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Effective Interventions Unit Supporting families and carers of drug users: A review

CHAPTER 1: INTRODUCTION

In recent years, there has been increasing recognition of the impact that an individual's drug use can have on other family members, including extended family and friends. Evidence suggests there is a significant impact on physical and mental health, financial circumstances and family relationships.

A major contributor to this wider recognition of the difficulties faced by families and carers has been the growth of family support groups. A number of these groups have also become active in developing other areas of service provision in their wider communities. They may take on a lobbying role as in Glasgow and Edinburgh where they campaigned for the development of drug treatment services in the early 1980's. Today, family support groups are increasingly playing a key role in support for families, carers and friends of drug users and provide a range of support, such as complementary therapies, provision of information and training.

Family support groups, however, although very important, are only one method of supporting families. There has been growing interest from family members, Drug Action Teams (DATs), Social Work, drug agencies and others in expanding the support available to families. To date, however, progress has been limited, in part due to the lack of research evidence about effective approaches. There are also limited resources currently available to assist those seeking to develop ways of supporting families.

The background and context

The Ministerial Drugs Task Force report "Meeting the Challenge"(1994) recognised the impact of drug use upon families. It stated that drug misuse can have a 'devastating effect on the families and friends of the individual, leading to the break-up of relationships and the breakdown of family life'. It recommended that carers and family members should be represented upon local Drug Forums in order to ascertain, co-ordinate and express the views of this group so that they could be incorporated into developments within the DAT Action Plans.

More recently, Tackling Drugs in Scotland - Action in Partnership (Scottish Office 1999) stated that DATs should work more closely with local communities, including building better connections with Social Inclusion Partnerships and Community Safety Partnerships, to further strengthen the participation of communities in informing the work of the DATs. A key objective was to enhance the support for families coping with a relative's drug use.

Discussion at the national Drug Conference on Communities and Drugs (Scottish Executive 2001) reiterated the need for further developments at both DAT and national level in community engagement and support for families. A survey of community groups carried out by the Scottish Drug Forum on behalf of the Effective Interventions Unit had highlighted the 'piecemeal' fashion of engagement and the lack of uniformity in what was defined as community engagement and involvement. This lack of engagement means that responses to supporting families have been limited to date.

A further development in recognising the needs of families and children was the publication of Getting our Priorities Right (Scottish Executive 2001). The document acknowledges the significant role that family carers play in relation to caring for the children of drug users and makes several recommendations in support of their needs.

In the last 12 months, however, there has been increasing activity designed to improve and enhance the support available to families and carers. One interesting development is the creation of local coalitions. In Argyll and Clyde, family support groups have come together with the aim of extending support to families by setting up a helpline. The support groups involved will share the organisation and the workload of running the service.

Another development is the appointment of family support workers who may help the formation of family support groups, provide direct support to family members and develop links with other agencies to widen access to other methods of support. These posts may be managed by agencies such as carers' organisations or drug agencies.

A national Family Support Conference took place in May 2002, jointly run by family support group members from throughout Scotland, Argyll and Clyde Alcohol and Drug Action Team, The Scottish Executive, the Scottish Drugs Forum and the DAT Association. This marked a major step forward in identifying the issues that affect the families and carers of drug users, and also raised the profile and importance of family support. Key issues to emerge were:

• the need for increased recognition by Drug Action Teams, drug agencies, Social Work, Health and other service providers of the importance of supporting families
• the need for two way communication between local communities and DATs and their partner agencies
• the benefits of sharing experience between local support groups
• the enthusiasm for more networking and liaison at a national level.

In October 2002, the First Minister announced that 180,000 would be made available from recovered criminal assets to help with the implementation of the key recommendations from the conference. These are: the establishment of a national network of family support groups; training in counselling skills; helping families to cope with relatives coming out of treatment and rehabilitation. It will also help to support grandparents and other family members who are caring for the children of drug using parents.

Aim of report

The aim of this report is to provide a body of evidence and information that can underpin and support the design and delivery of support to families and carers whether that takes place through the statutory sectors, voluntary agencies and organisations, or from within the community.

