Despite increased risk of secondary harms from a loved one’s substance use, including physical, social, emotional and financial problems, there are few resources available for family and friends. This study pilot tested an 8-week intervention for family and friends of people who use methamphetamines.
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Approximately 0.5% of the global population use methamphetamine, with rates rising at a rapid pace in countries like the United States, New Zealand, and Australia. Although methamphetamines and other stimulants are of course harmful to individuals who use them, persistent and serious drug use may also impact loved ones in numerous ways. Some family or friends may experience direct harms from acute substance use intoxication, which can lead to an increased risk of physical or interpersonal conflict. In some cases, substance use may lead to financial or legal strain, the burden of which may fall on families. More generally, family and friends often spend substantial time and energy concerned about their loved one, which can interfere with their own functioning, increasing stress levels and depression or anxiety symptoms. Thus, family and friends of people who use substances are at an increased risk of experiencing a range of harms and often require support in coping with their own mental and physical health.
Self-Management and Recovery Training (SMART), an international mutual help recovery organization, created an eight-module manualized mutual-support group known as SMART Family and Friends, to support loved ones affected by the substance-related behavior of a close one. SMART Family and Friends complements SMART Recovery’s existing services for those attempting to reduce or abstain from substances by modifying existing evidence-based strategies used in psychotherapy, typically based in cognitive-behavioral and motivational enhancement theories. This study assessed the feasibility and initial outcomes of an 8-week SMART Family and Friends live online video meeting for people affected by another’s methamphetamine use.
The study was a single-arm pre-post feasibility study using a mixed-methods approach. This means that there was no control group, and that all family and friends who enrolled in the study were assigned to receive the intervention. While 45 individuals were enrolled in a SMART Family and Friends group (36 enrolled in an 8-week group and 9 enrolled in a 2-day group), only 19 individuals completed all 8 modules; 38 individuals completed at least half of the modules. The 8-module intervention was designed to be completed in either eight 2-hour sessions over 8 weeks, or in two 8-hour sessions over 2 days. See figure below for an overview.
Participants were recruited online via the Australian SMART Recovery website between March–October 2021. Participants were deemed eligible if they were a family member, caretaker, or supporter of a person who used methamphetamine; if they reported willingness to attend the 8 modules of the SMART Family and Friends mutual-support group; were at least 18 years of age; were an English-speaking Australian resident with capacity to provide informed consent; and had access to a device with video conferencing capability. Because the study took place between March and October of 2021 (during the COVID-19 pandemic), video conferencing services were used to deliver groups.
At the final session, group participants completed a measure assessing participant satisfaction, which asked questions like “How helpful did you find SMART overall?” and “I would recommend SMART to someone in need of similar help”. Participants were also contacted 1 week after the group ended for an interview assessing participants’ overall experience, changes to well-being and general functioning, and coping strategies. Researchers extracted themes from interviews. They also collected survey data at baseline and 1-month after the end of the sessions. In the surveys, the researchers measured psychological distress, quality of life, and family functioning. Researchers compared outcomes from pre- to post-tests.
The sample of concerned others was comprised of parents (70%), significant others (18%), other family (8%), and friends (5%). They tended to be older (28% were 35-50 and 63% were 51-75) and female (88%). The amount of time their loved ones had been using drugs overall (including but not limited to methamphetamines) varied; 25% for 1-5 years, 25% for 6-10 years, 18% for 11-15 years, and 33% for 16+ years.
Participant Satisfaction with the Group
Overall, patients rated their satisfaction at a 4.32 out of 5, suggesting high satisfaction. Nearly all (94%) of participants reported that they would recommend the group to others.
Participant Perspectives on the Intervention
Seven themes emerged from the qualitative interviews, with 5 highlighting the benefits of the intervention and 2 highlighting challenges and recommendations for changes to the group. First, participants noted the convenience and accessibility of the remotely delivered intervention, suggesting that they attended more sessions than if the group was face-to-face. Participants also commented on the flexibility to vary their level of engagement depending on their confidence or mood as an additional benefit of the remote delivery of the intervention. Second, participants shared that the mutual support from others reduced feelings of isolation and helped to normalize feelings. Third, participants commented on the helpfulness of the accompanying workbook used to reference skills learned after the group had ended. Participants also commented that the workbook instilled confidence to cope and feelings of hopefulness. Fourth, participants spoke of the benefits to learn or consolidate skills related to fostering well being, self care, effective communication, reinforcing boundaries, and acceptance. Fifth, participants shared that they felt positively about their overall participation and wished they had engaged earlier, and some reported they might be interested in participating in similar groups in the future.
