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Drug and Alcohol Dependence Reports logoLink to Drug and Alcohol Dependence Reports
. 2026 May 20;19:100444. doi: 10.1016/j.dadr.2026.100444

Engaging communities in recovery: Evaluation of a patient and family advisory committee supporting implementation of the Road to Recovery model of substance use care in British Columbia

David Chang a, Seonaid Nolan b,c, Jeffrey Morgan b, Andrea Ryan c, Clint Barton d, Robert Chippeway e, Nichola Hall f, Colin Gregory b, Erika Mundel c, Travis De Wolfe b, Cheyenne Johnson b,g, Brittany B Dennis b,c,⁎
PMCID: PMC13234721  PMID: 42256666

Abstract

Background

The increasing presence of unpredictable toxic substances in the drug supply has intensified the need for substance use care models that integrate lived and living experience into program design and implementation. The Road to Recovery (R2R) initiative, launched in British Columbia in 2023, established a Patient and Family Advisory Committee (PFAC) to ensure clinical services and research processes reflect patient and family priorities. This study provides an early evaluation of the PFAC embedded within the R2R model.

Methods

A convergent mixed-methods design was used. An environmental scan of R2R administrative, clinical, and operational documents (2021–2025) described PFAC structure, membership, and program integration. This informed three virtual focus groups, conducted between May and June 2025 with PFAC members, research staff, and clinical operations leaders (n = 13). Discussions were audio-recorded, transcribed, and analyzed using inductive conventional content analysis.

Results

The PFAC was established in September 2023, including 20-members since inception, representing people with lived and living experience and health system stakeholders. The committee contributed to operational and research improvements, including revisions to survey tools, development of family-oriented resources, and adjustments to clinical policies. Participants valued the PFAC’s role but identified challenges related to emotional safety, role clarity, orientation, and feedback processes. Findings informed six domains of recommendations.

Conclusions

This evaluation demonstrates that a PFAC embedded within a substance use care program can meaningfully influence clinical and research activities. Clear, transparent, and emotionally safe engagement structures are essential to support sustained participation and more effective recovery-oriented substance use care.

Keywords: Substance use, Patient reported outcomes, Withdrawal Management, Recovery, Participatory Research, Community Research

Highlights

  • •

    Integration of lived experiences meaningfully shaped clinical and research improvements in a substance use treatment program.

  • •

    Lived experience informed clinical service design, research, and institutional policy improvements.

  • •

    Six recommendations are made to strengthen committee engagement, accessibility, and participation.

  • •

    No recovery stage is ideal; flexible, safe participation supports meaningful engagement.

1. Introduction

The substance use crisis is a significant public health challenge that continues to impact communities across North America. In the United States, overdose deaths have reached alarming levels, with 107,941 fatalities recorded in 2022 (Centers for Disease Control and Prevention, 2025). Similar patterns are seen in Canada, with over 52,544 deaths from drug toxicity since 2016 (Government of Canada, Health Canada, 2025). Within Canada, British Columbia (BC) is among the most affected provinces. In 2024, BC recorded an overdose death rate of 41 per 100,000 persons, with a total death count exceeding 16,000 since 2016 (Government of British Columbia BC Coroners Service, 2024, Public Health Agency of Canada, 2023). In parallel, hospitalizations and emergency department visits related to drug poisoning have surged to record levels, with over 48,108 hospitalizations and 198,811 emergency department visits since 2016 (Government of Canada Health Canada, 2025). The ongoing rise in substance-related harms, driven by an increasingly unpredictable and contaminated drug supply (Government of British Columbia BC Coroners Service, 2023), underscores the urgent need for coordinated, comprehensive substance use services informed by diverse perspectives, including those of people with lived and living experience, to address the complex health and social dimensions of substance use.

