Involving families in substance use treatment has long been considered beneficial, but the substance use disorder industry’s oncoming shift to value-based care may make them indispensable. 

Family programming can decrease the chances of relapse and provide a common language for family members to communicate about addiction, but most payers do not cover these services. Still, some providers offer free-of-charge family programming to bolster outcomes and drive value.

“Addiction is a family disease – it doesn’t just impact the individual,” Erin Goodhart, executive director of core programming and family services lead at Caron Pennsylvania, told Addiction Treatment Business in an email. “Families need to focus on their own recovery, which is why Caron provides a variety of family services.”

Wernersville, Pennsylvania-based Caron is a nonprofit organization offering a complete continuum of care for young adults, women, men and older adults in Pennsylvania, Florida, Washington, D.C., Georgia and New York. Caron also operates a research center that explores novel biomedical treatments for addiction.

Many SUD providers offer some type of family programming, but the extent and variety of services vary.

Caron offers various types of family services at its different locations, including education, counseling, three-day family workshops, and clinical visits with family members. In one offering, a family member lives with the patient and is fully immersed in the treatment process.

Serenity Lane, an Oregon-based SUD provider, offers family services including in-person visits on weekends, moderated discussions and education. Counselors also make “SO calls,” regularly updating the most involved person in the patient’s recovery to ensure clarity.

“You get to triangulate towards the reality of what’s going on at home,” Chris Harrington, clinical director of residential inpatient program at Serenity Lane, told ATB. “If we don’t consult the home that they’re going into, we might send them back to something that the family still not has not worked through.”

Serenity Lane is a private nonprofit SUD provider co-founded in 1973. The organization’s offerings include detox services, inpatient and outpatient treatment, a partial hospitalization program (PHP), an intensive outpatient program (IOP) and medication-assisted treatment (MAT).

Serenity Lane operates a 15-acre residential facility for up to 96 people and seven outpatient offices in Oregon.

Family services do not always involve biological family members and can include friends, colleagues or other members of a patient’s support system.

Not all patients wish to participate in family programming at Serenity Lane, Harrington said. Clinicians use motivational interviewing to encourage patients to do so, and peers will often recommend the program.

Getting family involved early can be crucial, according to Bruce Dechert, the director of family wellness at Mountainside Treatment Center.

Canaan, Connecticut-based Mountainside offers holistic addiction treatment with detox, residential, extended care, outpatient and virtual services, recovery coaching and adolescent services along with its family-focused programming.

Mountainside operates six locations in Connecticut, New Jersey and New York.

Family members are often contacted during the admissions process, Dechert said. Clinicians contact family members over the phone to explain family services as early as the first week of treatment.

The provider offers multiple support groups, family recovery coaches and outpatient virtual services consisting of individual and group therapy.

“What we’re trying to do in this process is to engage families in their support so that they can begin to understand not only what addiction is and isn’t, but what has happened in the process of getting people into treatment and what recovery can look like,” Dechert said.

How (and if) to bill

Serenity Lane, which operates on a daily rate for residential and hospital patients and on a fee-for-service basis for other services, does not bill for its family services.

“It’s over and above what we bill for,” Pete Kerns, CEO of Serenity Lane, told ATB. “If we could bill for it I don’t actually know if we would. We have found that it’s extremely beneficial and critical to the success people experience after they leave treatment.”

Most of Mountainside’s family services are also free, including its virtual support groups. Family members interested in the provider’s outpatient services, like individual therapy, use their own insurance to pay for treatment.

Some insurers do cover family services, Goodhart said. Caron’s family education programming is included in the company’s residential, PHP and IOP programs, including programs covered by insurance, and family therapy is included in its signature program.

Some of Caron’s other family offerings have fees. The provider offers online webinars, 12-step series and mutual support groups free of charge.

New criteria from the American Society of Addiction Medicine (ASAM) may increase providers’ ability to bill for services like family programming.

ASAM’s fourth edition criteria focused on holistic and patient-centered care for SUD treatment, encouraging providers to consider each patient’s preferences and social determinants of health. Caron leadership said they are hopeful that the new criteria will encourage payers to cover family services.

Benefits of family services

Research has demonstrated that family involvement in addiction treatment is beneficial for both patients receiving SUD treatment and their families. Family programs were found to decrease distress and the chance of relapse for people with SUDs while improving family function and coping skills for their family members.

Providers recognize additional benefits, including creating a shared language of recovery, reducing shame and creating a framework for the family to recover.

“The potential for recovery is far greater, because they’re both on the same page,” Kerns said. “When they left home, that family that household was unwittingly contributing to their substance use disorder. And now there’s a possibility that a home can [help] sustain their recovery for a lifetime ideally.”

Serenity Lane had to suspend its family programming during the COVID-19 pandemic. Harrington, who joined the company during this period, noted a pronounced difference in the organization’s patients with and without the family component.

“Most people really look forward to the weekends,” Harrington said. “I think it provides a sense of validation for our patients because the family, although it doesn’t excuse their behaviors, they understand them more.”

Operating a comprehensive family programming offering may be key to maximizing the clinical benefits. Some families may need more than one treatment option to meet their specific needs, according to one review of 95 relevant studies. The review also suggested that SUD providers need additional training on providing family-focused care and adapting interventions to diverse populations and cultures.

Family services as part of a value-based future

Services like family programming could become increasingly essential for SUD treatment providers as the industry looks toward alternative payment models, including bundled arrangements and value-based care agreements.

Caron previously told Behavioral Health Business that it has been fully embracing the shift to value-based care and focusing on driving value into its practices. The company measures care engagement, a common practice within value-based care, including within family services.

The shift away from fee-for-service models is “inevitable,” Kerns said. Serenity Lane is working to prepare itself as insurers move toward outcome-based models.

“Down the road, our contracts are going to change. Healthcare is changing,” he said. “No question about it, if we really want to improve outcomes, the family’s got to have a role.”

Beyond adding value to payers, family programs may expand providers’ patient pools. Family services amplify Mountainside’s word-of-mouth promotion and often lead to alumni referrals, Dechert said.

“We get people showing up to our support groups who have never been involved in Mountainside, but have heard about it, and by doing that, they then sometimes get their loved ones engaged in our treatment services, which would … obviously benefit our business model,” Dechert said.

Offering some type of family service is relatively common across the SUD industry, but the extent of the programming varies, and families must ensure that the education they receive from the provider aligns with what their family member who is receiving treatment is learning, Goodhart said.

“I think everyone has known for 50, 60 years that having families involved is important,” Dechart said.

Providers just need to hammer out the best ways to incorporate families into care, he said.