The Scottish Government

« Previous | Contents | Next »

Listen

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

CHAPTER 7: FAMILY SUPPORT GROUPS

This Chapter discusses the concept of a family support group and examines why people become part of these groups. It also looks at the potential benefits of family support group membership and the difficulties that groups and individuals face. This chapter also provides some examples of family support groups and points the reader to further resources. We have used evidence from the EIU literature review, the EIU mapping exercise, the EIU Reference Group and from the Family Support Scotland Conference 2002

1. What is a family support group?

A support group can be described as a group made up of individual members who have an issue or difficulty to cope with in their life that is common to other members. Support groups exist for a wide range of reasons including dealing with health issues such as HIV/Aids, mental health problems and addiction.

In relation to drug use, family support groups are made up of family members who are affected by a relative's drug use. When first attending a family support group, often the family member is feeling isolated, confused over what to do, and to a degree, to blame for their family circumstances and difficulties. The support group can provide a safe environment to explore issues that are a concern to the individual members. The fear of being judged may have held them back from seeking support elsewhere, but it may feel safe with people who know and face similar situations.

The support group helps members to make sense of their situation and allows them the opportunity to examine and recognise how they cope with the drug use, and the consequences of the methods they employ to cope. This can allow the family members to view themselves more positively and reduce feelings of responsibility for the difficulties they face.

The aim of family support groups is to collectively support each member through difficulties they may be facing within a group setting.

2. Benefits of attending a support group

The EIU interviews emphasised that support and information provided by others facing similar circumstances was key to the ethos of family support groups. The support given can assist family members in various ways to cope with their personal circumstances:

• to improve understanding of drug use and its effects upon individuals
• to achieve a positive impact on their physical and emotional health by reducing stress and assisting them to cope in less damaging ways
• to reduce the isolation and loneliness being experienced by the member. It can also reduce the sense of responsibility felt by helping the family member to put ownership of the drug problem with the drug user

Overall, attending a family support group can have an impact how the family member views, copes and responds to the issues affecting their lives. This will often lead to improved stability in the family but it is also useful to recognise that changes in views, attitudes and methods of coping can also lead to destabilisation in the family unit, especially at the initial stages of such changes.

From the evidence that we have gathered, we have identified the following benefits.

• Members become part of a collective voice. This can give members increased confidence and make it considerably easier to challenge and ask questions of others, such as Drug Action Teams.
• The group is non-judgemental. Everyone else within the group faces similar circumstances and difficulties. This means that they are less likely to judge or show shock at others' circumstances. This creates a safe environment for members to disclose their problems.
• Members become more informed about drugs and less likely to be manipulated. By being more informed, the family gains a wider understanding of drug use, behaviour, and dependency. They are then less likely to react or cope in ways that may be inappropriate and unhelpful either to themselves, other family members, or the drug user. Addiction of any sort is often accompanied by manipulative behaviour aimed at maintaining the addiction. Becoming more informed reduces the chances for the family to be manipulated in such a way.
• Reduces likelihood of member becoming dependent on the support from a one-one relationship. The fact that everyone within the group should be able to support each other is helpful in building up an individual member's network of support. It can also reduce the possibility of a member becoming overly reliant or dependent on any one person giving support. This is seen as a key benefit of group support in preference to one-one support (EIU literature review).
• Reduces stress experienced by the family member. The sharing of information and experience can reduce the anxiety of members and the isolation they feel. By hearing of others' experiences and gaining reassurance through obtaining accurate information, family members are more informed and able to realistically assess their concerns (EIU literature review)
• Builds confidence for coping. Being able to discuss their circumstances enables members to look at how they cope, think about the advantages and disadvantages associated and adapt their coping strategies.
• Empowers the family member. By acquiring new knowledge, skills and growth in self confidence gained from attending the group, the family member can increase their capacity to manage internal and external issues affecting their lives (EIU literature review).
• Development of skills. Members can develop skills associated with giving support and listening. They can also develop organisational skills related to the running and management of the group.
• Improved communication with other family members Discussion of their circumstances and gaining knowledge within the group can help family members to improve communication and discuss issues within the family (EIU literature review).

The EIU literature review also found that attending a support group could provide benefit where family, friends and professionals could not.

It is important to note, however, that providing support can have both a positive and a negative impact for the member. Support given with the best of intentions can sometimes make the member feel worse, more personally isolated and anxious. Negative elements that can come from attending a support group include:

• possibility of raised anxiety and despair amongst members from listening to others' experiences.
• fear of not being anonymous.
• feeling that you are not being listened to or that your opinion or experience is being dismissed by other members.