In response to BC’s ongoing drug toxicity crisis, driven by an increasingly unpredictable and contaminated drug supply containing unregulated harmful substances, a new comprehensive model of substance use care known as the “Road to Recovery (R2R) Initiative,” was launched (Wellar et al., 2025). R2R seeks to provide comprehensive and accessible substance use services across the continuum of care, including withdrawal management, transitional care, bed-based treatment, and long-term recovery supports (Wellar et al., 2025). Through a phased implementation approach, the model includes the development of 95 new substance use treatment beds within the Vancouver region. At present, 45 beds are operational, with full implementation anticipated by the end of 2026. It uniquely encompasses a wide range of clinical providers (i.e., peer support specialists, occupational therapists) and emphasizes culturally safe care for Indigenous patients through the inclusion of Indigenous-focused treatment programming and health providers (Wellar et al., 2025). In parallel to service implementation, a longitudinal research program was embedded within the R2R infrastructure to support real-time evaluation and inform coordinated, evidence-based improvements in care (Dennis et al., 2024).

From its inception, the R2R initiative has aimed to engage participation from communities impacted by substance use to ensure that care remains responsive to the needs and priorities of individuals who use drugs (Wellar et al., 2025). This is particularly important given the persistent stigma experienced by people who use substances, which can limit inclusion in research and care design, highlighting the need for more inclusive engagement approaches (Carroll et al., 2025). One key strategy has been the creation and integration of community advisory structures, such as patient and family advisory committees (PFACs), which create formal spaces for individuals with lived and living experience to contribute to program development, service planning, and ongoing quality improvement (Harrison et al., 2019). The development and implementation of PFACs in clinical and research settings have been well-documented, primarily through qualitative studies (Cunningham and Walton, 2016, Fisher et al., 2019, Fredriksson and Modigh, 2021, Harrison et al., 2019, Johnson et al., 2016, Missel et al., 2021, Oldfield et al., 2019). These studies highlight how patient engagement can enhance research relevance and describe strategies for recruiting and supporting diverse members (Cunningham and Walton, 2016, Fisher et al., 2019, Fredriksson and Modigh, 2021, Harrison et al., 2019, Johnson et al., 2016, Missel et al., 2021, Oldfield et al., 2019). However, descriptive studies of traditional models of patient engagement have not adequately described the inclusion of people with lived and living experience with substance use and recovery (Cunningham and Walton, 2016, Fisher et al., 2019, Fredriksson and Modigh, 2021, Harrison et al., 2019, Johnson et al., 2016, Missel et al., 2021, Oldfield et al., 2019), which may in part be due to structural barriers and a lack of tailored engagement strategies.

Community-based participatory research demonstrates how involving individuals with lived experience with substances in clinical and research program implementation is feasible and effective in improving the relevance and quality of interventions for substance use (Damon et al., 2017, Greer et al., 2018, Olding et al., 2018, Turuba et al., 2024). Yet, practical guidance on how to best integrate communities with lived experience of substance use into the formal design and implementation of a PFAC model, particularly in clinical settings, remains limited. Key gaps persist in optimizing recruitment and retention, supporting participation across stages of recovery, and ensuring feedback is translated into actionable program improvements. While some recommendations, including transparent communication, equitable power-sharing, and flexible, respectful approaches that avoid performative inclusion, are outlined in the Delphi consensus published by Hawke et al. (Hawke et al., 2025), these guidelines do not differentiate between mental health and substance use contexts. This distinction is critical, as the populations, experiences, and outcomes of mental illness and substance use differ in meaningful ways, whereby individuals affected by primary mental health conditions often face distinct etiologies, severities, treatment pathways, and stigma patterns compared to those with isolated substance use disorders (Blanco et al., 2021, Castaldelli-Maia and Bhugra, 2022, Franco et al., 2019).

To address these gaps, this study examines the early development and implementation of a PFAC embedded within the rollout of the R2R clinical program and its integrated health service and research evaluation. The study aims to (1) describe the committee’s purpose, structure, and establishment; (2) explore its role in supporting the implementation of substance use care and the associated research agenda; and (3) identify key facilitators and barriers to its integration and operation. Ultimately, this work seeks to inform best practices for community engagement in substance use care and guide future efforts to embed meaningful patient and family input into complex and evolving health systems designed to treat substance use disorders and support individuals across their recovery journey.

