The role of the human-canine bond in recovery from substance use disorder: A scoping review and narrative synthesis
Abstract
Recovery from substance use disorder (SUD) is a personal journey that includes connection with self and others, including animals – known as the human-animal bond (HAB). Research shows that canines are the most common type of animal integrated into animal-assisted interventions to support people with SUD. Yet, to our knowledge, there has been no review of the evidence on the role of canines in SUD recovery. The scoping review’s objective was to examine the literature on the human-canine bond’s role in recovery from SUD among adolescents and adults, including how the bond may help or hinder recovery. The review considered records that described the human-canine bond with respect to recovery in any recovery- or therapy-related setting globally. Eleven databases were searched, and 32 sources met inclusion criteria that involved companion dogs, therapy dogs, service/assistance, dogs and others. The thematic analysis across records identified three key benefits of the human-canine bond in SUD recovery: (1) a source of social connection and a conduit for human-to-human social connection, (2) a calming and comforting effect on individuals with SUD that can reduce stress and anxiety, and (3) the human-canine bond as a motivating factor for positive change. Through these themes, the bond may help divert substance use-related thoughts and reduce cravings, bolster engagement in treatment and recovery, and help to decrease and prevent substance use. However, a few articles found no role or a limited role of the human-canine bond in recovery, and challenges and considerations were reported, particularly for marginalized populations (e.g., related to obtaining and maintaining housing, employment, and SUD treatment). Most of the records discussed canine welfare in some capacity. Calls were also made for improved policy, public awareness, and animal welfare.
Introduction
Substance use disorder (SUD) is a treatable health and social issue that involves the continuous use of legal and/or illegal drugs including alcohol, despite negative impacts on the individual and others in their life (Government of Canada, 2023). As described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SUD includes both substance abuse and substance dependence and occurs on a continuum from mild to severe (American Psychiatric Association, 2013). Globally, it is estimated that 296 million people aged 15–64 used drugs in the past year and that 13% of these individuals experienced an SUD (United Nations Office on Drugs and Crime [UNODC], 2023). In the latest UNODC World Drug Report (2023), which focused on illegal drug use, 46% of the countries surveyed identified cannabis as the drug associated with the greatest number of SUDs in their jurisdiction, followed by opioids (31%; mainly heroin) and amphetamines (13%; mainly methamphetamine). Opioid use disorder continues to be a major public health issue, accounting for 70% of all deaths due to illegal drug-related SUDs and 38% of drug treatment globally (UNODC, 2023). The UNODC report also found that illegal drug-related SUDs accounted for 18 million years of healthy life lost due to disability and premature deaths (known as Disability-Adjusted Life Years; DALYs) in 2019. Opioid use disorders accounted for an estimated 71% of all illegal SUD-related DALYs during this time (12.9 million years; UNODC, 2023). The previous UNODC report also examined tobacco and alcohol and found that these drugs accounted for 230 million and 93 million DALYs, respectively (UNODC, 2022).
Recovery from SUD has been conceptualized as a personal journey that may include physical, psychological, spiritual, and social health (Government of Canada, 2023) and can span from harm reduction to abstinence. This has been referred to by various terms, including being in recovery, seeking recovery, wellness journey, and healing (McQuaid et al., 2017). Common elements among definitions of recovery are improved health, function, and quality of life (McQuaid et al., 2017). Connection to self and others is also recognized in various ways within recovery, although it is largely understood in relation to other humans. Rarely is connection considered in relation to animals – known as the human-animal bond (HAB; Dell and Butt, 2023).
The HAB has been conceptualized as “a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors essential to the health and wellbeing of both. This includes, among other things, emotional, psychological, and physical interactions of people, animals, and the environment” (American Veterinary Medical Association, 2023, para. 1). Research has consistently demonstrated the health and wellbeing benefits of the HAB across time and cultures, and throughout the lifespan (Walsh, 2009). For example, the HAB can reduce feelings of loneliness and depression in people, as well as alleviate physiological stress and distress responses (Beetz et al., 2012). Although not the focus of this protocol, the successful HAB is likewise identified as beneficial to the health and wellbeing of domestic canines (Wynne, 2020).
The HAB is experienced through interactions between humans and animals, including relationships with pets (also known as companion animals; Walsh, 2009). Unless otherwise stated, the term “pets” in this review refers to dogs or studies that included dogs and cats. We are aware that this does not account for many other species that are kept as pets across the world. In the USA, evidence highlights the growing importance of pets in peoples’ lives, as 70% of households now have a pet (compared to 56% in 1988), the majority of which are dogs (American Pet Products Association, 2022). Studies also show that most people consider their pets as friends or family (Risley-Curtiss et al., 2011; Volsche, 2019) and that 88% of Canadians in recovery from addiction recognize their animals or pets as an important source of support (McQuaid et al., 2017). Similarly, other Canadian research has found that pets, including cats and dogs, can be a complementary form of support for individuals recovering from SUD, in that they are perceived as companions, contribute to psychological safety, promote purpose and empowerment, and support health and wellbeing (Kosteniuk and Dell, 2020). This connection may be partly explained by attachment theory, in that pets can be a secure and consistent relationship in peoples’ lives, and thereby fulfill many essential needs (Fine and Beck, 2019). This is especially true when healthy attachments have been impacted by adverse childhood experiences, trauma, neglect, or other difficult experiences often associated with SUD (Fine and Beck, 2019).
The HAB can be integrated into animal-assisted services (AASs; Binder et al., 2024) with the goal of improving human health (International Association of Human-Animal Interaction Organizations and Jegatheesan, 2018). Previously known as Animal-Assisted Interventions, AASs include animal-assisted therapy (AAT), in which an AAT specialist deliberately integrates an animal into treatment planning and therapy as a modality, as well as animal-assisted activities (AAA), in which less structured interactions with animals – for example, visiting patients in hospitals – can help support therapeutic gains and quality of life (Morrison, 2007). Other AASs include assistance animals that support daily living among people with disabilities (Morrison, 2007), termed service animals in Canada & USA.
Overall, research shows that domestic dogs (canines) are the most common animal in AASs for SUD treatment (Flynn et al., 2022) and that canine AASs have positive impacts on the health and wellbeing of people with SUD. For example, canine AAT for hospitalized adults with SUD has been shown to promote the therapeutic alliance (Wesley et al., 2009), and in residential treatment facilities, AAA’s have helped reduce anxiety (Scott and Kirnan, 2021). In prisons and other carceral facilities, canine AAT for inmates with SUD has been associated with improved social skills, reduced substance cravings, anxiety, and depression (Contalbrigo et al., 2017) and supporting prisoners’ correctional plans (Chalmers et al., 2023). Some literature has also examined the impacts of service/assistance dogs on SUD among veterans, finding benefits related to increased social capital, enhanced wellbeing (Dell et al., 2023a), reductions in PTSD symptoms, and decreased use of substances (Husband et al., 2020; Williamson et al., 2021).
Despite this growing body of research, there has been no review of the evidence related to the role of the human-canine bond in SUD recovery. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis found no current or underway systematic reviews or scoping reviews on this topic. The search found reviews on AASs in health settings (Jones et al., 2019; Beck et al., 2022; Pandey et al., 2024) and reviews on the role of AASs and the HAB for mental health support (Downes et al., 2013; Hoagwood et al., 2017; Brooks et al., 2018; Koukourikos et al., 2019; Ward et al., 2022; Barr et al., 2024). Published in 2021, a systematic review of the role of canines in PTSD treatment indicated promising results, although the authors indicated a risk of bias which limited reliability (Vitte et al., 2021). A systematic review investigating the effectiveness of AASs more broadly was conducted by Kamioka et al. (2014), and findings point to the potential of AAT for addiction recovery, but the review did not focus on SUD or canines specifically. The impact of AASs in the treatment of SUD was reviewed more recently by Klemetsen and Lindstrøm (2017) but did not specifically investigate canines and lacked a replicable search strategy. A scoping review from 2022 (Beggs and Townsend, 2021) also touches on the positive outcome of AASs in addiction recovery centers but also did not outline a reproducible search strategy (Fig. 1).
