Since student L2 achievement is the primary objective of all language education contexts, a huge number of inquiries have explored the role of students’ personal characteristics in promoting their L2 achievement. A plethora of studies have also assessed the impact of teachers’ personal and professional qualities on students’ L2 achievement. Yet, the effects of teachers’ organizational commitment and loving pedagogy have largely been neglected. In addition, no review article has been undertaken to outline the consequences of teachers’ organizational commitment and loving pedagogy for students’ L2 achievement. Against this backdrop, the present article intends to describe the role of teachers’ organizational commitment and loving pedagogy in EFL students’ L2 achievement by reviewing the theoretical and empirical evidence. The review revealed that teachers’ organizational commitment and loving pedagogy can favorably influence EFL students’ L2 achievement. The implications for language teachers, teacher trainers, and educational administrators are also discussed. The academic mastery of a second/foreign language, which is called L2 achievement, is the sole objective of any language education context. Simply put, helping learners to attain higher L2 achievement is what language education contexts, including EFL contexts, are designed for. Student achievement, according to The concept of organizational commitment, also known as professional commitment, broadly refers to the depth and strength of an employee’s affiliation to an organization . AccordiThe construct of loving pedagogy reflects the extent to which “teachers are sensitive and caring in their perspectives, as well as understanding and respectful of their students” , p. 2. ANotwithstanding the value of teachers’ organizational commitment and loving pedagogy in improving students’ academic achievement , the con“affective commitment,” “continuous commitment,” and “normative commitment” (The notion of organizational commitment generally refers to “the relative strength of an individual’s identification with and involvement in a particular organization” , p. 92. mitment” . The firmitment” . The secmitment” . Normatimitment” .“loving pedagogy” or “pedagogy of love” pertains to “the care, sensitivity, and empathy that teachers have toward their students’ needs, learning experiences, and development” (The notion of lopment” , p. 2. Tlopment” . AccordiThe positive role of teachers’ organizational commitment in students’ L2 achievement can be explained through what As mentioned earlier in this study, the role of teachers’ organizational commitment and loving pedagogy in increasing student achievement has been kept under the carpet. Simply put, the impacts of these variables on student achievement have largely been ignored by researchers. It means that a few researchers have studied the potential consequences of teachers’ organizational commitment and loving pedagogy for student achievement . For onePreviously in this review article, the constructs of teacher organizational commitment, loving pedagogy, and student L2 achievement along with their components were characterized. Furthermore, through theoretical and empirical basis, the role of teacher organizational commitment and loving pedagogy in EFL students’ L2 achievement was outlined. Considering the theoretical and empirical basis, it is fair to conclude that teacher organizational commitment and loving pedagogy can make a noticeable difference in EFL students’ L2 achievement. Simply said, EFL students’ L2 achievement is subjective to the teachers’ level of commitment and teaching method. This seems to be insightful for all second and foreign language teachers, teacher trainers, and educational administrators. It is deemed illuminating for all language teachers in that they can understand the prominence of organizational commitment and loving pedagogy in promoting students’ language achievement. In doing so, teachers and students will build up a harmonious atmosphere, which will help them to actively engage in the class activities. For instance, in the authentic teaching practice, language teachers may be encountered with some struggling students who have great difficulty in learning. In particular, in my own education context of China, there are some students who come from a minority community, for example, Qinghai, Yunnan, Xinjiang or Tibet provinces. Those students have been exposed to multilingual context. That is to say, they need to study two other non-mother tongue languages, Chinese and English besides their own language. Towards these special group of students, teachers need to show more love, more care, more patience to help those students to actively engage in the language learning. Then students can have a confident feeling and mood to study and speak English. Then in these minority students’ thoughts, they want to study English, and really love English. With teachers’ help and some changes of their own, we believe that students’ English level can gradually improve. The finding of this review is also perceived enlightening for teacher trainers in that they can educate teachers on how to teach students through love. They can also brief them on how to remain committed to their profession, workplace, and learners. Additionally, with regard to the fact that working conditions can remarkably affect one’s organizational commitment, educational administrators are expected to provide teachers with an appropriate working environment to enhance their organizational commitment.All authors have made a direct and intellectual contribution to the work and got it ready for its publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


A Peer Support Work Group including members with lived experience advised each component of the study. Semi-structured interview data were content analyzed and memos generated to summarize themes related to the research question. Participants reported extensive professional and personal experience in human services, disability, and recovery. Emergent themes included the importance of accessibility and model fit, the notion of “peerness” and peer match, and essential aspects of peer recruitment, training, and support. An accessible, acceptable, effective model of peer support requires particular attention to the needs of this diverse and varied population, and the contexts in which they are identified, referred, and engaged in services.Individuals with disabilities may experience higher rates of opioid/substance use disorders (OUD/SUD) than other individuals and are likely vulnerable to unmet treatment needs. Peer support may be beneficial to these individuals, given the evidence of benefits in target populations with similar needs and the potential for overcoming barriers to treatment suggested in the available literature. The objective of this exploratory study was to specify essential considerations in adapting peer support for this population. Diverse key stakeholders ( Population-based data examining the intersection of disability and opioid (OUD)/substance use disorders (SUD) in the United States (US) is limited, but a growing body of research suggests that individuals with physical, cognitive, and/or sensory disabilities may experience higher rates of opioid/substance use disorders than individuals without disabilities ,5,6,7,8.The potential for opioid misuse and opioid use disorder (OUD) more broadly among individuals with disabilities has garnered increasing attention, considering the current opioid epidemic, particularly given the significant association between prescription opioid misuse and the treatment of chronic non-cancer pain . IndividIt is likely, given the significant gaps between OUD treatment need and receipt of treatment in the US in general ,24, thatPeer support is offered by a person with lived experience of a behavioral health or medical condition who has navigated the service system and is in recovery. Peer specialists or recovery coaches provide instrumental support , emotional support , informational support , and support through affiliations  ,30. PeerPeer supports have been suggested as beneficial to individuals disabled by spinal cord injuries and traumatic brain injury ,35, thouGiven the limited evidence or models for peer support at this intersection, informing adaptation of behavioral health models of peer support requires consultation with diverse stakeholders regarding the unique needs and challenges of the proposed new target population and service context. The objective of this study was to explore and elaborate essential considerations in adapting peer supports for individuals at the intersection of disability and opioid (mis)use through interviews with diverse stakeholders well-acquainted with peer support models in behavioral health and the needs of individuals with disabilities. Our larger goal is to inform the specification of peer supports tailored to this population, and to identify potential barriers and facilitators to implementing such supports.This study employed an exploratory, developmental design and qualitative methods, appropriate when the research question reflects the goal of developing or adapting an intervention or practice approach to new conditions or target populations . Diversen = 16) was recruited in 2019 and 2020 (prior to the COVID-19 pandemic) using a snowball approach, to reflect domains and experiences of interest: opioid/substance use and the disabling conditions of mental health disorders, traumatic brain injury, spinal cord injury, Autism, and others. Participants included those with lived experience as a disabled person, advocate, family member, or provider with in-depth personal and/or professional knowledge about the intersection of opioid (mis)use and disability. They had personal and/or professional experience in human services, as service providers, peer specialists, or service recipients. Given the lack of research on this target population, a purposeful sample was considered appropriate. The Peer Support Work Group provided initial recommendations for potential participants, based on their extensive experience and well-developed networks of colleagues. Additional participant recommendations were sought from interviewees. An email invitation was sent to nominees, along with an information sheet describing the study. The name of the person referring the nominee to the study was provided, with permission. Once the person agreed to participate, a follow-up email was sent with a copy of the consent form and background survey. The interview was scheduled and the participant’s preference for mode of interview  was solicited.A purposeful sample  with multiple responses allowed. Additional items captured the participant’s background in behavioral health, disability or human services .A semi-structured interview protocol allowed for open discussion and shifts in topics as initiated by the participant. The interview protocol included prompts pertaining to peer supports at the intersection of disability and opioid (mis)use: the definition of peer; the salience of disability in the opioid/substance use “world” and vice versa; the identification of models of peer support for this population; the essential elements of these models; barriers and facilitators of peer support at the disability/opioid (mis)use intersection; and recommendations for further development, adaptation and implementation of peer support models, improving care for this population in general. Research team members met regularly to debrief following interviews, compare notes regarding participants’ responses, and offer suggestions for the inclusion of participants and prompts in subsequent interviews.Background survey data were summarized to describe the sample. Interview recordings were professionally transcribed, and transcripts were uploaded into Dedoose, a web-based, mixed methods data management and analysis software . InterviThese were individuals with extensive professional and personal experience in human services, disability arenas, and in recovery themselves, who are very knowledgeable about peer supports. The vast majority (83%) of participants identified