Families and Methadone Treatment

Black family laughing together

If you know what methadone is, then you may ask yourself what families have to do with methadone treatment. The answer is relatively simple. In some cases, families have everything to do with methadone treatment. The primary way families are involved in methadone treatment is by participating in family therapy, which is an important part of treatment and recovery from substance use disorder (SUD), including opioid use disorder (OUD).

Let’s back up and define methadone and methadone treatment for anyone unfamiliar with either. We’ll elaborate below, but for now, simply understand that methadone is a medication used to treat people with opioid use disorder (OUD) – a.k.a. opioid addiction – and it’s part of an overall approach called medication-assisted treatment (MAT). Treatment specialists recognize MAT as the gold-standard treatment for opioid use disorder.

Back to the question:

Why, in some cases, do families have everything to do with methadone treatment?

The answer:

Because a robust support system of loving, concerned individuals create conditions within which a person in recovery from OUD can grow and thrive.

It’s not just families. Evidence shows that for people in recovery from alcohol use disorder (AUD), adding just one non-drinking friend to their social network dramatically increases the likelihood of sustained recovery. A similar thing is true for people with OUD: the stronger and wider the support system, the more likely the chances of a full and successful recovery.

And in this context, a committed and fully engaged family can form the first and most powerful base of support available to a person in treatment. In other words, they’re the foundation of the support system, and can play a vital role in the success or failure of any treatment plan.

The lion’s share of the work, of course, belongs to the person in recovery. However, with the full support of a loving family, a person in treatment can meet the challenge of that work with the knowledge their family has their back and is invested in their success.

Before we go any further, we’ll take a moment to define family therapy.

Family Therapy: The Basics

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers this definition of family counseling/therapy:

“Family counseling or therapy is a collection of treatment approaches and techniques founded on the understanding that if change occurs with one person, it affects everyone else in the family and creates a change reaction.”

In the context of substance use disorder treatment, including medication-assisted treatment (MAT) with methadone or another medication for opioid use disorder (MOUD), any friend or loved one concerned with the successful recovery of the individual in treatment can help the treatment and recovery process, if the person in treatment wants them to participate in the process.

In the publication “Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy,” SAMHSA outlines the principles of family participation in the SUD process, which applies to recovery from all substances of misuse or disordered use, including alcohol:

Families and SUD Treatment: Seven Core Principles

  1. Recognize the importance of family participation in treatment and recovery
  2. Emphasize collaboration and mutuality in treatment
  3. Recognize the value of harm reduction in OUD treatment
  4. Realize a successful treatment means improving quality of life for the whole family, not only the person in treatment
  5. Understand family support and a robust social network are crucial components of recovery
  6. Any family therapy plan must honor the cultural traditions of the family involved in treatment
  7. Recognize that SUD is a complex, multilayered disease, and families can play a pivotal role in helping an individual in treatment achieve long-term, sustainable recovery

Family therapy is based on a concept from developmental psychology called family systems theory. Here’s a simple way of understanding  family systems theory:

  1. We all grow up in a system of human relationships defined as a family
  2. Family dynamics play a pivotal role in individual development
  3. Families have a direct impact on any behaviors an individual develops

In the context of family systems theory, family members include spouses, children, parents, grandparents, adoptive parents/grandparents, aunts and uncles, cousins, other relatives, close friends, and chosen family.

Those are the initial facts about methadone, family participation in SUD treatment, and family participation in MAT treatment.

But why is all this important now, in 2023?

The Drug Overdose Crisis: Opioid Overdose

We just emerged from a worldwide pandemic that claimed over a million lives in the U.S. What many of us don’t realize is that the opioid crisis – which many call the opioid epidemic or the overdose epidemic – has claimed over a million lives since 1999.

Let’s take a look at the most relevant data on the opioid crisis. We’ll start with the overall statistics on drug addiction, which we now call substance use disorder (SUD).

