Slocum Susannah, Paquette Catherine E, Pollini Robin A
Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States of America.
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America.
J Subst Use Addict Treat. 2023 May;148:209023. doi: 10.1016/j.josat.2023.209023. Epub 2023 Mar 20.
Increasing evidence-based treatment for opioid use disorder (OUD) is key to reducing opioid-related morbidity and mortality. Family and close friends of people with OUD can play an important role in motivating and facilitating their loved ones' treatment. We examined evolving knowledge about OUD and its treatment among family and close friends of people who use illicit opioids and their experiences navigating the treatment system.
Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids in the past 30 days, and had a close relationship with someone who currently uses illicit opioids. Recruitment leveraged a nonprofit support network for family members of persons with a substance use disorder (SUD). We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22, April-July 2018) informed the development of a quantitative survey (N = 260, February-July 2020). Attitudes and experiences related to OUD treatment constituted an emergent theme in qualitative interviews, which informed a section of the subsequent survey.
Both qualitative and quantitative data indicated support groups were instrumental in increasing OUD knowledge and influencing attitudes toward treatment options. Regarding how best to motivate drug treatment engagement, some participants favored what they referred to as a "tough love" approach that typically included a preference for abstinence-based treatment, while others favored a positive reinforcement approach focused on enhancing treatment motivation. Loved ones' treatment preferences and scientific evidence played a minor role in determining preferred treatment modalities, and only 38 % of survey participants believed that using medications for OUD is more effective than treatment without medications. A majority (57 %) agreed that finding a drug treatment slot or bed was either somewhat or very difficult, and that once in the system treatment was costly and involved multiple returns to treatment after relapse.
Support groups appear to be important forums for gaining knowledge about OUD, negotiating strategies to motivate their loved ones' entry into treatment, and forming preferences for treatment modalities. Participants emphasized the influence of other group members more so than their loved ones' preferences or empirical evidence of effectiveness with regard to choosing treatment programs and approaches.
增加基于证据的阿片类物质使用障碍（OUD）治疗方法是降低与阿片类物质相关的发病率和死亡率的关键。患有OUD者的家人和密友在激励和促进其亲人接受治疗方面可发挥重要作用。我们研究了使用非法阿片类物质者的家人和密友对OUD及其治疗的认识变化，以及他们在治疗系统中的就医经历。
符合条件的个体为马萨诸塞州居民，年龄≥18岁，在过去30天内未使用非法阿片类物质，且与目前使用非法阿片类物质的人关系密切。招募工作借助了一个为物质使用障碍（SUD）患者家属提供支持的非营利网络。我们采用了顺序混合方法，即一系列半结构化定性访谈（N = 22，2018年4月至7月）为定量调查（N = 260，2020年2月至7月）的开展提供了信息。与OUD治疗相关的态度和经历是定性访谈中的一个新出现的主题，为后续调查的一个部分提供了信息。
定性和定量数据均表明，支持小组有助于增加对OUD的了解，并影响对治疗选择的态度。关于如何最好地激励参与药物治疗，一些参与者倾向于他们所谓的“严厉的爱”方法，通常包括倾向于基于禁欲的治疗，而另一些人则倾向于专注于增强治疗动机的积极强化方法。亲人的治疗偏好和科学证据在确定首选治疗方式方面作用较小，只有38%的调查参与者认为使用药物治疗OUD比不使用药物治疗更有效。大多数人（57%）同意，找到一个药物治疗床位或位置有点困难或非常困难，而且一旦进入治疗系统，治疗费用高昂，复发后需要多次重新接受治疗。
支持小组似乎是获取有关OUD知识、商讨激励亲人接受治疗的策略以及形成对治疗方式偏好的重要平台。在选择治疗方案和方法时，参与者更强调其他小组成员的影响，而非亲人的偏好或有效性的实证证据。