From our review of the evidence, the report sets out for DATs and service commissioners, managers and practitioners in the statutory and voluntary sectors, and in the community:

• the impact of drug use on families and carers and the nature and extent of their needs
• the role and purpose of different approaches to family support, including models of family support groups
• examples of practice
• sources of support and funding

How we gathered the evidence

The development of family support at all levels has been variable across Scotland. This may be due to a lack of knowledge about the way in which families are affected by the drug use of a family member and a lack of evidence about effective ways to support them.

We undertook a number of exercises to draw together this work on family support:

1. Reference Group

A Reference Group was established to draw on expertise from health, social care and the voluntary sector to support the EIU in the development of the family support work. This Group met on three occasions during the course of the work. Membership of the Reference Group is set out in Appendix 1 . The EIU are very grateful for their support and contributions.

2. EIU Literature Review

The EIU commissioned a review of the relevant research and policy literature (Bancroft et al., 2002). The review had four key objectives: to establish:

• what is known about the support needs of families of drug users
• what is known about the effectiveness of interventions designed to address those needs
• what is known about family support groups, the difficulties they face and how they become effective sustainable groups
• whether involving families in treatment programmes has beneficial outcomes for the family member and/or the drug user.

This review was conducted by The Centre for Research on Families and Relationships at the University of Edinburgh. Standard bibliographic search techniques were used, including both medical and social science databases. A wider internet search using a search engine was conducted in order to identify projects and literatures not indexed elsewhere. 'Grey' literature (unpublished work and items located through the World Wide Web) was obtained wherever possible, for example, directly from agencies themselves.

3. EIU Qualitative Study

The EIU commissioned a qualitative study aimed at eliciting the views and experiences of families affected by a relative's drug use. The study also sought the views of agencies and service providers involved in the treatment of drug use, those offering support to family members and service commissioners. The intention was to identify the varying needs of family members and what methods were most effective in supporting these needs. A total of 17 focus groups and 71 interviews were conducted in Glasgow, Dumfries and Galloway, Grampian, Lanarkshire and Tayside to investigate any demographic differences. The study was carried out by Marion Fisher Associates. Copies of the report are available from EIU on request.

4. EIU Mapping Exercise

The EIU conducted a mapping exercise to identify and review existing models of support across Scotland. This involved family support groups, the voluntary sector, drug services and social work services. This component involved a questionnaire survey of agencies and groups to establish what services they offered and highlight issues of importance to them. A total of 262 questionnaires were sent out and 122 returned. We acknowledge that this mapping is not comprehensive but we believe it represents a reasonable picture of the support for families and carers across Scotland.

5. EIU Conference survey

The EIU conducted a conference survey with family support group members attending the national Family Support Conference 2002 to elicit the experiences of individual family members in coping with drug use, seeking support and what support would be most beneficial to them. A total of 51 questionnaires were completed (over three quarters of those attending). The results of this survey also appear in the Conference Report.

6. EIU Interviews

The EIU also conducted a series of interviews with families and service providers to identify key themes and issues to be addressed in the report; and to provide examples of current provision.

Structure of report

Chapter 2 discusses the concept and aims of family support. It also identifies a number of benefits from offering support to families and carers.

Chapters 3 and 4 draw on the evidence to describe the impact of drug use on the family and the range of needs that arise among family members and carers.

Chapter 5 examines and discusses the variety of methods of supporting families coping with a relative's drug use.

Chapter 6 describes the range of support that is potentially available to families and carers. The Chapter also examines and discusses the factors that influence effective support by agencies and service providers.

Chapter 7 discusses the concept of a family support group and provides examples of practice. It also discusses some of the difficulties and challenges.

Chapter 8 identifies core principles to underpin effective support for families and carers and sets out key issues to address for DATs and partner agencies, agencies and service providers and family support groups.

Chapter 9 gives information about resources available at national and local level.

Appendices are listed at the back of the report. These contain membership of the EIU Reference Group, DAT contact list and summaries of the literature review, the qualitative study, the conference survey and the mapping exercise.

Throughout the report there are summary boxes showing key findings from the evidence and highlighting the main points of different methods and approaches.

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