Supporting Concerned Significant Others of People Who Use Substances in Rural Australia: A Qualitative Study of Barriers, Enablers and Service Preferences

OBJECTIVE: Problematic substance use can significantly affect the wellbeing of family members and friends (hereafter concerned significant others-CSOs). Despite the substantial burden they experience, CSOs face multiple barriers when seeking support for themselves. Further, limited research has explored what CSOs need from support services, particularly in rural contexts. This study aimed to identify (1) the enablers and barriers to accessing support services reported by CSOs in rural Australia and (2) to explore what CSOs in rural Australia want and need from services to support their own wellbeing. DESIGN: A descriptive qualitative study involving semi-structured interviews. Data was analysed using thematic analysis with a pragmatic focus. SETTING: Interviews were conducted via zoom, across rural Australia. PARTICIPANTS: Twenty-six CSOs are living across rural Australia. RESULTS: Two domains, each containing three themes, were identified. Domain 1 Factors influencing access to formal support included the themes: (1) personal barriers, (2) structural and systemic factors and (3) modes of delivery. Domain 2 Preferences and needs in support services included the themes: (1) the need for professional support, (2) recognition of CSOs' own needs and (3) qualities of effective professional support. CONCLUSION: CSOs' access to support is shaped by multiple structural and interpersonal factors. CSOs value professional and non-judgemental support delivered by clinicians knowledgeable about substance use. Findings highlight the need to strengthen rural service capacity and extend research involving CSOs who are not currently accessing support or those experiencing additional risks such as domestic violence. TRIAL REGISTRATION: Charles Sturt University Human Research Ethics Committee (approval number H23769), registered with the Australian New Zealand Clinical Trials Registry (ANZCTR, ACTRN12623000796684).