Although the aim of a group is to support, this can require a high level of sensitivity and consideration for the members.

3.Different types of support

Support can take different forms and some members may be better at giving and receiving certain types of support than others. Someone who is uncomfortable with expressing emotion may be more comfortable receiving information and support in a problem solving context, rather than through emotional support. Similarly, the type of support they need will differ from the needs of other members. This suggests that support should be flexible.

The support offered by family support groups can take a variety of different forms:

• Emotional support
• Information support
• Social support
• Problem solving
• Advocac
• Practical support

(Lockley 1995)

Fundamental to the functioning of a group is the concept that support is a two way process. Members may receive support but they should also be active in giving support to others within the group. If this fails to happen, then some members may feel aggrieved and exploited by other members, in that they are consistently giving support to other group members whilst their own support needs are unrecognised and unmet.

4. Different types of support groups

Groups can be structured and operate in a number of ways. The objectives within family support groups can also differ. Groups may exist primarily to support family members, whereas others may focus more on lobbying and campaigning, particularly for the development of services for drug users. This can have the advantage of making members feel as though they are making a difference to others.

Groups can be open to new members attending or may operate a closed group that runs for a specific period of time and where potential members are assessed before accessing the group. Some groups will operate under a definite structure and programme whereas others will operate under a much looser format.

It may also occasionally be necessary to look at establishing different types of groups in order to meet the specific needs of family members. As noted above, members may potentially have different issues with regards to their relative's drug use: i.e. a mother whose 14 year old son is occasionally using cannabis may experience heightened anxiety attending a group where a mother is relating her child almost overdosing on heroin. Likewise a father may find it difficult feeling at ease in a room full of women. Other areas where it may be appropriate to establish specific groups could include 'bereavement', 'young people and siblings', and 'HIV'. (see Chapter 4: The needs of families and carers)

Running of groups

There are 2 main approaches to running groups: self-help groups and facilitator-led groups. ADFAM (2000) identify the relative advantages and disadvantages of self-help and facilitator led groups. There are valuable points to note for those involved in support groups.

Self-help groups are run solely by the members:

Advantages

• Empowering
• Members can develop new skills and abilities
• No 'professional' involvement
• Autonomy / owned by group

Disadvantages

• Negative experiences may depress member and heighten anxieties
• Responsibility for group can lie with a few key members

EXAMPLE:

Facilitator led groups are led by a facilitator who assists in supporting members and ensuring everyone has opportunity to express themselves.

Advantages

• Can ensure no-one dominates the group
• Can motivate the group through difficult periods
• Someone to take responsibilty for the running of the group
• Facilitator can maintain a more detached position, enabling the group to work in a more constructive way
• facilitator can keep a balance between sharing difficulties and dwelling on them too much
• can reduce the organised workload for group members
• can enable members to discover strengths and to identify and meet their own needs

Disadvantages

• Poor facilitation skills can deskill and disempower members and groups
• May raise concerns about around confidentiality
• The facilitator can be seen as remote and not having the same understanding if not also living with drug use

5. What other services do family support groups in Scotland offer?

Many support groups offer a considerably wider range of support than that of group meetings. The support groups that participated within the EIU mapping exercise showed that they offered a considerable range of services, or have access to such forms of support through relationships with other agencies.

This highlights the diversity of family support groups within Scotland and demonstrates their determination to find the most beneficial support for others facing similar circumstances as themselves. The mapping, however, did not investigate what structure and operation was behind such services, or what difficulties groups faced through operating them.

Advantages of support groups providing other services are that members can acquire new skills and confidence in either delivering the service or through obtaining the resources to establish it. It then also provides a greater diversity of support for members, and potential members, to access.

6. Difficulties faced by groups

Family support groups can face difficulties in providing support and in the running of the group. Those that receive little by way of support from workers, agencies or other groups can be left isolated to try and find solutions to some of the difficulties that can be common when running a group.

Evidence gathered from the EIU mapping exercise, consultations and the Family Support Scotland Conference indicated that the main problems groups faced include:

Who supports the supporter?

The establishment of groups is often down to the determination of a family member/s to establish a group in their community. This can create difficulty particularly if ownership for the successful operation of the group lies with a few members. These members often have their own difficulties and support needs and this can result in their personal stress being worsened through the stress of keeping the group intact. It can also be the case that such people can give more support than they receive from the group by the nature of the role they play within the group.

Attracting new members

Many groups stated that they experienced difficulties in attracting family members to the group. Groups highlighted that a lack of confidence and understanding of what a support group could offer could inhibit people from attending the group. Joining a group can be an intimidating experience. New members have to meet a roomful of new people and also discuss personal and difficult issues they face.

