Families, addiction and
recovery
Louise Martin and Alex Copello
Skills Consortium conference, London, 14th February 2012
Individual vs. social view
of addictions
Despite the available evidence and
potential gain, shifting the
emphasis from individualised
treatment approaches to those
focused on the substance user’s
family and social environment
presents a number of significant
challenges
(Copello, 2006)
Why work with families?
1. ‘Carer burden’ is extremely high and families need support in
their own right
• Costs are financial, social, psychological, physical and
relational
• Reciprocity of well-being
• Families indirectly influence clients’ using behaviour
• We need to consider the whole system of the family, not just
the individual when thinking Recovery.
Why work with families?
2. Improved client treatment outcomes
•
•
•
•
•
Increases client entry into treatment
Improves engagement and retention of client in
treatment
Improves substance use outcomes for clients
Reduces relapse
Families play crucial role in facilitating recovery
How large is the problem?
It is estimated that there are approximately 15 million people
with drug use disorders globally and 76 million with alcohol
use disorders (Obot, 2005).
A cautious estimate of just one person seriously affected in each
case suggests a minimum of 91 million affected family
members
Most people would use a greater multiplier and produce a
higher figure
What is the extent of the problem?
•
Drug treatment
population
General
population
50,373 partners
55,012 parents
35,208 ‘other’
573,671 partners
610,970 parents
259,133 ‘other’
•
•
•
Total = 140,593 Total =1,443,774
Key findings from UK DPC study
about adult family members of
drug misusers.
What about alcohol misuse?
Up to 1 million children are
affected by parental drug misuse
& up to 3.5 million by parental
alcohol misuse (Manning et al.,
2009).
It is estimated that the impact of
drug misuse on the family costs
the UK £1.8 billion but also
brings a resource saving to the
NHS of £747 million through the
care provided.
THE UNIQUE SET OF STRESSFUL CIRCUMSTANCES FOR
FAMILIES COPING WITH ADDICTION
 Has the nature of severe stress, threat and abuse
 Involves multiple sources of threat to self and family, including emotional, social,
financial, health and safety
 Can have significant impact on children
 Worry for that family member is a prominent feature
 There are influences in the form of individual people and societal attitudes that
encourage the troubling behaviour
 Attempting to cope creates difficult dilemmas, and there is no guidance on the
subject
 Social support for the family is needed but tends to fail
 Professionals who might help are often at best badly informed and at worst critical
Symptoms of Ill Health
Control
Psych
P.Care
2
P.Care
1
Wives
Mexico
35
30
25
20
15
10
5
0
UK
Family Family members; psychiatric out-pts. and
community controls
members
Ray et al (2007)
Compared family members of people with substance misuse problems with
family members of similar persons without substance misuse.
Samples:
Family members n = 45,677 (male/female – 46/54%)
Comparison group n = 141,722 (male/female – 46/54%)
More likely to be diagnosed with medical conditions most commonly
depression and other psychological problems
Ray et al (2007) The excess medical cost… Medical Care
Policy
NTA (2008) “Supporting and Involving Carers”
•
•
•
•
•
•
Involve family in treatment where appropriate
Involve family in service planning
Routinely ask about family
Offer carers assessments
Develop support plan if needed
Help family think about how to cope with
substance use
Drug Strategy 2010
“Evidence shows that treatment is more likely
to be effective, and recovery to be sustained,
where families, partners and carers are closely
involved. We will encourage local areas to
promote a whole family approach to the
delivery of recovery services and to consider
the provision of support services for families
and carers in their own right”
NICE (2007) Drug Misuse:
Psychosocial Interventions
• Routinely ask about family, and the impact of
substance use on family
• Involve families in assessment and treatment
plan (with consent of client)
• Offer carers assessment
• Provide written information about impact of drug
misuse on families
• Offer guided self help where needed
• Provide information about support groups
• 5 sessions based on Copello’s model
• Behavioural Couples Therapy
What happens in
practice?
Practice
► Some very good examples of services for
family members but provision is patchy
► Implementation of evidence based
practice remains low
► Potential to improve availability and
response to families
We know that family members have
two related needs:
To receive advice and support on their
own right
To be supportive of the relative’s
treatment and involved if useful
Family Interventions
Family Interventions: Three Broad
Categories
• interventions that work with family members to
promote the entry and engagement of drug and/or
alcohol users into treatment
• the joint involvement of family members and the
relatives using drugs and/or alcohol in the treatment
of the user
• interventions aimed to respond to the needs of
family members affected by drug and alcohol
problems in their own right
[Copello, Velleman and Templeton, 2005]
TREATMENTS INVOLVING FAMILY MEMBERS (FMs)
Working With FMs
to engage relation in treatment
Joint involvement of FM Responding to Needs of FM
and their relatives in treatment
in their own rights
Family intervention
Conjoint family group therapy
Concurrent group treatment
Community reinforcement &
family training
Behavioural couples therapy
Al-Anon
Family therapy
Families Anonymous
Network therapy
Supportive stress
management counselling
Social behaviour & network
therapy
Parent coping skills training
M-PACT
5 - step intervention
Unilateral Family therapy
Cooperative counselling
Pressure to change
The stress-strain-coping-support model
Relative’s substance problem
Stress on family member
Social support
Ways of coping
Family member strain
5-Step Method
• 1 – Listen, reassure and explore concerns
• 2 - Give relevant targeted information (eg
substances, treatment, support)
• 3 - Explore coping responses – ‘engaged’,
‘tolerant’, ‘withdrawn’
• 4 – Discuss social support – map
• 5 – Discuss further support needs
Key message:
A little support can have wide
positive consequences
What do you do in your
services?
What can you do?
•
Find out what’s available in your area and decide what you can offer as a service
•
Identify families ‘champions’
•
Produce an information leaflet for families and carers
•
Let administrator/ receptionist know what you offer
•
Add a question about family members to your assessment form
•
Add ‘family’ to your regular team meeting agendas
•
Organise a ‘friends and family day’ at your service
•
Organise 5-step training for staff
•
Get systems in place for recording contacts, safeguarding issues etc
Potential Obstacles
• Not allocating sufficient resources
• Absence of managerial buy-in
• Expecting this to be done on top of normal
caseloads
• Seeing it as a ‘luxury’ rather than core
• Lack of systems for recording work
• Responsibility resting with one person