A critical first step to advancing knowledge and practice in this area is assessing the current state of the literature and what is known about this topic. Therefore, the objective of this scoping review is to examine the existing literature on the role of the human-canine bond with respect to recovery from SUD among adolescents and adults, including how the bond may help or hinder recovery. We aim to answer the question: What is currently known about the role of the human-canine bond with respect to recovery from SUD among adolescents and adults? Given that we are aiming to describe an emerging and highly multidisciplinary body of literature, a scoping review combined with a narrative synthesis was the most appropriate method.
Methods
The scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology and used the Participant, Concept, Context (PCC) framework (Peters et al., 2020). This review was conducted in accordance with an a priori published protocol (Dell et al., 2023b).
PARTICIPANTS
This review considered studies with human participants (adolescents and/or adults) who have experienced SUDs. This included SUDs related to alcohol, tobacco, cannabis, opioids, amphetamine-type stimulants, sedatives and tranquilizers, cocaine, hallucinogens, new psychoactive substances, and/or other drugs. Individuals experiencing other types of addiction (e.g., gambling, food-related, internet) were excluded. Children under 10 were also excluded, in line with guidelines set by the World Health Organization (2024).
CONCEPT
The primary concept under investigation in this review was the human-canine bond with respect to its positive and/or negative role in SUD recovery. Studies had to discuss the impact of the bond on humans to be included. This bond or attachment could have been experienced through a variety of human-canine interactions. Such AASs included canine-assisted activities, therapy dogs, community dogs (e.g., dogs that work in a range of community settings and facilities; Irish Guide Dogs for the Blind, 2023), service or assistance dogs (O’Haire et al., 2015), emotional support dogs, comfort dogs, and wellness dogs. The review also considered records that report on companion dogs (pet dogs). Records on the bond with other types of animals (e.g., equine, cats, rodents) were excluded, as were papers discussing any type of robotic or toy animal.
CONTEXT
The review included studies that reported on any SUD recovery- or therapy-related setting, including recovery programs, counseling and therapy spaces, educational programs, medical facilities (including hospitals and psychiatric facilities), prisons and other carceral facilities, individuals’ homes, community-based initiatives, and other contexts. The topic of SUD recovery in this review reflected evidence demonstrating its individualized nature and, therefore, included records on being in recovery, seeking recovery, healing, improved health, function, quality of life, harm reduction, and more (McQuaid et al., 2017). Only records in English were included for data extraction. Records conducted in any geographic context were eligible.
SEARCH STRATEGY
This scoping review aimed to identify published and unpublished studies including but not limited to quantitative and qualitative studies, commentaries, opinion papers, and editorials. Systematic reviews that met the inclusion criteria were also considered, depending on the research question. The review also included grey (unpublished) literature, including conference papers, research dissertations, book or book chapters, reports, and white papers. An initial limited search was undertaken in MEDLINE(R) (OVID) and CINAHL (EBSCO) to identify exemplar articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy. The search strategy, including keywords and thesaurus terms, was adapted for each database and information source. Given that this is an emerging area of study, the search was not limited to date or language. The reference lists of all included sources were used to identify additional sources.
The databases included in the search were: MEDLINE(R) (Ovid 1946 to present) (Dell et al., 2024f), CINAHL (EBSCO) (Dell et al., 2024a), EMBASE (Ovid) (Dell et al., 2024e), PsycInfo (OvidSP) (Dell et al., 2024i), Soc INDEX (EBSCO) (Dell et al., 2024e), Sociological Abstracts (ProQuest) (Dell et al., 2024h), Criminal Justice Abstracts with Full Text (EBSCO) (Dell et al., 2024d), Scopus (Dell et al., 2024g), Web of Science Core Collection (Clarivate 1900–present) (Dell et al., 2024i), CABI: CAB Abstracts (Clarivate 1910–present) (Dell et al., 2024c), and Academic Search Complete (EBSCO) (Dell et al., 2024b). Databases for gray literature to be searched included Google Scholar, conference proceedings from the International Society for Anthrozoology (ISAZ) and the Canadian Centre on Substance Use and Addiction, and reports and literature from the Human Animal Bond Research Institute’s index and research repository (HABRI Central) and member organizations of IAHAIO. The search strategy was peer-reviewed by a second librarian, using the PRESS Guidelines (McGowan et al., 2016).
EVIDENCE SELECTION
Following the search, all potentially relevant records were collated and uploaded into Covidence, and duplicates were removed. Following a pilot test, titles and abstracts were screened by two independent reviewers for assessment against the inclusion criteria. Potentially relevant sources were retrieved in full text and assessed in detail against the inclusion criteria by two independent reviewers. Full text sources were obtained using interlibrary loan services or through library subscriptions. Reasons for exclusion of sources that did not meet the inclusion criteria were recorded (see Supplementary Materials: Appendix A for criteria). Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion, and/or with input from a third reviewer. The results of the search and the study inclusion process are presented in the form of a PRISMA flow diagram using the PRISMA Extension for Scoping Reviews (see Fig. 1; Tricco et al., 2018).
DATA EXTRACTION
Data were extracted from papers included in the scoping review by three independent reviewers using a data extraction tool (see Dell et al., 2023b) developed by the reviewers and undertaken in Covidence (see Supplementary Materials: Appendix B for data extraction tool). The data extracted included specific details about the current state of the literature (participants, concepts, context, study methods including date, geographic setting) and about the positive and/or negative role of the human-canine bond in recovery from SUD (e.g., key themes that emerged). The data extraction tool was tested by two of the reviewers, who began by independently extracting data from three of the same articles. Three reviewers then reviewed their results and discussed any discrepancies until they reached consensus. They completed double extraction for all sources.
DATA PRESENTATION AND ANALYSIS
Data from the included records are presented in tables and a narrative summary. The tables were used to illustrate the central concepts arising from the included records, which are then described in more detail in the narrative summary. This format was chosen as it aligned with the goal to map what is known about the literature, as well as synthesize and draw comparisons between the primary findings (both positive and negative) from each individual source.
Results
STUDY INCLUSION
A total of 2665 records were identified from the included databases and an additional 47 from grey literature sources (2712 total). All records were imported into Covidence where duplicates were removed, leaving 2200 remaining. A further eight records were excluded because full text could not be obtained. After titles and abstracts were screened for relevance, 188 records were identified that met the inclusion criteria (156 from databases and 31 from grey literature and citation searching), and these were subjected to a review of the full text. Consequently, 156 reports were excluded (reasons reported in Supplementary Materials: Appendices A and C) leaving 32 studies for inclusion (11 from databases and 21 from grey literature and citation searching).
The following sections provide a descriptive summary of the included records’ characteristics, followed by a narrative summary to map what is known about the role of the human-canine bond with respect to recovery from SUD.
