Supporting family members

1. Supporting
family members

2. Introduction
In the following film clip, Viv Evans OBE, Chief Executive Officer of
national charity Adfam, introduces us to supporting family members.
Click here to listen to her talk about the importance of supporting family
members.
N.B. This resource focuses specifically
on supporting family members where
safeguarding does not appear to be
an issue.

3. Why support family members?
• In the resource Impact of substance use on family, friends and carers
we explored the various ways in which family members could be
affected by a loved one’s problematic substance use. It is clear they
need support in their own right.
• Listen to a father tell his story about the impact on him
and the realisation that he too needed help.
• Evidence clearly shows that supporting family members
of people with substance problems can significantly
improve their own health and well-being. It can support
the family members’ ability to cope with their loved one’s
substance use.
• It can also encourage the person with the problem to seek help and
support. (Orford et al. 2007)

4. Be clear on your remit
• You may be in a position to work with the family members in some
depth or you may only have minutes to offer support.
• Your intervention may range from a brief discussion and providing
information, to more regular contact and a supported referral to
specialist services.
• Key to both of these is active listening.
• Given the high rates of overlap with domestic abuse among people
with substance problems, care must be taken to have discussions,
however brief, in a safe and private environment. If it doesn’t feel
safe, people will not disclose.

5. Skills for supporting family
members
• You need to demonstrate:
– Active listening
– Warmth
– Empathy
– Good communication skills
– Honesty.
• Sometimes listening alone can help – you don’t necessarily have
to try to ‘fix’ it.
• Watch Professor Alex Copello talk about the importance of listening
to family members

6. Considerations for family
members
Three key considerations will be:
1. Whether or not they can trust you.
2. Whether they will find it hard to speak openly to you.
In this clip Viv Evans, Adfam, describes some of the difficulties
families may have talking about substance use.
3. Whether they feel too ashamed and will try to minimise the impact
it is having on them (Galvani 2012).
Here, Prof Alex Copello talks about the impact of substance use on
families.

7. Children and kinship care
• Family members, particularly grandparents, may take on the care of
children where there is problematic substance use by parents.
• Both the grandparents and children will need support in
understanding what is happening and in communicating their
thoughts and feelings.
• For children, being able to talk to someone about their experience
and worries is an important protective factor.
• Watch Advanced Practitioner, Vicki Ellis, from the
SWIFT family service talk about support for children.

8. What you can do to support family
members?
1. Find out what services are available that work with family members
in their own right.
2. Acknowledge how tough it has been for the family member being
with/living with someone with a substance problem.
3. Listen to their concerns and worries.
4. Suggest they get some help in their own right.
5. Provide information to them about services available
6. Offer to make a referral when appropriate.

9. Family Interventions
• A number of specialist family interventions are available. These range
from couples work to whole family and social network interventions to
those focussing on adolescent substance users.
• Self help or mutual aid support for family members is also available
through groups like Al-Anon (for more information go to http://www.al-
anonuk.org.uk/).
• Unless you are specialising in this area it is unlikely you will be involved
in facilitating such interventions but it is important to have an awareness
of what is available if you are going to refer people on.
• The following slide provides a list of the types of intervention you may
hear about and a link to further information.

10. Types of intervention
• Family based
– Community Reinforcement and Family Training (CRAFT)
– Multi-Systemic and Family Systems Therapy (FST)
– Social Behaviour and Network Therapy (SBNT)
• Couples
– Behavioural Couples Therapy (BCT)
• Adolescent
– Multi-systemic therapy
– Integrated family and cognitive behavioural therapy
– Multi-dimensional family therapy
– Brief strategic family therapy
– Parent coping skills training
• For further information on these interventions go to the further reading
section of this resource.

11. Family interventions (cont.)
• Templeton et al. (2010) reviewed 34 studies on interventions for
family members. Two in particular were highlighted:
– The Pressure to Change approach – this provides training in
coping skills for female partners of heavy drinkers at the same
time as increasing pressure on the partner to change.
– 5 step method – this can be used by non-substance specialists.
This method focuses on family members alone and involves
active listening, providing information, discussing coping
strategies, enhancing social support and assessing additional
needs/making onward referrals.

12. Cultural and ethnic considerations
• In many cultures close family ties will result in the family seeking help
together with the person with the substance problem.
• Family-based interventions fit well with families of this kind although
‘talking therapies’ often don’t suit older generations in some
ethnicities and cultures (Galvani et al. 2013).
• In a review of substance-related family interventions for people from
Asian communities, Manders and Galvani (2013) identified a lack of
specific interventions that were developed for minority ethnic groups.
• Substance use in some religions, e.g. Sikhism and Islam, is
prohibited and frowned upon and may often be denied by those with
problems. This reinforces the need for private and ‘safe’ environment
conversations away from others.

13. N.B. Domestic abuse and family
interventions
• Domestic abuse is a common co-existing factor with problematic
substance (and mental ill health). (See the resource on Domestic
Violence and Substance Use.)
• Care must be taken not to refer to, or engage in, couples’ or family
work where there is current or recent domestic abuse and/or child to
parent violence. You need to establish this first.
• Couples’ or family therapy can pose risks of further abuse to the
participants and retribution from the perpetrator for what is disclosed
during the intervention. This will, of course, inhibit family members’
ability to talk openly and engage fully during the intervention (Galvani
2007).

14. Finding services
• Service provision can vary from one geographical
area to the next so contact your local alcohol and
drug services to find out what is available.
• National family and addiction charity Adfam
also has a database of family services which
can be accessed at www.adfam.org.uk
• Watch Viv Evans, CEO, Adfam, discuss the services available to
families.

15. Final word
At the start of this resource we heard from a father about his
experiences as a parent of a daughter with problematic substance use.
To finish this resource, hear more of his story which describes how he
is coping now and how he gained from his involvement with a
parent/carers' support group.

16. References
• Galvani, S. (2007) ‘Safety in numbers? Tackling domestic abuse in couples and
network therapies.’ Drug and Alcohol Review, 26, 175-181
• Galvani, S. (2012) Supporting people with alcohol and drug problems. Bristol: Policy
Press
• Galvani, S., Manders, G. with Chaudhry, S. (2013) Developing a Community Alcohol
Support Package: An exploratory study with a Punjabi Sikh Community. Final report
to funder. Luton: University of Bedfordshire.
• Manders, G. and Galvani, S. (2013) Effective Family Alcohol Interventions for the
Punjabi Sikh Community. Luton: University of Bedfordshire
• Orford, J., Templeton, L., Patel, A., Copello, A. and Velleman, R. (2007) ‘The 5-Step
family intervention in primary care: I. Strengths and limitations according to family
members,’ Drugs: education, prevention and policy, 14:1, 29 – 47