NCAD Spotlight: Medications Can Offer an Opening for Family Involvement

Everyone talks of addiction as a family disease, but too few treatment programs accomplish more than paying lip service to genuine family involvement in the treatment and recovery process. At this summer's National Conference on Addiction Disorders (NCAD East) in Baltimore, leaders at Maryland Treatment Centers will explain how their young-adult outpatient treatment programming seeks to focus family involvement around an issue many parents can relate to: getting a child to take the medication prescribed for an illness.

“Every parent has a story of the recalcitrant kid who does not want to take the medication that has been prescribed,” Maryland Addiction Centers medical director Marc Fishman, MD, tells Addiction Professional. Fishman believes promoting adherence to medication treatment for opioid use disorder is a concept family members can embrace far easier than some of the less tangible aspects of their loved one's treatment and recovery plan.

Fishman and Maryland Treatment Centers psychologist and research scientist Kevin Wenzel, PhD, will discuss in their Aug. 15 NCAD East breakout session their efforts in advancing the organization's Youth Opioid Recovery Support (YORS) model. Currently available on only a limited experimental basis, with an Arnold Foundation-funded trial of its effectiveness under way, YORS has several core components:

• Engaging family members around a collaborative plan, governing everything from how information will be shared to how the young adult's medication treatment will be administered. “Get consents up front when the [patient's] motivation is good,” Fishman says.

• Home delivery of medication treatment. Fishman says the YORS effort has mainly used monthly injections of naltrexone (Vivitrol), administered by nurses in the patient's home. It recently has begun using long-acting injectable buprenorphine now that it is available.

• An assertive approach to encourage patients to attend their scheduled clinic visits. “We're hounding them to come into the clinic,” Fishman says. Three-way texting involving the treatment center, the patient and the parent has proven valuable, he says.

• Contingency management incentives to encourage medication dosing, in the form of gift cards to the patient for a variety of retailers.

While final data from the study are not yet available, Fishman says patients receiving the intervention are showing some striking outcomes compared with those receiving usual care. He says that at the six-month mark, only half of the YORS patients are meeting relapse criteria, while all of the usual-care patients are.

Barriers to involvement

Fishman says it should be acknowledged that it is not easy to encourage family involvement in treatment. It's difficult as a clinician or a program to have additional stakeholders to be concerned about, he says.

The NCAD session will address overcoming barriers to family involvement, such as young adults' pushback over what they see as parental over-involvement (“They do nothing but nag me”). Another obstacle comes in the form of concerns about confidentiality, though Fishman believes programs often will exaggerate and misapply this fear. “42 CFR limits our ability, but what's the higher good?” he says. In working with patients, “You can get to 'yes.'”

Join clinicians and executives at NCAD East, Aug. 15-18 in Baltimore, and work to improve and refine patient care as well as develop sustainable and successful treatment organizations. Visit https://east.theaddictionconference.com for more information.