Adfam as an umbrella organisation

Where do families fit in?

Who are Adfam?
Our mission: improve the quality of life for families affected by drug and alcohol use.Direct services in 3 prisonsInfluence policyProjectsSignpostingTrainingPublications and resourcesSupporting and developing networks and capacity

Overview
Nearly 1.5 million adults significantly affected by a relatives drug use250,000 children of problematic drug users1 million children affected by parental alcohol misuse

How are families affected?
Lack of informationFinancialCriminal activityEmotionalPhysicalStigmaIsolationThe cost of harms family members experience is about 1.8 billion per year

Why is it your concern?
Substance users primarily rely on their families for support: they are your co-workersAddiction is contextual and recovery has to be as wellThey need help to make sure their support is effectiveThey were there before the addiction and they will be there after the addictionThe support they provide would cost the NHS and LAs about 750 million to provide

What can you do?
Give informationExplore family relationships with the substance userReferral and partnership workingAcknowledge and respect family membersMinimise the vulnerability of family membersHave guidelines for engaging with family members, and training and support for staffConsider the whole family

Contact details
Kate PeakeRegional Development Coordinator

Adfam25 Corsham StreetLondonN1 6DRTel: 020 7553 7646k.peake@adfam.org.uk

www.adfam.org.uk @AdfamUK

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People with drug problems, however isolated will have networks of families and friends who will feel the impact of the drug problems, whether they have become estranged or continue to provide vital support. There are estimated to be nearly 1.5 million adults significantly affected by a relatives drug use nationally.
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Lack of informationLack of knowledge of drugs and alcohol/criminal justice system/treatment services, risks, rights etc-Where theres a lack of first hand knowledge understanding can be based on media images-Lack of knowledge may create vulnerabilities, eg: could be told by prisoner that smuggling contraband/class C drugs isnt that serious and blackmailed or emotionally bullied into smuggling items into prison.- On a police raid their loved one may be taken away/good seized with no communication from the police as to what they should do/who they should contact/why its happening. They may be terrified and may be treated as if theyre part of the problem. Similarly, if they dont know whats happening with their loved ones treatment, they can be extremely worried. They want them to get help and just want to know that theyre ok.

FinancialA drug or alcohol user may steal from their family. Gadgets, money, childrens christmas pressiesFamily members may have to quit work/go on sick leave due to stress.Grandparents may be left looking after their grandchildren, which can be a significant financial burden. Families may give them money and/or accumulate debt to try to stop them stealing.Families may face threats from drug dealers to pay the loved ones debts.

Criminal ActivityDrug dealers may turn up at the house demanding money Family members may purchase drugs for their loved one, in an attempt to limit their loved ones supply. They may be emotionally or physically threatened or coerced into bringing drugs or contraband into prison. They may get involved in criminal activity themselves to fund their loved ones habit because they dont want to see them suffer.

EmotionalFamily members may get depressed, have panic attacks, be unable to sleep, feel worthless, feel angry that this has happened, feel constantly terrified that their loved one is going to die.They may feel guilt and go over their own actions, wondering what theyve done wrong. They may face emotional blackmail from their loved one.They may feel a complete lack of control and spend no time thinking about themselves, their entire life is taken over by their loved one.They cant control their loved ones actions, but equally they can feel helpless within the services/systems. Decisions may be made without consultation with them, or the family may feel emotionally blackmailed by both the user and the services into complying, eg: home detox, being sent to their address on probation.They may have been suffering for years before they identify the problem.They have often been dealing with years of trying to hold the family together, of being the strong one, of being the one who picks up the pieces.If children are involved they may try to protect the children and bear the weight of their burdens single-handedly as well. Grandparents may be left to raise their grandchildrenChildren themselves may reverse roles with their substance using parents, to become the parent. Siblings and children of substance users may feel resentful at the amount of time, effort and money is spent on the user. In some cases family members may turn to substances themselves in order to cope, maybe alcohol, maybe prescription medication. If police have raided their house they may feel violated and very confused or distressedIf their loved one goes into prison, the family relationships can change over the time they are inside, and expectations on release can be very different.