Changes over time
The authors found statistically significant improvements (i.e., decreases) in psychological distress (from 24.28 to 20.50), impact on the family member (9.97 to 4.07), overall family burden (26.01 to 19.58), (problematic) emotional coping (4.51 to 2.95), tolerant inactive coping (3.45 to 2.27), and mental health symptoms (8.07 to 6.77). There was not a significant change in quality of life from pre-test to post-test (28.77 to 30.39).
The study found that, generally, the intervention was feasible and that participants liked the intervention overall. However, it is important to note that there was not a comparison group. This means that we cannot be entirely confident that reductions in outcomes are attributable to the intervention rather than to some other cause or just the passage of time. Despite this limitation, the qualitative results suggest that participants did feel as if they benefited from their participation and found it helpful. The remote delivery of the intervention, though not without limitation, increased access to the group in ways that may have been unlikely prior to the mainstreaming of video conferencing platforms (e.g., Zoom) during the COVID-19 pandemic. Even though remote delivery increases access, there are still disparities in access to broadband internet that parallel disparities for access to healthcare more broadly. Among those that do access groups via remote delivery, some participants reported that they felt some lack of connection in support where they might have received it in person. Overall, remotely delivered interventions have increased access to resources previously unavailable, and in many cases participants are now able to choose between in person and remote delivered options.
In addition to SMART Family and Friends, there are other options available for concerned family and friends. Al Anon groups are 12-step-based family support groups that, like 12-step mutual-help group for individuals, work by providing ready access to social support and role models. Community Reinforcement and Family Training, also known as CRAFT , is a support program for concerned significant others that improves the likelihood of their loved one attending treatment by teaching how to strategically use their own behavior to selectively reinforce their loved one’s abstinence and treatment seeking behavior. Though CRAFT has the strongest track record in studies showing benefits for concerned family and friends in helping their loved one to access treatment, studies also show Al-Anon participation is likely to provide benefits. The current study suggests SMART Friends and Family is also promising, and may be a valuable addition to available tools for those concerned about their loved one’s substance use, including methamphetamines.
SMART Family and Friends was feasible to deliver, acceptable to participants, and showed potential to improve outcomes among loved ones of those who use methamphetamines. However, the current study did not include a control group, and future clinical trials should be conducted that compare SMART Family and Friends to non-intervention as well as intervention control groups.
Rushton, C. M., Kelly, P. J., Thomas, T., Beck, A. K., Townsend, C., Baker, A. L., … & Larance, B. (2024). SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another’s methamphetamine use. Journal of Substance Use and Addiction Treatment, 161. doi: 10.1016/j.josat.2024.209355
l
Approximately 0.5% of the global population use methamphetamine, with rates rising at a rapid pace in countries like the United States, New Zealand, and Australia. Although methamphetamines and other stimulants are of course harmful to individuals who use them, persistent and serious drug use may also impact loved ones in numerous ways. Some family or friends may experience direct harms from acute substance use intoxication, which can lead to an increased risk of physical or interpersonal conflict. In some cases, substance use may lead to financial or legal strain, the burden of which may fall on families. More generally, family and friends often spend substantial time and energy concerned about their loved one, which can interfere with their own functioning, increasing stress levels and depression or anxiety symptoms. Thus, family and friends of people who use substances are at an increased risk of experiencing a range of harms and often require support in coping with their own mental and physical health.
Self-Management and Recovery Training (SMART), an international mutual help recovery organization, created an eight-module manualized mutual-support group known as SMART Family and Friends, to support loved ones affected by the substance-related behavior of a close one. SMART Family and Friends complements SMART Recovery’s existing services for those attempting to reduce or abstain from substances by modifying existing evidence-based strategies used in psychotherapy, typically based in cognitive-behavioral and motivational enhancement theories. This study assessed the feasibility and initial outcomes of an 8-week SMART Family and Friends live online video meeting for people affected by another’s methamphetamine use.