as having lived experience with the study topic. Over half (57%) identified as having a disability and nearly two-thirds (63%) identified as being in SUD recovery. More than half (58%) of the participants also reported having experience with a parent and nearly two-thirds (62%) with a family member with disabilities or in recovery. Over half identified as being peer specialists or recovery coaches (55%). Approximately one-quarter of the sample had educational backgrounds in each of these fields: social work, counseling, psychology, and education. Over three-quarters (79%) had a master’s degree or higher. All participants reported experience in the behavioral health, disability, or general human services fields, with more than half (57%) working 12 or more years in the field. Almost three-quarters of participants were female (71%), just under half (43%) were age 55 or older, and most identified as Caucasian or white (85%).Several themes emerged to inform the adaptation and implementation of peer supports for individuals with disabilities and OUD/SUD. Participants described barriers to current supports, as well as recommended strategies for further consideration and development. Study participants, purposefully selected for their personal and professional experiences, all stressed the potential value of peer models and the need for careful consideration of issues to support access, engagement, participation, and benefit for both the peer specialist and the person with a disability being served.Study participants reflected on issues of service accessibility, though many of these challenges are not specific to the intersection of disability and opioid (mis)use. Accessibility was discussed in terms of the availability of relevant peer supports, the ability and willingness to access services, and the capacity to take advantage of relevant resources and materials. Most stakeholders found it difficult to identify any available programs or formal model of peer support that adequately met the needs of their clients. As one remarked, “we don’t really have models for this kind of care, it’s more a thought experiment”. In response, some established the type of services they recalled needing or wanting for others seeking OUD/SUD treatment. One participant adapted a 12-step program to meet a particular need of his clientele. Another opted to provide informal peer support with the goal of meeting people with disabilities where they congregated; he felt it was a “system that felt sorry for them because of their disability” rather than notice their need for sobriety. As this participant explained, “…the treatment system prioritized his disability over his addiction. Their attitude was …don’t worry about it. Being in a wheelchair…you guys are exempt from life; you don’t have to worry about this stuff”.Physical accessibility is a common challenge among people with sensorimotor/mobility disabilities. Many traditional peer support meetings for people in SUD recovery  are held in church basements or other physically challenging spaces. As one participant pointed out, some meeting spaces  may be more accessible and easier to navigate for people with disabilities than others. Another participant suggested that the space had to be accessible, but also “warm and welcoming”. They suggested that peer support models  provide guidelines regarding meeting spaces, to ensure accessibility for disabled persons. In addition, location is an important issue for those with no access to transportation or who cannot drive. This individual lived in a rural area with limited public transportation, which he described as “…a huge factor in whether or not I can attend any type of meetings”.Many participants remarked on the difficulties in finding OUD/SUD treatment in an accessible facility in general. Some participants suggested that legal rather than programmatic efforts were required to ensure accessibility, and the challenge to the system had to come from the very people cut off from treatment. As one participant acknowledged, “…if there’s nobody from the disability community bringing litigation against the alcohol and drug service system for its inaccessibility, ain’t much gonna’ happen”.Participants reported that location matters in promoting participation in recovery services for individuals with disabilities. A participant recommended offering peer supports for substance use where people with disabilities “already are…having meetings in spaces that are frequently used by people with disabilities…is a way to expand opportunities for people with disabilities to get into recovery activities”. Another participant recommended the benefits of the co-location of services and supports: “…you need strong recovery support with…a hospital that specializes in your rehab services, at least close enough together so that someone who is disabled has access to get there and then to get back to the recovery center, especially if it is an inpatient recovery center”. Alternatively, the choice of location may keep people from participating, “…if…they’re trying to hide from certain people in their community”. The “right” location can be destigmatizing  and allow for participants to maintain confidentiality. Participants discussed dealing with the “double” stigma of both disability and OUD/SUD.Study participants recommended the use of virtual/online video technology to minimize or overcome access barriers. Virtual meetings or supportive online communities may convey benefits particularly to individuals who avoid or are made uncomfortable by in-person situations. As one participant pointed out, “…a lot of neurodivergent people have intense social anxiety and could benefit from online meetings as well”. Through the use of web conferencing platforms , individuals can choose to be seen, to share a photo, to block off a visual image completely or use the chat function. Individuals with disabling chronic health conditions that undermine in-person participation  may benefit from access to online support. Video and mobile technology  can be further aids to communication, enabling text communications between persons and peers.Another participant suggested the importance of having materials and resources in diverse formats  addressing issues of sensory, cognitive, information processing, or attentional impairments, and language or health literacy challenges. This participant described an illustrated AA pamphlet that is in picture form. According to this participant, AA materials increasingly are becoming available in diverse formats, to “expand the reach [to] more of those types of communities that really can’t access, whether its sight, vision, cognitive things getting in the way…”.Adaptation of the peer support model may be required to promote accessibility, acceptability, and use, particularly given the heterogeneous characteristics, experiences, and needs of the target population. Peer supports are not a “one size fits all” situation. As one participant recommended, “I think maybe there should be some kind of assessment in place first to make sure that it would be a fit for them”. Individuals with disabilities may be anxious, for example, in situations in which they feel they have no control . Personal care attendants may not be allowed or made welcome to assist the disabled individual. Models relying on group interaction and sharing may be confusing or uncomfortable for individuals with cognitive or interpersonal challenges. The feeling of lack of control or discomfort and accompanying anxiety may even be more disabling. Peer support that fits well with a person’s disability and coping style may simply not be available.The notion of “peerness” implies something about a person’s characteristics, conditions or life experiences, as well as their capacity to relate to the characteristics, conditions and life experiences of another. A peer was defined by study participants as “someone in recovery or someone with a similar disability” or both. For example, a peer might be someone who has incurred a brain injury consequent to a drug overdose or who suffered a brain injury and then “gotten hooked” on pain medication. A key characteristic is having lived experience and, preferably, similar lived experiences, so the peer understands the “challenges and frustration and a process people go through”. Aspects or characteristics of what is shared may vary in importance, as defined by the person receiving services, and may change over time. As one participant in a wheelchair contributed, “I was the only guy in a wheelchair going to 12-step meetings in my area at the time. However, they were able to identify with the emotions of addiction and recovery, and that’s when I felt like I belonged”.People should be matched with a particular peer specialist not only on the basis of diagnosis or functioning, but on identity, that is, how they define and see themselves, according to participants. Only the person can rank the many components of their identity in terms of importance or meaning; meeting someone with all the same identities as their own was described as rare. Several participants recommended an initial assessment be conducted, to provide for the best match possible. Some participants suggested that a person may actually want somebody different from themselves to provide support and an alternative role model. Individuals with disabilities may have experiences of having been assigned labels or to groups or having been compared with people presumed to be peers, rather than being allowed to build identities or relationships of their own choosing. A person may attach shame to their status or situation . Consequently, they may find a person with characteristics different from their own a better match. Ultimately, only the person served, together with the peer specialist, can evaluate the appropriateness of the match.Participants agreed that peer specialists should be at a later stage in their own recovery, with experience coping with their conditions and navigating systems. The perfect peer may be hard to find, though abstractly, “would be somebody who’s in recovery from an opioid use disorder, who also had a disability challenge or disabling condition that they have dealt with…” This participant acknowledged that it is more likely to find a peer in recovery from opioid (mis)use, who can be trained in accommodations for people with disabilities, than the other way around.Participants described what a peer offers and the ways in which they interact as important aspects of “peerness”. A peer who has had similar experiences and who has made progress in coping and recovery can serve as a positive role model and inspire motivation to make changes. Feeling understood is meaningful. As one participant described, “that…shows the power of at least understanding what it’s like to love someone or be someone with these multiple challenges and in recovery”. Being able to speak the same language, vernacular or jargon helps to build trust in the peer support relationship. Knowing that the peer has been through the same experiences reduces the shame associated with these experiences. “You know what I’m talking about. You know what addiction feels like. You know how hard this is”. The notion that “we’re in this together” introduces a mutuality that reduces stigma. “The more you can relate to somebody …or the more similarities that you see in them, the more likely the person is going to look to them as an example or as someone they can talk to and they can relate to…”Perhaps one of the most powerful opportunities provided by peer support is the offering of hope that change is possible. The peer is “someone who could have the language and the hope piece”. One study participant described the value in knowing someone who is “like me, can be here with me, and offer me…living proof that recovery from what I’m going through is possible. ‘I’ve had this experience, let me help you through this. I know you’re in pain. I know you’re hurting, but it’s gonna’ be okay because I already did it and I came out of it…’ And once you’ve been through it and feel better about it, you want to share it”.People with disabilities and/or opioid (mis)use may be recruited into peer support roles, motivated by the idea of helping others. Providing peer support gives a person a sense of purpose. One participant explained that, by recruiting people to provide peer support, you may give them a reason to stay clean and sober—to feel like they are “giving back”. “That’s a win-win-win-win for everybody, and I think that is where you have to figure out how can I best recruit those people, in a sense—have them ready, have them on standby, and let them know that what you’re doing has a great purpose. You’re doing this because you’re proving why this works”.Peer specialists or recovery coaches in the mental health or substance use sectors may require training, and benefit from ongoing supervision and support to work with people with disabilities different from their own. First, study participants noted that peer specialists and recovery coaches need to question their assumptions and recognize what they do not know about people with other types of disabilities. Peers must ask the right questions to understand accommodations a person may require. Participants recommended a focus on functioning, rather than disability or diagnosis per se, to tailor or customize accommodations. As one participant suggested, “To boil it down to a reasonable chunk that’s digestible would be to talk about…things that people need to be successful in a program.” Disabilities may be “hidden”. A person with a hearing difficulty may need people to talk louder, or to meet in a space with minimal background noise; a person with a cognitive impairment may need to process information in smaller pieces or at a slower pace. Peer training should focus on how to question assumptions; how to be respectful of, sensitive to, and make practical adaptations for physical, cognitive and sensory needs and challenges; and on how to inquire about needs that may not be readily observable.The behavioral health peer specialist’s feelings about working closely with someone with a disability should be explored, particularly if their own lived experience is dissimilar. One participant suggested a peer trained in the behavioral health perspective, but not knowledgeable about other disabilities, might feel like, “I don’t know how to do this. I’m scared. I don’t want to hurt this person”. Study participants suggested that training may help the peer be more patient, accepting, and empathetic, as well as provide practical tips. Peers must be “able to really sit with whatever is going on for the other person rather than trying to fix it right off the bat” and “use their experience in a way that doesn’t assume that the other person’s experience is exactly the same…”. The importance of ongoing supervision and support for a peer was underscored. Another participant recommended, “that [the peer] be trained also to understand that the person with the disability is really the expert on what they need”.Concern was expressed by participants that a peer specialist or recovery coach coming from the behavioral health context may not understand or may misinterpret the actions of a person with other disabilities, for example, an autistic person’s perseverative behavior. Cross-training efforts have been successful in addressing these issues. For example, behavioral health peer specialists with certification have been provided additional training on key aspects of life with a long-term disability, “including education around some of the more common diseases and disorders that kind of lead to disability. But also, how to navigate the managed care system, what the disability system is. So, we want our certified peer specialists to…really be specialized”. In another program described by a study participant, developmental disability workers received training in substance use disorders, “to be able to understand the problems of the clients they’ve been struggling with, because it’s an alcohol or drug problem and they don’t know what to do with it, because they live in the developmental disability world”.One participant underscored the likelihood that “everyone has trauma” and that “any kind of disability involves trauma—social, familial trauma, medical trauma”. Peers, who may themselves have experienced trauma, may benefit from supervision that takes their lived experiences into consideration, as they work together with and provide support to others with similar backgrounds and experiences. The best-case scenario, according to participants, is when peers are healthy and actively managing their own wellness and have had effective training and supervision “to manage their boundaries well”.Finally, peer specialist training, as well as peer support services, must be readily accessible, physically as well as in terms of the format and usability of training resources and materials. As one participant pointed out, “…it’s not always that easy or affordable for people to get certified”. Individuals with physical disabilities may face additional accessibility barriers to training. For example, a person in a wheelchair with a personal attendant may not be able to participate in a training that does not take the personal attendant’s schedule into account. This participant suggested that to be more accessible, certified peer specialist training must be disability informed and accommodate different needs .Peer supports may be beneficial to individuals with disabilities with co-occurring OUD/SUD given the potential for overcoming barriers related to treatment seeking and engagement, and the evidence of benefits in target populations with similar needs ,15,16,17Any model of peer support for individuals with disabilities requires particular and deliberate attention to the needs of a diverse and varied population. This is not unique to disability, as noted for people with mental illness or in the context of culturally sensitive care . While iThe co-location of OUD/SUD services, including peer supports, with disability/rehabilitation services may be the most effective strategy, where possible. A building “walk-through” at the OUD/SUD site would allow for the assessment of and attention to physical barriers that would make participation difficult. Alternate locations that are already accessible may be a better solution. Software packages facilitate the assessment of reading level; many packages for formatting images or creating simple videos are available. Having materials available in multiple formats will promote accessibility and use. Technology-based solutions, in general, may be useful in providing peer support to individuals with disabilities and OUD/SUD. Given the innovation in technology-based approaches to treatment and service provision during the COVID-19 pandemic, precedent has been set that supports continued use of virtual approaches in the future, to overcome a variety of challenges including transportation, mobility, language, scheduling of sessions, and payment.Ample discussion exists within the peer support literature about the meaning and nature of peer support, “peerness”, and the match of the peer with individual ,47. How Equally important, the focus of peer support on coping with disability and/or dealing with OUD/SUD recovery may shift over time, depending on the current situation, status and needs of the person served. Take the case of a person recently injured in a serious car accident while driving under the influence of drugs, an example suggested by one of the study participants. This person’s immediate focus may be on learning to live with a new disabling condition . However, the OUD/SUD contributing to the accident may also need to be addressed, but perhaps after a period of adjustment to the disability. The person may be better served by a peer with lived experience of disability first and then, when the timing is right, shift the focus to OUD/SUD recovery. Ideally, peer support could be available to address both concerns, but may not be available to be provided by the same peer specialist or recovery coach. This case highlights the importance of cross-training of peer specialists in diverse contexts, in hospital trauma units for example, to provide support to persons with complex physical and behavioral health needs.Peer specialists may come to this work having trained in the behavioral health or disability service sectors. Additional training, perhaps offered through continuing education programs, should focus on the intersection of disability and OUD/SUD, and fill in the gaps for peer specialists originally trained in one sector or the other. While it may not be necessary or possible for a peer specialist to become an expert in both diverse disabilities and OUD/SUD, training must focus on which questions to ask, and the best ways to ask them, to promote an understanding of a person’s needs and to clarify any assumptions a peer specialist might make about a person served. Training and ongoing guidance should be provided to assist peer specialists in reflecting on their own assumptions and experiences, to recognize the ways in which their personal and professional experiences can inform or impede their work, to enhance the likelihood of benefit to the person served as well as the peer.Peers are often seen as more authentic, less prescriptive, and less stigmatizing than practitioners providing more traditional behavioral health treatment . Peers mThis study was exploratory. The data were qualitative, obtained from a purposefully selected sample of known experts, with both extensive professional and personal experience in disability and OUD/SUD treatment and recovery. While the sample is small, participants reflected diverse training, disciplines, and roles, and drew from years of experience in the field. The majority identified as having a disability and as being in SUD recovery. Many had experience providing services, including peer supports, as the intersection of disability and OUD/SUD. A number had, themselves, created innovative solutions, building existing models or services to meet the needs of individuals at the intersection. In-depth interviews with these experts were a warranted first step in informing the development of relevant, accessible, potentially effective peer supports.Clearly, peer supports at the intersection of disability and OUD/SUD hold the promise of benefit for both the individual person served, as well as the peer providing the service. Better methods are essential to identifying and addressing the oftentimes complex characteristics, daily lives, and multifaceted needs of individuals with co-occurring disability and OUD/SUD to overcome barriers to services, facilitate engagement, and promote recovery. Peers may bring insights in addressing these challenges and, with relevant training and support, contribute to improved outcomes for individuals with disabilities and OUD/SUD. Future research should include larger samples of participants receiving and/or not receiving services, to obtain data regarding their perceptions of needs, barriers, the elements of effective peer support, and their perspectives on the definition of “success” in living with disability and OUD/SUD. Recommendations for peer support models, to be developed and tested, will likely vary depending in part on the context in which they are provided. It will be important to begin to understand the contingencies operating in diverse contexts and tailor peer supports to both the individuals being served as well as the context in which they are identified, referred, and engaged in services. Current training and certification guidelines may require modification or enhancement to include training and support for peers working with individuals at the intersection and their complex needs and lives. Policy change may be required to ensure reimbursement for effective peer supports. Peer support efforts at the intersection of disability and OUD/SUD have a strong foundation upon which to build in the disability and behavioral health sectors. Research findings and practice knowledge from both sectors must be integrated to address the needs of individuals living with these complex challenges, to promote optimal functioning, recovery, and the achievement of life goals.