DESCRIPTIVE SUMMARY
Study settings and populations
Most of the included records were published in the United States (n=14; 44%) or Canada (n=13; 41%; see Table 1). Many were scientific studies (n=23; 72%), and of these, nine used qualitative methods (39% of scientific studies). Most were published after 2015 (n=24; 75%); only two were published before the year 2000 (6%).
| Author, year | Location | Study design | Methods | Population and setting | Canine activity | Animal welfare findings or considerations |
|---|---|---|---|---|---|---|
| Campbell-Begg (2000) | Canada | Scientific study – Case study | Focus groups; Observational | 8 male adults with general SUD in residential treatment. | Therapy dog interacted with clients during four group meetings over a 21 day treatment period. | Not reported. |
| Chalmers et al. (2023) | Canada | Book – Summary of program | N/A | 33 male adults with general SUD in a correctional institution. | Over 3.5 days for each group included hands-on work with the therapy dogs through structured activities that incorporate basic canine obedience, information about dogs and the human-animal bond, as well as unstructured time for play and relaxation with them. | Dogs were evaluated by the program to ensure their compatibility with each other and their comfort in the prison environment. Participants were also invited to consider the dogs perspective/experience, and the health and wellbeing of both species was considered. |
| Contalbrigo et al. (2017) | Italy | Scientific study – Unmatched controlled study design | Clinical test or assessment | 22 male adults with general SUD in an attenuated custody institute. | Therapy dog visited for a 60 min session once a week for 6 months, following a standard scheme and with the support of a psychotherapist. | Dogs underwent an examination performed by a veterinarian. Health and welfare of dogs was monitored for the whole project. |
| Dell and Poole (2015) | Canada | Scientific study – Case study | Observational | 6 male and female adults with general SUD inmates in a forensic psychiatric facility. | Therapy dog team visited every 2 weeks for 12 months. Approximately 10 visits per prisoner. Visits ranged from 15 min to 1 h, averaging 30 min. | Not reported. |
| Dell et al. (2023a) | Canada | Scientific study – Qualitative | Interviews | 16 male and female adult military veterans. Veterans used alcohol, cannabis, cocaine, opioids, tobacco, and prescription medications. | Service dogs had been with the veterans for 3 years on average, ranging from 2–6 years. | Not reported. |
| Dell (2015) | Canada | Scientific study – Commentary | N/A | Male and female adults with general SUD in residential treatment, correctional institutions, hospitals, and methadone clinics. | Therapy dog visited people for over 300 h total. | Not reported. |
| Gibson et al. (2023) | Canada | Qualitative | Interviews; focus groups | 8 prison staff members associated with therapy dog program participants (adults in a medium security prison with general SUD). | A 4- day program that incorporated basic canine training, information about dogs, and the human–animal bond, as well as unstructured play and relaxation. Includes follow-up session 6 months later (less structured than initial program and allowed the program participants to reconnect with the program dogs, facilitators, and each other). | Ensuring the welfare of the dogs is central to the offering of the program. The dogs were assessed for their health, they had basic obedience skills, and their welfare was paramount throughout the program’s offering. |
| Gomez (2015) | United States | Dissertation – Qualitative | Interviews | 6 male adult probationers receiving outpatient treatment for general SUD related misdemeanors. | One probationer group a week assisted by a trained therapy dog and handler. Group (8–16 men) participated in minimum of six sessions. | Not reported. |
| Gray (1988) | United Kingdom | Scientific study – Case study | Clinical test or assessment; Survey/questionnaire | 1 elderly man in long-term care dependent on sedatives and tranquilizers. | A community dog service (volunteers bring their own dogs) over 10 weeks. A 5- year-old golden retriever and its volunteer sat near the man before he went to sleep so he could stroke it. The dog also jumped onto the bed and would lie down. | The dogs were temperament-tested. |
| Hovell and Irvin (2007) | United States | Scientific study – Commentary | N/A | Adults and children living in the United States using or exposed to tobacco. | Discussed companion dogs in homes where humans expose dogs to second hand smoke | Considered the effects of environmental tobacco exposure to pets and their health. |
| Howe and Easterbrook (2018) | United Kingdom | Scientific study – Qualitative | Interviews | 7 male and female adults with general SUD experiencing homelessness. | 5 participants owned companion dogs, one owned a rat, and one’s dog had recently passed away. | The interviewees reported that they proactively changed their behavior because they felt responsible for their pets’ welfare. |
| Husband et al. (2020) | Canada | Scientific study – Case study | Health system data; Interviews | 4 male and female adult veterans with PTSD. Veterans had used alcohol, cannabis and opioids in the 2-year period leading up to the study. | Participants had been matched with their service/assistance dog for approximately 2 years. | Not reported. |
| Kegel (2016) | United States | Dissertation – Experimental | Survey/questionnaire | 66 male and female adult veterans with alcohol use disorder living in the United States. | Veterans had their psychiatric service dogs for a minimum of 6 months. | Not reported. |
| Kerr-Little et al. (2023) | Norway | Scientific study – Qualitative | Interviews | 8 female and male adults who owned a dog while in active drug use. Adults used amphetamine type stimulants, cannabis, and opioids. | Participants had owned companion dogs from 1.5 years to 14 years (average of 5.9 years). 2 were not current dog owners but had owned a dog previously. | Ownership highlighted the fragility of some participants situations, namely, experiencing welfare inspections due to living conditions, and the need to sell drugs to secure money for dog food. The findings raised concerns about the welfare of the dog. |
| Kosteniuk and Dell (2020) | Canada | Scientific study – Qualitative | Interviews | 7 outpatients in an opioid assisted recovery service program. | Of the 7 participants, 4 had companion dogs. | Nearly all participants worried about the welfare of their companion animals within their neighborhood. Suggested a need for greater attention to animal welfare in future studies and that companion animals are not instrumentalized as a health intervention. |
| Kosteniuk et al. (2023) | Canada | Scientific study – Case study | Survey/questionnaire | 16 male adults with general SUD receiving inpatient addiction treatment in a correctional facility. | Facilitators attended the prison once a week for 2 h with the therapy dogs to integrate an experiential learning component into the intensive substance abuse treatment program. Participants were invited to visit with the dogs. | The health of all the program dogs was assessed. They had basic obedience skills; were extroverted, friendly and/or loving; and were evaluated to ensure compatibility with each other and their comfort in the prison environment. |
| Krause-Parello and Morales (2018) | United States | Scientific study – Qualitative | Interviews | 21 male and female adult veterans who used alcohol and/or drugs and who owned service dogs. | The age in years of participants’ service dogs ranged from 0.25 to 9, and length of ownership in years ranged from 0.10 to 8. | Not reported. |
| Lem et al. (2013) | Canada | Dissertation – Qualitative | Interviews | 10 male and female street-involved youth (18–24 years) with general SUD who owned or previously owned a companion animal while living on the street. | 8/10 participants had companion dogs. Two had owned dogs previously. | The needs of the animal were placed ahead of the owner’s needs. Some participants said their motivation for finding stable housing/shelter was for their dog. One participant could not maintain stable employment because of no reliable or safe animal care. |
| Madden Ellsworth et al. (2016) | United States | Scientific study – Experimental | Clinical test or assessment; Survey/questionnaire | 27 adolescent males (age 13–18) in residential treatment. Adolescents had used alcohol, amphetamine type stimulants, cannabis, cocaine, hallucinogens, new psychoactive substances, opioids. | Comparison group participated in a weekly 1 h recreational activity with shelter dogs for 8 weeks. | Dogs had no history of aggressive or concerning unpredictable behavior and were approved for public adoption by qualified animal-shelter medical and behavior staff. |
| Minatrea and Wesley (2008) | United States | Scientific study – Experimental | Clinical test or assessment; Observational; Survey/questionnaire | 24 individuals with general SUD in a residential treatment facility | Participants worked on recovery issues with the same human therapist, who used a therapy dog and Choice Theory or Reality Therapy techniques. | The participants did not want to scare or hurt the dog’s ears, so they monitored loud aggressive voice tones. |
| Pace (1996) | United States | Dissertation – Descriptive | Interviews; Observational; Survey/questionnaire | 3 female teens (age 14–16 years) with general SUD in a women’s residential treatment center. | 8 weekly sessions with a therapy dog composed of 50 min of activities associated with planned key learning objectives followed by a 20 min group discussion. Learning objectives included becoming comfortable with the dogs, improving communication skills, learning responsibility and trust, using positive reinforcement and improving self worth. | Not reported. |