SUD by Substance in 2021

Source: 2021 National Survey on Drug Use and Health (2021 NSDUH)

  • Alcohol use disorder: 29.5 million
  • Illicit drug use disorder: 24.0 million
  • Marijuana use disorder: 16.3 million
  • Opioid use disorder: 5.6 million
  • Pain reliever use disorder: 5.0 million
  • Methamphetamine use disorder: 1.6 million
  • Stimulant use disorder: 1.5 million
  • Cocaine use disorder: 1.4 million
  • Heroin use disorder: 1.0 million

Now let’s look at opioid overdose fatalities over the past six years.

Opioid Overdose Deaths: 2017-2022

Source: CDC National Vital Statistics System (NVSS)

  • 2017: 42,249
  • 2018: 46,802
  • 2019: 49,860
  • 2020: 68,630
  • 2021: 80,411
  • 2022: 82,797

Those statistics tell us why this topic – families and methadone treatment – is important right now, in this moment. Millions of people have opioid use disorder (OUD), tens of thousands of people die every year from opioid overdose, medication-assisted treatment with methadone is an effective, evidence-based treatment, and family participation in any form of SUD treatment improves outcomes: that’s our current situation.

Now let’s define exactly what we mean by medication-assisted treatment (MAT).

What Is Medication-Assisted Treatment (MAT)?

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as follows:

“Medication-assisted treatment (MAT) for opioid use disorder combines counseling and other recovery supports with prescribed medications. These medications help reduce cravings and withdrawal symptoms that come from stopping opioid use. The medications approved for MAT are methadone, buprenorphine, and naltrexone.”

In this article, we focus on methadone. To learn more about buprenorphine – a.k.a. Suboxone – please navigate to the blog section of our website and read this article:

Suboxone Treatment for Opioid Use Disorder

That article will tell you what you need to know about Suboxone. Now let’s get back to methadone with these basic methadone facts:

  • Methadone is an FDA-approved medication for opioid use disorder (MOUD)
  • Methadone mitigates opioid cravings and reduced opioid withdrawal symptoms.
  • It’s typically dispensed in liquid form
  • Methadone is dispensed daily, in single doses – with some exceptions – at FDA-certified opioir treatment programs (OTPs).

The benefits of methadone, confirmed by fifty years of research, include:

  • Increased treatment retention
  • Reduced withdrawal symptoms
  • Reduced opioid use
  • Decreased relapse rates
  • Decreased involvement with criminal justice system
  • Reduced rates of fatal overdose
  • Reduced spread of infectious disease
  • Improved family function, work, and academic functioning
  • Decreased overall premature mortality
  • Decreased risk taking/risky behavior

While methadone treatment is not always long-term, evidence indicates methadone treatment lasting less than 90 days is not more effective than other approaches to treatment. However, evidence also indicates people who engage in methadone treatment for over a year have the best likelihood of achieving long-term, sustainable recovery. Patients on methadone should not stop taking methadone without medical supervision. The best way to discontinue methadone treatment – the last phase of MAT, called tapering or medically supervised withdrawal – is slowly, over time, in collaboration with a substance use counselor and physician.

It’s clear MAT works, and of the medications for opioid use disorder approved by the FDA, methadone is particularly effective. An outside observer could safely assume that with this knowledge – and medication – available, every person with opioid use disorder would choose some form of medication-assisted treatment.

Let’s see if that’s the case.

Medication-Assisted Treatment for OUD in 2021

Source: 2021 National Survey on Drug Use and Health (2021 NSDUH)

  • 5.6 million people had opioid use disorder. This figure includes those with the disordered use of:
    • Heroin
    • Prescription opioids
    • Illicit prescription opioids
  • 1.2 million received treatment
  • 533,000 with OUD received MAT with MOUD
  • 1.1 million overall engaged in MAT for opioid use, regardless of OUD status
  • 887,000 with opioid misuse received MAT with MOUD

Unfortunately, the facts tell us that’s not the case.

That data shows us what we call the treatment gap, which is the difference between the number of people who need a specific treatment and the number of people who get that treatment. In the U.S. in 2021, none out of every ten people diagnosed with opioid use disorder did not receive the MAT, which – as we’ve said again and again in this article – treatment professionals consider the best available treatment for OUD.

