Can family involvement improve treatment of drug abuse

Can family involvement improve treatment of drug abuse? The research issue

A resurgence in heroin use is making it the most commonly used illicit drug by people entering drug abuse treatment programmes. And the UK has the fastest-growing number of heroin users of any country in Europe (The Guardian, July 6, 2003). Naltrexone is a medication that blocks the effects of heroin and other opioids (a class of drugs that includes heroin, morphine and codeine). Although an effective treatment for opioid abuse, naltrexone has not been widely used in drug abuse treatment, largely because of poor patient compliance in taking the medication. The present study examined whether behavioural family counselling, which involved a ‘recovery contract’ with a family member, would improve patient compliance and treatment outcomes. Design and procedure Participants were male opioid-dependent patients seeking outpatient treatment for substance abuse who lived with a parent, a spouse or other intimate partner, or other family member illing to participate in the treatment (and who did not also have a current substance use disorder). At the beginning of treatment all patients were given a prescription for naltrexone (50 mg/day) and were then randomly assigned to one of two treatment groups: behavioural family counselling (BFC) or individual-based treatment (IBT). In BFC, patients had an individual and a family session each week for 16 weeks and took naltrexone daily while the family member observed and verbally reinforced the patient’s medication ingestion (e.g. ‘I really appreciate you taking your medication’). In IBT, patients were started on naltrexone and were asked in their twice-weekly counselling sessions whether they had taken their daily dose, but there was no family involvement or compliance contract. Results and implications Patients in the two treatment groups were equally satisfied with the therapy they received. But BFC patients took naltrexone on more days during treatment than did IBT patients. Urine screening also showed t at they had longer periods of continuous abstinence from opioid use during treatment and in the 12-month follow-up period than patients in the IBT condition.
Finally, patients who received BFC had better secondary outcomes: that is, they had more days of abstinence from drugs other than opioids and displayed more positive psychosocial functioning (they experienced fewer drug-related, legal and family problems). This study demonstrates the importance of involving the patient’s significant others in treatment. It shows how a daily recovery contract can serve as a noncoercive method to encourage compliance with pharmacotherapy and commitment to treatment. Its significance is emphasized by the fact that medication can only be effective if it is taken.
Fals-Stewart, W., & O’Farrell, T., 2003, ‘Behavioral family counseling and naltrexone for male opioid-dependent patients’, Journal of Consulting and Clinical Psychology, 71, 432–42.