| Phillips (2004) | United States | Dissertation – Qualitative | Interviews | 11 male adolescent and young adults (age 16–23) and 10 sets of parents from a private residential treatment facility. Adolescents used alcohol, cannabis, cocaine, opioids, sedatives and tranquilizers. | Upon admission, each resident was given a Labrador retriever puppy 6–10 weeks of age. They then have the sole responsibility to care for and train the puppy during their stay. Upon completion of the program, the resident takes the puppy home as part of the resident’s aftercare plan. Residents will spend approximately 2 h per day working with or playing with their puppy. | Some residents who did not complete the program did not take their puppies home with the exception of three residents because it was decided that is what was best for the resident and the dog. |
| Poore (2023) | United States | Dissertation – Program evaluation | Survey/questionnaire | 6 male and female adults with general SUD at a partial hospitalization and outpatient facility. | Therapy dog group sessions included psychoeducation (on benefits of AAT) for 90 min twice weekly over a 14-day period. AAT was a therapy certified dog free to roam unless prompted for additional therapeutic intervention with clients. | Not reported. |
| Rath (2023) | Canada | Dissertation | Secondary data | 5 adult male inmates with general SUD and 5 prison staff members. | A 4-day canine-assisted learning program at a medium security prison. Through an experiential learning approach, the program objectives were centered around participants’ skills, personal growth, and mental health. The program focused on human-canine connections conceptualized through canine obedience training, play, and time for relaxation with the therapy dogs. The program also included a communication and problem solving focus. | Canine welfare is at the core of the program. The program handlers actively adjust to the needs of the dogs throughout the training process. They ensure that the dogs interact only with participants they are comfortable with and that their safety and well-being are maintained. |
| Scanlon et al. (2021) | United Kingdom | Scientific study – Qualitative | Interviews | 20 male and female dog owners who used alcohol and/or drugs living in homeless or at risk of homelessness | Most participants had 1 companion dog. One had 3. | All participants’ dogs were assessed for their health and welfare. Owners described ensuring that their dogs’ physical welfare needs were met. |
| Schenck (2009) | United States | Book – Case study | N/A | 1 woman with general SUD and in recovery. | The woman in recovery navigated pet parenthood. She grew up with a dog that she was very close to, whose death had caused her a lot of grief. As an adult, she first had animals that ran away or became sick from poor care but later on had dogs that were very well taken care of and she was also a breeder. | The narrator made sure her dogs went to the vet for wellness exams and had all their shots. She made sure to be a responsible pet parent and to stay committed to their wellbeing. |
| Schwab (2019) | United States | Dissertation – Quasi-experimental | Secondary data | 130 male and female adults with general SUD in a residential treatment facility. | Participants completed inpatient substance abuse treatment and brought their companion dogs with them to treatment. 66 did not have a canine in treatment, 64 did. | Not reported. |
| Scott and Kirnan (2021) | United States | Scientific study – Pre-post treatment group design | Clinical test or assessment | 76 male adult residents with general SUD in a residential treatment facility. | 3 AAA sessions with therapy dogs occurred 4–6 weeks apart. Participant groups were one or two participants per dog/handler team. Interactions consisted of petting and playing with the dogs and engaging in casual conversation with the dog handlers. | Ensured dogs were screened for temperament, sociability, and health. |
| Trujillo et al. (2020) | United States | Scientific study – Non-randomized experimental study | Clinical test or assessment; Survey/questionnaire | 31 adolescents (ages 12–17 years) in a school-based outpatient mental health and substance treatment. Adolescents had used alcohol, cannabis, hallucinogens and/or opioids. | Comparison group received AAT with a therapy dog 2 days each week, for up to 16 weeks. The therapist used AAT interventions to incorporate the therapy dog in mindfulness and communication exercises that helps the client practice Acceptance and Commitment Therapy (ACT) training. | The dog was under care of a veterinarian, fully vaccinated, and approved for work with adolescents in a mental health setting. A dog trainer also made visits to the therapy site to assess the dog to ensure that the dog continued to be suitable to work. |
| Wesley et al. (2009) | United States | Scientific study – Experimental | Survey/questionnaire | 231 male and female adults in a residential treatment facility. Clients had used alcohol, amphetamine type stimulants, cannabis, cocaine, hallucinogens, opioids, and benzodiazepines. | 26 group sessions over 3 weeks in which participants engaged in 1 h group therapy sessions with the therapist and therapy dog. The therapy dog performed interactive tricks, used as psycho-educational tools for the therapist, and moved from participant to another for physical touch. The dog was available when called, was nonjudgmental, and was predictable in her responses. | Human participants appeared physically and emotionally stable and presented no risk of harm to themselves, others, or the dog. |
| Williamson et al. (2021) | Canada | Scientific study – Mixed methods | Interviews; Survey/questionnaire | 5 male adult veterans with service dogs living in Canada. Veterans used alcohol, cannabis, opioids, and tobacco. | Service dogs were matched and trained (for 12 months) through a service dog organization. | Mental health professionals ensured that participating veterans’ PTSD symptoms were not severe enough to jeopardize any service dogs’ welfare. |
| Williamson et al. (2022) | Canada | Scientific study – Qualitative | Interviews | 5 male adult veterans with general SUD and PTSD. | Three veterans were matched with service dogs, and two trained their own companion dog as a service dog. | Additional study of the human-animal bond and attention to animal welfare is necessary. |
As shown in Table 1, there were a variety of study designs and methods used among the included papers, the most popular being qualitative (n=11; 34%), experimental (n=6; 19%) and case studies (n=5; 16%). Twenty-five records focused on adult populations (78%), and 12 included male-only populations (adult or adolescent; 38%). With respect to recovery, most papers examined general SUD (n=26; 81%), and/or alcohol use disorder (n=10; 31%). However, a variety of substances were discussed across the articles (e.g., opioids, cannabis, amphetamines, etc.; Table 1). The most common setting of interest was in the community (n=10; 31%) followed by residential treatment (n=9; 28%; Table 1).
Human-canine interactions
Most records investigated the role of therapy dogs (n=15; 47%). Human interactions with the therapy dogs varied in terms of duration and frequency, for example, ranging from 90-min sessions twice a week for 2 weeks (Poore, 2023), to 30-min sessions every 2 weeks for a year (Dell and Poole, 2015), to 60-min sessions every week for 6 months (Contalbrigo et al., 2017).
Nine records examined the role of companion dogs (30%), and five articles reported on service or assistance dogs (17%; Table 1). There was also variance among these records in terms of duration and types of interactions. This included, for example, how many years the dog had been with the human (e.g., Kerr-Little et al., 2023; Dell et al., 2023a), how many dogs each participant had (Scanlon et al., 2021), how many participants owned dogs compared to other animals (e.g., Howe and Easterbrook, 2018; Lem et al., 2013), or the type of training the service dog had received (e.g., Williamson et al., 2021).
Animal welfare
As shown in Table 1, 21 of the 32 included records (66%) discussed canine welfare in some capacity. This included calls for greater attention to animal welfare (Kosteniuk and Dell, 2020; Williamson et al., 2022). Most commonly, however, the papers discussed the dogs being temperament tested (Gray, 1988; Scott and Kirnan, 2021; Chalmers et al., 2023; Kosteniuk et al., 2023), or their health and welfare checked and monitored (Schenck, 2009; Madden Ellsworth et al., 2016; Contalbrigo et al., 2017; Trujillo et al., 2020; Scanlon et al., 2021; Gibson et al., 2023; Rath, 2023).
In several records, the welfare of the dogs was raised as a concern due to participants’ living situations, mental health, and/or SUD (Hovell and Irvin, 2007; Lem et al., 2013; Howe and Easterbrook, 2018; Kosteniuk and Dell, 2020; Scanlon et al., 2021; Kerr-Little et al., 2023). In contrast, some papers specifically reported that the participants posed no risk to the dogs involved (Wesley et al., 2009; Williamson et al., 2021). Interestingly, a study that described providing puppies to individuals in residential treatment described that some individuals who did not complete the program still took their puppy home upon discharge, because it was best for the welfare of the resident and the dog (Phillips, 2004). Although all residents who completed the program could take the puppies home, it was not reported if the treatment program had a process in place to assess the suitability of the participants’ home environments for them.
