Scottish Government

Effective Interventions Unit Supporting families and carers of drug users: A review

CHAPTER 2: FAMILY SUPPORT: CONCEPT, AIMS AND BENEFITS

This Chapter discusses and examines the concept of family support drawing on the findings of the literature review, the qualitative study and the views of the EIU Reference Group. It also identifies a number of benefits.

1. What is family support?

There seems to be no single, agreed definition of family support. The EIU evidence shows that there is a variation in views and experiences on the nature and purpose of working with families of drug users. It may be that the term "family support" will - rightly - cover a range of possible support activities.

The research evidence shows that interventions involving family members have often been aimed at getting the substance user to engage in treatment. As a result, evaluations have focused on this outcome rather than on the benefits to the family (EIU literature review). We know that families often seek support for their drug using relative rather than for themselves. The underlying assumption by both family and agencies seems to be that the recovery of the drug user will reduce the stress experienced by the family and, consequently, the need for family support. This outcome is dependent, however, on whether the drug user is willing to undertake treatment and whether stabilisation or abstinence is achieved. This can be a long term process. Even if the drug user does make progress, it does not mean that the family's health, social and financial circumstances improve straightaway. In Chapters 3 and 4 we describe in more detail the impact of drug use upon families and carers and the range of their needs.

In the EIU qualitative study, participants from social work, health and other agencies reported that they perceived a wide range of support services to be available to families. This included many services aimed primarily at the drug user or relevant to drug using parents and dependants. In contrast, family members reported that they saw little support being available to them. This may be due in part to lack of knowledge among families about what support exists and how it can be accessed. However, it may also point to differences in perception about what constitutes an appropriate service to meet the needs of families.

As noted above, the first approach to services by the family may be to gain information and support for their drug using relative but families can seek support for a range of reasons:

• to gain information and knowledge about drugs, their effects and available treatment
• to seek support to help them to cope emotionally
• to seek practical assistance for themselves or other family members e.g. in caring for grandchildren, financial problems

Reponses from agencies to the EIU mapping indicated that agencies and service providers may tend to think about family support primarily as a way of improving the support for the drug user. This may be a benefit of working with, and supporting, families. However, the evidence that we have gathered strongly suggests that, to be effective in helping families, the service that is being offered should have clear aims and objectives specific to that client group. This is a key issue for DATs and partner agencies when assessing needs and planning and commissioning services for families and carers in their area; and for agencies and service providers from all sectors, including the community, when designing and delivering services.

2. What does family support aim to do?

The overall aim of family support is to limit the harm to family members that can result from their relative's drug use. It aims to minimise the personal stress of family members and to ensure they are not left alone to cope with situations where they may have little knowledge or understanding. It also aims to help them recognise their own needs and the importance of that recognition to their own health and that of other family members. This, in turn, can enable family members to cope better with their drug using relative.

Provision of support to families should aim to meet the wide range of needs that families experience when faced with coping with a relative's drug use. Families may need emotional support which may be addressed by approaches such as family therapy, counselling and support groups. Other needs may have to be addressed through the provision of practical support: for example, respite, advocacy and complementary therapies. Support can also be given by providing information to assist the family member gain a level of knowledge that improves how they understand and deal with their circumstances.

3. Who is support for?

The term 'family' can be defined broadly. Over the years, family support appears to have focused mainly on mothers, through their traditional role as the 'carer'. The qualitative study confirmed that it is often the mother of the drug user who is most likely to be active in seeking support. Almost three-quarters of those attending the Family Support Conference 2002 were mothers. One tenth were fathers.

This can have a direct impact on how the needs of families are recognised and how responses to supporting families are developed. For agencies and service providers, it is important to recognise that, although other family members may not be active in seeking support, it does not mean they do not have individual needs. It may require alternative methods of contacting such 'hard to reach' individuals and the development of a range of methods of providing support in order to best meet these needs.

For the purpose of this document the definition of 'family' covers:

• family members (immediate and extended)
• significant friends
• carers - the term carer covers those caring for a drug user or caring for dependants of drug using parents
• dependent children of drug using parents

4. What are the benefits of supporting families?

Providing effective support to families and carers can be a difficult task, in part related to the circumstances and issues they face. Families and carers say that they can feel judged and stigmatised (EIU interviews; conference survey). This demonstrates that there can be certain risks associated with offering support to families. Sometimes, the desire to assist can result in families develop unrealistic expectations. Support given in the shape of advice, with the best of intentions, can leave the family member feeling worse. It may also create greater conflict within the family.

However, the evidence strongly suggests that support that is well structured, consistent and addresses the needs of families and carers can produce significant benefits to their personal health, well being and relationships.

From our review of the evidence and the responses to our consultation, we have identified a number of benefits for family members from appropriate support to meet their needs:

• Helps families and carers to recognise and understand their own needs and seek help. Providing support directly to families gives them the opportunity to identify their own heath, social and emotional needs and offers a source of information and help.
• Improves the family's understanding of drugs, dependency and treatments. If the family has a better understanding of the situation they face, it can reduce their anxieties, and demystify the drug users' behaviour. It can also help to minimise collusion and manipulation within the family.

• Everyone working together towards a shared goal. Where the drug user is receiving treatment, giving support to families helps to create a common goal for the agency, drug user and family to work towards rather than the family having expectations that may be unrealistic at that time e.g. abstinence rather than stabilisation. This can reduce pressures put upon the drug user that may be counter-productive (EIU mapping exercise).

• Improves communication within the family. Support for the family can reduce the level of tension within the family and allow family members to address and discuss their feelings. By being able to talk about issues, rather than conceal them, families can rebuild trust and relationships. It can also mean that families respond to the drug user in a consistent way (e.g. all refuse to lend money rather than one giving in to demands) which reduces conflict within the family.

• Reduces isolation. Support can reduce the isolation experienced by families. Information about other appropriate support services can also extend the pool of support and the networks available to family members.

• Identifies and can address family issues. Support for the family can allow for an integrated approach to other issues and problems within the family that impact either on their well being or the recovery of the drug user. It can also ensure that the needs of children are identified.

• Increases support for the drug user. As noted above, this is recognised as a benefit by drug agencies, although it should not be the prime objective. If support helps the family to deal with the problems arising from drug use, they may be able to offer support to the drug user.