Investigating the role of interpersonal relationships on low-income SUD patients’ recovery: a qualitative analysis of various stakeholders in New York state

Abstract

Background

While positive impacts of recovery capital and social capital in facilitating substance use disorder (SUD) recovery is increasingly documented, research has shown that low-income and marginalized individuals have lower social capital and may rely on different networks. A more comprehensive approach is needed to understand the social capital of low-income individuals with SUD and how these relationships impact their treatment and recovery.

Methods

Qualitative data were gathered through semi-structured interviews and analyzed employing thematic analysis. Participants included individuals with SUD (n = 10), clinicians (n = 12), and policy leaders (n = 13).

Results

Three themes emerged: 1) Patients’ positive and negative interpersonal relationships with friends and family influenced decisions to seek treatment; 2) strong patient-provider relationships, often defined by the quality of SUD providers and treatment settings, were perceived as crucial for staying in treatment; and 3) justice involvement facilitated treatment access yet deteriorated treatment engagement. Themes emphasized social and structural factors that inhibit patients from fostering support and treatment engagement.

Conclusions

Our study underscores the importance of interpersonal relationships in SUD treatment-seeking and recovery and the need for positive interactions across the care continuum within broader social networks. Opportunities for positive interpersonal relationships include increasing access to language-concordant treatment; provider training to enhance cultural humility and patient-provider relationships; and mechanisms that improve interpersonal relationships between patients, parole officers, and other justice system members. Accentuating the role of interpersonal relationships and expanding social support interventions can pave the way for structural changes that improve recovery by harnessing different types of social capital.

Keywords:

• Social support
• substance use
• disparities
• recovery capital
• stakeholder engagement

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health/National Institute of Drug Abuse; grant number R01DA044526 (Alegria PI).

Notes on contributors

Nusrath Jahan

Nusrath Jahan is a medical student at the Tufts University School of Medicine. She is interested in examining disparities across the healthcare continuum and exploring systemic changes to address these inequities. She is committed to increasing healthcare access and improving health equity for marginalized populations.

Neerav Gade

Neerav Gade is a research associate at Mathematica Policy Research. He is passionate about exploring the intersections between health disparities and individuals’ built and social environments, especially related to housing, food systems, and insurance access. He is interested in evidence- and community-based research and policy levers to promote health equity.

Jenny Zhen-Duan

Jenny Zhen-Duan, PhD is an instructor at Harvard Medical School and a researcher and psychologist at Massachusetts General Hospital. Her current work focuses on examining the biological mechanisms (i.e., epigenetic, neuroendocrine) linking traumatic stressors and substance use among Latinx adolescents.

Marie Fukuda

Marie Fukuda is a project coordinator at the Disparities Research Unit at Massachusetts General Hospital. Her interests range from arts to social justice and open space and community advocacy with a focus on the empowerment of communities through civic engagement.

Rodolfo Estrada

Rodolfo Estrada is a medical student at the Warren Alpert Medical School of Brown University, interested in systemic approaches to improving health care access and quality for marginalized populations. He is especially interested in patient-centered changes and integrated, longitudinal services.

Margarita Alegría

Margarita Alegría, PhD is a professor in the Departments of Medicine and Psychiatry at Harvard Medical School and Chief of the Disparities Research Unit at Massachusetts General Hospital. Her research focuses on improving health care services for diverse racial/ethnic populations and strategies to integrate community perspectives into health services.