Caring for a loved one with an eating disorder typically comes with a multitude of challenges, yet siblings and partners are often overlooked. It is important to understand if current clinical guidance for supporting carers are effective and being utilised for these groups, to help meet their needs.To identify the experiential perspectives of siblings and partners of a loved one with an eating disorder compared with guidance for improving the adequacy of support provided to carers published by Beat and Academy for Eating Disorders.Three online focus groups were held for ten siblings and five partners from across the UK . Carers had experience of caring for a loved one with anorexia nervosa (13 carers) or bulimia nervosa (two carers), across a range of therapeutic settings. Focus group transcriptions were analysed with thematic analysis.Four key themes were identified: (a) role-specific needs, (b) challenges encountered by siblings and partners, (c) generic needs and helpful strategies or approaches, and (d) accounts of service provision and family support.Overall, the majority of experiences reported by siblings and partners did not meet the published guidance. Consequently, clinical practice recommendations were identified for services, alongside the charity sector, to take a proactive approach in detecting difficulties, providing skills training and emotional/practical support, adapting/tailoring peer support groups and supporting online facilitation. Our findings part-informed the design of our national online survey on loved ones’ experiences of care in eating disorders. Therefore, all close relationships, such as parent–child, sibling and intimate adult relationships, are typically affected and reorganised in the presence of an eating disorder, with the illness typically taking a central position.8 However, previous literature exploring the needs and perspectives of carers has primarily focused on parents.5 Thus, other common groups of carers, including siblings and partners, have remained overlooked, despite recent research showing that the adverse effects of being a carer for a loved one with a serious mental health condition are not limited to parents.12 To improve the adequacy of support provided to carers, both Beat (the leading UK eating disorder charity)13 and the Academy for Eating Disorders 14 recently published guidance outlining recommendations on improving the adequacy of support provided to carers such as siblings and partners.  were aged between 21 and 30 years at the time of focus group participation. All participants lived in either England  or Scotland . The demographic and illness-related characteristics of their loved one with an eating disorder are displayed in In total, ten siblings  and five partners  participated. Focus groups 1 and 2 consisted of five siblings each, and a third focus group consisted of the five partners. All participants were of White ethnicity, and the majority . All participants provided written informed consent to participate. Because of COVID-19 restrictions, the three focus groups were hosted online via Microsoft Teams for Mac (Version 16.35). The focus groups were semi-structured; participants were initially asked if they had previously seen the guidelines and then discussed their perspectives and experiences of the recommendations that they felt were most important. The topic guide (Appendix 1) and additional details of the methodology used for these focus groups are described elsewhere.16 a patient and public involvement group  were involved in all stages of the research, including designing the topic guide for the focus groups in this study. Moreover, an individual with lived experience of caring for a sibling with an eating disorder was viewed as an expert by experience, and was involved in all stages of this research. This included data analysis and manuscript writing, to improve representation and sensitivity. We felt a participatory approach was especially important for this project, as siblings and partners are commonly overlooked caring groups. This has led to a paucity of research in this area. Their involvement in all stages of the study helped to ensure our project remained important and relevant to siblings and partners.In line with participatory research methodologies,17 To address potential researcher bias, an independent researcher (P.M.), who was not involved in the study design or focus group participation, coded the transcripts alongside two other researchers within the team (R.B. and H.C.). Utilising multiple researchers, with a mix of clinical and lived experience expertise, to independently code and analyse our rich data led to the unanimous results and increased the reflexivity and rigour of the study.An inductive approach to thematic analysis was used at the semantic level.In the initial analysis phase, three researchers  familiarised themselves with the data through re-reading the transcripts and noting interesting aspects. The three researchers identified potential codes for each focus group independently, and then met to discuss inconsistencies. Initial themes and subthemes reflecting broad units of common ideas were formed by grouping relevant codes together. In the final phase, the researchers consolidated and clearly defined the themes and subthemes, and their interrelated links, over several meetings.https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/support-services/nvivo-downloads).Iterative analysis of the transcript showed that saturation of data was reached, as the final focus group transcript produced no new themes or subthemes. The final thematic framework was then devised over a series of four meetings between the research team. Analysis was carried out using NVivo for Mac  would be more helpful than the generic guidance for carers that they had seen, which was often geared toward parents. Suggestions included support, guidance and practical training tailored toward siblings.‘ … So you have a carer-patient relationship which is not dissimilar to a parent-child relationship, it can be very difficult to get back to an adult-adult relationship from there.’ Focus group 3, partner, male.‘ … We need to also look after our relationship and relationships are just entirely forgotten in this process and I appreciate that is probably beyond the scope of what you do but getting that relationship part right post-treatment will aid with recovery and help with the relapse because you know.’ Focus group 3, partner, male.‘ … Having that clinical support of just really reinvigorating your toolkit as a partner and how you help is very useful, I think.’ Focus group 3, partner, female.Partner-specific needs and issues were highlighted by participants, including issues with navigating life with an eating disorder within an intimate adult-to-adult relationship, and difficulties surrounding choice of whether to remain with their partner throughout periods where they had seemingly changed as a result of being so unwell. A need for couple's therapy was also highlighted, as well as resources specifically tailored toward partners.‘ … It can be quite hard to kind of feel like your problems are valid enough to seek support yourself or even just knowing that someone is out there, sort of monitoring you whilst you're supporting someone else can be quite validating, I think.’ Focus group 1, sibling, female.‘ … Having someone actually say, “are you OK?” I think it would make a big difference.’ Focus group 1, sibling, male.Participants reflected upon their desire for validation of one's own needs and the importance of looking after one's own psychological well-being. Further narratives highlighted the need of services taking a proactive approach themselves to reaching out to siblings and partners.‘ … My sibling shares a lot more with me than she does with our parents but that can be quite a huge burden because it's like “aww man how do I not compromise her trust, but also if I'm told something concerning how, what do I do with that information?”’ Focus group 1, sibling, female.‘ … The stress that everyone is feeling makes the relationships in the family really difficult as well, when there's one person who is so ill in the family.’ Focus group 2, sibling, female.There were several subthemes representing the challenges encountered by carers. Siblings reflected upon addressing challenging family dynamics and variations in family structure, including divided loyalties, trust issues, familial stress because of the eating disorder and feelings of exclusion by certain family members because of focus on the ill person.‘We [my well sister and I] both managed to support each other really really well in that way because we both could see different sides of things, we've always been quite different but we do, I think together she can say something and I can think oh I've not actually noticed that and then we sort of work together to be able to help each other and rationalise each other.’ Focus group 2, sibling, female.‘I've got three sisters … and for us we did have peer support from each other because, you know, the three of us were trying to deal with it, but if we hadn't had that it would have been really difficult.’ Focus group 2, sibling, female.There were also some positive accounts. For example, some participants described how different family members found their own way to support each other.‘At the start you're sort of thrown into it you don't have any hand holds or foot holds or paths with directions of which way to go you just have to kind of figure it out.’ Focus group 1, sibling, male.‘ … I felt so guilty for reaching out for help because I wasn't the one who was struggling here, it was my sibling.’ Focus group 1, sibling, female.Participants described overwhelming emotions and perceived lack of information and guidance, such as strategies for providing adequate support. Siblings also noted difficulties with applying the information they had read online to their individual circumstances. Overwhelming emotions described by siblings included stigma and guilt over feeling that they were not providing their loved one with adequate support and that they were struggling and in need of some support for themselves.‘ … You can feel so helpless as a partner.’ Focus group 3, partner, female.‘I think when she relapsed in terms of blaming myself in that I wasn't able to support my partner enough that she was going to slip through the net and I should have been there for her enough.’ Focus group 3, partner, male.‘Or they are denial, because my wife wouldn't acknowledge there was a problem, everybody else could see it but she couldn't.’ Focus group 3, partner, male.Partners described overwhelming feelings of helplessness, uselessness and self-blame over not doing more to support their partner and help them to access the services they needed to. Feelings of loneliness were also expressed. Furthermore, some partners described accounts of living with problematic behaviour and thoughts, such as loved ones not acknowledging that there was a problem.