2. Methods

2.1. Mixed-methods design

A structured evaluation of the development and implementation of the R2R PFAC was undertaken using a convergent parallel mixed-methods design (Creswell and Creswell, 2017), integrating findings from an environmental scan of the R2R clinical and operational infrastructure with qualitative data from focus groups. The environmental scan was conducted to describe the purpose, structure, and development of the PFAC through a review of internal documents, meeting logs, and membership records. In conjunction, three semi-structured focus groups were implemented to capture stakeholder perspectives and recommendations. The environmental scan was conducted first and directly informed the development of the focus group interview guides by identifying key domains, terminology, and areas of variation in PFAC structure and implementation, which were subsequently used to tailor question prompts and ensure relevance to participants’ experience. Findings from both data sources were integrated to understand the PFAC’s development, function, and impact. The environmental scan provided context on structure and implementation, while focus groups were performed to evaluate how the committee functioned in practice, including perceived barriers, facilitators, and areas for improvement.

This study is reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines (von Elm et al., 2008). As this project was classified as a quality improvement initiative, it was exempt from Research Ethics Board review and did not require informed consent.

2.2. Environmental scan of the R2R patient and family advisory committee development and implementation

A comprehensive review of administrative, clinical, and operational documents from the R2R clinical program (2021–2025) was undertaken to describe the organizational framework of the R2R PFAC and capture the committee’s establishment, policies, and integration within the broader care model. This included a review of both internal and external documents spanning the pre-implementation and post-implementation phases of R2R (2021–2025). Internal documents, including the clinical program outline, PFAC Terms of Reference, meeting minutes, and membership logs. External sources included published research on R2R (Dennis et al., 2024, Wellar et al., 2025), news releases from the British Columbia Ministry of Mental Health and Addictions (Government of British Columbia, 2023, Government of British Columbia, 2024), and publicly available organizational briefs from the BC Centre on Substance Use (BC Centre on Substance Use n.d.).

These sources were reviewed by two evaluators to extract key information. No formal data extraction tool or thematic framework was applied. Extracted information was organized descriptively to document membership composition, meeting frequency, the committee’s timeline of development, engagement strategies, shifts in composition, integration with the Indigenous Wellness and Reconciliation (IWR) team, observable impacts on the R2R program, and contributions to clinical and research activities.

2.3. Focus groups of community partners and the patient and family advisory committee

Between May and June 2025, three one-hour virtual focus groups were conducted to explore stakeholder perspectives on the PFAC and its role within the R2R initiative. Focus groups were conducted independently for 1) PFAC Community Members, 2) research team members, and 3) clinical leadership and operational staff. Participants were grouped based on their primary role within the R2R program. In some cases, individuals held multiple roles and were included in the group that best reflected their primary involvement in R2R. For instance, members of the research and/or clinical operations teams may have also had lived experience of substance use, and this was captured. Each group was asked a set of semi-structured questions to reflect on the purpose, function, and impact of the PFAC, as well as to identify strengths, challenges, and opportunities for improvement. Convenience sampling was used to recruit participants via email through the R2R program. A total of 13 individuals were invited to participate, of whom 13 attended the focus groups. Participation was voluntary, and no formal target sample size was set. The interview guide was informed by information gathered during the environmental scan and developed collaboratively with the R2R research and clinical operations teams. The guide was further reviewed by the PFAC facilitator to ensure relevance (provided in Supplementary Appendix A). At the end of each focus group, participants were invited to complete an optional, anonymous survey, used to capture sociodemographic information including age, gender identity, and participant role(s). The survey also included a question asking participants whether they believed there was an optimal stage of recovery at which individuals should join the PFAC.

Lived and living experience was defined broadly to include individuals with current or past substance use, as well as family members or close supports of individuals who use substances. We recognize that these experiences are heterogeneous and shaped by diverse social and recovery contexts. Consideration was given throughout the study to how participant perspectives and researcher roles may influence data interpretation.

