Concerned Significant Others Research Articles

Level of Agreement Between Problem Gamblers\u2019 and Collaterals\u2019 Reports: A Bayesian Random-Effects Two-Part Model

This study investigates the level of agreement between problem gamblers and their concerned significant others (CSOs) regarding the amount of money lost when gambling. Reported losses were analyzed from 266 participants (133 dyads) seeking treatment, which included different types of CSO–gambler dyads. The intraclass correlation coefficients (ICCs) concerning the money lost when gambling during the last 30 days were calculated based on the timeline followback. In order to model reports that were highly skewed and included zeros, a two-part generalized linear mixed-effects model was used. The results were compared from models assuming either a Gaussian, two-part gamma, or two-part lognormal response distribution. Overall, the results indicated a fair level of agreement, ICC = .57, 95% CI (.48, .64), between the gamblers and their CSOs. The partner CSOs tended to exhibit better agreement than the parent CSOs with regard to the amount of money lost, ICCdiff = .20, 95% CI (.03, .39). The difference became smaller and inconclusive when reports of no losses (zeros) were included, ICCdiff = .16, 95% CI (− .05, .36). A small simulation investigation indicated that the two-part model worked well under assumptions related to this study, and further, that calculating the ICCs under normal assumptions led to incorrect conclusions regarding the level of agreement for skewed reports (such as gambling losses). For gambling losses, the normal assumption is unlikely to hold and ICCs based on this assumption are likely to be highly unreliable.

Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions

BackgroundAround 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.MethodsThe study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.DiscussionWe expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.Trial registrationClinical trials.gov ID: NCT03281057. Registration date: September 13th, 2017.

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12-14 sessions of the full CRAFT intervention, 4-6 sessions focused on Treatment Entry Training (TEnT), or 12-14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO's mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (χ(2)2 = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1-6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2-7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4-2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT. (PsycINFO Database Record

The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial

Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.

The extent and type of gambling harms for concerned significant others: A cross-sectional population study in Finland

This study investigates the proportion of concerned significant others (CSOs) of problem gamblers at population level and describes the extent and type of gambling harms for CSOs. Cross-sectional random sample data ( n = 4515) were collected in 2015. The data were weighted based on age, gender and residence. CSOs were identified using a question including seven options. Gambling harms were inquired using structured questions. Descriptive statistics and Chi-Squared and Fischer's exact tests were used. Overall, the proportion of CSOs was 19.3%. Males had close friends with gambling problems more often than females, while females had family members with gambling problems more often than males. Of the CSOs, 59.5% had experienced one or more harms. Females experienced more harms than males. Typical harms were worry about health or well-being of close ones, emotional distress and problems in interpersonal relationships. CSOs with a problem gambler in the family, particularly a partner, child/children or mother, experienced harms more often than CSOs with a problem gambler as a close friend. Female gender was associated with a larger extent of harms. The extent of harms was greatest if the problem gambler was a family member; however, a substantial amount of harms were experienced when the problem gambler was a close friend. CSOs and their position in evaluating gambling harms in general should be acknowledged. Persons beyond the nuclear family and the harms they encounter should be better acknowledged in prevention and harm minimisation. Early identification and a clear referral path to tailored support in occupational, social and healthcare settings may be considered.

Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: study protocol for a randomised controlled trial

IntroductionProblem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual...

The Efficacy of Individual Community Reinforcement and Family Training (CRAFT) for Concerned Significant Others of Problem Gamblers