‘When my sibling was an in-patient, that information came through her, so it was dependant on her telling us that there were these things available.’ Focus group 2, sibling, female.‘ … They had my number and I had their number sort of thing which she had agreed to confidentiality so I was allowed to know sort of what was going on, but … at the time they might not want you to be involved or sort of want you know what's happening and that completely makes sense there could be some problems with confidentiality as well.’ Focus group 1, sibling, female.‘[My sibling] was really resistant to that, like I said before she didn't particularly like having the therapy anyway so having us involved, she was quite resistant to that.’ Focus group 1, sibling, female.Narratives referred to the reliance on patient consent for knowledge of and access to carer support and inclusion to any carer groups, such as family therapy. Both confidentiality issues regarding sharing patient information with carers in adult services and patient reluctance to either engage in, say, family therapy or interventions that include involving the family were referred to in this subtheme.‘I'd come back on uni holidays and things and that was really hard, um because you weren't living with it every day you just had to deal with it when you came back.’ Focus group 1, sibling, female.Participants outlined the logistical and geographical constraints encountered when supporting a loved one with an eating disorder; for example, accessibility of support groups when at university and geographical challenges.‘There is not a lot of material out there as a man with an eating disorder.’ Focus group 3, partner, female.‘ … Particularly for older or complex patients the scope of care is insufficient.’ Focus group 3, partner, male.Reports suggested there was a lack of support for underrepresented groups, such as siblings and partners caring for older people with eating disorders, complex and enduring cases or male patients with an eating disorder.‘ … Video resources where you can access someone sort of explaining it to you, because I think it's much more easily explained than it is read.’ Focus group 1, sibling, male.‘The most important one for me would be to provide carers with more comprehensive information about the eating disorder.’ Focus group 3, partner, male.‘I'd find a pack quite frankly a bit condescending and trite.’ Focus group 3, partner, male.This theme incorporates needs that are applicable to all people caring for a loved one with an eating disorder and perceived strategies, tools and approaches deemed helpful to the caring role. These needs included practical guidance, information and training on how best to support their loved one. Suggestions included psychoeducational guidance, support, resources, training videos and general training on how to respond to the various scenarios that commonly occur when supporting a loved one with an eating disorder.‘In all honesty it's been amazing coming to be here and listen to everybody else's different experiences and stuff so thank you because it gives me hope.’ Focus group 3, partner, female.‘ … They were all just parents and I think I could feel a generational gap and it would be so much nicer to be able to get support from people my age.’ Focus group 1, sibling, female.Participants indicated the helpfulness of peer groups, social support and shared understanding. This included peer support groups, in either a face-to-face or online group format, as well as perceived helpful social support from family, friends and peers. Some participants reflected on their previous use of peer support, particularly through social media, whereas others perceived it as a potentially helpful and comforting avenue of support. There were also several examples of empathy and support provided to each other within the study focus groups. Some participants shared an appreciation for being able to talk and listen to others outside of their family network who understood some of what they were going through. A preference for professional moderation with usage guidelines for support groups was also noted, as well as having some consistency in the attendees to enable familiarity and connections to form. Some narratives referred to negative aspects of support groups, such as becoming worried when hearing the experiences of others or being of a different demographic (e.g. a lot older) than others within a peer support group and thus finding it difficult to relate and connect. There was a link between this subtheme and ‘use of the internet and social media as a support mechanism’, since many support groups are online based.‘I'm not sure how that would work in practice but just something more consistent where you can build up some kind of trust with the people you are talking to.’ Focus group 1, sibling, female.‘ … It would have been invaluable for me to be able to feel more included in the process.’ Focus group 3, partner, male.Many reports highlighted the need for consistency, continuity and inclusion in care. These ranged from having access to a team of professionals who have first-hand knowledge and experience of the treatment of the loved one to continuity throughout the process, such as from in-patient treatment through discharge, and the importance of feeling included in care.‘ … Being able to actually ask someone else questions is also really important because obviously everyone else's experiences will be so different.’ Focus group 2, sibling, female.‘ … I think most of us would recognise that this is a very specific manifestation on a case-by-case basis and sometimes you really do need to be told what's the best personal thing you can do for your patient, not the population. So, I felt it needed a bit more specific contact throughout the treatment.’ Focus group 3, partner, female.Participants recognised that everyone's experiences are different and therefore expressed a desire for tailored emotional and practical professional support, to address one's individual set of circumstances with regard to both the loved one with the eating disorder and their family, rather than generic support, which may not apply.‘I think just being made aware of what is available would be really useful.’ Focus group 2, sibling, female.There was a suggestion for greater awareness, dissemination and accessibility of support for families and carers, along with detailed information on how to access such support, such as the Beat guidelines, being made more accessible.‘One major source of support for me was actually Instagram, it was following other siblings who had similar experiences to me … ’ Focus group 1, sibling, female.Narratives referred to the use of the internet and social media as a support mechanism. There was a link between this subtheme and the ‘peer groups, social support and shared understanding’ subtheme as several references to peer group support consist of online forums, such as those organised by Beat.‘I did seek help, like counselling services whilst at university.’ Focus group 1, sibling, female.‘I'm very outgoing in trying to educate myself on bulimia … ’ Focus group 3, partner, female.There was evidence of carer self-efficacy and useful strategies adopted by carers to improve their own well-being and situation with their loved one. Examples included seeking independent support from external bodies, such as pastoral care at university, therapy from work or other support independent of the patient's family or care teams. Accounts also reflected upon what carers deemed important in the recovery process, such as open and honest communication for partners.‘I think if the only option is to go through her, that wasn't something we could do.’ Focus group 1, sibling, female.‘ … There were definitely things where if she was present, I wouldn't say because it might reflect badly on her, she might feel bad about how sometimes the family feel, it makes them sort of embarrassed to share, I think it can be quite traumatic for the family, so it's like I think it's really important that whatever the support is it's very separate.’ Focus group 1, sibling, female.Responses for siblings emphasised the importance of attaining support independent of the patient, because many of their issues and concerns were related to the impact that the eating disorder has had on the patient and the family. Accounts highlighted the need for siblings to be regarded as a resource in the recovery process, as well as recognition of their own need to be involved.‘We did something called multi-family therapy which was through CAMHS [Child and Adolescent Mental Health Services], which was um 4 days, 5 days, really intense, but really helped.’ Focus group 2, sibling, female.‘I felt that when my wife was in there was a lot of support. They made sure I understood what was going on all the way, it was a good experience.’ Focus group 3, partner, male.This theme encompasses responses that represent any aspect of service provision. There were some positive reports of service provision and support for families regarding the availability of support being offered to the family within the service provision package, both during in-patient stay and the transition period. The importance of family inclusion was emphasised. Examples of helpful support included (multi-)family therapy, having a care coordinator, having a direct line of contact with the treatment team and workshops on how to support their loved one.‘We're on a waiting list for the third time and there's … we've been on this waiting list for over a year but each time we have to go through all the hoops again of the GP [general practitioner], the local mental health and quite frankly those channels are not fit for purpose for eating disorders.’ Focus group 3, partner, male.‘ … They never gave me any information or advice giving or anything like that.’ Focus group 2, sibling, female.Some participants reflected upon perceived inadequacies in service provision and transition for patients and carers received throughout the various stages of treatment, such as long waiting lists and difficulties obtaining referrals and initial diagnoses, and the adverse effects this had on the patients and their loved ones trying to support them. Lack of adequate support for both patients and carers during periods of transition between services, such as between in-patient/day patient care and out-patient care, was also highlighted.‘I've seen a big change during lockdown and obviously we've not been able to go to in-patient, it's always been like through videocall, and I think that's also made it difficult.’ Focus group 1, sibling, male.Moreover, responses described the impact of lockdown and COVID-19 on the care that families received from services.14 For example, some reflected on the good standards of care their loved one received, as well as some positive experiences of family support being included within the service provision package and a recognition from services of the importance of family inclusion. Other examples of helpful support for carers reported included access to a care coordinator, multi-family therapy and workshops for supporting their loved one.This study sought to explore the experiential perspectives of siblings and partners caring for a loved one with an eating disorder compared with published clinical guidance. We identified four main themes summarising the perspectives of ten siblings and five partners of a loved one with an eating disorder: (a) role-specific needs, (b) challenges encountered by siblings and partners, (c) generic needs and helpful strategies or approaches, and (d) accounts of service provision and family support. Some positive experiences of service provision and support for families were shared by siblings and partners, in line with the guidance from Beat and AED.20 This suggests the guidance is not being followed regarding engaging and effectively communicating with carers during transitions and providing non-discriminatory access to appropriate specialist care.12 Our findings also reflected challenges commonly identified by carers of loved ones with an eating disorder, including overwhelming emotions and lack of information and guidance.21 These findings were despite both the Beat and AED guidelines noting the need for carers to be provided with useful and comprehensive information, resources and support.The study also identified several challenges encountered by carers across a range of treatment settings and at various stages of treatment. Some of these challenges were in keeping with those commonly discussed within previous literature on eating disorder service provision, such as poor support for carers during transition periods  and a need for greater support for underrepresented eating disorder groups, namely males and older women, and their carers.22 Moreover, some siblings described logistical and geographical constraints in supporting their sibling, such as moving away from the family home to university. For partners, difficulties navigating intimate adult-to-adult relationships with a loved one with an eating disorder, coping with the changes in the person they first fell in love with as a result of the eating disorder, as well as the element of choice surrounding remaining with their partner, were expressed.Notably, our findings built upon our current understanding of the challenges of caring for a loved one with an eating disorder that are particularly relevant to sibling and partners. For siblings, this included the management of sibling relationships in the context of an eating disorder, as well as effects on family dynamics and their position in the family, with feelings of responsibility and divided loyalties being identified.13 stress the importance of offering all carers, including siblings, a needs assessment and continually monitoring their well-being to allow timely referral to appropriate specialist services as necessary. This may include offering social support and learning opportunities. Likewise, AED14 outlines the right for carers to have regular and ongoing communications with professionals, as well as to receive information, resources and support services to enable them to understand and carry out their caring responsibilities.Considering many siblings and partners felt ‘overlooked’, guilty for seeking help and reliant on loved ones for support and inclusion, our participants emphasised the need of a more proactive approach from services by reaching out to partners and siblings, validating their needs and offering appropriate support. Indeed, the best-practice standards by BeatCollectively, despite some positive experiences, our findings highlight several unmet needs of siblings and partners of loved ones with an eating disorder when compared with published guidelines, indicating a need for closing these gaps in support. In light of eating disorder services being over-stretched, particularly since the COVID-19 pandemic, this could be an area for collaboration between eating disorder specialist healthcare providers and the charity section, so that together, the range of needs of all carers  are considered and met.13 and tailored to the individual circumstances, something that was highlighted as important in our sample.Our focus groups gathered the unique personal perspectives of siblings and partners and generated several recommendations for moving toward the best-practice standards and healthcare rights published by Beat and AED, respectively. Recommendations for fostering a more proactive approach included increasing the dissemination (e.g. advertisement and accessibility) of the support available and making healthcare professionals and services more mindful of carer groups beyond parents. Regularly screening for concerns among siblings and carers could also be used to flag difficulties to care teams. Such a proactive approach may also reduce the need for siblings and partners to seek their own alternative support, which may be less eating-disorder specific, from avenues such as work or university. This could help to ensure that emotional and practical professional support is specialist, as recommended by Beat,13 and AED.14 Previous research has highlighted the benefits of such an approach; the New Maudsley collaborative care intervention provides carers with theoretical and practical knowledge for coping with eating disorders.23 This approach has been successful both in the form of a workshop and self-help guides, providing choice and flexibility. Some skill-based self-help guides for carers25 also have sections specifically aimed at siblings and partners, providing tailored and accessible guidance.Our sample identified that practical guidance, information and training would be beneficial, in accordance with recommendations from Beat27Greater access to couple's therapy was also recommended for partners, to address the difficulties described by partners, namely navigating intimate adult-to-adult relationships with an eating disorder. Thus far, empirical literature has supported the treatment of adults in a couple's context, and an increasing evidence base has shown promising relational and therapeutic outcomes for couple's-based interventions for adults with eating disorders.21 Previous research has shown the benefits of peer support groups for carers including siblings and partners, such as sharing experiential knowledge and mutual understanding.29 Building upon Beat's recommendation of offering carers options for peer support, our sample indicated support groups tailored for siblings or partners might be beneficial, given their experiences of attending groups that had been primarily populated by parents. A preference of group attendee consistency to build connections and professional moderation were noted. To reduce logistical and geographical constraints associated with accessing such support, our participants suggested online delivery methods and use of social media.In line with previous research, seeking social support was also identified as a way of coping.Further practical steps that healthcare providers, alongside the charity sector, could collaboratively undertake to meet the guidance outlined by Beat and AED include ensuring that all services have easily accessible resources specifically aimed at siblings and partners; having a named person who understands the sibling/partner's circumstances and can be contacted, irrespective of geographical distances, such as university; and involving siblings and partners in their loved one's journey, where appropriate.Given the long duration of the eating disorder for the loved ones in most of our sample, it is likely that they had experience of healthcare services before 2017 and 2019, when the AED healthcare rights and Beat best-practice standards were respectively published, and indeed before the investment of Community Eating Disorder Services for Children and Young People (CEDS-CYP) in 2016. Therefore, it is difficult to determine the level of influence the guidelines and investment may have had. That said, it is noteworthy that most of our participants’ loved ones were still accessing services, and most participants had no previous awareness that these publications existed.30 it is possible that CEDS-CYP facilitate sibling involvement to a greater extent. Additionally, 80% of partners had only supported their loved ones through adult mental health services, meaning they could not provide experiences of CEDS-CYP. Future research should seek to explore if there are disparities between CEDS-CYP and adult services, as well as between out-patient, day care and in-patient settings, in adhering to the Beat and AED publications.Furthermore, our analyses did not yield a direct comparison between services, making it difficult to ascertain whether our findings are equally relevant across settings. For example, as family therapy is more common in CEDS-CYP compared with adult mental health services,20Despite data saturation being reached, our sample was small and lacked diversity. All of our sample self-reported ethnicity as White, and most loved ones with an eating disorder were female, aged 21–30 years and had anorexia nervosa, making it hard to ascertain if our findings are generalisable to wider sibling and partner caregiving groups. To increase the diversity of our sample, we aim to widen access to this research project via our national online survey. We aim to recruit individuals from diverse cultural and socioeconomic backgrounds, and well as those caring for loved ones in underrepresented eating disorder groups, such as men and older women.Given the online recruitment and focus group facilitation methods utilised, participation may not have been possible for carers without access to appropriate devices, poor internet connectivity or a lack of a private space. Additionally, as participants were provided with a £20 voucher for participation, some participants may have presented as carers for monetary gain, resulting in potential participant misrepresentation and potential reduction in sample validity. To address this risk, recruitment through eating disorder services may be beneficial in future research. Moreover, our findings may be biased as our participants may have reflected those with negative service experiences who were more motivated for change.Overall, this qualitative focus group study, which captured the experiential perspectives of siblings and partners of a loved one with an eating disorder, identified that the best-practice standards and healthcare rights published by Beat and AED are not being fulfilled. Notably, several changes for improving support for siblings and partners were identified, including a proactive approach from services to detect difficulties, promote skills training, provide emotional/practical support and tailored peer support groups, and support online facilitation, which could be delivered either in-house or through signposting to the charity sector, such as Beat. These findings have been used to inform the development of a large-scale national online survey to identify the experiences and needs of carers of individuals with eating disorders.