Conventional content analysis was used to structure the analysis of qualitative data from the focus groups (Neergaard et al., 2009). Focus group discussions were recorded and transcribed using a natural language processing software that facilitated initial coding and theme development (Otter.ai, 2025). A range of inductive codes were developed to reflect the study’s objectives, with particular emphasis on participants’ experiences, perceptions of committee structure and function, and recommendations for future committee development. A summary codebook is provided in Supplementary Appendix B.

The data were first open-coded to capture initial impressions and recurring concepts, followed by more focused coding to refine themes and identify areas of consensus and divergence across stakeholder groups. This iterative process was informed by continual comparison of transcripts with emerging concepts to ensure consistency and depth of interpretation. Validation techniques included the integration of field notes taken during focus groups, which were later compared against the transcriptions and artificial intelligence (AI)-generated summaries, which were reviewed by two members of the research team. Furthermore, thematic coding derived from the conventional content analysis was presented back to the full PFAC, research, and clinical operations teams for additional content validation.

2.4. Development of PFAC recommendations

Based on the results generated from the thematic analysis of focus group transcripts, a set of actionable recommendations were generated to guide future PFAC development and promote the continued success of PFAC integration within R2R. Recommendations were organized into core domains based on cross-stakeholder consensus identified during coding and comparative analysis. Following this analysis, preliminary recommendations were presented to the PFAC for content validation and refinement to ensure they accurately reflected member perspectives. Feedback from this session was incorporated into the final set of recommendations, which were subsequently reviewed by the broader R2R evaluation team, inclusive of members of the research (i.e., principal investigators, program manager, research assistants and coordinators, analyst, graduate students) and clinical operations team (i.e., quality improvement nursing lead, clinician division director).

3. Results

3.1. R2R patient and family advisory committee: an environmental scan of the PFAC development and organizational structure

The R2R PFAC was established in September 2023. A timeline of PFAC implementation is presented in Fig. 1, which with key research and clinical program engagement milestones highlighted. The committee was created through leadership from the clinical operations team and initially facilitated by clinical operations staff. Over time, facilitation transitioned to a doctoral graduate student with experience in participatory and community-based research approaches. Meetings have been held monthly, with intermittent breaks during December and the summer months. All meetings have taken place virtually, with the exception of one in-person meeting held 1.5 years into the initiative. Meeting length has typically ranged from 60 to 90 min.

Fig. 1.

Fig. 1

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Caption: Patient and Family Advisory Commitee (PFAC); Opiod Agonist Therapy (OAT); Indigenous Wellness and Reconciliation.

Since its inception, approximately 20 individuals have participated in the PFAC (with an average group size of approximately 8 members at any given time). Membership has included people with lived and living experience of substance use, family members, former patients, members of the clinical operations and research teams, and one member of the health authority’s Indigenous Wellness and Reconciliation team. Membership was established through existing connections and networks, where participants were invited on a rolling, voluntary basis, and there was no predefined term of participation. Membership has fluctuated due to life circumstances, including various stages of recovery and competing personal or professional commitments. Recruitment strategies have included word of mouth, professional networks, and referrals through the research team. While membership has shifted over time, core participation has been retained through flexible engagement options and ongoing relationship building.

The PFAC has engaged directly with members of the research and clinical operations teams. Information from each meeting is captured in detailed meeting minutes, which are circulated among relevant stakeholders through email services. These documents serve as the primary tool for ensuring transparency and continuity. Feedback, ideas, and concerns raised by PFAC members are brought back to the clinical and research teams through established feedback loops, allowing for adaptations and implementation of suggestions. This engagement has led to documented contributions to both the clinical and research components of the R2R initiative.

3.2. PFAC community member focus group

Five committee members of the PFAC attended this focus group. The median age of participants was 40 years (age range 35–83). Attendees represented individuals with lived and living experience of substance use and family members of people with lived and living experience of substance use. PFAC members described their involvement in the committee as personally meaningful and motivated by a shared desire to improve care for people who use substances. They consistently valued the opportunity to contribute their lived and living experiences, which they felt were respected and listened to in meetings.

