families disempowered by addiction

Families Disempowered by Addiction

Jim OrfordAlcohol, Drugs, Gambling and

Addiction Research Group, The University of Birmingham

Unhooked Thinking, Bath, May 2007

The most common and damaging misunderstanding about drug dependency is that it only concerns the person using the drugs.

Fergal Keane, 2007

ADDICTION AND THE FAMILY (ADF) GROUP

• The University of Birmingham/Birmingham and Solihull Mental Health NHS Trust Substance Misuse Service

Alex CopelloIkan IbangaMajid MahmoodSherillyn McNeilJim Orford

• The University of Bath Mental Health R&D Unit/Avon & Wiltshire Mental Health Partnership NHS Trust

Rhea ArmisteadLorna TempletonRichard Velleman

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

Concerned and Affected Family Members (and Friends)

• Partners, parents, children, siblings, grandparents, other relations, friends, colleagues

• Of close relatives and others with alcohol and drug (and gambling) problems

FAILURE TO INCLUDE FAMILY AND NETWORK

• Theoretical failureCritical, pathologising models

Ambiguous models

Partial models

• Practical failureTo minimise harm to affected family and others

To enlist family and network support for change

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

ANALOGOUS FORMS OF STRESSFUL LIFE CIRCUMSTANCES

Persecution

Disaster

Family unemployment

Relative’s chronic illness

Relative’s mental illness

Relative’s HIV/AIDS

In war zone

Partner’s combat stress

Relative’s brain injury

Relative’s dementia

Bullying at work

Work overload

UNDERSTANDING THE FAMILY EXPERIENCE

STRESS STRAIN COPING SUPPORT

Signs ofstrain

Threatto home

Stressfulliving

Worry rerelative

SleepEating

Depre-ssed

Humbug

Un-certain

Finance

Sociallife

Perfor-mance

NeglectNeglect

FAMILY MEMBERS’ WORRIES ABOUT THEIR RELATIVES

Worry about the relative’s physical health

Worry that the relative is neglecting himself or herself

Worry about the relative’s mental health

Worry that the relative’s education, work or sporting performance is failing

Worry about the relative’s financial affairs

Worry about the frequency, quantity or form of the relative’s addictive behaviour

Worry about the company the relative is keeping

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

COMMON THREATS TO HOME AND FAMILY

• Finances depleted

• Atmosphere harmed

• Home invaded

• Social life restricted

• Worry about children

• Police involved

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

Family Members’ Ways of CopingSTANDING UP

TO IT

PUTTING UP WITH IT

WITHRAWING AND GAINING

INDEPENDENCE

Resigned, accepting

Sacrificing, compromising

Supporting the relative

Controlling, protecting the family

Confronting, talking rough

Refusing, resisting,

being assertive

Avoiding, escaping

Not worrying, getting a new life

A Mother’s Network Diagram

Mother

- Mother-in-law

- Husband

+ Two sisters

- Daughter's ex-

boyfriend

- Daughter's coffee-bar

friends

- Other parents

- Daughter's schoolfriend and family

+ Policeman

+ Daughter's social

worker

- Another social

worker

- Criminal justice system

+ A close friend

+ Friend in casualty

- Other close

friends

+ Work colleagues

- Step-father

Main Modifiers of the Core Family Member Experience

THE CORE EXPERIENCE

is modified by

Traditional vs modern family

roles

Substance use pattern

Licit or illicit; traditional or

recently introduced

Culture: individual, familial or communal

Relationship to misusing

relative

FM female or male

Family material circumstances

SOME THEORETICAL LINKS

Stressful life events and chronic life difficulties (Brown)

Conservation of resources theory (Hobfoll)

Empowerment theory (Rappaport)

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

… it ought to be both surprising and shocking that there has been so little in the way of co-ordinated response to families living with the drug problem of their son or daughter, brother or sister.