PhysicalFamily members may face physical abuse, particularly where alcohol is concerned. The violence could come from either children/adolescents or adults, and the former can bring increased shame and stigma.They may fact threats or actual violence from drug dealers

StigmaFamily members may get tarred with the same brush as the drug users. It may be assumed that because theres a drug user in the family theryre all like that. Words such as scum, loser, low-life may be used. There can be a judgement and a loss of trust from people (handbags being moved)

Isolation -They may fear other peoples judgement and so not tell friends or other family membersThey may not go out for fear of what their loved one will do in their absenceThey may not invite people back as they dont know what to expect on returning to the houseThey may slowly lose contact with friends and family members as the addiction takes centre-stageThey may not have anyone who understands and will listen without judgementThey may be off work on sick, increasing their isolation
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Phoenix Futures ran a survey of their clients and found that 70% said that their mum was their main source of support. Supporting these families and having family-based interventions has been acknowledged as making a significant contribution to effective adult drug treatment, by NICE and 12007 Clinical Guidelines. The Drug Strategy of 2010 also recognises that when it comes to the recovery agenda families have an important part to play, both in supporting their loved one through their recovery journey, and as an part of the persons lives that may have issues that need addressing in order for the persons recovery to be successful. Family members want to help, they want to support you in your work, but without support for themselves their attempts at helping may contribute to the problem, eg: lack of boundary setting. We all know that supporting someone who uses drugs or alcohol can be extremely difficult, but its even more difficult if youre doing it with no prior experience of it, and no support for yourself. People in recovery have told us that as soon as their family started getting support for themselves, they felt much more supported themselves and able to make the hard decisions about their own recovery. The support that families provide would cost the NHS and local authorities about 750 million to provide if it were not available, but family members frequently feel excluded, dont have access to the information that would help them help their loved one, and struggle to be recognised as part of that support structure by their loved ones workers.
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Give information- Provide generic information to family members explaining what will happen when their loved one enters treatment/gets taken away in a policy van/goes on probation etcDont take the substance user at their word that no family member is affected, dig deeper.Explain that family members are affected, whether they recognise it or not. Explain why youre asking for permission to share informationAsk if you can give generic advice/a referral to the family members and explain why youre asking this.Continue to revisit the issue in later sessionsHave clear guidelines for staff, substance users and family members around information sharing.If a family member rings up and you cant give them any info, explain why, and give them generic info about services and treatment

Explore family relationshipsMake sure that the broader family dynamics are explored with the substance user and help them to understand what problems there have been in the past, what problems there might be in the future, and what they might be able to do about these.

Referral and partnership workingFind out what services are out there and build referral links with them.Identify ways that a family member can support the substance users recovery process and build a relationship with their family support worker.Work jointly with family support groups to look at how the recovery pathways of a substance user and their family members might interact and ensure they work together.Where possible this may lead to whole-family working between the two agencies.

Acknowledge and respect family membersIf they phone up, be sensitive and understanding of the pressure and stress that theyre under. Ask them if theyre getting support for themselves.Identify ways of celebrating a substance users achievements with the whole family.Appreciate that family members visiting prison can feel vilified by association, be friendly.Build a sense of collaboration with family members

Minimise the vulnerability of family membersInformation can go a long way to helping reduce the vulnerability of family members, and a referral to support is also extremely important.In the criminal justice system there are additional considerations, such as observing key areas incase pressure is put on family members to smuggle drugs and contraband in.

Have guidelines for engaging with family members, and training and support for staff- There needs to be clear guidelines so all staff understand what they should be doing. These need to be reviewed on an annual basis.- Without training and support its easy for family work to get left behind. The more common a practice becomes the better people become at doing it and the less effort it takes. When new ways of working are introduced it can seem like hard work. Supporting each other to find ways of making it work is important. It doesnt have to be a problem, but it can seem like one if youre trying to don it on your own.

Consider the whole familyCommissioners: think about whether families own recovery needs are being met by the services you commission.Drug and Alcohol workers: consider how family members might be affected by changes to the users regime. Think about the role that the family has in the recovery pathways of your substance users, think about what the recovery pathways of the family members might look like, and work with your local family support groups to ensure youre supporting each others work wherever possible.
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