Skip to main content
Log in

Assessing Feasibility and Barriers to Implementing a Family-Based Intervention in Opioid Treatment Programs

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Families Facing the Future (FFF) is an intervention designed specifically for families with a parent in methadone treatment. FFF is unique because it addresses prevention for children and recovery for parents in a single intervention. The primary goals of the program are to prevent parents’ relapse, help them cope with relapse if it occurs, and teach parenting skills in order to reduce the likelihood of substance use among their children. FFF has been implemented as an adjunct to treatment in several Opioid Treatment Programs, but has not been widely adopted due to various implementation barriers. The aims of this study, therefore, were to (1) assess the perceived feasibility of implementing FFF and (2) identify/describe barriers to implementing FFF. An online survey was used to assess implementation feasibility, while individual qualitative interviews were conducted to explore specific barriers to implementation. Data collection from a total of 40 participants (20 patients and 20 providers) was conducted from August 2022 to October 2022 at two Opioid Treatment Programs in Florida. Analyses revealed high feasibility scores, indicating that FFF was viewed by both patients and providers as a practical intervention to implement. Despite strong perceived feasibility of the intervention, qualitative findings identified several implementation barriers with respect to difficulty attending parent training sessions, aversion to in-home visits, and lack of funding (inability to provide patient incentives/bill insurance). This study provides evidence that while patients and providers view FFF as having high feasibility, significant implementation barriers exist. This paper fills a void in the literature by informing if and which modifications might be necessary to facilitate wider adoption of FFF in real-world Opioid Treatment Program settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References

  1. Solis JM, Shadur JM, Burns AR, et al. Understanding the diverse needs of children whose parents abuse substances. Current Drug Abuse Reviews 2012;5(2):135–47. Available at: https://www.ingentaconnect.com/content/ben/cdar/2012/00000005/00000002/art00006. Accessed 21 August, 2023.

  2. Feder KA, Ali MM, Sherman LJ, et al. Elevated prevalence of antisocial behavior in adolescent children whose mothers misuse opioids. Drug and Alcohol Dependence 2020;215:108153. Available at: https://doi.org/10.1016/j.drugalcdep.2020.108153. Accessed 21 August, 2023.

  3. Milaney K, Passi J, Zaretsky L, et al. Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services. Harm Reduction Journal 2021;18(1):1–0. Available at: https://doi.org/10.1186/s12954-021-00539-8. Accessed 21 August, 2023.

  4. Szalavitz M, Rigg KK. The curious (dis) connection between the opioid epidemic and crime. Subst Use Misuse. 2017 Dec 6;52(14):1927–31. Available at: https://doi.org/10.1080/10826084.2017.1376685. Accessed 21 August, 2023.

  5. Rigg KK, DeCamp W. Explaining prescription opioid misuse among veterans: A theory-based analysis using structural equation modeling. Mil Behav Health. 2014 Apr 3;2(2):210–16. Available at: https://doi.org/10.1080/21635781.2014.917011. Accessed 21 August, 2023.

  6. Naji L, Dennis BB, Bawor M, et al. A prospective study to investigate predictors of relapse among patients with opioid use disorder treated with methadone. Substance Abuse: Research and Treatment 2016;10:SART-37030. Available at: https://doi.org/10.4137/SART.S37030. Accessed 21 August, 2023.

  7. Rigg KK, McLean K, Monnat SM, Sterner III GE, Verdery AM. Opioid misuse initiation: implications for intervention. J Addict Dis. 2018 Oct 2;37(3–4):111–22. Available at: https://doi.org/10.1080/10550887.2019.1609336. Accessed 21 August, 2023.

  8. Kumpfer KL, Alvarado R, Whiteside HO. Family-based interventions for substance use and misuse prevention. Substance use & misuse. 2003 Jan 1;38(11–13):1759–87. Available at: https://doi.org/10.1081/JA-120024240. Accessed 3 October, 2023

  9. Dawe S, Harnett PH, Staiger P, et al. Parent training skills and methadone maintenance: clinical opportunities and challenges. Drug and Alcohol Dependence. 2000 Jul 1;60(1):1–1. Available at: https://doi.org/10.1016/S0376-8716(00)80002-2. Accessed 3 October, 2023

  10. Catalano RF, Haggerty KP, Gainey RR. Prevention approaches in methadone treatment settings: Children of drug abuse treatment clients. In: Tims FM, Leukefeld CG, Platt JJ, editors. Handbook of Drug Abuse Prevention. Boston, MA: Springer 2006:173–96. Available at: https://doi.org/10.1007/0-387-35408-5_9. Accessed 21 August, 2023.