Treatment options for concerned significant others (CSOs) of problem gamblers are limited, and available treatments focus exclusively on the distress of CSOs. Community Reinforcement and Family Training (CRAFT) is a comprehensive treatment program for CSOs of substance abusers that has been shown to reduce CSO distress in addition to the substance abuser's alcohol or drug behaviour. CRAFT capitalizes on the well-documented fact that family members have considerable influence on the substance abuser's decision to enter treatment. The present study modified the CRAFT approach into an individual treatment format for CSOs of problem gamblers and examined its efficacy in comparison to a CRAFT self-help workbook in a randomized clinical trial. A total of 31 participants were recruited. No statistical differences were found between the groups; however, effect sizes indicated that participants who received the CRAFT individual intervention seemed to have better outcomes than did those who received the CRAFT workbook (decreased days and dollars gambled by the gambler and improved CSO functioning). No differences between groups were found for gambler treatment entry rates over the follow-up period in terms of effect sizes. The results provide initial, but limited, support for the CRAFT approach delivered to CSOs of treatment-resistant problem gamblers in an individual treatment format compared with the self-help workbook format. Further research with larger sample sizes is needed to gauge the efficacy of the CRAFT individual intervention compared with the CRAFT self-help workbook.

Efficacy of the Community Reinforcement and Family Training for concerned significant others of treatment-refusing individuals with alcohol dependence: A randomized controlled trial

BackgroundThe Community Reinforcement and Family Training (CRAFT) is a promising approach for Concerned Significant Others (CSOs) of alcohol-dependent individuals (ADI) that aims to engage treatment-refusing patients in alcohol treatment and to improve CSO functioning. To date, only two randomized controlled trials (RCTs) of CRAFT-based treatment for CSOs of ADI are available, both conducted in the U.S. For the first time, this study analyses the efficacy of CRAFT in a sample of CSOs outside of the U.S. MethodsParticipants were recruited through the treatment system (general practitioners, psychotherapists, addiction counselling services) and through media solicitation. After brief screening, 94CSOs were randomly allocated to an immediate intervention condition (II) or a wait list condition (WL) that received the CRAFT intervention after 3 months. Data for the follow-up assessments at 3 and 6 months was provided by 78CSOs (II N=42; WL N=36). In addition, a follow-up assessment (f-u) was conducted after 12 months (Response rate 92%). ResultsAt 3-month f-u, II revealed significant higher ADI engagement rates (40.5%) compared to WL (13.9%); after WL received the CRAFT intervention, engagement rates did not differ between both groups at 6- and 12-month f-u. CSOs in both groups reported significant improvements in terms of mental health and family cohesion after having received the intervention, i.e. II at 3-months f-u and WL at 6-month f-u. ConclusionsData show that CRAFT is effective for treating CSOs of alcohol dependent individuals in terms of treatment engagement and improvement of CSOs mental health and family cohesion.

Internet-delivered cognitive-behavioural therapy for concerned significant others of people with problem gambling: study protocol for a randomised wait-list controlled trial

IntroductionAbout 2.3% of the adult population in Sweden are considered to suffer from problem gambling, and it is estimated that only 5% of those seek treatment. Problem gambling can have...

Understanding text-based persuasion and support tactics of concerned significant others.

The behavior of concerned significant others (CSOs) can have a measurable impact on the health and wellness of individuals attempting to meet behavioral and health goals, and research is needed to better understand the attributes of text-based CSO language when encouraging target significant others (TSOs) to achieve those goals. In an effort to inform the development of interventions for CSOs, this study examined the language content of brief text-based messages generated by CSOs to motivate TSOs to achieve a behavioral goal. CSOs generated brief text-based messages for TSOs for three scenarios: (1) to help TSOs achieve the goal, (2) in the event that the TSO is struggling to meet the goal, and (3) in the event that the TSO has given up on meeting the goal. Results indicate that there was a significant relationship between the tone and compassion of messages generated by CSOs, the CSOs’ perceptions of TSO motivation, and their expectation of a grateful or annoyed reaction by the TSO to their feedback or support. Results underscore the importance of attending to patterns in language when CSOs communicate with TSOs about goal achievement or failure, and how certain variables in the CSOs’ perceptions of their TSOs affect these characteristics.

Gambling frequency, gambling problems and concerned significant others of problem gamblers in Finland: cross-sectional population studies in 2007 and 2011.