NARRATIVE SUMMARY
The thematic analysis across records identified three key benefits of the human-canine bond in SUD recovery: (1) a source of social connection and a conduit for human-to-human social connection, (2) a calming and comforting effect on individuals with SUD that can reduce stress and anxiety, and (3) the human-canine bond as a motivating factor for positive change (Table 2). Through these themes, the bond may help divert substance use-related thoughts and reduce cravings, bolster engagement in treatment and recovery, and help to decrease and prevent substance use.
| Author, year | Findings relevant to the research question | No role or limitations | Consideration or challenge | Social connection | Comfort or calming | Motivation for change |
|---|---|---|---|---|---|---|
| Campbell-Begg (2000) | Individuals became less guarded and supported one another. Dog was a comfort, source of unconditional love, increased self-esteem, and aided coping strategies and life skills required to maintain abstinence. | x | ||||
| Chalmers et al. (2023) | Impacted bio-psycho-social, spiritual, cultural, and relational domains (provide opportunities to develop a bond and reconnect with themselves and others), which in turn contributed to improved mental health and decreased substance misuse. | x | ||||
| Contalbrigo et al. (2017) | Strengthened therapeutic impact on mood and behavior, improved psychological functioning and reduced some dysfunctional symptoms. There was a significant reduction in violence and drug craving. | x | ||||
| Dell and Poole (2015) | The prisoner-dog interactions were the SAMHSA principles in action: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. Promoted recovery and resilience. The therapy dog was also able to interact with prisoners in ways that humans cannot. | x | ||||
| Dell et al. (2023a) | Supported veterans through dimensions outlined by the SAMHSA: a sense of community and purpose, comfort outside the home, and physical, mental, and emotional wellbeing. Improved education and policy are necessary to further legitimize service dogs. | x | x | x | x | |
| Dell (2015) | Helped with healing from substance misuse through a bonding, therapeutic alliance, comforting, bringing calmness, offering motivation, and was a form of nonjudgmental social interaction. | x | x | |||
| Gibson et al. (2023) | Created a distinct and integrated sense of comfort, support, and love for participants—all elements of compassionate care. They also decreased aggression and alleviated tension, and helped improve self-esteem. This, in turn, helped to build trust between participants and staff as well as the institution. | x | x | |||
| Gomez (2015) | Probationers experienced an improvement in the quality of group participation, increased feelings of trust and attachment, increased connection to self-states, and increased personalized sharing. However, AAT was not suitable for dog phobic members. | x | x | |||
| Gray (1988) | The participant successfully weaned off sleeping pills after 4 years, and his sleep was 25 min longer when the dog was present. The dog may have facilitated the increase in sleep by being a relaxing presence, and may have contributed to the participant’s lack of anxiety and depression. The participant enjoyed the dog’s presence and his attachment to the dog could have taken his mind off the sleeping pills. | x | x | |||
| Hovell and Irvin (2007) | Many patients will not change their smoking to protect themselves or even their family members, but might do so to protect their pet. Single adults may be missed by anti-tobacco campaigns because they do not have a spouse or child to protect from second-hand smoke. Efforts to educate that second-hand smoke is harmful to dogs might boost the effectiveness of smoking cessation advice. | x | ||||
| Howe and Easterbrook (2018) | Pets helped regulate substance abuse because of responsibility felt toward dependent pets and to effectively care for pets. However, one participant reported that owning a pet was a barrier to accommodation and accessing substance use-related supports. | x | x | |||
| Husband et al. (2020) | Provided a steady and additional source of personalized support. Decreased PTSD symptoms, problematic use of licit and illicit substances, and stabilized or decreased use of prescription medication. | x | ||||
| Kegel (2016) | Supported a greater quality of life, as evidenced by two survey items: helping/encouraging others and expressing themselves. No difference was found in alcohol use between veterans with a psychiatric service dog and those without. | x | x | |||
| Kerr-Little et al. (2023) | Increased social connection and gave stability and structure that had been lacking before. Challenges included meeting with service providers, especially to access housing and treatment services to support recovery. | x | x | x | ||
| Kosteniuk and Dell (2020) | A complementary and unique form of support that encouraged a strengths-based approach to recovery. Motivated recovery and abstinence. Dogs specifically provided physical protection and psychological safety, which offered peace of mind and decreased anxiety. | x | x | x | ||
| Kosteniuk et al. (2023) | Shifted relational dynamics, addressed feelings of isolation and disconnection, and benefited thinking patterns and perspectives. Helped prisoners generalize and apply key learnings to recovery from addiction and mental health challenges. | x | ||||
| Krause-Parello and Morales (2018) | A protection against maladaptive coping behaviors such as substance use, including excess alcohol consumption. Dogs improved veterans’ physical and psychological health, provided a calming effect and a form of social support, and supported sustaining their independence. The public’s lack of knowledge and understanding of legal accommodation requirements were noted. | x | x | x | ||
| Lem et al. (2013) | Pet before self was the overarching theme, in which the needs of the animal were placed ahead of the owner’s needs. Some participants said their motivation for finding stable housing/shelter was for their dog. Companion animals provided unconditional love, trust, and constancy. However, one participant could not maintain stable employment because of no reliable or safe animal care. | x | x | |||
| Madden Ellsworth et al. (2016) | Reduced negative affect and provided positive experiences contributing to their personal growth. | x | ||||
| Minatrea and Wesley (2008) | Positively influenced the counselor and client relationship. The group using AAT was more attached to the counseling process, placed a higher value on the experience, and exhibited less stress during the process. | x | x | |||
| Pace (1996) | Benefits included increased patience, increased confidence, decreased fear of dogs, fun, knowledge, improved communication skills, decreased stress/diversion from substance abuse issues, and a sense of support/acceptance. When asked if the program helped their recovery, subjects identified positive changes in their lives. | x | x | |||
| Phillips (2004) | A strength and set the program apart from other treatment centers. Incentivized coming and staying in treatment was an escape and a different escape than using any type of substance. Served as an anchor to the treatment experience and an anchor to the aftercare plan. | x | ||||
| Poore (2023) | Dog therapy was associated with higher satisfaction with treatment, self-worth and self-confidence. The dogs had a calming effect and helped participants manage their anxiety. Helped with improvements in treatment and developing relapse prevention plans. However, participants who would not recommend the program stated the following reasons: (1) being a pet owner and (2) being nervous around animals; specifically dogs. | x | x | |||
| Rath (2023) | Two themes suggested how the dogs aided in alleviating the participants’ internalized stigma and, in turn, contributed to their development in positive self-identity: (i) Participants perceived the dogs as caring for them through their emotional and physical presence and unconditional love, (ii) The dogs and handlers exuded a perceived sense of trust toward participants. | x | x | |||
| Scanlon et al. (2021) | A sense of responsibility for companion dogs encouraged less criminal activity, and alcohol and drug use. | x | ||||
| Schenck (2009) | The narrator learned about responsibility and the commitment needed to take care of her dogs and the meaning of unconditional love, which are also important when maintaining her recovery. | x | x | |||
| Schwab (2019) | Canines are important to patients that are seeking treatment, and support should be provided in some way or the patient would not desire to bring their canine with them. However, dogs did not change the time in treatment. Patients in treatment are likely to stay the amount of time allotted by insurance. | x | x | |||
| Scott and Kirnan (2021) | Act of petting the dogs increased calm, leading to a reduction in anxiety. The dogs served as a bridge to interactions with handlers and staff. | x | x | |||
| Trujillo et al. (2020) | Associated with better treatment outcomes, client engagement, and clients reported a high level of appreciation for the presence of the therapy dog. There was no difference in sobriety between groups. | x | x | x | ||
| Wesley et al. (2009) | Enhanced the therapeutic alliance in a group setting. This can improve the probability of recovery success. However, some individuals in the groups did not benefit from the AAT. This included clients seeking treatment for a dual diagnosis, clients who were being investigated by child protective services, and clients seeking treatment for alcohol dependence. | x | x | |||
| Williamson et al. (2021) | Use of substances (e.g., opioids) decreased. Benefits included petting to help regulate emotions, and increased confidence/helped veterans get out of the house. Each veteran linked change in their substance use to working with their service dogs but not to the same degree as with their PTSD symptoms. This may have been because service dogs were not trained to specifically address substance use behaviors. | x | x | |||
| Williamson et al. (2022) | Fostered social capital, harm reduction, motivation for healthy behavior change, and engagement in treatment plans decreased substance use and related cravings. | x | x |
A few papers found that there may not be a notable role of the human-canine bond as it relates to SUD recovery. A small number also noted that some individuals with SUD may not benefit from the human-canine bond as much as others. Other considerations and challenges were reported, including implications for individuals experiencing low income and/or homelessness, and issues related to public policy and awareness of the human-canine bond.
