Families, addiction and recovery

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Families, addiction and recovery. Louise Martin and Alex Copello Skills Consortium conference, London, 14 th February 2012. Individual vs. social view of addictions. - PowerPoint PPT Presentation

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  • Families, addiction and recoveryLouise Martin and Alex Copello

    Skills Consortium conference, London, 14th February 2012

  • Individual vs. social view of addictions

  • Despite the available evidence and potential gain, shifting the emphasis from individualised treatment approaches to those focused on the substance users family and social environment presents a number of significant challenges

    (Copello, 2006)

  • 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-beingFamilies indirectly influence clients using behaviourWe need to consider the whole system of the family, not just the individual when thinking Recovery.

  • Why work with families?2. Improved client treatment outcomes

    Increases client entry into treatmentImproves engagement and retention of client in treatmentImproves substance use outcomes for clientsReduces relapseFamilies play crucial role in facilitating recovery

  • 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

  • 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 populationGeneral population50,373 partners55,012 parents35,208 other573,671 partners610,970 parents259,133 otherTotal = 140,593Total =1,443,774

  • THE UNIQUE SET OF STRESSFUL CIRCUMSTANCES FOR FAMILIES COPING WITH ADDICTIONHas the nature of severe stress, threat and abuseInvolves multiple sources of threat to self and family, including emotional, social, financial, health and safetyCan have significant impact on childrenWorry for that family member is a prominent featureThere are influences in the form of individual people and societal attitudes that encourage the troubling behaviourAttempting to cope creates difficult dilemmas, and there is no guidance on the subjectSocial support for the family is needed but tends to failProfessionals who might help are often at best badly informed and at worst critical

  • Symptoms of Ill HealthFamily members; psychiatric out-pts. and community controlsFamily members

  • 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

  • Policy

  • NTA (2008) Supporting and Involving CarersInvolve family in treatment where appropriateInvolve family in service planningRoutinely ask about familyOffer carers assessmentsDevelop support plan if neededHelp family think about how to cope with substance use

  • Drug Strategy 2010Evidence 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

  • NICE (2007) Drug Misuse: Psychosocial InterventionsRoutinely ask about family, and the impact of substance use on familyInvolve families in assessment and treatment plan (with consent of client)Offer carers assessmentProvide written information about impact of drug misuse on familiesOffer guided self help where neededProvide information about support groups5 sessions based on Copellos modelBehavioural Couples Therapy

  • What happens in practice?

  • 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

  • To receive advice and support on their own right

    To be supportive of the relatives treatment and involved if usefulWe know that family members have two related needs:

  • Family Interventions

  • Family Interventions: Three Broad Categoriesinterventions 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]

  • Concurrent group treatment

    Al-Anon

    Families Anonymous

    Supportive stress management counselling

    Parent coping skills training

    5 - step interventionWorking With FMs to engage relation in treatmentJoint involvement of FMand their relatives in treatmentResponding to Needs of FMin their own rightsFamily intervention

    Community reinforcement & family training

    Unilateral Family therapy

    Cooperative counselling

    Pressure to changeConjoint family group therapy

    Behavioural couples therapy

    Family therapy

    Network therapy

    Social behaviour & network therapy

    M-PACTTREATMENTS INVOLVING FAMILY MEMBERS (FMs)

  • The stress-strain-coping-support modelRelatives substance problemStress on family memberFamily member strainSocial supportWays of coping

  • 5-Step Method1 Listen, reassure and explore concerns2 - Give relevant targeted information (eg substances, treatment, support)3 - Explore coping responses engaged, tolerant, withdrawn4 Discuss social support map5 Discuss further support needs

  • Key message:

    A little support can have wide positive consequences

  • What do you do in your services?

  • What can you do?

    Find out whats 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

  • Potential ObstaclesNot allocating sufficient resourcesAbsence of managerial buy-inExpecting this to be done on top of normal caseloadsSeeing it as a luxury rather than coreLack of systems for recording workResponsibility resting with one person

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