This study compares past-year gambling frequency, gambling problems and concerned significant others (CSOs) of problem gamblers in Finland by age, from 2007 and 2011. We used random sample data collected in 2007 (n = 4722) and 2011 (n = 4484). The data were weighted, based on gender, age and region of residence. We measured the past-year gambling frequency using a categorical variable, while gambling severity was measured with the South Oaks Gambling Screen. We identified CSOs by a single question including seven response options. Chi-Squared and Fisher's exact tests were used. Overall, the past-year gambling frequency change was statistically significant between 2007 and 2011. Among 18-64-year-old Finnish people, the proportion of non-gamblers decreased. Yet, among 15-17-year-old respondents, non-gambling increased and gambling problems decreased. Among 18-24 year olds, the proportion of close ones with gambling problems also decreased. On the other hand, the proportion of family members with gambling problems increased among the 50-64 year olds. The increase in adult gambling participation was mainly explained by infrequent gambling. The proportion of gambling problems from the gamblers' and CSOs' perspective remained unchanged, yet significant changes were observed within age groups. The short-term changes in under-age gambling problems were desirable. Future studies should explore the adaptation and access hypotheses alongside gambling problems.

Commentary on "Applying the codependency concept to concerned significant others of problem gamblers: Words of caution"

The focus of Calderwood and Rajesparam’s ‘‘Words of Caution’’ is the treatment and mistreatment of concerned significant others (CSOs) affiliated with problem gamblers. A cautionary tale, it was prompted by the negative experience of one of Calderwood or Rajesparam, who observed an ‘‘expert’’ facilitator, self-described as a recovering addict, browbeat the participants of a hospital-sponsored psychoeducational group for problem gamblers and CSOs. On four separate occasions with four different family members, the lead facilitator’s first question to the CSO asked: ‘‘What is your problem?’’ Then, like a broken record, the expert proceeded to badger group participants about the putative characteristics of codependency for six weeks, albeit without actually ever uttering the offensive c-word. Noting that three of the four CSOs enrolled in the group became drop-outs, the authors became worried that other CSOs might also be at risk, because ‘‘workers in the gambling field have adopted or adapted treatment strategies used in the substance abuse field,’’ by which they mean problem-focused family systems theory, a codependency disease model of human behavior, and in-your-face confrontation. As an antidote, Calderwood and Rajesparam prescribe ‘‘more recent therapeutic trends such as a strengths perspective, solution-focused therapy, and a stress-coping model of understanding CSOs.’’

Applying the codependency concept to concerned significant others of problem gamblers: Words of caution

Two competing models of understanding concerned significant others (CSOs) of people with addictions have emerged: codependency (CD) and stress-coping. In the context of CSOs of problem gamblers, some research has begun to examine the effectiveness of the stress-coping model, but no research to date has examined the utility of incorporating the CD concept into treatment planning. The purpose of this paper is to: critique the CD concept while highlighting possible differences between problem gambling and substance abuse (i.e., financial issues, the ability to hide the problem, cognitive distortions, and societal attitudes); identify important considerations when working with CSOs of problem gamblers; make recommendations for program managers regarding hiring and training practices; and recommend directions for research and in-depth program evaluations to assess what is actually occurring in existing practice.

Where Codependency Takes Us: A Commentary

In their article ‘‘Applying the codependency concept to significant others of problem gamblers: Words of caution’’, Calderwood and Rajesparam critique the codependency concept and highlight its problems when applied to problem gambling treatment. In this commentary I will show how codependency falls short of true family systems thinking and raise some questions concerning clinical work that includes concerned significant others (CSOs). Language Matters Once a concept such as codependency has gained traction through wide circulation in popular and addiction recovery culture, it acquires a taken-for-granted meaning that seldom gets scrutinized. It is to the authors’ credit that they take up this concept for examination. They suggest that codependency has become short-hand for connoting that CSOs are problematic, and characterized as ‘‘external focusing,’’ ‘‘self-sacrificing,’’ ‘‘attempting to control,’’ ‘‘suppressors of their own emotions,’’ ‘‘needing to be needed,’’ ‘‘victims’’ and ‘‘partners-in-crime.’’ Cast in this negative light, partners are stigmatized and accusatorily treated by professionals. Language shapes perception. Because of these ingrained negative connotations, it is best that the terms codependent and codependency be avoided. Further, codependency as a concept needs to be deconstructed. The authors suggest that codependency is influenced by family systems theory. They equated the ‘‘expert,’’ ‘‘confrontational and accusatory’’ style of a therapist they observed with the family systems approach of Minuchin. In reality, codependency that assigns blame to the partner falls short of systems thinking. Rather than ascribing pathology to an individual in the family, family systems therapists look for the patterns of interaction that are circular and recursive and thereby result in symptom development. Moreover, there are many schools of family therapy, and family therapists are among the first in the mental health field to raise sensitivity to how language is used – notable are the contributions of Michael White in narrative therapy, of Jay Haley in the Ericksonian tradition (which later gave rise to

