Role of Family and Social Network Support in Mental Health


When people who abuse alcohol and other substances coupled with those who have mental problems are placed on the treatment, they find themselves spending a lot of time with social health workers and their families. The significance of social network support and families in the recovery process becomes apparent upon noting that research has provided strong evidence that families and social network personnel can tremendously enhance the recovery process of drug addicts and people inflicted by mental health challenges. Among the youth in the UK, substance abuse has been linked with mental health (Ashenberg, 2001: Meltzeret et al. 2003: Fife, McCreary, Brewer & Adegoke 2011: Sheidow, McCart, Zajac & Davis 2012). Based on the evidence of the ability of social network support services in facilitating the recovery process of substance abusers, effort has been made in the UK to put in place social care responses to substance-addicted patients (Forrester et al. 2008, p.411). One of such initiatives is the effort of Scotland to enhance social care practice for families and children who are influenced by their parents’ engagement in substance abuse through the enactment of various policy documents coupled with a myriad of consultations (Scottish Executive 2001). A standing committee on misuse of substance was also formed in Scotland within the Association of Directors of Social Work. This committee made a clear statement that it endeavoured to improve the profiles of social workers in the alcohol and drug fields while working closely with Alcohol and Drugs Partnerships (ADPs) to facilitate enactment of a strategy that would help in enhancing social network partnership that would enhance the recovery process of substance abusers (ADSW 2010). In this effort, the roles of families in the recovery process for patients were excluded. This research literature review seeks to examine how families and social network support can interact to influence the recovery process of substance abusers- this condition being a risk factor for mental health problems.


Peers and families play pivotal roles in enhancing the recovery of substance abuse and mental health patients. Most of the patients responding better to medicinal interventions also have better emotional support from their families coupled with informational support from their recovered peers. In overall, the objectives of this literature review include evaluating the role of family in mental health and substance misuse recovery in addition to the role of social support network in mental health recovery. The articles that were reviewed are only the ones, which relate to the roles of social network support in the recovery of mental health problems emanating from various sources such as substance abuse. Tobacco was eliminated from the list of abused drugs. The logic behind this selection is that substance abuse is a causation of mental health problems for such studies. Hence, managing substance abuse leads to the administration of mental health problems. The articles included for the review are the ones, which are at most one decade old written in English. Selection of the article was narrowed to those reporting on the findings of studies conducted in the developed nations including the UK and the UK. Prior to the inclusion of an article in the review, it was evaluated for reliability and capacity to fit the inclusion and exclusion criteria. Thorough scrutiny of abstracts accompanying the articles was done as a rapid data extraction method to determine whether the articles’ findings measured up to the topic of interest. The search yielded 28 articles. Thirteen of the articles were excluded from inclusion in the review since they failed to meet the inclusion and exclusion criteria. The fifteen articles that remained were journal articles. Their findings and conclusions are presented in the literature review that follows. Conclusively, all the articles reviewed emphasise the significance of either family or social network support and or both in fostering mental health and substance abuse recovery. According to the findings, the contributions of peers and primary care workers in the social network support programs increase recovery rates so that patients are able to recover faster than when only medicinal interventions are used. Some of the key words that are helpful in the search include peer support, substance misuse, mental health, role, contribution, recovery, family, peer support, and social network support.


The research strategy deployed in the current research objected to find unpublished and published studies on the roles of families and social network in the recovery of substance abuse and mental health patients. The first step entangled conducting a search of the key terms in the research topic from the EBSCO host in MEDLINE and CINAHL libraries. Search of the references used in this research in these databases was also done to seek more information on the research topic. However, the research focused only on the articles published in English language. To make sure that the research results measure up to the progress made in the nursing field, the articles considered for review are limited to a period of 10 years (between 2000 to 2012). A search on unpublished scholarly works included government websites to look for the UK Government health documents-Department of Health-UK, NICE Guideline documents, and WHO documents. A search was then conducted in CINAHL with full text, MEDLINE with full text, and PsycARTICLES.