The study was a single-arm pre-post feasibility study using a mixed-methods approach. This means that there was no control group, and that all family and friends who enrolled in the study were assigned to receive the intervention. While 45 individuals were enrolled in a SMART Family and Friends group (36 enrolled in an 8-week group and 9 enrolled in a 2-day group), only 19 individuals completed all 8 modules; 38 individuals completed at least half of the modules. The 8-module intervention was designed to be completed in either eight 2-hour sessions over 8 weeks, or in two 8-hour sessions over 2 days. See figure below for an overview.
Participants were recruited online via the Australian SMART Recovery website between March–October 2021. Participants were deemed eligible if they were a family member, caretaker, or supporter of a person who used methamphetamine; if they reported willingness to attend the 8 modules of the SMART Family and Friends mutual-support group; were at least 18 years of age; were an English-speaking Australian resident with capacity to provide informed consent; and had access to a device with video conferencing capability. Because the study took place between March and October of 2021 (during the COVID-19 pandemic), video conferencing services were used to deliver groups.
At the final session, group participants completed a measure assessing participant satisfaction, which asked questions like “How helpful did you find SMART overall?” and “I would recommend SMART to someone in need of similar help”. Participants were also contacted 1 week after the group ended for an interview assessing participants’ overall experience, changes to well-being and general functioning, and coping strategies. Researchers extracted themes from interviews. They also collected survey data at baseline and 1-month after the end of the sessions. In the surveys, the researchers measured psychological distress, quality of life, and family functioning. Researchers compared outcomes from pre- to post-tests.
The sample of concerned others was comprised of parents (70%), significant others (18%), other family (8%), and friends (5%). They tended to be older (28% were 35-50 and 63% were 51-75) and female (88%). The amount of time their loved ones had been using drugs overall (including but not limited to methamphetamines) varied; 25% for 1-5 years, 25% for 6-10 years, 18% for 11-15 years, and 33% for 16+ years.
Participant Satisfaction with the Group
Overall, patients rated their satisfaction at a 4.32 out of 5, suggesting high satisfaction. Nearly all (94%) of participants reported that they would recommend the group to others.
Participant Perspectives on the Intervention
Seven themes emerged from the qualitative interviews, with 5 highlighting the benefits of the intervention and 2 highlighting challenges and recommendations for changes to the group. First, participants noted the convenience and accessibility of the remotely delivered intervention, suggesting that they attended more sessions than if the group was face-to-face. Participants also commented on the flexibility to vary their level of engagement depending on their confidence or mood as an additional benefit of the remote delivery of the intervention. Second, participants shared that the mutual support from others reduced feelings of isolation and helped to normalize feelings. Third, participants commented on the helpfulness of the accompanying workbook used to reference skills learned after the group had ended. Participants also commented that the workbook instilled confidence to cope and feelings of hopefulness. Fourth, participants spoke of the benefits to learn or consolidate skills related to fostering well being, self care, effective communication, reinforcing boundaries, and acceptance. Fifth, participants shared that they felt positively about their overall participation and wished they had engaged earlier, and some reported they might be interested in participating in similar groups in the future.
Changes over time
The authors found statistically significant improvements (i.e., decreases) in psychological distress (from 24.28 to 20.50), impact on the family member (9.97 to 4.07), overall family burden (26.01 to 19.58), (problematic) emotional coping (4.51 to 2.95), tolerant inactive coping (3.45 to 2.27), and mental health symptoms (8.07 to 6.77). There was not a significant change in quality of life from pre-test to post-test (28.77 to 30.39).
The study found that, generally, the intervention was feasible and that participants liked the intervention overall. However, it is important to note that there was not a comparison group. This means that we cannot be entirely confident that reductions in outcomes are attributable to the intervention rather than to some other cause or just the passage of time. Despite this limitation, the qualitative results suggest that participants did feel as if they benefited from their participation and found it helpful. The remote delivery of the intervention, though not without limitation, increased access to the group in ways that may have been unlikely prior to the mainstreaming of video conferencing platforms (e.g., Zoom) during the COVID-19 pandemic. Even though remote delivery increases access, there are still disparities in access to broadband internet that parallel disparities for access to healthcare more broadly. Among those that do access groups via remote delivery, some participants reported that they felt some lack of connection in support where they might have received it in person. Overall, remotely delivered interventions have increased access to resources previously unavailable, and in many cases participants are now able to choose between in person and remote delivered options.
