Families Hold Influence over Treatment Choices of Young Adults with Opioid Use Disorder

BOSTON – A new study from Boston Medical Center’s Grayken Center for Addiction found that young adults with opioid use disorder (OUD) strongly consider family opinions about treatment options, and family stigma can often negatively impact their decision on whether to engage in medication for OUD. 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, researchers recommend in the Journal of Addiction Medicine.

Young adults (ages 18-25) have the highest prevalence of OUD of all age groups, and the fatal opioid overdose rate among young adults has significantly increased since 1999. Despite this, young adults typically have higher relapse rates, lower engagement rates, and lower retention rates than older adults in medication treatment. There are a few reasons for low engagement in medication treatment among young adults, including a lack of age appropriate addiction treatment programs. 

There is a great need to better understand how young adults make decisions about OUD and treatment and who or what may influence their decision-making process. Since families 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.

“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,” said lead author Sarah Bagley, MD, director of the CATALYST Program for young adults at the Grayken Center for Addiction at Boston Medical Center. “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.”

This study, which consisted of 20 young adults with OUD, identified three themes on family attitudes that impacted treatment choices by young adults:

1. Family history of SUD and treatment negatively impacts how young adults perceived their substance use and treatment – About half of the young adults described a history of alcohol 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. Many families held negative or stigmatizing views of medication treatment – More than half of young adults felt that family members held stigmatizing views about SUD and medications for opioid use disorder (MOUD), leading to more complications when there was family involvement or awareness of treatment. 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. Acceptance by family was important to young adults but they acknowledged 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. 

Interventions that consider family relationships may be critical in caring for young adults for OUD. 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. With their influence and opinions on treatments, families can be powerful allies in working with young adults with OUD.