Review of Literature

Definition of addiction treatment and recovery

Several researchers have sought to clarify the controversial subject of addiction treatment and recovery with some claiming that the field of addiction treatment has no universally acceptable clinical definition of the terms mental health recovery and substance misuse recovery. In fact, Laudet maintains, “there is no comprehensive consensus of what a definition of “recovery” is even among those individuals who are themselves in recovery from substance use disorders” (2007, p.244). Nevertheless, he argues that the term recovery can be defined in myriads of domains including social or family domain, psychiatric, physical, chemical dependency, spiritual, psychological, and biomarker domains. The results of his study indicate that the reliability of any of the domains in providing a precise definition of the term recovery is based on the degree of validity coupled with reliability of the instrument that is deployed to measure the domain. His study provides a fundamental basis for assessing treatment outcomes for scholarly studies.

However, Bradford approaches the same subject though from another perspective. For quick recovery of mental health patients, he points out the issue of nobility of continuity of care to patients whether in the health facilities or within their families. One would question on the validity of the finding because the article is not clear about it. However, as an assumption, he might have arrived at it by observing the response of patients to treatment through pharmacotherapy and psychotherapy. The recovery process was dependent on the “continuity of care while in the shelter, short-term goal setting, and the availability of case-management services through a contact with a psychiatric social worker” (Bradford et al. 2005, p.763). Social workers’ support was vital for quicker response to treatments.

The Need for creating social support network for people of all ages

Bone et al. (2011) examined the roles of social network support on the recovery, lives, and sustained wellbeing of “two long-term first nations’ volatile substance misusers in Canada” (p.119). These people are Cynthia and Russell. Oral life and visual art-based methodologies were deployed to conceptualise and analyse the concept of support from the paradigms of western and indigenous worldviews. Bone et al (2011) found out that applying Barrera’s concepts of social support to the experiences of the two participants highlighted that social support was inadequate to foster the recovery of patients during their childhood, adolescents, and in their early adulthood. However, the finding may be unreliable and biased because there is no explanation of the sampling strategy that was employed to come up with the two people. It is also not clear on how he landed on the regions from where the two came. From the context of indigenous worldview on substance abuse and recovery, a means of understanding “the abuse of culturally based communal support in their life was established” (Bone et al. 2011, p.125). Following their exposure to substance abuse, the support they received provided an opportunity for understanding their experiences, embracing them, and linking them with their cultural identities and community perceptions about substance misuse. From these findings, awareness created through social support networks can enhance the rate of recovery of substance abuse patients.

Forrester et al. (2008) reported that social network support could foster quicker recovery of children who are influenced by their parental substance abuse behaviour. The study was based on Wales targeting “families that are aware of social services where there are serious concerns relating to parental alcohol or drug abuse” (Forrester et al. 2008, p.410). The results of the study evidenced that children who received social services help were able to recover faster (spent less time in recovery care facilities). This advantage produced cost savings while compared with interventions like substance abuse courts and family drugs.

On the same subject, Gruber and Fleetwood (2004) found out that the part played by in-home work “with substance-use-affected family members has a considerable potential for addressing family and personal issues that are often not well addressed by continuing care interventions” (Gruber & Fleetwood 2004, p.1379). They found that families play pivotal roles in the recovery process of substance abuse patients through fostering the reintegration of the patients, substance avoidance, and seeking solutions to conflicts between the abuser, their husbands, wives, and children.

In study 1, while using N= 190 participants selected representatively, Scherer and Worthington (2012) reported low levels of forgiveness and trust for their family members who had misused alcohol. Still on the same issue, using N= 141, the authors presented a “model demonstrating family cohesion and forgiveness related to a state forgiveness of alcohol-misusing family members” (Scherer & Worthington 2012, p.160). Using this model, the authors demonstrated that forgiveness is a function of trust that family members of substance abuse have on the abuser and the degree of perception of the abusers’ refusal efficacy. The finding is valid since the sampling technique was scientifically chosen to cover families that had alcohol abusers in the US. The participants embraced the abusers without ease in their families. Based on these results, the authors concluded that forgiveness and trust among family members of substance abusers are essential factors for the recovery of substance abusers. They help them to feel not being neglected or sources of social disorderliness within their families.

