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Stigma, shame, and gaps in care frequently prevent patients with substance use disorders from accessing needed medical treatment. These barriers, common in addiction medicine, can also disrupt care for comorbidities such as cancer and are often worsened by social marginalisation and adverse personal circumstances. Two innovative models, the Therapeutic Family Care (Accueil Familial Thérapeutique [AFT]) and patient expert roles, address these challenges.

At the ALBATROS Congress, addiction medicine specialist Chanaëlle Obadia, MD, presented a clinical case study of a patient with alcohol dependence to underscore the necessity of tailored care. Obadia leads the AFT unit at the Centre Hospitalier des Quatre Villes in Paris, France.

During her presentation, Obadia detailed the case of “Jean,” whom she met during her residency. Jean, then in his 50s, arrived for alcohol withdrawal treatment. He lived in social housing and worked for 30 years as a municipal gardener. “He had a lip wound,” Obadia recalled. “Embarrassed, he admitted falling while intoxicated but avoided the emergency department, preferring treatment in the addiction unit during his scheduled admission.” After Obadia treated his wound, Jean completed the alcohol withdrawal treatment. “Like many others, he later stopped the treatment. I did not expect to see him again,” she said. “But life circles back.”

Therapeutic family care, established under a 1986 French decree, provides an alternative to psychiatric hospitalisation. In this model, individuals living with mental health conditions stay with an approved foster family and receive structured medical, psychiatric, and psychosocial support. This approach serves people who need stability but not intensive hospital care, thereby promoting recovery and social inclusion.

“In 2023, after I joined the AFT unit in Sèvres, we received an admission request, and I recognised Jean,” said Obadia. “When I saw him again, with the scar still visible, I felt quietly proud.” Jean faced multiple challenges, including recent hospitalisation for pulmonary embolism, squatters occupying his unsafe home, job insecurity, and a bladder cancer diagnosis during AFT medical evaluations.

Jean agreed to move in with strangers as a foster family. “Because sometimes, when there’s not much left, there’s still the connection,” said a care team member.

“AFT delivers care through human relationships as an alternative to institutional treatment. It creates a structured yet personalised living space. The literature shows varied definitions: AFT extends beyond addiction to geriatric psychiatry and other fields of study. Some frameworks emphasise separation from harmful environments, while others focus on bridging hospitalisation and community reintegration. Crucially, AFT involves medically prescribed placements in which patients live with hospital-approved, trained foster families for months, supported by dedicated medical-psychosocial teams.”

The AFT serves two primary goals: preventing chronic institutionalisation and supporting gradual reintegration into stable environments. Before joining, Jean underwent a comprehensive assessment by a physician, nurse, psychologist, social worker, and patient expert, which was a pivotal encounter.

“It was the patient expert who explained how AFT worked, reassured Jean about daily life in a foster home, and told him, ‘I will be there,’” Obadia said. “More than anyone else, they represented credible, relatable recovery.” At the centre, patient experts hold full-time roles, attend clinical meetings, colead therapeutic groups, and provide continuous support. While their role in addiction care is growing, their responsibilities remain poorly defined, with limited impact studies.

To address this, Obadia led a study at Bichat Claude-Bernard Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]) comparing AFT with hospital-based treatments. “The main question was simple: Does having a patient expert make a difference?” AP-HP’s patient experts trained individuals with lived addiction experience to support inpatients during withdrawal.

The mixed-method study aimed to identify patient expert contributions and evaluate their impact.

Qualitative analysis defined three patient-expert roles: emotional support through shared vulnerability, mediating clinician-patient communication, and therapeutic education about addiction. Quantitatively, 49 patients completed validated questionnaires and two clinician-recommended scales pre- and post-intervention (< 48 hours). The results showed reduced shame and guilt, increased self-esteem, and heightened motivation. Obadia stated: “Patients reported high satisfaction and significantly better understanding of patient experts’ complementary role alongside clinicians.”

“Strengthening patient expert integration requires more research and formal training,” Obadia emphasised. AP-HP now offers a university diploma in Becoming a Patient Expert in Mental Health, which she urged be shared with eligible patients.

Jean stayed in AFT for a year. “Initially withdrawn, he gradually opened up to the patient expert and care team,” Obadia shared. “He maintained alcohol abstinence and quit smoking after 4-5 months.” Jean later reconnected with his estranged daughters, holidayed with them, met his grandchildren, resolved administrative issues, and completed arduous cancer treatment. He was featured in an AFT documentary.

“Jean isn’t unique,” Obadia noted. The Sèvres AFT program was launched in 2007 and supported more than 150 patients (mostly men; mean age, 48 years). The average stay was 8.5 months, and nearly half of the residents arrived homeless. All patients transition to secure housing, typically supported apartments or recovery communities, upon discharge.

A major challenge was recruiting foster families. Currently, the program operates three programs supported by 30 foster families.

While Jean’s case should not be generalised or idealised, it demonstrates that effective cancer treatment for some patients requires more than medication; it demands trusted relationships, stable support systems, and daily psychosocial care. “Without these foundations, treatment can become inaccessible,” concluded Obadia.

This story was translated from Medscape’s French edition.