The treatment gap is something we can rectify – but we need everyone’s help. That means people in treatment, people with friends in treatment, and family members of people in treatment. We need everyone’s help in three areas:

  1. Reducing stigma around MAT
  2. Increasing awareness of the effectiveness of MAT
  3. Raising awareness about the role families can play in methadone treatment

We’ll discuss that last item now: the role and benefits of family participation in SUD treatment, which applies directly to family participation in MAT with methadone.

Families, Methadone Treatment, and Recovery

If we check the definition of MAT, we find a key phrase: “…combines counseling and other recovery supports with prescribed medications…” What that means is that MAT is not only about medication. It’s a holistic approach to recovery that leverages all possible avenues of support to maximize the likelihood of a positive result. Those avenues include individual therapy, group therapy, and family therapy. We define and explain family therapy above.

Now let’s look at the positive outcomes associated with family therapy during MAT with MOUD.

Family Participation in SUD Treatment: Core Benefits

Source: Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy (SAMHSA)

Family participation in the context of SUD treatment is associated with:

  • More enthusiastic participation in treatment
  • Longer treatment retention
  • Prevention of substance use in other family members
  • Individual benefits:
    • Decreased drug use
    • Decreased relapse to drug use
    • Improvement in mental health symptoms
    • Improved social, family, school, and work functioning
  • Family benefits:
    • Reduced conflict
    • Stable interactions/interpersonal dynamic
    • Improved overall communication
    • Reduced risk of negative impact on children

Research indicates several treatment approaches involving families can increase the likelihood of successful recovery.

Family Therapy: Evidence-Based Therapeutic Techniques

Source: Treatment Improvement Protocol 39: Substance Use Disorder Treatment and Family Therapy (SAMHSA)

Multi-Dimensional Family Therapy (MDFT):

  • MDFT operates on the assumption that change occurs in three primary places: home, school, and in the community
  • MDFT-trained providers tailor therapy to unique client need in these three places, or life domains, which creates an effective web, or system, of support for each person in treatment

Behavioral Family Therapy (BFT):

  • BFT is rooted in the concept that the disordered use of substances use is learned behavior
  • In some cases, family members model this negative behavior, which reinforces the behavior
  • BFT counselors help families learn to reinforce positive, alternative behavior, such as decreased drug use and /or abstinence
  • BFT is indicated for any family involved in the SUD recovery process

Solution Focused Brief Therapy (SFBT):

  • SBFT counselors prioritize practical solutions to acute challenges in order to create a template for solving subsequent problems.
  • Counselors help patients and family identify the circumstances when the patient does not use drugs, and families help reinforce/create those circumstances to promote the desired behavior

Community Reinforcement and Family Training (CRAFT)

  • CRAFT helps families with a loved one with SUD who refuses/strongly resists treatment
  • Family members learn to reinforce desired behaviors, i.e. not using drugs
  • Family members learn not to interrupt the natural consequences of drug use

Psychoeducation Workshops

  • Psychoeducation classes teach families and individuals the important facts about treatment, addiction, and recovery
  • Family education may include workshops on healthy communication, resolving conflict, boundary setting, codependency, and others.

It may come as a surprise that a medication-based treatment includes family therapy that covers topics and issues like psychoeducation, conflict resolution, and communication skills. Upon reflection, this combination of medication and behavioral therapy reflects trends across the medical field. We now regularly include lifestyle changes in treating chronic diseases like diabetes, hypertension, obesity, and others. Family support helps in those instances, too: family members help keep the person in treatment on track to total health.

The Power of Family

In that way, treatment for OUD with methadone in an MAT program is no different than treatment for chronic physical disease: family support can make all the difference. As we mention above, the person in treatment does the heavy lifting. It’s their life, their recovery, and their personal success ultimately depends on them. With that said, when a family unites around the concept of recovery and understands how they can support their loved one without enabling them, then their chances of achieving sustainable, long-term recovery increase.

In short, when families engage in the therapeutic process, outcomes improve. And when outcomes improve for one person, those positive outcomes ripple outward and benefit the family, and by extension, benefit the community.

That’s how we move toward a holistic vision of total health. One person at a time, one family at a time, and one community at a time.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.