Who should offer substance abuse recovery services?

Cousins, Antonini, and Rawson (2012) conducted a research “regarding substance abuse recovery support and services (RSS) delivered across California where these services are offered and by whom” (p.325). In the research, the researchers made inquiries “regarding RSS measurement efforts, funding mechanisms, and technical assistance needs” (Cousins, Antonini & Rawson 2012, & p.325). The study was confined to 57 counties. The results indicated that 23 of the 37 counties responded claiming that they offered RSS. In these counties, CACs (certified addiction councillors) and then volunteers, peers, and clinicians provided much of the RSS services. For the case of recovery communities’ organisations, volunteers and peers were deployed to provide the service.

Cousins, Antonini, and Rawson (2012) found out, “Sober living homes were the most prevalent types of RCO followed by recovery centres, faith-based or recovery ministries, and recovery schools” (p.325). No recovery was accomplished from the homes of the patients. According to Cousins, Antonini, and Rawson (2012), this exposition evidenced how families could directly influence the recovery of mental health and substance abusers absent. Only 37 percent of the counties reported collecting data on patients had recovered from substance abuse. The funding of the mental health and substance abuse programs was also below par since only 45 percent of the counties reported to fund RSS. However, the inference should only be limited to within California as opposed to how the authors used it as applying to all counties even beyond the area of study.

The study by England, Orford, Templeton, and Patel (2007) was however reliable based on their research coverage in relation to the above inference by Cousins, Antonini, and Rawson. Using 143 primary care professionals, England, Orford, Templeton, and Patel (2007) evidenced, “a strong support for a form of intervention that involved face-to-face discussion with a primary care professional who received the full intervention of being able to talk to a professional who had the time to listen and who appeared interested, understanding, and caring” (Orford, Templeton & Patel 2007, p.29). According to the findings, the primary care professional acts like a greasing agent for enhancing the process of recovery among people affected by family members who abuse substances including alcohol.

Relationship between drug substance attitudes, mental health, family ritual, and religious involvements

Using a sample size of 141 African- American women, Fife, McCreary, Brewer, and Adegoke (2011) found that negative relationships existed between substance abuse and religious attendance. However, the sampling was not representative, as the researchers did not cover well the countries, which harbour African-American women. Through the deployment of hierarchical regressions analyses of the results of the study, it was found out that both mental health and its severity were crucial indications and predicators of substance abuse. “Church attendance with one’s family (religious ritual) accounted for a significant portion of the variance for substance abuse, above, and beyond the variance accounted for by mental health problems and drug attitudes” (Fife, McCreary, Brewer & Adegoke 2011, p.87). As a social network support, the church failed in the tests of fostering the recovery of both substance abusers and mentally ill people.

Orford, Templeton, and Patel 2007 employed self-help manual to train patients on coping strategies of the impacts of family members who abused substances. They found out that self-help manual contained some active ingredients for enhancing recovery. Several members of families with persons abusing substances reported that their ways of coping with the situation had transformed on receiving brief information on how to induce the recovery process on reading the self -help manuals. “Common constellation of changes included increased consciousness of the nature and extent of the relative’s drinking or drug use and its family effects, an acknowledgement of the family member’s own needs and rights” (Orford, Templeton & Patel 2007, p.29). Based on these results, Orford, Templeton, and Patel (2007) suggest that a 5-step intervention strategy yielded positive results in the recovery process while applied in primary care settings although it had some limitations since it was not effective in the families, which had long-standing problems emanating from substance misuse experiences. The challenge rendered the results less reliable.

The cost of alcohol and substance abuse on families

Copello, Templeton, and Powell used the documented negative impacts of alcohol and other substances abuse on families to compute the cost of substance abuse on families and society as a whole. They also presented “findings from the first piece of research undertaken in the UK to model numbers of adult family members of illegal drug miss-users associated costs” (Copello, Templeton & Powell 2010, p.64). The article summed up by discussing the impacts of the models for the development of policies for mental health and substance abuse recovery programs. However, there is bias in the findings of the study indicate since it generalises the results using the UK as the basis without incorporating other countries’ results. According to them, perception and taking responsibility of the costs associated with putting substance abuse and mental health patients on treatment make families shun way from participating fully in the recovery process of their members.

