LEXINGTON, Ky. — When someone is using substances or living with a substance use disorder, support often extends far beyond clinical settings. Family members, friends and loved ones may become part of a person’s day-to-day safety net, helping them navigate risk, treatment, recovery, relapse and survival. 

Researchers in the University of Kentucky College of Social Work (CoSW) are studying those support networks and asking a complex but urgent question: How do families and close friends support loved ones who use opioids or stimulants, and what do they need to provide that support more effectively? 

The ongoing study is led by Aaron Brown, Ph.D., and Lynden Bond, Ph.D., two faculty members at CoSW. Their research examines the experiences, knowledge and attitudes of people supporting family members or close friends with substance use problems involving opioids or stimulants. 

The work comes at a critical time. Substance use disorder continues to affect millions of individuals and families across the United States. According to a 2024 National Survey on Drug Use and Health, 48.4 million people age 12 or older had a substance use disorder in the past year. While national overdose deaths declined in 2024, nearly 80,000 people still died from a drug overdose, underscoring the continued need for prevention, treatment, harm reduction and recovery support. 

In Kentucky, the impact remains especially significant. The 2024 Kentucky Drug Overdose Fatality Report found that 1,410 Kentucky residents died from a drug overdose in 2024, a decrease from the previous year but still a profound loss for families and communities. Fentanyl and methamphetamine remained the most commonly identified substances in overdose deaths statewide. 

For rural and Appalachian communities, the issue is often shaped by additional barriers, including limited access to treatment, transportation challenges, economic stressors and fewer nearby health care resources. Research from the Appalachian Regional Commission has found that Appalachia has experienced disproportionately high rates of opioid misuse and overdose deaths, with Central Appalachian communities among those most affected. 

“Family members and close friends often play a critical role in supporting people who use drugs, but their experiences and perspectives are not always well understood,” Brown said. “This research helps us better understand how people provide support, what challenges they face and what resources might help them most.” 

To begin the study, Brown conducted a national survey of more than 1,200 adults across the United States. Among respondents, 318 individuals identified as having a close friend or family member who uses opioids or stimulants and agreed to be contacted for future research. 

Brown and Bond then co-led the next phase of the project with their research team, including doctoral students Abraham Teye and Blake Conley. The team conducted in-depth interviews with more than 20 participants, asking about their experiences supporting loved ones, their understanding of harm reduction strategies and the resources they have used or needed. 

For many participants, support meant learning how to respond in moments of immediate danger while also navigating the emotional weight of loving someone at risk. 

“With my brother, we were always trying to get him to stop, and he was always using,” one interview participant said. “You know, if they were still using, at least do it safely so they don’t die.” 

Another participant described learning how to use naloxone, a medication that can rapidly reverse an opioid overdose. 

“I learned that the faster you can get the Narcan into them, if they overdose, the better,” the participant said. “So, I encourage them to make sure they let other people know around them that they do have Narcan and where it’s located so that in case it is needed, they can use it.” 

The interviews also revealed how difficult it can be for family members and friends to understand what their loved ones are experiencing, especially when substance use is shaped by stigma, fear, pain or trauma. 

“I know a little bit about fentanyl, what I see on TV,” one participant said. “Do I know what it feels like? Do I know what that person is going through? No. And that is pretty important. That’s a pretty important factor. It’s like I always push people away if I didn’t think they really understood what I was going through.” 

The study builds on a growing body of research examining how substance use affects families and communities, particularly in regions where opioid and stimulant use have had profound impacts. Brown’s previous work has examined recovery support programs serving individuals in Appalachia, including initiatives that help people access housing, transportation, health care and other essential services during recovery. 

This project expands that work by focusing on the people often standing closest to those experiences: parents, siblings, partners, friends and other loved ones who may be trying to keep someone safe while also managing uncertainty, grief, stress and hope. 

“People supporting loved ones with substance use disorder are often trying to make difficult decisions with limited information and limited support,” Brown said. “By listening to their experiences, we can better understand how to connect families and communities with practical resources that reduce harm and support recovery.” 

The next phase of this work will be supported through funding from the Kentucky Opioid Abatement Advisory Commission (KYOAAC), which was established to distribute opioid settlement funds for efforts that address the impact of the opioid epidemic in Kentucky.  Brown received KYOAAC funding to build on this study by developing and testing resources specifically designed to serve Kentuckians who have family members affected by opioid use. 

The project will focus on practical harm reduction education, overdose prevention, and support strategies that can help Kentucky families navigate substance use, reduce risk, and connect loved ones with resources that support safety and recovery.