  11. Title IV-E Clearinghouse: Families Facing the Future [Internet]. HHS.gov. 2019 [cited 2023 Jun 14]. Available from: https://preventionservices.acf.hhs.gov/programs/207/show#:~:text=FFF%20is%20rated%20as%20a. Accessed 3 October, 2023.

  12. Haggerty KP, Skinner M, Fleming CB, et al. Long‐term effects of the Focus on Families project on substance use disorders among children of parents in methadone treatment. Addiction. 2008 Dec;103(12):2008–16. Available at: https://doi.org/10.1111/j.1360-0443.2008.02360.x. Accessed 3 October, 2023

  13. Catalano RF, Haggerty KP, Fleming CB, et al. Focus on Families: Integration of relapse prevention and child drug abuse prevention training with parents in methadone treatment. In: Monti PM, Colby SM, O'Leary TA, editors. Therapist's Guide to Evidence-Based Relapse Prevention. Seattle, WA: Academic Press 2007:237–257. Available at: https://doi.org/10.1016/B978-012369429-4/50041-0. Accessed 21 August, 2023.

  14. Catalano RF, Gainey RR, Fleming CB, et al. An experimental intervention with families of substance abusers: One‐year follow‐up of the focus on families project. Addiction 1999;94(2):241–54. Available at: https://doi.org/10.1046/j.1360-0443.1999.9422418.x. Accessed 21 August, 2023.

  15. Catalano RF, Haggerty KP, Gainey RR, et al. Reducing parental risk factors for children's substance misuse: Preliminary outcomes with opiate-addicted parents. Substance Use & Misuse 1997;32(6):699–721. Available at: https://doi.org/10.3109/10826089709039371 Accessed 21 August, 2023.

  16. Catalano RF, Haggerty KP, Fleming CB, et al. Children of substance abusing parents: Current findings from the Focus on Families project. In: McMahon RJ, Peters RDV, (Eds.) The Effects of Parental Dysfunction on Children. NY: Kluwer Academic Press/Plenum Publishers; 2002: 179–204. Available at: https://link.springer.com/chapter/https://doi.org/10.1007/978-1-4615-1739-9_9 Accessed 21 August, 2023

  17. Pasman E, Kollin R, Broman M, Lee G, et al. Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities. Addiction Science & Clinical Practice 2022;17(1):35. Available at: https://doi.org/10.1186/s13722-022-00316-3. Accessed 21 August, 2023.

  18. Rosen D, Smith ML, Reynolds III CF. The prevalence of mental and physical health disorders among older methadone patients. American Journal of Geriatric Psychiatry 2008;16(6):488–97. Available at: https://doi.org/10.1097/JGP.0b013e31816ff35a. Accessed 21 August, 2023.

  19. Glenn MC, Sohler NL, Starrels JL, et al. Characteristics of methadone maintenance treatment patients prescribed opioid analgesics. Substance Abuse 2016;37(3):387–91. Available at: https://doi.org/10.1080/08897077.2015.1135225. Accessed 21 August, 2023.

  20. Phillips J, Carpenter KM, Nunes EV. Suicide risk in depressed methadone-maintained patients: associations with clinical and demographic characteristics. The American Journal on Addictions 2004;13(4):327–32. Available at: https://doi.org/10.1080/10550490490482973. Accessed 21 August, 2023.

  21. Odegaard KE, Pendyala G, Yelamanchili SV. Generational effects of opioid exposure. Encyclopedia. 2021 Jan 18;1(1):99–114. Available at: https://doi.org/10.3390/encyclopedia1010012. Accessed 3 October, 2023.

  22. Ahammer A, Halla M. The intergenerational persistence of opioid dependence: Evidence from administrative data. Health Economics. 2022 Nov;31(11):2425–44. Available at: https://doi.org/10.1002/hec.4589. Accessed 3 October 2023.