Members appreciated the flexibility in how meetings were structured and called for hybrid or in-person options, with in-person gatherings described as particularly “powerful.” These in-person sessions were seen as opportunities to build stronger relationships among committee members and staff, contributing to a greater sense of trust, connection, and comfort. Emotional safety was a recurring theme, with members emphasizing the importance of having a strong chair during difficult discussions and information on how to access to emotional supports if in need.

However, many expressed uncertainty about whether their feedback was implemented, pointing to a lack of communication about the impact of their contributions. As an example, a recurring topic raised by PFAC members, both during meetings and in follow-up reflections on this manuscript, was the importance of strengthening aftercare and post-program supports once individuals transition out of R2R services. Members emphasized that while aftercare is planned within the broader model, it remains an area that needs more visibility and clearer integration throughout program development and evaluation.

While recruitment and retention were not seen as major issues among committee members, participants noted that early recovery could make participation more vulnerable. They also highlighted the emotional toll of sharing lived experience, emphasizing the need for more emotional and logistical support for committee members in early recovery, such as access to peer support.

PFAC members suggested that engagement could be improved through stronger onboarding and clearer preparation processes. Specifically, they recommended onboarding new members with an outline of the R2R program, a summary of past PFAC contributions, and clearly defined expectations for committee roles and responsibilities. Improved preparation materials were also emphasized, such as circulating a structured agenda before each meeting to allow members time to reflect and prepare.

3.3. Research team focus group

Four members of the R2R research evaluation team attended this focus group. The median age of participants was 30 years (range from 25 to 35). Roles of the attendees included physician-researcher and research team members (coordinators, program managers). One participant reported lived experience with a family member who used substances.

The research team regarded the PFAC as an essential partner in strengthening the R2R cohort study and health service evaluation. They credited the committee with significantly influencing how research tools were designed, particularly by improving cultural safety, language, and reducing participant burden (i.e., how questions were asked, focus on number of questions asked). The PFAC also helped shift research priorities toward more relevant areas for individuals with lived experiences including mental health supports and aftercare resources.

Researchers highlighted how the committee’s input led to practical adjustments, including shortening questionnaires and increasing honoraria. They emphasized that adapting engagement strategies over time, including simplifying materials and focusing questions, improved the relevance and quality of feedback. For example, researchers began asking more participant-centered questions such as, "Are there things you think are important that I’m missing?" to create space for meaningful input.

Early challenges engaging with PFAC included communication barriers stemming from overemphasis of academic concepts and language, which was perceived to confuse PFAC committee members. Lack of orientation to research processes was thought to be a major contributor to confusion among PFAC members. For instance, the research team noted that presenting the PFAC with a 35-page questionnaire was a largely ineffective and overwhelming approach to gathering feedback, especially for those unfamiliar with research processes or with limited access to technology.

Maintaining balanced participation within PFAC discussions was also an area for potential improvement, particularly in ensuring that quieter members’ perspectives were not overshadowed. Additional challenges arose when feedback occasionally conflicted with clinical or research frameworks, or when internalized stigma was expressed. For example, during a meeting about refining survey response options, the group debated whether to include both “use due to physical dependence” and “use to prevent withdrawal.” Committee members with lived experience emphasized that, while clinically related, these options reflect different lived realities and should not be conflated. Similarly, research team members noted that some language used, even by those with lived experience, unintentionally reinforced stigma (i.e, use of words like addict, drunk).

The team emphasized the need for improved onboarding tools, such as a welcome package outlining the R2R initiative and its research goals and general research processes. They also recommended clearer feedback loops to demonstrate how PFAC input leads to real change. Additionally, they reflected on the importance of being prepared to respond with care when active substance use occurs during meetings, suggesting the need for protocols that maintain both group safety and support for participants.

3.4. Clinical operations team focus group

Four members form the clinical operations team attended this focus group. The median age was 42 years (range from 35 to 44). Roles included project planning, physician, research team member. One individual from the clinical operations team also noted a history of lived experience as a family member of someone who has used substances.