In addition to SMART Family and Friends, there are other options available for concerned family and friends. Al Anon groups are 12-step-based family support groups that, like 12-step mutual-help group for individuals, work by providing ready access to social support and role models. Community Reinforcement and Family Training, also known as CRAFT , is a support program for concerned significant others that improves the likelihood of their loved one attending treatment by teaching how to strategically use their own behavior to selectively reinforce their loved one’s abstinence and treatment seeking behavior. Though CRAFT has the strongest track record in studies showing benefits for concerned family and friends in helping their loved one to access treatment, studies also show Al-Anon participation is likely to provide benefits. The current study suggests SMART Friends and Family is also promising, and may be a valuable addition to available tools for those concerned about their loved one’s substance use, including methamphetamines.
SMART Family and Friends was feasible to deliver, acceptable to participants, and showed potential to improve outcomes among loved ones of those who use methamphetamines. However, the current study did not include a control group, and future clinical trials should be conducted that compare SMART Family and Friends to non-intervention as well as intervention control groups.
Rushton, C. M., Kelly, P. J., Thomas, T., Beck, A. K., Townsend, C., Baker, A. L., … & Larance, B. (2024). SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another’s methamphetamine use. Journal of Substance Use and Addiction Treatment, 161. doi: 10.1016/j.josat.2024.209355
l
Approximately 0.5% of the global population use methamphetamine, with rates rising at a rapid pace in countries like the United States, New Zealand, and Australia. Although methamphetamines and other stimulants are of course harmful to individuals who use them, persistent and serious drug use may also impact loved ones in numerous ways. Some family or friends may experience direct harms from acute substance use intoxication, which can lead to an increased risk of physical or interpersonal conflict. In some cases, substance use may lead to financial or legal strain, the burden of which may fall on families. More generally, family and friends often spend substantial time and energy concerned about their loved one, which can interfere with their own functioning, increasing stress levels and depression or anxiety symptoms. Thus, family and friends of people who use substances are at an increased risk of experiencing a range of harms and often require support in coping with their own mental and physical health.
Self-Management and Recovery Training (SMART), an international mutual help recovery organization, created an eight-module manualized mutual-support group known as SMART Family and Friends, to support loved ones affected by the substance-related behavior of a close one. SMART Family and Friends complements SMART Recovery’s existing services for those attempting to reduce or abstain from substances by modifying existing evidence-based strategies used in psychotherapy, typically based in cognitive-behavioral and motivational enhancement theories. This study assessed the feasibility and initial outcomes of an 8-week SMART Family and Friends live online video meeting for people affected by another’s methamphetamine use.
The study was a single-arm pre-post feasibility study using a mixed-methods approach. This means that there was no control group, and that all family and friends who enrolled in the study were assigned to receive the intervention. While 45 individuals were enrolled in a SMART Family and Friends group (36 enrolled in an 8-week group and 9 enrolled in a 2-day group), only 19 individuals completed all 8 modules; 38 individuals completed at least half of the modules. The 8-module intervention was designed to be completed in either eight 2-hour sessions over 8 weeks, or in two 8-hour sessions over 2 days. See figure below for an overview.
Participants were recruited online via the Australian SMART Recovery website between March–October 2021. Participants were deemed eligible if they were a family member, caretaker, or supporter of a person who used methamphetamine; if they reported willingness to attend the 8 modules of the SMART Family and Friends mutual-support group; were at least 18 years of age; were an English-speaking Australian resident with capacity to provide informed consent; and had access to a device with video conferencing capability. Because the study took place between March and October of 2021 (during the COVID-19 pandemic), video conferencing services were used to deliver groups.
At the final session, group participants completed a measure assessing participant satisfaction, which asked questions like “How helpful did you find SMART overall?” and “I would recommend SMART to someone in need of similar help”. Participants were also contacted 1 week after the group ended for an interview assessing participants’ overall experience, changes to well-being and general functioning, and coping strategies. Researchers extracted themes from interviews. They also collected survey data at baseline and 1-month after the end of the sessions. In the surveys, the researchers measured psychological distress, quality of life, and family functioning. Researchers compared outcomes from pre- to post-tests.