Sheidow, McCart, Zajac, and Davis (2012) explore the effects of substance abuse on social roles coupled with the functioning of adults who have indulged in substance misuse. Such adults have high co-morbidity levels between serious mental illness and substance abuse. A comparison and summary are made on “the impact of these co-occurring problems on the transition of emerging adults from school and training environments to adult work roles” (Sheidow, McCart, Zajac & Davis 2012, p.235). The authors find, “emerging adults with co-occurring serious mental health conditions” (Sheidow, McCart, Zajac & Davis 2012, p.235) are the groups mostly susceptible to abusing substances more than other groups of people studied. However, there is a need to recognise that minimal programs have been developed in the UK to take care of the needs of these people so that they can recover from the impacts of substances abuse.

Co-morbid and mental health and substance use in Scotland

Baldacchino (2007) conceptualises various issues, research, problems, enacted policy solutions, and interventions adopted in Scotland due to co-morbid mental health and substance abusing people who seek medical treatments and those who do not seek treatments. The results indicate that the UK and Scottish nationals respond differently to issues of co-morbidity.

On the same subject, Bischof et al. (2007) classified substance-abusing persons into two broad groups: low problem-low support (LPLS) and high problems-High support (HPMS). He then studied the stability of the recovery of these groups on the long term (24 months) by measuring their responses using standardised instruments among them being social support combined with collateral and personalised interview data. The results indicated, “The cluster groups in social support diminished over time. However, even at follow-up, LPLS revealed less social support by friends when compared to LPHS showing significant higher rates of relapse and utilisation of formal help than HPHS and LPHS” (Bischof, G et al. 2007, p.905). They concluded that differences in trajectories of natural recovery are affected by the threshold of substance related problems and psychological resources among individuals. However, although the conclusion matches that of Baldacchino (2007), the research area of coverage is not well brought out for the reader to tell whether it is enough to be relied up or not.

The Role of Help Groups in Recovery

Self-help -groups are essential in aiding in linking up people to other people forming a social network support group of people who have been successfully coping with substance abuse situations. In their study, Powell and Perron (2010) find, “mental health or substance use agencies can increase access to evidence-based benefits of self-help groups by engaging them in organisational exchanges” (p.315). These organisational exchanges are formed through social network support. However, the inference may be weak since the authors do not give a case where agencies have been used to confirm their claim.

By studying how peers may help in the substance and mental health recovery, the results of Salzer’s (2002) study conducted on peers in the UK indicate that peer recovery support services can reduce probabilities of relapse. They “are designed and delivered by peers who have been successful in the recovery process as they embody a powerful message of hope, as well as a wealth of experimental knowledge” (Salzer 2002) p.356). This finding is reliable since it has been tested to evidence that social network support groups need to comprise people who have had experience in substance abuse with an additional help of a primary care provider. According to her, recovery is enhanced by social support services.


Categorisation of the research findings facilitates the grouping of the results for single synthesis of the results. The 18 findings stemming from the exploration of literature review document evidence that family plays positive roles in the Mental Health and Substance Misuse Recovery process. From this context, recovery is taken to encompass abstinence from substance abuse and prevention of relapse. Six findings of the remaining articles are further scrutinised and explored. The author seeks to establish solid evidence on the roles of social network support in mental health and substance abuse recovery. These researches determine the relationship between social workers and peers’ contributions in the recovery of substance abuse and mental health.


