Family Influence Impacts Opioid Use Disorder Treatment Decisions for Young Adults

The Bottom Line

Young adults (ages 18-25) with opioid use disorder (OUD) are likely to strongly consider their family’s opinions when it comes to treatment options—especially medication for OUD (MOUD). Interventions that target these views and consider the importance of family relationships should be an important strategy to engage and retain young adults in care for OUD. 

Context

Young adults have the highest prevalence of OUD of all age groups, and the fatal opioid overdose rate among young adults has significantly increased since 1999. Additionally, young adults typically have higher relapse rates, lower engagement rates, and lower retention rates than older adults in medication treatment. 

A recent study published in The Journal of Addiction Medicine, conducted by researchers at the Grayken Center for Addiction at Boston Medical Center, explores the link between familial attitudes about treatment for substance use disorders and the affect that has on young people struggling with those disorders.  Since families and other caregivers are uniquely situated to play an important role in treatment decisions, this study explored how young adults with OUD perceive their families’ beliefs about OUD and medication treatment and how those beliefs impacted their treatment decisions. Families also have the potential to encourage engagement in care and provide ongoing support outside of the treatment system. Family involvement in the treatment of adolescents with substance use disorder (SUD) has been shown to improve outcomes, including retention.

Study Objective

To understand how young adults with OUD perceive their family’s beliefs about OUD and treatment and how those beliefs impacted the young adults’ treatment decisions and retention within that treatment plan.

The Details

Researchers at Boston Medical Center conducted a qualitative study of a convenience sample of 20 young adults with OUD receiving care from an urban safety net hospital in Massachusetts. They explored young adults’ perceptions of how their families viewed medication treatment. Further, they conducted semi-structured interviews that were recorded and transcribed. Then they analyzed interviews using hybrid inductive and deductive categorization to support thematic analysis.

Findings

The study’s findings identified three key themes on family attitudes that impacted a young adult’s treatment decision:

1. Family history of SUD and treatment – About half of the young adults described a history of alcohol use disorder and other SUDs in their families and recalled experiences from childhood that impacted their goals for themselves, as well as their treatment decisions. These included the desire to be different from their affected family members and negative views of methadone treatment due to association with adverse aspects of childhood.

2. Negative and stigmatizing view of medication treatment – More than half of young adults felt that family members held stigmatizing views about MOUD. Some participants believed their parents were too focused on the duration of treatment and felt pressure to taper off MOUD, despite the fear of relapse, and some felt they had to defend their treatments and how they were treated within healthcare systems. Yet not all family views about MOUD were negative – about a third of young adults shared that they received support from family regarding their medication treatment.

3. Family acceptance was important, but not the only factor – Many young adults mentioned that keeping treatment decisions from family was sometimes necessary. A few participants thought they could eventually share that they were taking medications because they were currently doing well in their recovery. These participants identified that their parents’ goal was for them to stop using substances and hoped that parents could recognize that medication treatment was an important part of their recovery. Other participants believed they could be open with certain people in their lives about treatment but needed to keep MOUD hidden from their parents due to a lack of understanding. One young adult also expressed a concern that sharing with others about treatment with medications would signal the extent of their drug use – the hiding of treatment did not specifically have to do with MOUD but with the stigma related to opioid use disorder.

In the context of poor engagement and retention in care of young adults with OUD, there is a significant need to explore new ways to improve care and a need for evidence-based approaches that include families. Interventions that consider family relationships may be critical in caring for young adults for OUD. With their influence and opinions on treatments, families can be powerful allies in working with young adults with OUD.

Pull Quote

“The ever-increasing prevalence of OUD among young adults is quite alarming and a serious issue that needs to be addressed as quickly as possible. It may be obvious that families have a role in the treatment of young adults with OUD, but with this study, we were able to gain a deeper understanding of the extent of their influence, how young adults perceive and use their families’ views, and how this information could be best used to improve care.”