy can enhance patient outcomes and helps the family recover. Substance use disorder in a family of any size affects family dynamics, communications, healthy coping skills, as well as increases a child’s risk of developing SUD and/or mental health challenges.

• National Academy for State Health Policy (NASHP). With the increase in overdoses, alcohol use, and substance use during the pandemic, measuring and sharing data became more critical than ever. A study by NASHP reported that “Comprehensive data – often gathered from across the state, local, and federal resources – enables state and local leaders to tailor their prevention, treatment, and recovery responses and make the most of scarce resources.”

Impactful Federal, State, and Local Policies

• To date, 47 states and the District of Columbia have enacted both Good Samaritan and Naloxone Access laws as part of an effort to reduce overdose deaths, while encouraging individuals to respond to opioid overdoses. These laws protect people from certain criminal penalties if they call 911 to save an overdose victim. The Government Accountability Office (GAO) reviewed 17 studies on Samaritan and Naloxone laws and found a pattern of lower rates of opioid-related overdose deaths among states that have enacted Good Samaritan laws, as well as an increased likelihood of individuals calling 911 if they are aware of the laws .

• SAMHSA's Center for Substance Abuse Treatment (CSAT), Building Communities of Recovery (BCOR) may be a source of funding for Family Recovery Programs. The purpose of this program is to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction. These grants are intended to support the development, enhancement, expansion, and delivery of recovery support services (RSS) as well as the promotion and education of recovery. Programs will be principally governed by people in recovery from substance abuse and addiction who reflect the community being served.

Available Tools and Resources

• SAMHSA provides a dedicated website titled "Resources for Families Coping with Mental and Substance Use Disorders."

• National Association for Children of Addiction provides a variety of resources for families in recovery.

• National Center on Substance Abuse and Child Welfare offers a webinar titled "Building Hope for Family Healing and Recovery."

• Research Recovery Institute Guide for Family Members provides numerous supportive resources for families.

• The Sobriety Treatment & Recovery Teams (START) is a model for working with families affected by substance use disorder and child welfare involvement.

• Celebrating Families! is a successful, evidence-based 16-week curriculum that addresses the needs of children and parents in families that have serious problems with alcohol and other drugs. The curriculum engages every member of the family, ages three through adult, to foster the development of healthy and addiction-free individuals. A typical cycle was designed to serve 6 to 15 families depending on the site's physical facilities, referral process, and intake of eligible families.

• CRAFT (Community Reinforcement and Family Training) teaches families and friends how to positively interact with a loved one struggling with their substance use. With an evidence-based approach, participants can learn behavioral and motivational strategies. Training is also available for parents of teenagers with substance use disorder.

Promising Practices

• Baltimore’s Family Recovery Program works with families where substance use is a major factor in the removal of their child/children.

• Family Treatment Courts (FTC) – Casey Family Programs studied services provided by Family Treatment Courts across the country, especially their family services that are not exclusive to the court system. FTCs offer strategies including early identification of substance use disorder, access and referral to treatment, recovery coaches, intensive case management, one-on-one engagement, and family-centered treatment. They found each strategy can and should be implemented in any child and family well-being system and in all family courts, in collaboration with community partners.

• Maryland Department of Human Services has developed a fact sheet detailing five different promising practices for family engagement, including Adult Focused Family Behavior Therapy, Multisystemic Therapy – Building Stronger Families, Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR), and Sobriety Treatment and Recovery Coaches (START).

• National Judicial Opioid Task Force evaluated the Parent Partner Programs in a document titled "Promising Practice to Keep Families Struggling with Substance Use Disorder Together." Parent Partners (aka parent mentors, peer specialists, allies) have previous direct experience in the child welfare system. Parent Partners assist parents currently involved or at risk of becoming involved with the child welfare system. Whether the services are based in courts, welfare agencies, or independent, they provide peer support to new parents entering the system. This study shows how these programs have increased trust and confidence in the child welfare and juvenile court systems in several cities.