This document discusses the impact that a person's problematic substance use can have on their family members and friends. It notes that while interventions often focus on supporting the individual with the substance use problem, less attention is paid to the effects on family and friends. These effects can include physical and mental health problems, financial issues, relationship challenges, and domestic violence. The severity of impact depends on factors like whether family members live with the individual, provide their care, experience abuse, or use substances themselves. The document provides an overview of research demonstrating the stress, health problems, and emotional difficulties family members may face when a loved one has problematic substance use.

1. Impact of problematic
substance use on
family members, friends
and carers.

2. Introduction
• When someone has problems relating to their substance use, the
attention is focussed on that person, how to help them and, for some
people, what type of intervention is available for them.
• A number of interventions involve family members/ friends/carers –
usually these are focussed on how those family members can support
their friend or relative with the substance problem.
• Far less attention is paid to the impact the person’s substance use is
having on family members and the support they need in their own
right.

3. Impact
• This resource focuses on the impact of substance use on family
members/friends/ carers and what to consider in your discussions
with them, however brief. For brevity, ‘family member’ will be the
term used to represent these relationships throughout this resource.

4. Who may be affected
There are a range of people who can be affected when someone they
love or care for has problems relating to their substance use. These
include:
 Parents of substance using children
 this could be children of any age, be they 11 or 51!
 Brothers and sisters
 Partners
 Carers
 Extended family members, e.g. Grandparents
 Friends.

5. Negative impact?
• We tend to think problematic substance use will
automatically have a negative impact.
• While this is likely when someone’s substance use is consistently
problematic, people do report some positive aspects of using
substances, e.g. sociability or expressing themselves more openly
under the influence of a substance.
• The positive aspects of use need to be heard in order for it to inform
any further discussions about challenges to change and what
support the person may need to be offered in different aspects of
people’s lives.
• However, this resource will focus more on the negative impact of
problematic substance use on family members.

6. Types of impact
• Living with, or being close to, a person with problematic substance
use can result in a range of social and health problems for the family
member.
• These include:
– Physical health problems
– Psychological and mental health problems
– Financial problems
– Emotional problems
– Relationship stress and breakdown
– Loss of employment
– Domestic violence and abuse.

7. Types of impact (cont.)
• Adfam is a national UK charity that focusses on supporting family
members and friends of people with substance problems.
• This clip hears from its Chief Executive, Viv Evans, about the types
of impact it can have on people
• This practice and lived experience has been supported by an
increasing amount of research evidence.

8. Impact: research evidence
• Copello et al.’s (2000) research shows that the health and wellbeing of
family members living in a household with someone with substance
problems can be negatively affected.
• This stress has been found to heighten risk of mental and physical
health problems and also worsen pre-existing health problems.
• In the following film clips, Professor Alex Copello talks about the impact
of problematic substance use on family members and the stress that
families experience.
• Orford et al. (2005) found evidence of family members being exposed to
“multiple and often chronic stressors” resulting from the problematic use
of close relatives.
• Barnard (2005) identified feelings of loss, sadness and anger within the
family. It led to tensions between parents and other children in the family
as well as between parents.

9. Factors affecting impact?
• A number of factors can affect the type of impact, and extent of the
impact, a person’s substance use can have on other family
members.
• As a reflective practitioner it is helpful to ask yourself
the following questions to consider what the impact
might be:
– Is the family member responsible for the wellbeing
of the person with the substance problem,
for example, due to the person’s age or a disability?
– Does the family member live in the same household/ family
home?
– If so, is the family member in a position to walk away or leave the
relationship or situation to get some respite or space?
– If not, how is this lack of respite going to impact on the person’s
experience?

10. Factors affecting impact? (cont.)
• Other questions to consider in determining impact on family
members include:
– Has the individual’s problematic substance use resulted in
problems at school, work or in the community for other members
of the family?
• If so, in what way?
– Are finances or other practical responsibilities shared?
• If so, are there debts, for example,
adding to stress levels?
– Has the family member’s health and well being suffered as a
result of their loved one’s problematic substance use?
• If so, what support or treatment are they receiving?

11. Factors affecting impact? (cont.)
• Does time spent trying to help the person with the problem detract
from time spent with other members of the family?
– What type of additional stress and strain does this put on other
family relationships and communication?
• What other support does the family member have to
draw on?
– Are there family and friends outside the
household the family can go to or talk to or
are they dealing with this on their own?
• Is their loved one’s problematic substance use leading to, or
exacerbating, other problems they may have?
– How is their physical, emotional and mental health?

12. Factors affecting impact? (cont.)
Co-use of substances
• Some partners or family members may be using a substance with
the person identified as having problems relating to their use.
• This could be as a result of coercion, as a coping mechanism for
the stress of living with someone with problematic substance use,
or because they also choose to use substances....or all of the
above.
• Consideration needs to be given to whether the family member
needs specialist substance use services in their own right, as well
as support as someone who is affected by the problematic use of
their loved one.
• They may not even realise that using substances when their family
member is around is unhelpful – even if their own use is non-
problematic.

13. Factors affecting impact? (cont.)
Domestic abuse and child-to-parent abuse
• Conflict and arguments are often a feature among families where a
person has a substance problem.
• This is not the same as domestic or child-to-parent abuse which is
frightening and controlling.
• However, domestic abuse, from child to parent/ grandparent, from
sibling to sibling, or between partners is also common among
people with substance problems.
• This can add to the negative impact on the family members’ health
and well-being, particularly their psychological and emotional well-
being.
• Use the following link to take you to the resource focussing on
Domestic Violence and Substance Use.

14. References
Barnard, M. (2005) Drugs in the family. The impact on parents and siblings. Final report.
York: Joseph Rowntree Foundation
Copello, A., Templeton, L., Krishnan, M., Orford, J. and Velleman, R. (2000) A treatment
package to improve primary care services for relatives of people with alcohol and drug
problems. Addiction Research, 8, 471-484.
Copello, A., Orford, J., Velleman, R., Templeton, L., & Krishnan, M. (2000). ‘Methods for
reducing alcohol and drug related family harm in non-specialist settings.’ Journal of
Mental Health, 9, 329–343
Orford, J., Natera, G., Copello, A., Atkinson, C., Mora, J., Velleman, R., et al. (2005).
Coping with alcohol and drug problems: The experiences of family members in three
contrasting cultures. London: Brunner-Routledge.