Social connection
Twenty-three of the 32 records discussed the human-canine bond as it related to social connection and SUD recovery. Most often, the social connection between the dog and the individual with a SUD was focused on. Several studies that took place in prisons and other carceral facilities, and residential treatment settings described that therapy dogs can contribute to recovery among adolescents and adults because of the perceived accepting and non-judgmental nature of the dog, the dog’s perceived unconditional love, and the bonding between the human and the dog (Pace, 1996; Campbell-Begg, 2000; Dell, 2015; Chalmers et al., 2023; Gibson et al., 2023; Rath, 2023). Two of these papers concluded that through this social connection, dogs can support mental health, provide diversion from substance use and facilitate positive change (Pace 1996; Chalmers et al., 2023). Campbell-Begg (2000), Gibson et al. (2023), and Rath (2023) also found that connections with therapy dogs can increase humans’ self-esteem, aid coping strategies, and enhance life skills as they relate to recovering from SUD. Also of note, Gray (1988) conducted a case study in long-term care to investigate whether contact with a community dog at night could help address an elderly man’s dependence on sleeping pills. The man weaned off pills and he slept 25 min longer when the dog was present. The participant enjoyed the dog’s presence and his attachment to the dog could have been what took his mind off the sleeping pills (Gray, 1988). As reported by Dell and Poole (2015), therapy dogs can often interact with individuals in ways that humans cannot.
In the companion animal and service dog literature, similar findings were reported. In the community, these types of dogs can provide a personalized, and steady additional source of support to a variety of populations, and thereby help reduce, prevent, and stabilize the use of substances (Schenck, 2009; Lem et al., 2013; Krause-Parello and Morales, 2018; Husband et al., 2020; Kosteniuk and Dell, 2020; Kerr-Little et al., 2023). In a unique study by Schwab (2019), individuals in residential treatment brought their companion dogs with them. This shows how important dogs can be to patients seeking treatment and suggests that they provide support in some way (Schwab, 2019).
The records also indicated that dogs can be a conduit for human-to-human social connection. In the community, service/assistance dogs for veterans, can help foster social capital, encourage individuals to re-engage with others, and get outside of the home to partake in social activities (Kegel, 2016; Williamson et al., 2022; Chalmers et al., 2023; Dell et al., 2023a). In treatment, therapy dogs can also bolster the therapeutic alliance by facilitating more positive interactions as well as bonding between the individual with an SUD and the counselor or therapist (Minatrea and Wesley, 2008; Dell, 2015; Scott and Kirnan, 2021). Other records indicated that therapy dogs can enhance the therapeutic alliance in group treatment settings by helping adults in treatment feel more trusting, more willing to share, and participate in conversations with others (Campbell-Begg, 2000; Wesley et al., 2009; Gomez, 2015). Most notably, therapy and service/assistance dogs can facilitate more supportive and open environments through nonjudgmental and accepting social interactions, such as in residential treatment, prisons and other carceral facilities, and inpatient and outpatient settings (Campbell-Begg, 2000; Dell, 2015; Gomez, 2015; Kosteniuk et al., 2023). As a result, individuals may become more attached to the treatment process, place a higher value on the treatment experience, and exhibit less stress (Minatrea and Wesley, 2008).
Calming and comforting effects
Findings from 15 of the included records indicated that the human-canine bond can have calming and comforting effects on individuals with SUD, and that this can help support recovery by reducing stress, anxiety, and drug-related cravings. Specific to service/assistance dogs, Dell et al. (2023a), Krause-Parello and Morales (2018), and Williamson et al. (2021) found that service/assistance dogs have a calming effect on veterans with SUDs, which can help regulate their emotions, support independence and confidence, and protect against maladaptive coping through substance use.
Therapy dogs can also bring calmness and comfort in residential treatment, prisons, and other carceral facilities to help with healing from SUD. The physical act of petting therapy dogs can help reduce anxiety and stress, and support diversion from substance use among adults in treatment (Pace, 1996; Dell, 2015; Scott and Kirnan, 2021). Contalbrigo et al. (2017) conducted a controlled study to investigate the efficacy of a therapy dog program for male inmates with SUD in an attenuated custody institute (a low security, live-in facility) and found a statistically significant decrease in anxiety and depression among individuals involved in the program. In addition, Gibson et al. (2023) and Rath (2023) both found that the caring and comforting nature of therapy dogs can contribute to feelings of trust among adults with SUD in prisons and other carceral facilities. This can help address internalized stigma (Rath, 2023) and decrease levels of aggression and tension among inmates (Gibson et al., 2023). Therapy dogs can also help adolescents in treatment feel more comfortable and safer in therapy (Trujillo et al., 2020) and reduce negative effects (Madden Ellsworth et al., 2016). In turn, the literature suggests that the calming and comforting effects of therapy dogs may facilitate engagement in treatment and promote more positive experiences in institutions (Gibson et al., 2023; Minatrea and Wesley, 2008; Trujillo et al., 2020; Poore, 2023), as well as promote positive changes in peoples’ lives (Pace, 1996; Madden Ellsworth et al., 2016).
In the community, companion dogs may also offer peace of mind and decrease anxiety by providing physical protection and psychological safety, particularly for adults with SUD who live in neighborhoods that experience a comparatively high rate of social and economic challenges (Kosteniuk and Dell, 2020). In the case study conducted by Gray (1988), a community dog in a long-term care facility provided a relaxing presence that made an elderly man feel less anxious and depressed, and in turn, assisted with his sleep and elimination of sleeping pills.
Motivation for change
Eleven of the papers discussed the human-canine bond as a motivating factor for change. Through qualitative interviews, Howe and Easterbrook (2018), Scanlon et al. (2021), and Lem et al. (2013) each found that companion dogs can be a reason for adults and youth living in homelessness to reduce their alcohol and drug use, as these groups may feel a sense of responsibility for their companion dogs as dependents. Pet before self was the overarching theme in the study by Lem et al. (2013), in which the needs of the animal were placed ahead of the youth’s needs. For example, some participants said their motivation for finding stable housing or shelter was that it was for their dog (Lem et al., 2013). In addition, Scanlon et al. (2021) and Lem et al. (2013) both found that dogs can help reduce drug-related crime and arrests for these populations.
Kerr-Little et al. (2023) and Kosteniuk and Dell (2020) interviewed similar, low-income populations with SUDs, and found that dog ownership can provide stability and structure that had been lacking before, and which can motivate recovery and abstinence. Similarly, a book chapter written by Schenck (2009) provided a story from the perspective of a woman in recovery from SUD and her experience of what she depicted as navigating pet parenthood. She described the responsibility and commitment needed to take care of her dogs, which was important for maintaining her recovery. In the lives of veterans with SUDs, service/assistance dogs may also be a motivating factor for healthy behavior change by providing a sense of purpose (Dell et al., 2023a; Williamson et al., 2022). In turn, this dynamic can help veterans leave the house and re-engage with community (Dell et al., 2023a; Williamson et al., 2022).
