1. Families, addiction and recovery
Louise Martin and Alex Copello
Skills Consortium conference, London, 14th February 2012

2. Individual vs. social view of addictionsAC

3. 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) AC

4. 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. LM

5. 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 LM

6. 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 AC

7. What is the extent of the problem?
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.
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 AC 7

8. 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 AC

9. Symptoms of Ill Health Family members
Family members; psychiatric out-pts. and
community controls 2 1 5 10 15 20 25 30 35 UK
Mexico
Wives
P.Care
Psych
Control AC

10. 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 AC

11. Policy LM

12. 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 LM

13. 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” LM

14. 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 LM

15. What happens in practice?

16. 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 AC

17. 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 AC

18. Family Interventions

19. 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] AC

20. TREATMENTS INVOLVING FAMILY MEMBERS (FMs) Joint involvement of FM
Working With FMs
to engage relation in treatment
Joint involvement of FM
and their relatives in treatment
Responding to Needs of FM
in their own rights
Concurrent group treatment
Al-Anon
Families Anonymous
Supportive stress management counselling
Parent coping skills training
5 - step intervention
Family intervention
Community reinforcement & family training
Unilateral Family therapy
Cooperative counselling
Pressure to change
Conjoint family group therapy
Behavioural couples therapy
Family therapy
Network therapy
Social behaviour & network therapy
M-PACT AC

21. The stress-strain-coping-support model
Relative’s substance problem
Stress on family member
Social support
Ways of coping AC
Family member strain

22. 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 AC

23. A little support can have wide positive consequences
Key message:
A little support can have wide positive consequences AC

24. What do you do in your services?LM

25. 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 LM

26. 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 LM