“Everything that I thought that they would be, they weren’t:” Family systems as support and impediment to recovery

Family help provision for adults diagnosed with co-occurring severe mental illness and substance dependence is understudied. This article draws on verbally-administered structured and semi-structured interviews with one group of 122 behavioral health care clients and one group of 54 client-nominated family members. In New Mexico, USA, these were collected as part of a larger, long-term study. We examine the latter’s concerns and fears, relative desire to be involved with treatment, and difficulties connecting with professionals, as well as forms of assistance they gave to clients and intra-family communication. We found that family members’ actions and communications often support client recovery through resource provision and other, intangible forms of help. However, their misunderstandings of and lack of knowledge about client experiences can also impede recovery. We also compare the two groups of interviewees’ perspectives on assistance given to clients by family members. We give examples of family attempts to deliver help and their consequences. Last, we offer suggestions for providers and policymakers to better help family members achieve their goal of caring for clients in recovery.

► Family support is provided actively and passively, and directly and indirectly.
► Family members’ lack of information can lead them to unintentionally impede recovery.
► Key impediments are loss of trust, lack of knowledge, and misunderstandings.
► Family members were rarely included in treatment or provided supports.
► Agencies saying they want family participation laid all responsibility on clients.