Supporting family members

Introduction In the following film clip, Viv Evans OBE, Chief Executive Officer of national charity Adfam, introduces us to supporting family members. Click here to listen to her talk about the importance of supporting family members.importance of supporting family members N.B. This resource focuses specifically on supporting family members where safeguarding does not appear to be an issue.

Why support family members? In the resource Impact of substance use on family, friends and carers we explored the various ways in which family members could be affected by a loved one’s problematic substance use. It is clear they need support in their own right.Impact of substance use on family, friends and carers Listen to a father tell his story about the impact on himListen to a father tell his story and the realisation that he too needed help. Evidence clearly shows that supporting family members of people with substance problems can significantly improve their own health and well-being. It can support the family members’ ability to cope with their loved one’s substance use. It can also encourage the person with the problem to seek help and support. (Orford et al. 2007)

Be clear on your remit You may be in a position to work with the family members in some depth or you may only have minutes to offer support. Your intervention may range from a brief discussion and providing information, to more regular contact and a supported referral to specialist services. Key to both of these is active listening. Given the high rates of overlap with domestic abuse among people with substance problems, care must be taken to have discussions, however brief, in a safe and private environment. If it doesn’t feel safe, people will not disclose.

Skills for supporting family members You need to demonstrate: –Active listening –Warmth –Empathy –Good communication skills –Honesty. Sometimes listening alone can help – you don’t necessarily have to try to ‘fix’ it. Watch Professor Alex Copello talk about the importance of listening to family membersimportance of listening to family members

Considerations for family members Three key considerations will be: 1.Whether or not they can trust you. 2.Whether they will find it hard to speak openly to you. In this clip Viv Evans, Adfam, describes some of the difficulties families may have talking about substance use.talking about substance use 3.Whether they feel too ashamed and will try to minimise the impact it is having on them (Galvani 2012). Here, Prof Alex Copello talks about the impact of substance use on families.impact of substance use on families

Children and kinship care Family members, particularly grandparents, may take on the care of children where there is problematic substance use by parents. Both the grandparents and children will need support in understanding what is happening and in communicating their thoughts and feelings. For children, being able to talk to someone about their experience and worries is an important protective factor. Watch Advanced Practitioner, Vicki Ellis, from the SWIFT family service talk about support for children.support for children

What you can do to support family members? 1.Find out what services are available that work with family members in their own right. 2.Acknowledge how tough it has been for the family member being with/living with someone with a substance problem. 3.Listen to their concerns and worries. 4.Suggest they get some help in their own right. 5.Provide information to them about services available 6.Offer to make a referral when appropriate.

Family Interventions A number of specialist family interventions are available. These range from couples work to whole family and social network interventions to those focussing on adolescent substance users. Self help or mutual aid support for family members is also available through groups like Al-Anon (for more information go to anonuk.org.uk/). anonuk.org.uk/ Unless you are specialising in this area it is unlikely you will be involved in facilitating such interventions but it is important to have an awareness of what is available if you are going to refer people on. The following slide provides a list of the types of intervention you may hear about and a link to further information.

Types of intervention Family based –Community Reinforcement and Family Training (CRAFT) –Multi-Systemic and Family Systems Therapy (FST) –Social Behaviour and Network Therapy (SBNT) Couples –Behavioural Couples Therapy (BCT) Adolescent –Multi-systemic therapy –Integrated family and cognitive behavioural therapy –Multi-dimensional family therapy –Brief strategic family therapy –Parent coping skills training For further information on these interventions go to the further reading section of this resource.

Family interventions (cont.) Templeton et al. (2010) reviewed 34 studies on interventions for family members. Two in particular were highlighted: –The Pressure to Change approach – this provides training in coping skills for female partners of heavy drinkers at the same time as increasing pressure on the partner to change. –5 step method – this can be used by non-substance specialists. This method focuses on family members alone and involves active listening, providing information, discussing coping strategies, enhancing social support and assessing additional needs/making onward referrals.

Cultural and ethnic considerations In many cultures close family ties will result in the family seeking help together with the person with the substance problem. Family-based interventions fit well with families of this kind although ‘talking therapies’ often don’t suit older generations in some ethnicities and cultures (Galvani et al. 2013). In a review of substance-related family interventions for people from Asian communities, Manders and Galvani (2013) identified a lack of specific interventions that were developed for minority ethnic groups. Substance use in some religions, e.g. Sikhism and Islam, is prohibited and frowned upon and may often be denied by those with problems. This reinforces the need for private and ‘safe’ environment conversations away from others.

N.B. Domestic abuse and family interventions Domestic abuse is a common co-existing factor with problematic substance (and mental ill health). (See the resource on Domestic Violence and Substance Use.)Domestic Violence and Substance Use Care must be taken not to refer to, or engage in, couples’ or family work where there is current or recent domestic abuse and/or child to parent violence. You need to establish this first. Couples’ or family therapy can pose risks of further abuse to the participants and retribution from the perpetrator for what is disclosed during the intervention. This will, of course, inhibit family members’ ability to talk openly and engage fully during the intervention (Galvani 2007).

Finding services Service provision can vary from one geographical area to the next so contact your local alcohol and drug services to find out what is available. National family and addiction charity Adfam also has a database of family services which can be accessed at Watch Viv Evans, CEO, Adfam, discuss the services available to families.services available to families

Final word At the start of this resource we heard from a father about his experiences as a parent of a daughter with problematic substance use. To finish this resource, hear more of his story which describes how he is coping now and how he gained from his involvement with a parent/carers' support group.hear more of his story

References Galvani, S. (2007) ‘Safety in numbers? Tackling domestic abuse in couples and network therapies.’ Drug and Alcohol Review, 26, Galvani, S. (2012) Supporting people with alcohol and drug problems. Bristol: Policy Press Galvani, S., Manders, G. with Chaudhry, S. (2013) Developing a Community Alcohol Support Package: An exploratory study with a Punjabi Sikh Community. Final report to funder. Luton: University of Bedfordshire. Manders, G. and Galvani, S. (2013) Effective Family Alcohol Interventions for the Punjabi Sikh Community. Luton: University of Bedfordshire Orford, J., Templeton, L., Patel, A., Copello, A. and Velleman, R. (2007) ‘The 5-Step family intervention in primary care: I. Strengths and limitations according to family members,’ Drugs: education, prevention and policy, 14:1, 29 – 47