In the first comprehensive quantitative analysis of the past 140 y of US congressional and presidential speech about immigration, we identify a dramatic rise in proimmigration attitudes beginning in the 1940s, followed by a steady decline among Republicans (relative to Democrats) over the past 50 y. We also reveal divergent usage of positive  and negative  frames—over time, by party, and between frequently mentioned European and non-European groups. Finally, to capture more suggestive language, we introduce a method for measuring implicit dehumanizing metaphors long associated with immigration  and show that such metaphorical language has been significantly more common in speeches by Republicans than Democrats in recent decades. We classify and analyze 200,000 US congressional speeches and 5,000 presidential communications related to immigration from 1880 to the present. Despite the salience of antiimmigration rhetoric today, we find that political speech about immigration is now much more positive on average than in the past, with the shift largely taking place between World War II and the passage of the Immigration and Nationality Act in 1965. However, since the late 1970s, political parties have become increasingly polarized in their expressed attitudes toward immigration, such that Republican speeches today are as negative as the average congressional speech was in the 1920s, an era of strict immigration quotas. Using an approach based on contextual embeddings of text, we find that modern Republicans are significantly more likely to use language that is suggestive of metaphors long associated with immigration, such as “animals” and “cargo,” and make greater use of frames like “crime” and “legality.” The tone of speeches also differs strongly based on which nationalities are mentioned, with a striking similarity between how Mexican immigrants are framed today and how Chinese immigrants were framed during the era of Chinese exclusion in the late 19th century. Overall, despite more favorable attitudes toward immigrants and the formal elimination of race-based restrictions, nationality is still a major factor in how immigrants are spoken of in Congress. Immigration is one of the most important and divisive topics in American public life. From the rise of vocal antiimmigrant politicians in recent years, it is tempting to conclude that attitudes toward immigration are more negative—or at least more polarized—than ever before. However, resistance to newcomers has always been a central part of our public discourse about immigration. From anti-Chinese fearmongering in the 1880s to concerns about Southern and Eastern European immigrants in the 1920s to the antiimmigration rhetoric of the Trump administration (2017 to 2020), claims that certain types of immigrants can never truly join American society have been a perennial part of our discourse. For example, Senator Henry Cabot Lodge, an architect of antiimmigrant legislation, declared a century ago, “[Immigration] is bringing to the country people whom it is very difficult to assimilate” .Our analysis is based on a combination of methods. To identify relevant speeches, along with a corresponding tone , we make use of automated text classification based on extensive human annotations. Using a semiautomated process, we also curate and apply a set of lexicons for analyzing relevant frames . Finally, to quantify implicit dehumanizing metaphors in speeches, we develop an approach using neural contextual embedding models to measure if references to immigrants are suggestive of various metaphorical categories (Discussion); for immigration specifically, our analysis reveals the beginnings of this, predating the rise in generic political polarization observed in Gentzkow et al.  and the passage of the 1965 Immigration and Nationality Act, and being net positive on average in nearly all sessions of Congress since the early 1950s. Extending this analysis to presidential communications, we find President Trump to be a stark exception, as the first president in modern American history to express sentiment toward immigration that is more negative than the average member of his own party. As with many political issues, the two parties have become increasingly polarized over time, and we find a linear increase in polarization on immigration, beginning in the late 1970s under President Carter. Today, Democrats are unprecedentedly positive about immigration, whereas Republicans are as negative as the average legislator was in the 1920s during the push for strict immigration quotas. This divergence is clearly part of a broader trend toward polarization on many issues . Moreover, there is a striking similarity between how Mexican immigrants are framed today and how Chinese immigrants were framed during the period of Chinese exclusion in the 19th century: more negative in tone; greater explicit emphasis on frames such as “crime,” “labor,” and “legality”; and significantly greater use of implicit dehumanizing metaphors, in comparison to European groups.Thus, while far more members of Congress today express favorable attitudes toward immigration than in the past, there remains a strong and growing strain of antiimmigration speech, especially among Republicans, along with perennial references to threats, legality, and crime. Despite the elimination of country-specific immigration quotas in the 1960s, expressed opinions toward immigrants still vary greatly by country of origin, and enduring rhetorical strategies continue to be deployed against more marginalized groups.Data), we collected human annotations and trained machine learning classifiers to identify speeches relevant to immigration, along with an accompanying tone . Both panels of Top. A comparable time series for presidents is shown in Bottom, by applying the same models to all presidential communications collected by the American Presidency Project  through the advent of strict immigration quotas in the 1920s. The pervasiveness of negative sentiment can help make sense of the political context that gave rise to a suite of increasingly restrictive immigration regulations. It is particularly noteworthy that we do not find a rise in negative speeches leading up to the Emergency Quota Act of 1921. Rather, we find that political sentiment in Congress was staunchly antiimmigration for more than 4 decades, which is consistent with the political history that has recounted the many congressional attempts to pass antiimmigration legislation, all of which were struck down by the president, in the years before the successful passage of quotas . By contrast, Republican legislators are now approximately as overtly antiimmigration in their speeches as the average legislator was during the Age of Mass Migration from Europe and the 1920s quota periods.The trends for presidential attitudes toward immigration should be treated more cautiously as there is less text available from presidents overall and because these estimates involve a slight domain shift . Nevertheless, we document a similar pattern, whereby early presidents were more antiimmigration than modern presidents. In recent years, presidents have been uniformly more proimmigration than the average member of Congress, including both Republicans like Ronald Reagan and Democrats like Jimmy Carter. In historical comparison, President Trump was a stark exception: by his utterances, he was the most antiimmigration president to sit in office over the past 140 y, relative to the average attitude of the time expressed in Congress.Identifying Groups).Although the difference in tone between the parties today is larger than at any point in the past, tone also varies dramatically depending on which groups of immigrants are being discussed. Speeches mentioning Chinese immigrants were overwhelmingly negative during the period of Chinese exclusion (1882 to 1943), while the tone toward Italian immigrants was slightly more favorable (yet still negative) at the time. Attitudes toward all groups improved from 1940 to 1970, with mentions of Chinese and Mexican immigrants remaining relatively more negative overall. Mentions of Italian immigrants are overwhelmingly positive today, but since the late 1970s, the average gap in tone between speeches mentioning Mexican as opposed to Italian immigrants has remained approximately as large as the gap in tone that exists between Republicans and Democrats today.SI Appendix for trends for more individual countries, regional averages, and a regression analysis controlling for other factors.)Although few countries are mentioned as frequently as these three, this pattern is mirrored in broader regional trends: most European countries are referred to positively on average by the 1960s, Asian countries by the 1980s, with countries in the Caribbean (Haiti and Cuba) remaining negative on average until the 2000s. (See Measuring Impact for details).To better understand the language that is suggestive of proimmigration or antiimmigration tone in the full corpus of immigration speeches, we train interpretable logistic regression models to approximate the predictions of our contextual embedding models and determine feature importance using Shapley values . Table 1Among early antiimmigration terms, we find words representing threats (“dangerous” and “cheap”), control (“permit” and “violation”), and the targets of early antiimmigration legislation (“undesirable” and “Chinese”). By midcentury and beyond, different threats appear , along with themes of legality  and crime , both of which continue into the present.Among proimmigration terms, we see an early focus on “desirable” characteristics (“industrious”), land (“property” and “agriculture”), and service (“gave” and “served”). The post-WWII era saw the rise of “humanitarian” concerns (“discriminatory” and “migrants”) and an emphasis on community and belonging . These too continue into the present (“victims” and “community”), along with a celebration of once-vilified communities .−4, respectively), meaning that the observed tone difference by group is not simply a matter of Mexico primarily being mentioned by Republicans.Interestingly, despite the relatively negative tone associated with Mexican immigrants in the modern period (compared to other groups), we do find strong positive associations with the terms “Hispanic” and “Latino,” which refer to much broader communities. Part of the reason is likely that these terms are much more commonly used by Democrats than Republicans  and hence are indicators of Democratic speeches, which are more likely to be proimmigration. Importantly, however, references to “Mexico” and “Mexican” are still more frequent in our corpus and indeed are mentioned with very similar frequency by Democrat and Republicans in the context of immigration (3.7 vs. 3.5 × 10Curating Frames).In order to understand the rhetorical divergence between parties in terms of how they characterize immigration at a more general level, we focus on several important aspects  of the debate on immigration. As a direct and transparent way of measuring the prevalence of these frames, we build and share a series of lexicons for this issue. Drawing upon prior work on the framing of immigration in the media , 24, we Right) and a century earlier (Left). There is almost no difference in the frames used by the two parties in the earlier time period. By contrast, speakers make strongly divergent use of different frames today, with Republicans more likely to explicitly frame immigration in terms of “crime,” “legality,” “threats,” “deficiency,” and the notion of a “flood/tide” of immigrants. Many of the terms driving this association will be familiar from commonly heard antiimmigration comments, including “flood,” “pouring,” “illegal,” “smuggling,” “stealing,” and “cheap.” earlier , Left. TSI Appendix).Democrats, by contrast, are more likely to emphasize the positive frames of “family,” “victims,” “contributions,” and “culture,” which is reflected in terms in our lexicons such as “hardworking,” “worthy,” “parents,” “children,” “integrating,” “diverse,” and “contributing.” Although