The role of families and social support networks
There has been an increasing recognition of the role that families can play in drug treatment, as well as the need to address the specific concerns of family members themselves regarding coping with a problem drug user in the family. A growing literature has highlighted how families can help prevent/ influence the use of drugs by other family members, improve substance-related outcomes and help minimise the negative effects that an individual’s drug use can have on other members of their family. In turn, family members and wider social support networks can be a significant asset to an individual’s recovery.
Substance misuse is associated with a wide range of health and social problems for individuals. But, it can also have a devastating impact on the individual’s family members, including their extended family, carers and friends.
There are a range of family-based treatment interventions that are recommended by:
Despite recommendations, family focused interventions are not routinely available, with services predominantly concerned with treatment that focuses on the individual, not their family/ wider social support network. With an estimated 1.5 million people in the UK affected by a relative’s drug use, and patchy service provision, the number of those receiving this support is low compared to the numbers affected.
Family interventions can be broadly categorised into two areas:
- Interventions where there is joint involvement of drug using individuals and family members
- Interventions that respond to the needs of family members who are affected by a relative’s substance misuse and that work with family members in order to help a using relative engage in treatment.
It’s important that workers ‘think about families and social support networks’, when working with clients. Central to this is the acknowledgement of how families can be a useful asset in an individual’s drug treatment and play a key role in supporting their recovery, and that family members can have needs of their own that should be recognised.
Questions you may choose to ask about your service and your own clinical practice can be used by workers to help them objectively think about what their service has to offer in relation to families and social support networks, as well as their own approach to working with clients.
Family-focused treatment interventions
What follows are recommended interventions and where they are recommended:
- Behavioural Couples Therapy (BCT) [NICE 51]
- Community Reinforcement Approach (CRA) [2007 Clinical Guidelines]
- Family support [NICE 51]
- Family therapy [2007 Clinical Guidelines]
- Social Behaviour and Network Therapy (SBNT) [2007 Clinical Guidelines].
These interventions are summarised in more detail in the Family interventions classification table.
The Skills Consortium’s Skills Hub has a wide range of resources for each of these interventions. The resources are categorised into six types: guidance & evidence base, manuals, competencies, training, implementation and shared learning. Family and social support network resources on the Skills Consortium’s Skills Hub lists these resources (by intervention type).
Although these are specialist interventions, it’s important to remember that families and wider social support networks can play a central role in supporting individuals achieve their overall recovery goals, with the overarching principles of these interventions important foundations to working with substance users generally.
Families in their own right
Families of those involved in substance misuse can be affected in a number of ways that can be very stressful and disruptive, including:
- physical and psychological health, such as:
- negative emotional and mental impacts, such as guilt, self-blame, anger, rejection, disappointment, denial, shame, powerlessness, anxiety and depression
- ill health as a result of living with a drug user.
- family relationships, such as:
- family members often having to fulfill a role that is different to their position in the family, such as that of a carer
- the development of conflict between family members, negatively affecting family relationships
- significant impacts on children
- the feeling that family members have to deal with these problems alone/ within the family.
- financial difficulties through:
- theft and repaying debts
- the costs associated with treatment and caring for dependents.
- social life:
- family members focusing on the drug using individual at the expense of their own needs.
In turn, family members have two related needs from treatment:
- The need for advice and help, in order to support their relative’s treatment – which can involve playing a role in that treatment
- The need for advice and support in their own right, as someone affected by a relative’s substance misuse.