The Promise and Potential of Mentors in Combating the Opioid Cris

by Michael Garringer (originally published on the NMRC blog)

The last year has seen an increasingly bright spotlight shined on one of the nation’s most damaging and pernicious challenges: the struggle of many communities and individual citizens with opioid addiction. It seems that the nation is just now coming to grips with the depth and severity of the problem and the statistics on the subject are grim:

• In 2016, 116 people in the United States died from overdoses of opioids¹
• One study² found that opioid overdoses increased over 30% across 45 states between 2016 and 2017, with a 70% increase in the Midwest over that same timeframe, indicating that this problem is actually getting worse
• Between 21 to 29 percent of patients prescribed opioids for chronic pain misuse them³, resulting in about 80% of heroin users first getting addicted via prescribed opioids⁴.
• The estimated economic impact of this crisis is $78.5 billion a year⁵.
• And unfortunately, this is an issue that directly impacts young people: One study⁶found that 3.6% of youth ages 12-17 had misused opioids in the past year, with that number climbing to 7.3% of those 18-25.

Statistics like these have certainly grabbed the attention of the press and the administration, which has made combating the opioid crisis a cornerstone of its domestic policy, particularly in mobilizing the Department of Health and Human Services to implement a five-pronged strategy to combat the issue. The Senate is also currently working on the Opioid Crisis Response Act of 2018, which would spur additional efforts across many federal agencies. The Department of Justice has awarded $59 million in the last year to local law enforcement and other groups to combat the issue.

With problems this large in scale, and with such damaging effects on communities and individuals, it can be hard to see how something as simple as a relationship between a child and a caring adult could make much of a difference. However, there are some theoretical and research-based reasons why mentors and mentoring programs might be able to play a meaningful role in this national effort.

In MENTOR’s 2016 national survey of mentoring programs, we found that about 12.5% of programs were housed in youth-serving organizations that also offered substance abuse prevention or treatment/recovery services, with 3% of all programs indicating that their mentors explicitly focused on that topic with the youth they served. While it appears not many programs do direct mentoring work in the substance use area, many more have easy access to expertise and referrals to more robust treatment services if needed for mentees.

To date, the research on using mentoring to prevent substance use initiation or to prevent abuse once use has started is a bit mixed. The most comprehensive examination of this comes from a synthesis by Thomas, Lorenzetti, and Spragins who examined the impact of mentoring on alcohol and drug use across six separate evaluations. Four of the six studies showed some impact on reducing alcohol use. However, none of these impacts were statistically significant. Two of the studies were able to be “pooled” (combined, essentially) and those two, considered together, did show a statistically significant impact on reducing alcohol use.

The story on drugs is less clear. Only two of the six studies in the synthesis showed any impact on drug use, and one of those was only for marijuana. Additionally, in the 2011 mentoring meta-analysis by DuBois and colleagues⁷, substance use was one of the few outcome categories examined that failed to demonstrate a statistically significant positive impact. Patrick Tolan’s meta-analysis⁸ of programs that use mentoring to prevent juvenile delinquency found evidence of a small impact on drug use, but it was unclear how much mentoring was happening in those programs, as they frequently offered many other interventions alongside mentoring. Other major mentoring studies (such as the Role of Risk study) have similarly failed to find much evidence of impact on substance use.

It is worth noting, however, that there are hints in research in related fields that indicate relationships with caring adult and peer mentors might be beneficial. For example, there is robust literature on the value of supportive peer-to-peer relationships in helping youth and adults who are in treatment systems, including substance abuse treatment. One review⁹ of peer support groups in treatment settings concluded, “peer support services that include groups delivered to those with substance use problems show[ed] associated benefits in the following areas:

1. substance use,
2. treatment engagement,
3. HIV/HCV risk behaviors, and
4. secondary substance-related behaviors such as craving and self-efficacy.”

Another synthesis¹⁰ of nine studies using peer mentors and other supports in treatment contexts concluded that there were positive benefits across the studies in terms of future substance use and recovery-related factors.