Among adolescents and youth in school-based and residential treatment, therapy dogs can motivate engagement. Trujillo et al. (2020) found that adolescents who received treatment in school with a therapy dog attended more therapy sessions than those who received treatment without the dog. These youths also experienced a greater improvement in their overall wellbeing. A distinct study by Phillips (2004) reported on a private residential treatment program that provided adolescents and young adults with puppies. Residents were responsible for caring for and training the puppy during their stay and could take the puppy home as part of their aftercare plan. The canine therapy program was perceived as a strength of the program by the residents that set it apart from other treatment centers as it incentivized treatment initiation and retention.
Another unique commentary by Hovell and Irvin (2007) reported on environmental tobacco smoke exposure as a motivating factor in the general population, in that some individuals may not reduce or quit smoking to protect themselves or their family, but they might do so to protect their pet. It was specifically mentioned that public health guidance on second-hand smoke exposure to dogs might motivate individuals to smoke less or quit smoking, especially single adults who may be missed by anti-tobacco campaigns because they do not have a spouse or child (Hovell and Irvin, 2007).
Limited or no role
Three articles found that there may not be a notable difference in SUD-related outcomes between those interacting with dogs versus those who do not. Specifically, two articles found no differences in sobriety between groups interacting with therapy and service/assistance dogs versus those not interacting (Kegel, 2016; Trujillo et al., 2020). Both articles discussed small sample size as a potential contributor to this finding. One other study conducted in the United States found that bringing a companion dog into treatment is not associated with time in treatment, and that insurance is a stronger predictor (Schwab, 2019).
Three other papers considered that some individuals with SUD may not benefit from the human-canine bond as much as others. For example, clients seeking treatment for a dual diagnosis and clients who are being investigated by child protective services did not experience the same benefits as those not involved with child protective services in work by Wesley et al. (2009). Williamson et al. (2021) also interviewed a group of veterans with comorbid substance use and PTSD and found that although the veterans associated decreases in their substance use with having a service/assistance dog, they did not associate this to the same degree as with their PTSD symptoms. This may have been because the service/assistance dogs were trained to address PTSD symptoms and not SUD (Williamson et al., 2021). Poore (2023) noted that therapy dogs should not be considered with dog-phobic individuals.
Considerations and challenges
Other considerations and challenges were noted in five articles. Howe and Easterbrook (2018) and Kerr-Little et al. (2023) both described that for individuals experiencing low income and/or homelessness, a companion dog may present challenges to obtaining housing and SUD treatment services. Dog ownership can also highlight social and economic challenges, such as experiencing welfare inspections due to living conditions and the need to sell drugs to secure money for dog food (Kerr-Little et al., 2023). Similarly, Lem et al. (2013), who interviewed street-involved youth, noted that maintaining stable employment can be a challenge if youth cannot access reliable or safe dog care, and that youth may forego housing or shelter to stay unhoused with their companion animal.
Despite an emerging body of literature in this review indicating the benefits of service/assistance dogs for veterans with SUDs, calls were also made for improved public policy and awareness to further legitimize service/assistance dogs for military veterans and promote their benefits (Krause-Parello and Morales, 2018; Dell et al., 2023a).
Discussion
This review is the first to synthesize what is known about the human-canine bond as it relates to SUD recovery among adolescents and adults. The results suggest that the human-canine bond can: (1) be a source of social connection and a conduit for human-to-human social connection, (2) provide a calming and comforting effect on individuals with SUD that can reduce stress and anxiety, and (3) be a motivating factor for positive change. In turn, the bond may help divert substance use-related thoughts and reduce cravings, bolster engagement in treatment and recovery, and help to decrease and prevent substance use. However, the results also suggest that there can be no role or a limited role of the human-canine bond in recovery, and that there may be notable challenges and considerations to consider for some populations. The records also suggest a need for improved animal welfare, policy, and public awareness related to the human-canine bond in this field.
Overall, the review’s findings align with fundamental models of human health and addiction, which identify inter-connected factors that support human wellness and that can promote SUD recovery. Examples include the biopsychosocial model (Skewes and Gonzalez, 2013), the Substance Abuse and Mental Health Administration’s (SAMHSA) working definition of recovery (SAMHSA, 2012), and domains of recovery capital (Hennessy, 2017). In this scoping review, the social and connective role of dogs mirrors the importance of the psychosocial domain in the biopsychosocial model (Skewes and Gonzalez, 2013), the community domain of the SAMHSA model (SAMHSA, 2012), and the micro- and meso-levels of the recovery capital model (Hennessy, 2017). Social connection is also experienced as therapeutic alliance, with studies identifying it as mediator of change (Baier et al., 2020). This is highlighted in a recent systematic review with adolescents (Sulaman et al., 2023) and interspecies research with adults (Fujimura and Nommensen, 2017; Howie et al., 2019). It is also well documented that individuals with SUD often experience insecure attachment, which should be considered in the provision of SUD interventions (Schindler, 2019). This includes considering AAS on an individual basis and taking the human’s and animal’s needs into account.The calming and comforting effects of the human-canine bond found in this review may be related to the physiological effects that dogs can have on humans. This includes how the presence of dogs and petting dogs can buffer stress and anxiety, lower heart rate, and decrease cortisol levels in humans – even more significantly than human-human relationships (Polheber and Matchock, 2014; Teo et al., 2022). Recent research involving equine therapy has also found similar outcomes, specifically with adults experiencing SUD (Friend et al., 2023). In addition, when dogs connect with humans, the dog’s cortisol levels can decrease (Coppola et al., 2006). These hormones indicate activation of the parasympathetic nervous system and oxytocinergic system and down-regulation of hypothalamic-pituitary-adrenal axis, which indicates that the human-canine bond may provide health benefits, including relaxation, bonding, and stress reduction (Teo et al., 2022). Correlations between oxytocin in humans and pet dogs have also been reported in the literature, which may be related to bonding and attachment theories (Handlin et al., 2012).
Building on literature that has found animal caregiving as a motivator for improving human health (Hodgson et al., 2015), this review also found that the human-canine bond can motivate change as it relates to SUD. Sub-themes of dogs as dependents, dogs providing a sense of purpose, and being an incentivizing factor in therapeutic settings were highlighted, all of which may have important clinical and practical implications. Contingency management has received some attention in relation to SUD recovery, specifically in the context of treatment (Cowie and Hodgins, 2023). Although evidence suggests that prize-based incentives in treatment can help motivate individuals to pursue and maintain SUD recovery (Forster et al., 2019), research also shows that there are several ethical issues to consider. This includes risk of gambling relapse, potential for feelings of deception, a lack of attention to social and structural determinants of health, and vulnerability and power dynamics (Gagnon et al., 2021). With these issues in mind, future studies should further investigate the efficacy of the human-canine bond as it relates to motivating SUD recovery, especially the potential ability of the bond to promote a sense of responsibility and purpose in individuals with SUD, as found in this review.
Together, the findings of this scoping review highlight that the human-canine bond has an important role across the spectrum of SUD recovery. Specifically, canines can interact with humans with SUD in ways that humans cannot (Dell and Poole, 2015) or choose not to, for example, because of drug-related stigma (Kosteniuk and Dell, 2020). In future research, this may be an important consideration given the crucial link between trauma, disconnection, and SUD (Burke and Carruth, 2012).
