Helping families heal in substance use treatment: A qualitative study about the role of peer support specialists with client families.

Introduction: Peer support specialists (PSS) are people with previous psychiatric illness or substance use disorders who use their experience to support those facing similar hardships. PSS offer a range of beneficial outcomes to both the PSS and clients. The most immediate social connections to those seeking treatment are often their families, yet no PSS studies are inclusive of family involvement. Strong theoretical and empirical support exists for family involvement in addiction treatment, but no studies to date on families in substance use treatment include PSS. This study offers a first look at PSS's experiences with client families. We aimed to describe experiences and attitudes of PSS in working with families of those seeking substance use treatment.

Methods: This qualitative study included 25 adult PSS with at least 1 year of work experience in substance use treatment and state credentialing board certification. Participants had one interview either in a focus group format or individually. The recruitment and data collection phase lasted from November 2020 to June 2021. The semi-structured interview protocol included six main questions and interviews lasted 60 to 75 min. Upon completion of each interview, the recordings were transcribed and inductively coded. Thematic analysis of the codes identified overarching themes and their implications were described with associated quotes.

Results: Thematic analysis generated three interrelated themes. First, participants described the various ways they often work with the families of their clients, which seemed to be dependent on the age of the client. Second, participants identified the negative aspects of working with families such as family drama, stress, and co-dependency issues. Last, the third theme identified the ways in which PSS assist families in healing from the effects of addiction. The themes identify a complicated and conflicting approach to work with families. Overall, it seemed PSS were operating on their own experiences or suggestions given by supervisors to guide them with no training on how to approach families.

Conclusions: This study highlights a deficit in PSS training on their role with families, family intervention, and the impact of family on substance use treatment for adults and youth. More research needs to establish the PSS role with families and with clients from marginalized backgrounds. Credentialing and national associations that support PSS should develop additional training and education opportunities related to working with families for PSS, supervisors, and organizational leadership who employ PSS for substance use treatment.