The operations team described the PFAC as a foundational element in guiding the evolution of the R2R program, frequently referring to it as a "North Star." They viewed PFAC engagement as a key element of ensuring services remained aligned with lived experience and the real-world needs of those accessing care.

Participants provided several examples of PFAC driven improvements, including program changes to reduce boredom, adjustments to smoke break policies, offering virtual versus in-person assessment options for access to withdrawal management, and enhanced family engagement practices. The committee’s role in informing community outreach, peer support initiatives, and shaping resources like a missing persons protocol was also acknowledged. Operational leaders found PFAC feedback to be validating and helpful for recalibrating services during system shifts.

Challenges identified to be impacting PFAC engagement included inconsistent member attendance, dropouts due to death or loss of contact details (i.e., new phone number), and a lack of formal tracking systems for committee impact. Concerns were also raised around inviting individuals too early in recovery, and ensuring that committee members are supported. These situations highlighted the need for greater emotional safety supports for individuals in recovery participating in PFAC. The team also noted logistical challenges such as not knowing what is realistically feasible and limited hybrid/phone access.

Suggestions for improvement included sharing questions in advance, clarifying what changes are realistically feasible within institutional limits for PFAC members, and increasing virtual accessibility to enhance participation. Emphasis was placed on improving two-way communication to ensure PFAC members see how their input informs decision-making to enhance engagement.

3.5. Focus group thematic summary and comparisons

All groups affirmed that the PFAC plays a crucial role in centering lived experience in the design and delivery of substance use care. Participants agreed that PFAC feedback had led to specific, positive changes across research tools, operational policies, and clinical services.

When discussing the functioning and impact of the PFAC, all groups identified challenges related to member attendance and emotional safety. The research and operations teams noted the importance of setting clear expectations and preparing questions in advance to support meaningful participation. PFAC members emphasized the value of emotional support systems, a clear meeting structure, and the presence of a supportive chair as key factors in creating a safe and productive environment. While PFAC members felt heard during discussions, both they and the research and operations teams highlighted a disconnect related to how feedback was implemented, citing a lack of clear communication and follow-up.

There was strong cross-group agreement that participation in the PFAC should not be restricted to individuals at a particular stage of recovery. However, there was consensus on the importance of maintaining respectful participation norms. Researchers and operational leaders recommended setting boundaries to limit attendance during periods of active substance use due to the potential impact on other participants in recovery. To ensure inclusivity, some participants suggested offering alternative engagement methods, such as one-on-one interviews or separate feedback mechanisms, for individuals who may not be well suited to group meetings.

On the topic of recruitment and retention, PFAC members were generally unconcerned, whereas the research and operations teams identified it as a potential challenge, particularly in relation to sustaining involvement from individuals early in recovery or those with active substance use. All groups recognized the importance of diverse perspectives and emphasized that ongoing support and clear role definitions are essential for long-term engagement.

3.6. Summary recommendations for future committee development

Recommendations to improve the effectiveness and sustainability of the PFAC emerged based on consensus across focus group discussion (Fig. 2). Recommendations were organized into core domains, including: feedback and transparency; flexible participation and accessibility; member orientation and onboarding; emotional safety and participation guidelines; preparation and expectation management; and pathways for input and broader engagement. Supplementary Appendix C provides a detailed summary of the development of recommendations.

Fig. 2.

Fig. 2

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Caption:Summary of recommendations developed using data captured from consensus of focus groups. Definitions: R2R: Road to Recovery; PFAC: Patient and Family Advisory Committee.

In addition to these recommendations, the demographic survey showed consistent agreement that there is no optimal stage of recovery for PFAC participation. Stakeholders agreed that restricting membership to abstinent individuals could exclude valuable perspectives, with one member noting that “suggesting an optimal stage of recovery… can be perceived as a deficits-based approach,” potentially overlooking important insights into care operations and research from those still navigating the system.