IMPLICATIONS OF THE FINDINGS FOR RESEARCH
The findings of this review set the stage for future research on the HAB in the context of SUD and recovery. However, the current body of research on the human-canine bond in this context has several limitations, including small sample sizes and a high prevalence of non-peer-reviewed sources such as books, commentaries, and dissertations. This indicates a developing field in need of more robust and comprehensive studies. Specifically, there is a need for more research that assesses exactly how and why the human-canine bond is important for recovery. This study did not investigate the impact and reliability of the human-canine bond in this context, emphasizing the necessity for further investigation into how the bond facilitates recovery among diverse groups. For example, as found in this scoping review, why is it that some populations may not benefit as greatly or as consistently from this bond, and what does this mean for practice? Future studies should also examine the efficacy and utility of the human-canine bond as it relates to motivating SUD recovery. This could include a focus on harm reduction, given the known empirical importance of harm reduction in the spectrum of recovery (Strang et al., 2012).
While future research should expand on the ways in which the human-canine bond is therapeutically integrated, it should also consider the effects of the bond on the dogs involved. This includes focusing on a more inclusive One Welfare approach that recognizes the interconnection between human and animal health and the welfare of canines (Pinillos et al., 2016). This approach aims to provide a mutual understanding of the benefits of canines and ethical considerations, while also safeguarding the bond and its positive impacts from inadequate animal care (Pinillos et al., 2016; Lindenmayer and Kaufman 2021). Another area for future consideration is examining the effects of robotic animals on SUD. Although out of scope for this review, this may be an important area of research given advancements made in robotics and the sometimes poor suitability of integrating live animals into treatment plans. It could also address ethical concerns for live animals, and help researchers understand the processes of the HAB.
Quantitative assessment methods could provide more insights into the efficacy of the human-canine bond relating to SUD recovery, addressing a common criticism within this field (Holder et al., 2020). For instance, members of our research team were the first to conduct a controlled trial of therapy dogs in a hospital emergency department for patients in pain, including those experiencing emotional pain from SUD (Carey et al., 2022). As found in this review, there is a small but growing number of quantitative studies in the field. This introduces the strength of mixed-methods studies to better understand this emerging area as well as innovative methodologies that are more than human-focused. Again, it is important to note that a quality assessment of the existing literature fell beyond this review’s scope. Therefore, implications for practice and policy could not be graded. A systematic review should be conducted in the future.
Given that this review only examined English literature, which lacked cultural and gender diversity lenses, future studies could also consider intersectional perspectives. For example, research shows that females may be more likely to identify a supportive relationship with animals or pets in their SUD recovery compared to males (McQuaid and Dell, 2018), yet this review found a large body of literature that included male-only populations. Dogs are also known to play diverse roles across cultures, impacting human wellbeing as companions, protectors, and spiritual allies (Walsh, 2009). For example, in North America, the diminishing role of dogs in Indigenous communities due to historical disruptions like colonialism has contributed to a sense of disconnection from other beings, which may lead to increased substance use (Laugrand and Oosten, 2002; Matheson et al., 2022). Through an intersectionality lens, prospective research might delve into the role of canines in SUD recovery across cultures, such as the Mayan culture where they hold a revered place (Rodríguez-Mejía and Sexton, 2010; Cunningham-Smith et al., 2020), as well as canine roles among the Indigenous peoples of the Pacific Northwest (Anza-Burgess et al., 2020) and within Aboriginal communities (Musharbash, 2017). Connection is often identified as the opposite of addiction (Maté, 2008). Therefore, integrating canine-assisted interventions in cross-cultural initiatives might help address gender-specific needs, trauma healing, and cultural belonging, all of which are crucial for human health (Marsh et al., 2015, Wendt et al., 2019). However, it must be acknowledged that not all cultures are dog-oriented, as in North America. This indicates a need to look beyond the human-canine bond while learning from the canine-orientated findings reported here to other species, including for different cultures and sub-groups.
IMPLICATIONS OF THE FINDINGS FOR PRACTICE
The findings from this review have practical implications for the integration of canines across various therapeutic settings and populations. The diverse operationalization of the human-canine bond among the included records – ranging from service/assistance dogs for veterans, therapy dogs in residential treatment facilities, to companion animals supporting street-involved populations – demonstrates its importance along a spectrum of care. This diversity emphasizes the adaptability of the bond and suggests that it can be tailored to meet the needs and circumstances of vast demographics and environments.
For practitioners, these findings highlight the potential benefits of adopting more inclusive policies regarding the presence of dogs within service environments. Addressing concerns related to zoonosis (diseases that can be transmitted from animals to humans) has been a barrier to the wider adoption of canines in various spaces (Lefebvre et al., 2006). However, the increasing presence of animals in therapeutic settings indicates that effective measures can be implemented to mitigate these risks. For example, in Canada, health policy on dog visitations exemplifies a proactive approach to incorporating therapy dog teams within healthcare settings (Cypress Health Region, 2018; Sunrise Health Region, 2018). Practitioners should be encouraged to explore similar policies, ensuring that both the welfare of dogs and the safety of human participants are adequately protected. By doing so, the therapeutic potential of the human-canine bond can be harnessed more widely, offering additional support to individuals seeking, navigating, and maintaining SUD recovery.
Conclusion
The objective of this scoping review and narrative synthesis was to examine the existing literature on the role of the human-canine bond with respect to recovery from SUD among adolescents and adults, including how the bond may help or hinder recovery.
The results of this review suggest that the human-canine bond can play an important role in SUD recovery. This was reported across therapeutic settings and populations and involved companion dogs, therapy dogs, service/assistance dogs, and others. Specifically, this review found that the human-canine bond can be a source of social connection and a conduit for human-to-human social connection, have a calming and comforting effect on individuals with SUD that can reduce stress and anxiety, and be a motivating factor for recovery. However, a few articles found no role or a limited role of the human-canine bond in recovery, and challenges and considerations were reported, particularly for marginalized populations that face barriers to obtaining and maintaining housing, employment and SUD treatment. Most of the records addressed the welfare of the canines in some capacity, although calls were also made for improved policy, public awareness, and animal welfare.
Future research could consider that the current body of research has small sample sizes and a high prevalence of non-peer-reviewed sources. This indicates a need for more robust and comprehensive research. We recommend that future studies should specifically investigate the themes found in this scoping review more closely, using larger sample sizes and quantitative methods to assess the efficacy of the human-canine bond relating to SUD recovery. Given the gaps related to diversity as a limitation of this review (i.e., English-only, North American-centric body of literature), research should highlight intersectional perspectives across different cultures and sub-groups.
In practice, the findings of this review indicate that the human-canine bond has a promising role in the lives of adolescents and adults with SUD indicate that the bond can offer a type of connection that cannot be replicated by humans or service providers. At a time when SUD rates are higher than ever, innovative research and policy are critical (UNODC, 2023), and considering the human-canine bond may be one way to assist with this.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
ETHICS STATEMENT
Research ethics board review was not required to complete this protocol because it is based exclusively on published literature. It will be assumed that published canine-related research that we extract data from was completed with appropriate ethical oversight and treatment.
ACKNOWLEDGMENTS
The authors respectfully acknowledge that much of this work took place on Treaty 6 Territory and the Homeland of the Métis. The authors thank Sheila Laroque (University Library, University of Saskatchewan) for completing the PRESS Review Assessment of the search strategy.
AUTHOR CONTRIBUTIONS
CD (lead author) led the conceptualization of the study, and all other authors contributed. BK, CD (lead author), and CD collaborated to develop the study’s methods. CD developed the search strategy. BK, CT, and AC completed the screening and data extraction. BK led the analysis, and drafted the results and manuscript, and all authors provided input and feedback throughout.
FUNDING STATEMENT
Funding was provided by the Canadian Research Initiative in Substance Misuse and the Office of One Health & Wellness, University of Saskatchewan.
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Issue publication date: 1 January 2024
Received: 26 May 2024
Accepted: 14 September 2024
Published online: 9 October 2024
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