some terms carry more weight than others in these measures, many terms contribute to each frame, and these patterns are robust to the exclusion of any individual term (shown by lines in Identifying Mentions and Measuring Dehumanization). Using this method, we measure the extent to which mentions of immigrants in speeches “sound like” a mention of several metaphorical categories that have been previously discussed in the literature on immigration: “animals,” “cargo,” “disease,” “flood/tide,” “machines,” and “vermin”  and today (from Mexico). In particular, we focus on Chinese immigrants during the period of Chinese exclusion up to the start of WWI and Mexican immigrants over the past 2 decades, comparing each to mentions of immigrants from European countries during the same time period.Much historical attention has been devoted to the period leading up to the immigration quotas in the 1920s and the nativist opposition to so-called “new” immigrants from Southern and Eastern Europe , 27, we The negative tone toward Chinese immigrants is entirely consistent with the many pieces of anti-Chinese legislation introduced into Congress during this time. Despite representing less than 1% of the foreign-born population in 1900, the Chinese were subject to numerous restrictions, including the 1875 Page Act, the 1882 Chinese Exclusion Act, and the 1888 Scott Act. It is notable that mentions of Chinese immigration remained frequent and negative until just before the Chinese Exclusion Act was repealed, in 1943. Moreover, by comparing mentions of Chinese immigrants to those of Europeans, we find that the language used to describe the former showed significantly greater use of implicit dehumanizing language and greater explicit emphasis on the threatening aspects of immigration (“crime” and “threats”), as well as related aspects like “labor” and “legality.”This combination of frames underscores the dual nature of how Chinese immigrants were perceived—both as a threatening, immoral outsider and as a potential source of cheap labor —which isAmerica saw a gradual loosening of immigration laws in the 1940s—issuance of a small number of special visas during WWII, the repeal of the Chinese Immigration Act in 1943, and the Displaced Persons Act of 1948—laying the groundwork for efforts by President Truman, and later Presidents Kennedy and Johnson, to redefine America as a “nation of immigrants” . We findSI Appendix).The causes of these changes in policy and expressed attitudes are complex—past work has pointed to the practical problem of labor shortages in the midcentury economy and humanitarian reactions to the Nazi genocide , 6. Our It is particularly striking that for nearly 30 y after the border reopened in 1965, the positive sentiment toward immigration did not fully erode, even as immigration from developing countries like Mexico, China, and India increased greatly. Instead, an enduring partisan divide on immigration emerged in the late 1970s, although the Republican party in Congress remained neutral or positive toward immigration, on average, until the election of Bill Clinton and the creation of NAFTA in the early 1990s. The timing of this polarization predates that found in Gentzkow et al.  correlated with public opinion on the issue at the state level, after correcting for year fixed effects. On the other hand, we do not find any evidence of systematic differences in tone among House members in election vs. nonelection years (SI Appendix), although this question is worthy of further investigation.Understanding the causes of this polarization, and whether attitudes on immigration are being driven in a top-down or bottom-up manner, is largely beyond the scope of this paper. However, additional analyses in When considering the groups being mentioned, we find stark differences in framing between European and non-European groups, both for Chinese immigrants in the late 19th and early 20th century and for Mexican immigrants today. In both cases, more implicitly dehumanizing metaphors are used to describe the non-European group. There is also a striking similarity in the use of explicit frames, with a greater emphasis on “crime,” “labor,” and “legality” for the non-Europeans and less on “family,” “contributions,” “victims,” and “culture.” Moreover, although immigrants of nearly all of the most frequently mentioned nationalities are now mentioned in overwhelmingly positive terms on average, this emerged more slowly for those from Asia, the Caribbean, and Latin America. Mexico remains the strongest outlier, with a persistent gap in tone between mentions of European  and Mexican immigrants, equivalent to the modern gap between Democrats and Republicans.Today, people from Mexico represent the largest proportion of entrants to the United States, and the country or nationality was mentioned in more than 10% of immigration speeches over the past 2 decades. As scholars have documented, many modern immigration laws and the rhetoric of “illegal” immigrants were crafted specifically to target immigration from Mexico, including seasonal workers and other temporary workers without full citizenship , 37. As Much like China, people from Mexico were the target of early discrimination and institutionalized inequality in the United States, including the delayed statehood of New Mexico due to its large Mexican and Indian population . Mexico Complementary insights can be derived from public opinion polls, which also reflect the increase in proimmigrant sentiment that we observe in our series from 1965 to the present. For the past 50 y, Gallup has asked Americans, “On the whole, do you think immigration is a good thing or a bad thing for this country today?” In 2019, a staggering 77% of Americans answered that immigration was a good thing. This was up from the low point of 52% in 2002, the year after the September 11 attacks. Respondents are also asked, “In your view, should immigration be kept at its present level, increased or decreased?” In the mid-1990s, a full 65% of respondents said that immigration should be decreased; in 2020, that number fell to just 28%—the lowest share to ever answer this question in the affirmative .However, our analysis of congressional and presidential speeches—which provide a consistent measurement over a much longer period of time than is available from opinion polls—shows the picture is more complicated. Not only has party polarization been growing steadily over time, attitudes among Republican legislators are as negative toward immigration as members of Congress were during the push for restrictive quotas. Moreover, although Chinese immigrants are spoken of in largely favorable terms today, they are still discussed more negatively than immigrants from Europe.In addition, recent years have seen a resurgence in anti-Asian sentiment and hate crimes –43, antiSI Appendix. For presidential communications, we downloaded all available presidential documents from The American Presidency Project (SI Appendix.)For the 43rd through the 111th sessions of Congress, we used a digitized copy of the Congressional Record from Gentzkow et al. . For the Project . For imm Project  and cens Project .  being about immigration or not and 2) for those relevant to immigration, being proimmigration, antiimmigration, or neutral. Because of the relative rarity of speeches about immigration , an extensive set of keywords was used to select possible segments for annotation, although all speeches were eventually classified as relevant or not, as described below.SI Appendix) and comparable agreement rates across time, indicating that they did not have substantially more difficulty with data from the earlier time period, despite having less familiarity with the language and politics of that time. These judgements were aggregated using a Bayesian item response model to obtain a probability distribution over labels for each segment, while accounting for individual annotator biases (SI Appendix).A team of five annotators provided judgements on a total of 7,626 segments , with at least two annotations for most segments. Although not all segments can easily be classified as proimmigration, neutral, or antiimmigration, annotators showed reasonable levels of agreement on both relevance and tone .The annotated segments with inferred labels were then used to train relevance and tone classifiers, building on a recent neural language model, RoBERTa . As is cSI Appendix). The same classifiers were also applied to presidential communications, treating paragraphs as individual segments for classification. To encourage replication and further research, we make available both the raw annotations and relevant speeches with predicted labels as part of the accompanying online materials.Finally, these classifiers were used to identify relevant segments of congressional speeches, along with a predicted tone, aggregating predictions on segments into predictions on speeches. The raw annotations in aggregate show very similar patterns to the predicted labels on the full set of speeches, further demonstrating the validity of our findings , the associated nationality , other common ways of referring to these groups , and modern hyphenated forms . The average tones of speeches that include any of these references are shown for the 3 and 14 most frequently mentioned nationalities in To identify the terms that are most important for proimmigration or antiimmigration tone in our corpus , we traiSI Appendix.To identify and measure the prevalence of certain key aspects of immigration speeches, we curated lexicons for 14 immigration frames (thematic groups of words). To do so, we began by identifying terms  that occurred significantly more frequently in reference to mentions of immigrants compared to mentions of generic people . Based on a combination of initial exploration, comments from annotators, and prior literature on mass media coverage of immigration , 24, 50,To identify references to foreign-born people in our corpus, we collect direct mentions , as well as group terms , and more generic person references with an associated nationality , in speeches that we have classified as being about immigration. The sentences in which these mentions appear were then used to measure dehumanizing metaphorical language for each group (see below). For the comparison of sentences mentioning European vs. non-European immigrants , we alsoPast work has attempted to measure dehumanization using static word vectors  but has To do so, we make use of a masked language model called BERT , which was pretrained to predict the identity of missing words given the surrounding context . Rather In order to repurpose this model to detect implicit metaphorical language, we began with several metaphors that have been previously described in the literature in immigration and dehumanization, such as “animals” and “cargo” –13, 25. **Identifying Mentions), we remove the mention  from the sentence, replacing it with a special “[MASK]” token—indicating a gap to be filled—producing a sentence with a masked word . We then process the masked sentences through the model and compute how likely it is—according to the model—that the gap would be filled by each term in each of our metaphorical categories. We then add up the probabilities for each word in each category to get an overall score for each category for that sentence. The overall “dehumanization” scores in SI Appendix show trends over time for each individual category, as well as examples.For each sentence that mentions an immigrant or immigrant group (r = 0.73), showing that this method is a reliable way of measuring metaphorical language at scale (details in SI Appendix).To validate this method, we collected human judgements on a sample of masked contexts. For each such context, three of the authors of this paper independently rated whether an animal term would be a plausible replacement for the mask token, given the surrounding context. The annotations showed reasonably strong agreement  and correlated strongly with the log probabilities assigned by the model (Supplementary File