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