Lastly, a 2011 synthesis¹¹ focused on youth and adults with mental health needs (and high rates of substance use) concluded: “What PSWs [peer support workers, which can be analogous to what mentors in some programs are tasked with] appear to be able to do more successfully than professionally qualified staff is promote hope and belief in the possibility of recovery; empowerment and increased self-esteem, self-efficacy and self-management of difficulties and social inclusion, engagement and increased social networks.” 

Applying the Findings to Mentoring

In these emphasized findings, one can see the seeds of the role mentors might play in supporting young people who are struggling with addiction or dealing with the aftermath of a loved one’s struggle with opioids. These results highlight how mentors might work alongside recovery professionals to offer much needed social support, systems navigation, and emotional support.

Mentors and mentoring programs could be a tremendous asset to young people already engaged in opioid abuse by:

• Providing them with hope and motivation to get better
• Connecting them to treatment services and working alongside treatment professionals and others from related interventions
• Helping them stay on treatment plans by providing instrumental support (transportation to appointment, help finding employment, fostering educational attainment) and well as teaching coping skills and self-management
• Facilitating the broadening of their networks of support, including other mentors and a broader community that can support treatment goals.

Mentors, of course, can also be helpful on the front-end of this issue, by supporting the healthy development of young people that prevents the initiation of use in the first place.

Lastly, mentors might also be instrumental in stepping in when youth are dealing with the addiction or substance use-related incarceration of parents and other adults in their lives. There has been considerable effort in the mentoring field for some time to provide mentoring to children of incarcerated parents and youth in the foster care system, with both of our NMRC reviews on these topics highlighting a number of areas in which mentors appear able to have a positive impact on youths’ behavior, relationships, educational success, and emotional well-being.

We look forward to working with OJJDP and other federal agencies to deploy mentors across the nation in service of combating the devastating effects of this crisis. Mentoring programs should build connections with treatment specialists and other service providers, as well as law enforcement and child welfare agencies, so that we might all be responsive to the needs of young people impacted by this issue. There can be perhaps no higher calling for a mentor than to step into a life that has been ravaged by something as harsh as opioid abuse and not only work to give that life hope and a brighter future, but to keep it from being lost entirely. Or, if services can reach youth early enough, preventing that initial use in the first place, especially considering just how addictive and harmful these substances can be. On this issue, mentoring may actually be an issue of life and death.

If your mentoring program does work on this topic, or if you know of programs that are using mentors in this way, we’d love to hear your stories and thoughts about how mentors can be part of the solution. Leave a comment below!

---

References

¹ Centers for Disease Control. (2017). National Vital Statistics System, Mortality. CDC Wonder. Atlanta, GA: US Department of Health and Human Services, CDC. https://wonder.cdc.gov

² Vivolo-Kantor, A.M., Seth, P., Gladden, R.M., et al. (2017). Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses-United States, July 2016-September 2017. Atlanta, GA: Centers for Disease Control and Prevention

³ Vowles, K.E., McEntee, M.L., Julnes, P.S., Frohe, T., Ney, J.P., & van der Goes, D.N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain, 156(4), 569-576. doi:10.1097/01.j.pain.0000460357.01998.f1.

⁴ Muhuri, P.K., Gfroerer, J.C., & Davies, M.C. (2013). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Rev, August.

⁵ Florence, C.S., Zhou, C., Luo, F., Xu, L. (2016). The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care, 54(10):901-906. doi:10.1097/MLR.0000000000000625.

⁶ Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data

⁷ DuBois, D. L., Portillo, N., Rhodes, J. E., Silverthorn, N., & Valentine, J. C. (2011). How effective are mentoring programs for youth? A systematic assessment of the evidence. Psychological Science in the Public Interest, 12, 57–91.

⁸ Tolan, P. H., Henry, D. B., Schoeny, M. W., Lovegrove, P., & Nichols, E. (2014). Mentoring programs to affect delinquency and associated outcomes of youth at-risk: A comprehensive meta-analytic review. Journal of Experimental Criminology, 10, 179–206. doi:10.1007/s11292-013-9181-4.

⁹ Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154. http://doi.org/10.2147/SAR.S81535

¹⁰ Bassuk, E. & Hanson, J., Greene, R.N., Richard, M., & Laudet, A. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment, 63. doi:10.1016/j.jsat.2016.01.003.

¹¹ Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20: 392–411