The literature review above discusses the various roles that can be played by families and social network support groups in the recovery of patients of substance abuse and mental health. In the establishment of these relationships, there is the absence of consistency of a common ground for defining the subject matter of the researches: recovery. However, this absence is not an immense challenge to hinder exploration of the body of knowledge in the topic of research since “although a single disciplinary group such as physicians may agree upon a definition, there is no such agreement among the broader field of treatment professionals, addiction researchers, program evaluators, and policymakers” (Frank & Hargreaves 2003, p.567). Consistent with the findings of the articles categorised under synthesis 2, recovery from substance abuse and mental health problems- often likened with substance abuse, several other researches, for example (Millard & McAuley 2008: Metsch, Wolfe, Fewell & McCoy 2001: Moore, Young, Barrett & Ochshorn 2009: Lowden & Hall 2006) recognise the contribution of social support in the healing process. Some of the elements of social support include informational support, affiliation, emotional, and instrumental support (Galvani & Forrester 2009, p.13: Lemieux & Schroeder 2004, p.7). While some of these supports may be well offered through social network support, for instance, informational support, others such as emotional support are best offered through familial contributions in the recovery process. This argument is well developed in the in articles whose findings are categorised under synthesis 1. From the literature review, peers are incredible in enhancing the process of recovery. The incorporation of peer recovery services in a social network support is paramount in that, according to DiNitto (2005), “one of the strengths of peer recovery support services has been their adaptability to many stages and modalities of recovery, as well as to different services settings and organisational contexts” (p.207). The value of the adaptability of the services is that they serve as incredible tools for extended support for recovery beyond various systems of treatment to entail the communities in which the mentally ill and substance abusers live. Some scholars have also found out that peer social services produces faster recovery rates when used alongside medicinal interventions (Birchwood Orford, McGovern & Mueser 2006: Grant, Huggins & Connor 2004). While it is advocated in this literature review research that a peer social service support is crucial from recovery from substance abuse associated disorders “because of the variations in settings, organisational contexts, recovery stages, and pathways, identifying commonalities in peer recovery support services can be challenging” (Hayden 2004, p.25). However, from the findings of the literature review, as an element of social network support, peer services avail a means of providing social service support to substance abusers from valid pathways that lead to recovery among them being those that are predominantly spiritual, cultural, religious, and secular among others. Members of peers groups are diverse compared to familial members.

It is evident from the literature review research that, in the recovery process, emotional support is vital and can best be provided by family members of the patients. Therefore, the roles of both family and social network support are paramount in the mental health and substance abuse recovery. The review findings have a number of implications to the practice of mental health and substance misuse recovery in the UK. A common principle is that families and social care workers- through social network support- have different roles in the recovery of mental health and substance misusing patients. These roles cannot be inter-transferred between the two. The implication is that the UK deserves to develop programs for creating awareness and training of family members on their roles and capacity to enhance recovery of their patients rather than obligating the entire responsibility to social health care workers. This approach would have the implication of truncating into the reduction of recovery costs since patients would spend lesser time in recovery centres. A method of disseminating information to family members that interaction with recovered peers may facilitate rapid recovery of patients is vital because family members of substance abuse patients have the risk of thinking that such interactions would perhaps result in relapse. The bottom line implication here is that much focus should be deployed in peer recovery services. The UK and the US experiences cannot apply to the developing nations. Thus, the applications of the findings are limited in the sense that they are valid within the UK and the US. The literature is rich in roles that are played by social care workers, peers, and family members through social network support programs in enhancing recovery of substance abuse patients.

Search Table

Search-S Keywords Results
S1 Recovery OR Abstinence 12146475
S2 Recovery AND Abstinence 7612
S3 Mental Health Recovery 767358
S4 Substance Abuse Recovery 376438
S5 Substance Abuse Recovery OR Substance Use Abstinence 433447
S6 Substance Abuse Recovery AND Substance Use Abstinence 26794
S7 Family 71594689
S8 Social network support OR peer support OR family support 17867652
S9 Social network support AND peer support AND family support 296231
S10 Role OR Contribution 56498328
S11 Role AND Contribution 6172032
S12 Substance Attitude 791829
S13 Peer recovery support OR Peer recovery service 370465
S14 Peer recovery support AND Peer recovery service 249428
S15 Mental health agencies OR Substance use agencies 2292715
S16 Mental health agencies AND Substance use agencies 415900
S17 Self help group 5130113
S18 S1+S2+…………..S18 13851262



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