  23. Smith JC, Alderman L, Attell BK, et al. Dynamics of parental opioid use and children's health and well-being: An integrative systems mapping approach. Frontiers in psychology. 2021:2402. Available at: https://doi.org/10.3389/fpsyg.2021.687641. Accessed 3 October, 2023

  24. Liddle HA. Family‐based therapies for adolescent alcohol and drug use: Research contributions and future research needs. Addiction. 2004 Nov;99:76-92. Available at: https://doi.org/10.1111/j.1360-0443.2004.00856.x. Accessed 3 October, 2023

  25. Austin AM, Macgowan MJ, Wagner EF. Effective family-based interventions for adolescents with substance use problems: A systematic review. Research on social work practice. 2005 Mar;15(2):67–83. Available at: https://doi.org/10.1177/1049731504271606. Accessed 3 October, 2023

  26. Copello AG, Velleman RD, Templeton LJ. Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review. 2005 Jul;24(4):369–85. Available at: https://doi.org/10.1080/09595230500302356. Accessed 3 October, 2023.

  27. Rigg KK, Murphy JW. Storylines as a neglected tool for mental health service providers and researchers. International Journal of Mental Health & Addiction. 2013 Jan;11: 431–440. Available at: https://doi.org/10.1007/s11469-012-9426-x. Accessed 3 October, 2023.

  28. Rigg KK, Cook, HH, Murphy, JW. Expanding the scope and relevance of health interventions: Moving beyond clinical trials and behavior change models. International Journal of Qualitative Studies on Health and Well-Being. 2014 Jul; 9(1): 24743. Available at: https://doi.org/10.3402/qhw.v9.24743. Accessed 3 October, 2023.

  29. Creswell JW. A concise introduction to mixed methods research. SAGE Publications, 2021. Available at: https://books.google.com/books?hl=en&lr=&id=xLU6EAAAQBAJ&oi=fnd&pg=PP1&dq=29. Accessed 3 October 2023.

  30. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: About the Survey. U.S. Department of Health & Human Services. Available at: https://nsduhweb.rti.org/respweb/about_nsduh.html. Accessed 3 October, 2023.

  31. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: Summary of Methodological Studies, 1971–2014. Rockville, MD: Substance Abuse and Mental Health Services Administration (US), 2014. Available at: https://www.ncbi.nlm.nih.gov/books/NBK519735/. Accessed 21 August, 2023.

  32. Substance Abuse and Mental Health Services Administration. Reliability of Key Measures in the National Survey on Drug Use and Health. Office of Applied Studies, Methodology Series M-8, HHS Publication No. SMA 09–4425, Rockville, MD: Center for Behavioral Health Statistics and Quality. Available at: https://www.ncbi.nlm.nih.gov/books/NBK519794/. Accessed 3 October, 2023.

  33. Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implementation Science 2017;12. Available at: https://doi.org/10.1186/s13012-017-0635-3. Accessed 21 August 2023.

  34. Lofland J, Snow D, Anderson L, et al. Analyzing social settings: A guide to qualitative observation and analysis. Long Grove, IL: Waveland Press, 2022. Available at: https://books.google.com/books?id=976ZEAAAQBAJ&printsec. Accessed 3 October, 2023.

  35. Snow J, Mann M. Qualtrics survey software: Handbook for research professionals. Qualtrics Labs, Inc., 2012. Available at: https://books.google.com/books/about/Qualtrics_Survey_Software.html?id=Nhq5NAEACAAJ. Accessed 3 October, 2023.

  36. Campbell KA, Orr E, Durepos P, et al. Reflexive thematic analysis for applied qualitative health research. The Qualitative Report 2021;26(6):2011–2028. Available at: https://doi.org/10.46743/2160-3715/2021.5010. Accessed 21 August 2023.

  37. Edhlund BM, Mcdougall AG. NVivo 12 essentials: your guide to the world’s most powerful data analysis software. Stallarholmen, Sweden: Form & Kunskap AB, 2019. Available at: https://books.google.com/books?id=DiWGDwAAQBAJ&printsec=frontcover#v=onepage&q&f=false. Accessed 21 August, 2023.

  38. Oesterle TS, Kolla B, Risma CJ, et al. Substance use disorders and telehealth in the COVID-19 pandemic era: a new outlook. Mayo Clinic Proceedings 2020;95(12):2709–2718. Available at: https://doi.org/10.1016/j.mayocp.2020.10.011. Accessed 21 August 2023.

