Recognizing the Role of Companion Animals in Addiction Recovery

Empirical status Awareness exists within the addiction profession about the significance of the concept of connection in recovery.1 The term recovery is variously referred to, including: being in recovery, seeking recovery, wellness, health, and healing journey, to name a few. Common elements amongst definitions of recovery are seeking a life worth living without using, optimism that recovery is possible, recognition that it is a process, and acknowledgement that there is always hope.2 Connection is recognized in various ways in recovery, and for the most part is understood in relation to other humans, one’s self, a higher power, and even nature. Rarely is connection with an animal acknowledged. This past decade has seen an increase in the number of studies examining the potential health benefits for humans from their interactions with companion animals, or pets. Anecdotally, the evidence is clear, our relationships with pets improve our lives. Purchasing trends in North America over the past decade support this; there is a continual growth in the number of pet owners,3 income spent on pet health and accessories is increasing,4 and the integration of pets into our lives is being accommodated (pets accepted in retail stores, hotels, patio restaurants, etc.). Given the emergent state of the research field, an empirical understanding about the role of pets on human health is not conclusive. A recent systematic review of 54 quantitative studies on the impacts of pets on human mental health had mixed results.5 An earlier systematic review of quantitative studies found similar mixed results, but the “qualitative studies illuminated the intensiveness of connectivity people with companion animals reported.”6 There is a definite need for more rigorous and robust quantitative and qualitative study designs, consistency in the populations studied so comparisons can be made, and consideration of confounding variables alongside pet ownership. In 2011, Herzog7 went so far as to say that media accounts have contributed to an unsubstantiated “pet effect.” A decade later he referred to the “pet effect paradox,” indicating “what we believe about the positive impact of pets on our lives and actual research results are unclear.”8 Empirical understanding of how pets may positively impact people’s substance use health and recovery is almost non-existent. Fortunately, the Canadian Centre on Substance Use and Addiction included a question on its 2018 national recovery survey. It found that 88% of Canadians identified their relationship with animals or pets as an important support in their recovery, and 44% found this relationship to help in continuing their recovery from addiction.2 In an attempt to understand the meaning behind these noteworthy percentages, our team undertook a first-of-its kind exploratory, qualitative study. In a small qualitative study, we examined how pets supported recovery from addiction among seven patients in an opioid agonist therapy program. We found that companion animals fulfill supportive roles that other humans can not or chose not to provide. Our findings align with and expand upon the four dimensions of a life in recovery outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA)—purpose, community, health, and home.9 To illustrate, SAMHSA defines the community dimension as “having relationships and social networks that provide support, friendship, love, and hope.”10 In our study, participants identified their pets as family members who promoted a sense of belonging. These relationships with companion animals were described as equal to and in some cases superior to their connection with humans. Pets acted as confidents for the participants during stressful times and were described as a consistent source of unconditional love and acceptance. One participant shared:You go to … groups, you can’t say everything you want in those places … Somebody’s always opinionated. Somebody’s got something to say. Like you don’t need, sometimes you don’t want anybody to say anything to you, you just want to vocalize your thoughts … When you have a dog, and you can talk for an hour or two hours or whatever, you sit there and you’re with your animals.9 In a follow-up qualitative study, we examined the benefits and challenges of having a service dog among 16 veterans in or seeking recovery from addiction and living with posttraumatic stress disorder. Service dogs are specially trained to assist a person with visible or invisible daily living challenges.11 We found that all veterans perceived their service dogs as an important and unique support in their lives, and that the animal positively impacted all four of SAMHSA’s dimensions of recovery through a sense of connection. However, veterans also described challenges related to the regulation and legislation of service dogs in their province or territory, which sometimes hindered their ability to participate in meaningful daily activities and contributed to a sense of disconnection. Attachment and other theories In the nonaddiction literature, the underlying connection between humans and animals is identified as the human-animal bond (HAB). The American Veterinary Medical Association defines the HAB as “a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and wellbeing of both.”12 Drawing on this definition, and taking what we currently know about the positive influence of companion animals on people’s health, one potentially partial explanation of their beneficial impact on addiction recovery is attachment theory. The absence of bonding and connection in one’s life is commonly identified as a facilitator of addiction, but it is not well studied.13 Attachment theory has been applied by a few authors to explain the linkage of disrupted attachment with addiction.14,15 It has also been applied to explain the benefits of the HAB in human wellness.16 Attachment theory, originating in the work of Bowlby and expanded by others (eg, Ainsworth), suggests that attachment with figures and the style of attachment are important in human development and adult wellness. Research with companion animals supports that humans identify their pets as attachment figures.17,18 They are recognized as family members by some19 and for others, pets can parallel a child-parent relationship.20 Attachment with an animal, when human connections are absent or problematic because of addiction, may be one starting place to understand their possible benefit in individuals’ recovery. Further investigations Given what is currently known, what can we do in the addictions field to be more animal-informed as the research evidence continues to evolve? First, we can acknowledge the more than 15,000 year history of the domestication of dogs and their evolution alongside humans. More recent, dogs have been selectively bred to fulfill specific human needs. Second, with this understanding, we can recognize the important role of companion animals in some of our patients’ lives. Hodgson et al21 share that asking patients about pets is “a nonthreatening way to build rapport and demonstrates interest in the whole family, which can improve physician-patient therapeutic alliance.”(p.526) Recognizing companion animals as potential supports in our patients’ lives may also provide us with unique insight into their health behaviors (eg, patient motivation to go for a walk). For suggestions on how to be animal-informed in your practice, access our team’s resource, titled “Top 10 Things to Know about the Human-Animal Bond, Addiction and Recovery” at https://colleendell.com/top10 and download a list of addiction service provider resources at https://colleendell.com/resources.

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