Family members’ perspectives of laws, policies and practices in substance use disorders treatment: a qualitative exploration of seeking help for concurrent disorders

Despite the high prevalence of co-occurring mental and substance use disorders, family perspectives and experiences with accessing care for affected family members remain underexplored. This qualitative study, using participatory action research principles, aimed to examine family members’ perspectives and experiences in accessing help and navigating care systems for individuals living with concurrent disorders in Canada. We conducted semi-structured in-depth interviews with 87 family members between February and August 2024. The data analysis team, inclusive of members of the community organization Families for Addiction Recovery, used thematic analysis to identify overarching themes that capture participants’ perspectives on and experiences with accessing care for concurrent disorders in Canada, including clinical practices and organizational contexts. We identified five themes in participant narratives: (1) An early start to mental health difficulties; (2) Accessing help for concurrent disorders: person and system level barriers; (3) When every door is the wrong door; (4) The elusive diagnosis; and (5) Searching for hope. Affected family members invariably described unsuccessful efforts to get timely and appropriate help, and experiences of powerlessness and disillusionment as the difficulty accessing and navigating services was matched by diagnostic confusion, and dismissal in healthcare encounters. Family members were nonetheless able to reflect on areas for advocacy and change. Findings underscore the importance of early recognition of mental health and substance use health difficulties, and the urgency of training and capacity building to deliver evidence-supported integrated mental and substance use health care across health care settings in Canada.