Marina Barnard, Drug Addiction and Families, 2007, p. 51

TREATMENTS INVOLVING FAMILY MEMBERS (FMs)

A. Working with FMs to encourage their relatives’ engagement in treatment

e.g. Family ‘intervention’; Community reinforcement and family training; Unilateral family therapy; Cooperative counselling; Pressures to change

B. Joint involvement of FMs and their relatives in their relatives’ treatment

e.g. Conjoint family group therapy; Behavioural couples therapy; Family therapy; Network therapy; Mutual help organisations

C. Responding to the needs of family members in their own right

e.g. Concurrent group treatment; Al-Anon, Families Anonymous; Supportive stress management counselling; Parent coping skills training

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

PRINCIPLES OF THE FAMILY AND SOCIAL NETWORK ADDICTION TREATMENT SYSTEM

Serves the aims of both family harm minimisation and treatment of the ‘misuse’

Flexible regarding point of entry and continuation of treatment

Takes an unambiguously non-pathologising stance towards family and network members

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

The 5-STEPS MethodFor Family Members in Their Own Right

1. Listen non-judgementally

2. Provide information

3. Discuss ways of coping

4. Explore sources of support

5. Arrange further help if needed

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

TRANSFORMATIONS DESCRIBED BY FAMILY MEMBERS RECEIVING 5-STEPS IN PRIMARY

CARE

• Increased focus on own life and needs (gaining independence)

• Increased assertiveness over the misuse (resisting and being assertive)

• Taking a calmer approach towards the misusing relative (reduced emotional confronting)

• Increased awareness of the relative’s misuse problem and its effects on family members (cognitive change)

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

ISSUES ARISING IN THE USE OF 5-STEPS IN PRIMARY CARE

I. Professionals

– Identification and recruitment difficult– Cases often too complex– Difficulties of practice roles and time available

II. Family Members

– Material needed earlier– Material not directive or powerful enough– May not impact the ‘misuse’

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

Social Behaviour and Network Therapy:To Provide Support for Using Relatives

Always ‘think network’Draw a network diagramInvite members of the networkStrengthen the networkDiscuss themes of: communication,

coping, information, joint activitiesWork with any part of the networkPlan for the future

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

Benefits from SBNT include:

• Improved understanding from ‘network members’

• Increased open communication

• More support and helpful control for focal clients

• Reduced exposure to social support for continued alcohol/drug misuse

ISSUES ARISING IN THE USE OF SBNT WITH DRUG PROBLEMS

Identifying any positive network support

Deciding who makes for the most supportive network members: parents, siblings, friends, others?

Improving communication about drug use in the network

Dealing with confidentiality

Birmingham Alcohol, Drugs, Gambling & Addiction Research Group

5-STEP MET

SBNT

Family member(s)

(FMs)

Focal person (FP)

FM(s) and FP

A Wife Worried about her Alcohol Misusing Husband

Wendy

HusbandBob

DaughterKaren

SonDavid

FriendJackie

FriendDebra

GP

A Father Worried about his Drug Misusing Son

Rasheed Wife Saima

Son Ali

Son Wahid

Daughter Rubina

Brothers & sisters

Four Options in Primary Care

SBNTsessions

5-Stepsessions

Self-helpmanual

Web-basedself-help manual

Generalised Network Diagram

Family

F

F PAP

Work

W

W

Leisure

Fr

Fr

Fr

Fr

Fr

Substance/object

Otheruser

Otheruser

Otheruser

BARRIERS TO WORKING WITH FAMILIES

Individualistic philosophy

Theories

Policies

Training

Contracts

Record-keeping systems

Advocacy

A policy move away from framing the harms of problem drug use in individual terms towards their greater contextualisation within families would obviously carry with it many resource and organisational implications.

Barnard, 2007, p.153

UNDERSTANDING the family experience

DEVELOPING ways of responding

DISSEMINATING within existing services

PROMOTING policy change