Response to the commentaries by Lee, Harkness, and Orford

We would like to begin by thanking the reviewers, editors, and authors of the commentaries, for their enthusiasm for this topic and their support for our agenda to re-open the debate about the codependency (CD) concept. Our primary goal is to initiate sufficient critical discussion for service providers to be more cautious about using the CD tenets while at the same time reflecting on its origins, strengths, and limitations. While we recognize that the concept has had some utility for a large number of people around the globe, we are concerned about the societal messages that the concept conveys, such as women being responsible for others’ addictive behaviour, and the devaluing of caregiver roles. Our motivation in the original opinion paper came from the experience of witnessing a service provider’s first words to concerned significant others (CSOs) of problem gamblers be ‘‘What is your problem?’’ Orford’s indication that this example is very widespread confirms for us the importance of initiating this debate. We thank Lee for providing the family theory perspective. We are both too young to have been directly involved with, or knowledgeable about, the emergence of the CD concept. So our statement that the conceptualization of CD was influenced by family systems theory was solely based on what we found in the literature (e.g., Krestan & Bepko, 1992; Miller, 1994). We welcome Lee’s clarifications pertaining to family systems therapists like White, Haley, and Satir, and their call to ‘‘raise sensitivity to how language is used’’, and her clarifications pertaining to the fact that ‘‘in the second wave of family therapy, the therapist is seen as a co-constructor rather than an expert in the therapeutic process.’’ These points from Lee contribute further to our argument that the CD concept has failed to evolve in a way that is aligned with the direction of other supportive interventions. As Lee indicates, ‘‘the negative assignment of blame and neediness to the partners in ‘codependency’ is a bastardization of family therapy’s way of conceptualization and problem formulation.’’ Neither of us isa family therapist, hence ourindividualistic bias.We agree that the CD literature focuses too much on the individual, and we support Lee’s argument for the

Reasons for Entering Treatment Reported by Initially Treatment-Resistant Patients with Substance Use Disorders

Many individuals with substance use disorders are resistant to entering formal treatment, despite the negative consequences that plague their own lives and the lives of concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) has been developed as an effective strategy for helping family members who are concerned about the alcohol/drug use of a loved one who refuses to seek treatment. The present study explored reasons and feelings that played a part in these resistant individuals' (identified patients [IPs]) decision to begin treatment. Written statements and feelings of 36 initially treatment-refusing IPs, who were engaged into treatment via their CRAFT-trained CSOs, were examined upon entering treatment. Self-report forms assessed three complementary domains about entering treatment: (1) feelings about coming for treatment, (2) important reasons for entering treatment, and (3) reasons for entering treatment narratives. It was shown that the occurrences of self-reported positive emotions and statements that expressed a positive wish for change outweighed negative feelings and statements. Although conceivably these CRAFT-exposed IPs may have provided different responses than other treatment-seeking populations, the current study's strong IP reports of positive feelings, reasons, and narrative statements regarding treatment entry nonetheless address potential concerns that treatment-refusing IPs might only enter treatment if felt coerced by family members and while experiencing salient negative feelings overall.

Concerned significant others of people with gambling problems in Finland: a cross-sectional population study.

BackgroundProblem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs.MethodsThe data (n = 4484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011–2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher’s exact tests, and logistic regression analysis.ResultsAltogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; p ≤ 0.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; p ≤ 0.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24–3.31) for past-year gambling problems, 1.46 (1.08–1.97) for loneliness and 1.78 (1.38–2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09–2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24–3.93) for mental health problems, 1.39 (1.03–1.89) for loneliness and 1.97 (1.43–2.71) for daily smoking.ConclusionsCSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.