4. Discussion

This mixed-methods evaluation provides one of the first detailed descriptions of a PFAC embedded in the design and implementation phases of a new substance use program. Findings highlight how the committee contributed to both research and clinical improvements, such as survey design revisions, development of family resources, and adjustments to operational policies. Beyond this, PFAC was noted to play a key role in enhancing service delivery, promoting cultural and emotional safety, and elevating patient-prioritized issues like mental health, aftercare, and family involvement. Stakeholders highlighted areas for strengthening the committee’s function, supporting the creation of interrelated recommendations to support meaningful participation in substance use care.

Evidence on strategies to develop and implement PFACs in substance use care is still emerging. A review by Oldfield et al. (2019) notes that while PFACs are increasingly used across healthcare settings, few studies measure their impact, as well there has been limited focus on substance use services. Switzer et al. (2019) describe a community advisory committee for people with HIV who use drugs, emphasizing inclusive and accessible structures but with limited generalizability to broader substance use populations. Their work also centers on committee design and facilitation rather than the tangible impacts of committee input and areas for improvement. Similarly, Haines-Saah et al. (2024) outline principles for family involvement in drug policy and overdose prevention, but outside of formal advisory structures. In contrast, this study demonstrates how a PFAC embedded in a newly implemented structured substance use system of care can directly shape research, clinical practice, and program development and implementation. Committee members contributed to operational policies, family supports, and research tools in ways that were both actionable and sustained.

Through this evaluation, the PFAC demonstrated value by integrating lived experience into decision-making across the R2R program. Its feedback influenced questionnaire design, evaluation metrics, operational priorities, and service innovations, such as family support resources and protocols for reconnecting with missing persons. These contributions reflect growing recognition that co-designed care and research are more responsive and equitable (Brown Speights et al., 2017, Israel et al., 2010, Israel et al., 2005, Lizaola et al., 2011, O’Fallon and Dearry, 2002). For other settings seeking to implement similar advisory structures, this study displays the importance of investing in supportive infrastructure from the outset. While some studies have reported similar recommendations for patient engagement in health system design (Anderson et al., 2022, Anderson et al., 2021, Brust et al., 2025, Hatlie et al., 2020), to our knowledge, few have addressed these within the context of substance use treatment.

Two key implications for practice emerged from this evaluation. Following these findings, structured feedback summaries have been introduced to improve transparency and communication regarding how PFAC input is applied. More broadly, this evaluation highlights two interrelated and novel contributions. First, it underscores the importance of establishing deliberate infrastructure, such as feedback mechanisms, to support equitable, transparent, and sustainable engagement. Second, it challenges assumptions about participant readiness by demonstrating that there is no single “optimal” stage of recovery for PFAC involvement. Across stakeholder groups, restricting participation to abstinent individuals was seen as potentially excluding critical perspectives, particularly from those for whom the system is not working. Taken together, these findings suggest that meaningful PFAC engagement depends both on inclusive participation across recovery stages and on systems that ensure contributions are visibly and effectively integrated into decision-making.

The findings have several implications for participatory health research, particularly in addiction care. While this study generated practical recommendations for improving the structure and sustainability of patient and family advisory committees, evidence-based approaches for engaging communities in recovery remain unclear. The results of this study align with previous research on the role of PFACs in guiding research and operations (Fisher et al., 2019, Hawke et al., 2025). For example, frameworks such as community-based research review processes (CRPs) have been developed to strengthen the ethical integrity, cultural relevance, and shared decision-making of community partnerships (Shore et al., 2015); however, their application to substance use populations, particularly those in early recovery, has not been evaluated. These gaps highlight the need for further research to understand how to effectively and safely engage people in recovery in participatory health research. While the recommendations in this study reflect strong stakeholder consensus, they are based on a small number of focus groups. Future evaluations should build on these findings through structured qualitative research examining the long-term impacts of PFAC engagement on health outcomes, system design, and research uptake.