  39. Mark TL, Treiman K, Padwa H, et al. Addiction treatment and telehealth: review of efficacy and provider insights during the COVID-19 pandemic. Psychiatric Services 2022;73(5):484–491. Available at: https://doi.org/10.1176/appi.ps.202100088. Accessed 21 August 2023.

  40. Knopf A. Addiction telemedicine comes into its own with COVID‐19. Alcoholism & Drug Abuse Weekly 2020;32(13):5–6. Available at: https://doi.org/10.1002/adaw.32673. Accessed 21 August 2023.

  41. Azzi‐Lessing L. Serving highly vulnerable families in home‐visitation programs. Infant Mental Health Journal 2013;34(5):376–390. Available at: https://doi.org/10.1002/imhj.21399. Accessed 21 August 2023.

  42. Gruber KJ, Fleetwood TW. In-home continuing care services for substance use affected families. Substance Use and Misuse 2004;39(9):1379–1403. Available at: https://doi.org/10.1081/JA-120039395. Accessed 21 August 2023.

  43. Hiratsuka VY, Parker ME, Sanchez J, et al. Cultural adaptations of evidence‐based home‐visitation models in tribal communities. Infant Mental Health Journal 2018;39(3):265–275. Available at: https://doi.org/10.1002/imhj.21708. Accessed 21 August 2023.

  44. Husebø AM, Storm M. Virtual visits in home health care for older adults. The Scientific World Journal 2014:1–11. Available at: https://doi.org/10.1155/2014/689873. Accessed 21 August 2023.

  45. Marsch LA, Guarino H, Acosta M, et al. Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. Journal of Substance Abuse Treatment 2014;46(1):43–51. Available at: https://doi.org/10.1016/j.jsat.2013.08.012. Accessed 21 August 2023.

  46. Young LB. Telemedicine interventions for substance-use disorder: a literature review. Journal of Telemedicine and Telecare 2012;18(1):47–53. Available at: https://doi.org/10.1258/jtt.2011.110608. Accessed 21 August 2023.

  47. Malotte CK, Hollingshead JR, Rhodes F. Monetary versus nonmonetary incentives for TB skin test reading among drug users. American Journal of Preventive Medicine 1999;16(3):182–188. Available at: https://doi.org/10.1016/S0749-3797(98)00093-2. Accessed 21 August 2023.

  48. Meredith SE, Jarvis BP, Raiff BR, et al. The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. Psychology Research and Behavior Management 2014:103–114. Available at: https://doi.org/10.2147/PRBM.S59792. Accessed 21 August 2023.

  49. Peles E, Schreiber S, Sason A, et al. Earning “take-home” privileges and long-term outcome in a methadone maintenance treatment program. Journal of Addiction Medicine 2011;5(2):92–98. Available at: https://doi.org/10.1097/ADM.0b013e3181e6ad48. Accessed 21 August 2023.

  50. Stitzer M, Bigelow G, Lawrence C, et al. Medication take-home as a reinforcer in a methadone maintenance program. Addictive Behaviors 1977;2(1):9–14. Available at: https://doi.org/10.1016/0306-4603(77)90003-X. Accessed 21 August 2023.

  51. Stitzer ML, Iguchi MY, Felch LJ. Contingent take-home incentive: effects on drug use of methadone maintenance patients. Journal of Consulting and Clinical Psychology 1992;60(6):927. Available at: https://doi.org/10.1037/0022-006X.60.6.927. Accessed 21 August 2023.

  52. Peles E, Schreiber S, Domany Y, et al. Achievement of take-home dose privileges is associated with better-perceived sleep and with cognitive status among methadone maintenance treatment patients. The World Journal of Biological Psychiatry 2014;15(8):620–628. Available at: https://doi.org/10.3109/15622975.2014.897003. Accessed 21 August 2023.

Download references

Funding

This study was funded by a grant from the Foundation for Opioid Response Efforts.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khary K. Rigg PhD.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Foundation for Opioid Response Efforts.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rigg, K.K., Proctor, S.L., Kusiak, E.S. et al. Assessing Feasibility and Barriers to Implementing a Family-Based Intervention in Opioid Treatment Programs. J Behav Health Serv Res 51, 151–163 (2024). https://doi.org/10.1007/s11414-023-09873-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-023-09873-0

Navigation