The impacts of problem gambling on concerned significant others accessing web-based counselling

The ‘concerned significant others’ (CSOs) of people with problem gambling frequently seek professional support. However, there is surprisingly little research investigating the characteristics or help-seeking behaviour of these CSOs, particularly for web-based counselling. The aims of this study were to describe the characteristics of CSOs accessing the web-based counselling service (real time chat) offered by the Australian national gambling web-based counselling site, explore the most commonly reported CSO impacts using a new brief scale (the Problem Gambling Significant Other Impact Scale: PG-SOIS), and identify the factors associated with different types of CSO impact. The sample comprised all 366 CSOs accessing the service over a 21month period. The findings revealed that the CSOs were most often the intimate partners of problem gamblers and that they were most often females aged under 30years. All CSOs displayed a similar profile of impact, with emotional distress (97.5%) and impacts on the relationship (95.9%) reported to be the most commonly endorsed impacts, followed by impacts on social life (92.1%) and finances (91.3%). Impacts on employment (83.6%) and physical health (77.3%) were the least commonly endorsed. There were few significant differences in impacts between family members (children, partners, parents, and siblings), but friends consistently reported the lowest impact scores. Only prior counselling experience and Asian cultural background were consistently associated with higher CSO impacts. The findings can serve to inform the development of web-based interventions specifically designed for the CSOs of problem gamblers.

The concerned significant others of people with gambling problems in a national representative sample in Sweden - a 1 year follow-up study.

BackgroundResearch into the impact of problem gambling on close social networks is scarce with the majority of studies only including help-seeking populations. To date only one study has examined concerned significant others (CSOs) from an epidemiological perspective and it did not consider gender. The aim of this study is to examine the health, social support, and financial situations of CSOs in a Swedish representative sample and to examine gender differences.MethodsA population study was conducted in Sweden in 2008/09 (n = 15,000, response rate 63%). Respondents were defined as CSOs if they reported that someone close to them currently or previously had problems with gambling. The group of CSOs was further examined in a 1-year follow up (weighted response rate 74% from the 8,165 respondents in the original sample). Comparisons were also made between those defined as CSOs only at baseline (47.7%, n = 554) and those defined as CSOs at both time points.ResultsIn total, 18.2% of the population were considered CSOs, with no difference between women and men. Male and female CSOs experienced, to a large extent, similar problems including poor mental health, risky alcohol consumption, economic hardship, and arguments with those closest to them. Female CSOs reported less social support than other women and male CSOs had more legal problems and were more afraid of losing their jobs than other men. One year on, several problems remained even if some improvements were found. Both male and female CSOs reported more negative life events in the 1 year follow-up.ConclusionsAlthough some relationships are unknown, including between the CSOs and the individuals with gambling problems and the causal relationships between being a CSO and the range of associated problems, the results of this study indicate that gambling problems not only affect the gambling individual and their immediate close family but also the wider social network. A large proportion of the population can be defined as a CSO, half of whom are men. While male and female CSOs share many common problems, there are gender differences which need to be considered in prevention and treatment.

Willingness and appropriateness of peers participating in emerging adults' substance misuse treatment

This study investigates the feasibility of adapting empirically-supported family treatments for emerging adult peer dyads. Data were collected (n=84) from emerging adults and their peers. Peers completed measures of substance use, willingness to participate in their friends' treatments, and an adapted version of the Significant Other Behavior Questionnaire (SBQ), which measures concerned significant others' (CSO) responses to another's use such a punishing, supporting, or withdrawing from the user. Peers were more likely to support sobriety or enable use, versus punishing use or withdrawing from their friends. Overall, peers were quite willing to assist in treatment, but heavily using peers were less enthusiastic. For some emerging adults, their current peers may represent untapped resources to integrate into treatment, and providing peer-enhanced treatments may expand the reach of services to non-treatment seeking populations.