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Family-Focused Approaches to Opioid Addiction Improve the Effectiveness of Treatment

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– Written by Helena J.V. Rutherford, Ph.D., Yale School of Medicine, Declan T. Barry, Ph.D., Yale School of Medicine, and Linda C. Mayes, MD, Yale School of Medicine
– Edited by Rebekah Levine Coley, Ph.D., Boston College
– For more information, contact Martha Zaslow, Ph.D. Director for Policy, Society for Research in Child Development, at mzaslow[at]srcd.org

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In treating opioid addiction, moving from an individual approach to a family-focused approach to treatment can have lasting benefits for children and parents, and decrease health care costs. In 2017, the U.S. Department of Health and Human Services declared opioid addiction a public health emergency. Opioids—which include prescription medicines for pain relief, synthetic drugs such as fentanyl, and heroin(1) —lead to an average of 115 deaths by overdose per day in the United States.(2,3)The medical and legal response has mainly focused on individual needs, yet opioid addiction has wide-ranging impacts not only on individuals, but also on their families and children. New evidence finds that family-focused approaches can improve upon models that treat individuals, expanding benefits and cost efficiencies, and improving the health and development of children.

Opioid Addiction Affects Whole Families, With Important Implications for Children
Parents’ opioid addiction affects children’s development from the prenatal stage through adulthood. These effects occur both directly, through biological and neurological processes, and indirectly, through compromised parenting and family stress.

Current Treatment Options Are Limited
The gold standard treatment option for adult opioid addiction is the controlled administration of prescribed methadone or buprenorphine, termed opioid agonist treatment.(18,19) For pregnant women, this treatment optimizes maternal and neonatal outcomes after birth.(19) Yet access is limited by cost constraints and lack of coverage through Medicaid and private insurance.(18) Even for parents who have access, opioid agonist treatment programs often overlook the impact of opioid addiction on children and families. Similarly, programs rarely attend to the cooccurrence of addiction and other mental health issues.(20) Other treatment approaches that are often easier to afford, such as medically supervised discontinuation of opioid use during pregnancy, have high relapse rates and less maternal engagement in prenatal care, and do not provide postnatal parenting support essential for healthy child development.(21)

Family-Focused Treatment Models Can Fill Gaps and Improve Children’s Well-Being
Because opioid addiction affects not only parents but also children and families, we need family-focused treatment models that attend to the needs of, and optimize outcomes for, both parents and children. Current treatment approaches fall short in meeting these goals, yet there are successful models that can inform improvements in treatment. Specifically, evidence suggests the need for coordinated and family-focused treatment models, particularly those that promote effective parenting. Numerous family-focused models have proven effective. Research shows that:

Critical Next Steps for Targeting Opioid Addiction and Improving the Lives of Children and Families
Family-focused approaches have beneficial effects on multiple family members and may reduce overall health care costs. We now need carefully planned expansions of family-focused treatment models with continued evaluations to determine when and for whom such treatments are appropriate and most effective, and how integrated care models can best maximize the efficacy of opioid agonist treatment and address co-occurring medical and psychiatric conditions.

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