The sample of concerned others was comprised of parents (70%), significant others (18%), other family (8%), and friends (5%). They tended to be older (28% were 35-50 and 63% were 51-75) and female (88%). The amount of time their loved ones had been using drugs overall (including but not limited to methamphetamines) varied; 25% for 1-5 years, 25% for 6-10 years, 18% for 11-15 years, and 33% for 16+ years.
Participant Satisfaction with the Group
Overall, patients rated their satisfaction at a 4.32 out of 5, suggesting high satisfaction. Nearly all (94%) of participants reported that they would recommend the group to others.
Participant Perspectives on the Intervention
Seven themes emerged from the qualitative interviews, with 5 highlighting the benefits of the intervention and 2 highlighting challenges and recommendations for changes to the group. First, participants noted the convenience and accessibility of the remotely delivered intervention, suggesting that they attended more sessions than if the group was face-to-face. Participants also commented on the flexibility to vary their level of engagement depending on their confidence or mood as an additional benefit of the remote delivery of the intervention. Second, participants shared that the mutual support from others reduced feelings of isolation and helped to normalize feelings. Third, participants commented on the helpfulness of the accompanying workbook used to reference skills learned after the group had ended. Participants also commented that the workbook instilled confidence to cope and feelings of hopefulness. Fourth, participants spoke of the benefits to learn or consolidate skills related to fostering well being, self care, effective communication, reinforcing boundaries, and acceptance. Fifth, participants shared that they felt positively about their overall participation and wished they had engaged earlier, and some reported they might be interested in participating in similar groups in the future.
Changes over time
The authors found statistically significant improvements (i.e., decreases) in psychological distress (from 24.28 to 20.50), impact on the family member (9.97 to 4.07), overall family burden (26.01 to 19.58), (problematic) emotional coping (4.51 to 2.95), tolerant inactive coping (3.45 to 2.27), and mental health symptoms (8.07 to 6.77). There was not a significant change in quality of life from pre-test to post-test (28.77 to 30.39).
The study found that, generally, the intervention was feasible and that participants liked the intervention overall. However, it is important to note that there was not a comparison group. This means that we cannot be entirely confident that reductions in outcomes are attributable to the intervention rather than to some other cause or just the passage of time. Despite this limitation, the qualitative results suggest that participants did feel as if they benefited from their participation and found it helpful. The remote delivery of the intervention, though not without limitation, increased access to the group in ways that may have been unlikely prior to the mainstreaming of video conferencing platforms (e.g., Zoom) during the COVID-19 pandemic. Even though remote delivery increases access, there are still disparities in access to broadband internet that parallel disparities for access to healthcare more broadly. Among those that do access groups via remote delivery, some participants reported that they felt some lack of connection in support where they might have received it in person. Overall, remotely delivered interventions have increased access to resources previously unavailable, and in many cases participants are now able to choose between in person and remote delivered options.
In addition to SMART Family and Friends, there are other options available for concerned family and friends. Al Anon groups are 12-step-based family support groups that, like 12-step mutual-help group for individuals, work by providing ready access to social support and role models. Community Reinforcement and Family Training, also known as CRAFT , is a support program for concerned significant others that improves the likelihood of their loved one attending treatment by teaching how to strategically use their own behavior to selectively reinforce their loved one’s abstinence and treatment seeking behavior. Though CRAFT has the strongest track record in studies showing benefits for concerned family and friends in helping their loved one to access treatment, studies also show Al-Anon participation is likely to provide benefits. The current study suggests SMART Friends and Family is also promising, and may be a valuable addition to available tools for those concerned about their loved one’s substance use, including methamphetamines.
SMART Family and Friends was feasible to deliver, acceptable to participants, and showed potential to improve outcomes among loved ones of those who use methamphetamines. However, the current study did not include a control group, and future clinical trials should be conducted that compare SMART Family and Friends to non-intervention as well as intervention control groups.
Rushton, C. M., Kelly, P. J., Thomas, T., Beck, A. K., Townsend, C., Baker, A. L., … & Larance, B. (2024). SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another’s methamphetamine use. Journal of Substance Use and Addiction Treatment, 161. doi: 10.1016/j.josat.2024.209355
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