The study is not without limitations. First, the short evaluation timeframe provided only an early snapshot of committee development and may not capture how roles, processes, and impacts evolve over time. Second, findings are shaped by the unique structure and context of the R2R program, which may limit transferability to other settings. Third, the relatively small number of focus group participants limits the range of perspectives represented, and the views of those who disengaged from the committee could not be captured. This may bias findings toward active participants. Finally, the broader context of substance use care is rapidly evolving, with shifting policy priorities, service models, and patient needs. Ongoing evaluation is needed to ensure recommendations remain responsive and sustainable.

Taken together, these considerations underscore the importance of continued evaluation as this model evolves.

5. Conclusion

The PFAC has emerged as a critical component in R2R’s evolution, helping to guide care and research in a more responsive, inclusive, and community-informed direction. By centering lived and living experience, the committee has contributed to key innovations in the program and supported a shift toward more patient-centered substance use care. As this model develops, sustained and meaningful engagement, supported by clear structures and feedback, will be vital to maintaining its relevance and impact.

CRediT authorship contribution statement

Seonaid Nolan: Writing – review & editing. Brittany B. Dennis: Writing – review & editing, Writing – original draft, Supervision, Methodology, Formal analysis, Conceptualization. David Chang: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis. Cheyenne Johnson: Writing – review & editing. Travis De Wolfe: Writing – review & editing. Andrea Ryan: Writing – review & editing. Jeffrey Morgan: Writing – review & editing. Clint Barton: Writing – review & editing. Erika Mundel: Writing – review & editing. Colin Gregory: Writing – review & editing. Nichola Hall: Writing – review & editing. Robert Chippeway: Writing – review & editing.

Declaration of Generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the author(s) used Otter.ai in order to assist with focus group note-taking and assist with quotation searches. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.

Funding

The Road to Recovery Evaluation is funded as part of a philanthropic gift through the St. Paul’s Foundation at Providence Health Care over five years (2023 – 2027). Support for members of the R2R research team has also been provided by: the Michael Smith Health Research BC (Scholar awards for BD), the University of British Columbia’s Steven Diamond Professorship in Addiction Care Innovation (SN), and the University of British Columbia’s Summer Student Research Program (DC). Funders had no role in study design, data collection, analysis, interpretation, writing, or decision to submit.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Declaration of Competing Interest

The authors have no competing interests to declare.

Acknowledgements

The Road to Recovery Clinical Service and Research Evaluation were developed and are being implemented and delivered on the traditional and unceded territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations. We are grateful for the opportunity to live, work, and grow as humble guests on this land. We extend our sincere gratitude to all members of the R2R PFAC for their time, insights, and commitment to shaping a more responsive and inclusive model of substance use care. Your lived and living experience has been instrumental in guiding the direction of both clinical services and research evaluation. We also thank the R2R research and operations teams for their collaboration and contributions to this evaluation, as well as the IWR team for their continued guidance and participation. Furthermore, this project would not be possible without the collaboration of the British Columbia Centre on Substance Use, Providence Health Care and its Indigenous Wellness and Reconciliation Team, Vancouver Coastal Health, the Ministry of Mental Health and Addiction, and the Regional Addiction Program. Finally, BC's philanthropic community has provided a significant source of funding for the R2R model of care and the evaluation, for which we are incredibly grateful.

GLOSSARY

PFAC

Patient and Family Advisory Committee supporting program and research design.

Lived and Living Experience

Personal experience with current or past substance use.

R2R Model

Road to Recovery system of substance use care in British Columbia.

Aftercare

Post-program supports that promote continuity of care and recovery.

Participatory Research

Research approach involving community partners in decision-making.

IWR Team

The Indigenous Wellness and Reconciliation team within Providence Health Care (a Vancouver region health authority in BC) provides culturally safe care and advocacy that bridges Indigenous healing practices with Western medicine.

Content Analysis

Inductive qualitative method used to identify themes in focus group data.

Mixed-Methods Design

Combination of qualitative and quantitative approaches in a single study.

Footnotes

Appendix A

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.dadr.2026.100444.

Appendix A. Supplementary material

Supplementary material

mmc1.docx (3.3MB, docx)

References

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