Other factors to be considered are:

• transport issues,
• lack of child care,
• being visible as a family with problems (this is especially the case within rural areas)

Over half of support groups (59%) who participated in the EIU mapping exercise contain 1-10 members. It should be noted that within the nature of support groups it can be beneficial that numbers of members are not overly high as this can reduce the opportunity for members to participate fully.

Stigma

Many groups involved in the EIU qualitative study and interviews described how the stigma attached to drug use was a major factor that meant families were unwilling to come forward for support and share their experiences. Kenny (2000) found that 'there is enormous stigma attached to being the parent of a drug user or being a member of a family in which there is a drug user. Groups also state that there can be a backlash from the community and officials to the setting up of a group in their area. This again can relate to stigma, prejudice and ignorance from others.

Resources and funding

The running of support groups requires a certain amount of funding for costs such as accommodation, phone costs, publicity and stationery. Groups highlighted that accessing sources of funding was a difficulty. The result can be that group members who may be experiencing financial hardship in relation to their family difficulties are also financially out of pocket for activities related to operating the group. Obtaining funding was often a further stress for those whose responsibility it was and groups regularly cited receiving little assistance from 'professionals'.

Receiving funding can also bring about issues for the group in that it may affect the autonomy of the group and their degree of self control. Throughout the EIU qualitative study some groups highlighted difficulties they had experienced since receiving funding. These included difficulty in accessing funds when they were managed by outside agencies and groups feeling as though they did not have enough control over the purpose and use of funding.

The short term nature of funding can restrict a support group from developing long term objectives, cause insecurity about the future of the group and affect the motivation of members in supporting each other.

Accommodation

Finding premises to conduct meetings is a problem for many family support groups. Having appropriate accommodation is seen as essential in the success of the group. Venues such as schools, drug agencies and social work premises may be seen as a threat to families not wishing to come into contact with services, regardless of whether these organisations have direct involvement with the support group or not.

Confidentiality and anonymity

People may fear coming to family support groups because they are worried that they are exposing their situations and are uncertain whether it is safe to do so. They may have concerns that what they say may be repeated elsewhere. At its worst, this can carry significant risks. In discussing such topics as the dealing of drugs personal safety can be compromised if information is given to others. Any breach of confidentiality can result in the member not being able to trust the group and reduce their capacity to share their experiences and feelings in safety. This issue is of particular importance within rural areas where there is an increased likelihood that potential members may know others in the group.

Group dynamics

Groups can face numerous difficulties. They may contain personalities who either dominate proceedings or exclude others. They can also become 'stale' in that one meeting can become very like the next one and members become disillusioned. Personalities may clash and it can become difficult to provide or take support in such an environment. Such difficulties can be hard to resolve and require sensitive handling.

Keeping direction

Maintaining motivation of members can be difficult when coping with a relative's drug dependency or addiction. The despondency felt by members can mean the content of meetings, by the very reason for their existence, can often be negative and despairing. Consequences of this can be that members decide not to attend and make it further difficult to maintain the motivation of the remaining members. All this can have a negative impact upon those sustaining the group.

Family support group meetings may tend to deal with the same issues repeatedly and members may question the usefulness of attending in such cases.

Recognition by others

Throughout the UK this is identified as a major grievance by support groups (Kenny, 2000). It is common for family support groups to feel isolated from other agencies and structures. Groups regularly say that they are not taken credibly by others or are seen as a nuisance. Often support groups can feel remote from the decision making and that their voice is not heard at strategic level. Therefore, the understanding of those making decisions (DATs) can be limited in relation to families and drug use, and their needs.

Of the family support groups involved within the EIU mapping exercise, over two thirds were involved with their local drugs forum, under a fifth were involved at DAT level. It is also the case that such involvement can be a negative experience, especially if there is no perceived benefit to the support group or family members. It can therefore, be difficult to achieve positive working relationships.

The EIU mapping showed that almost a fifth of groups stated they experienced difficulty in establishing positive relations with other agencies.

7. Who assists family support groups?

Although some family support groups identify that they have received little or no support in becoming established and in the running of them, other groups highlight a range of organisations that have assisted them. A wide range of agencies has a responsibility to ensure that groups are supported to access opportunities and in assisting them in dealing with difficulties. Such agencies include:

Drug Action Teams(DATs)/ Drug Forums - can assist in accessing funding and in keeping group informed within decision making. It also ensures that issues for families and communities are heard at strategy level. Most DATs have co-ordinators that can assist with information regarding the work they do and what assistance they can offer. (A list of DAT contacts is contained within Chapter 9 Resources)

Social Work departments - can provide assistance with accommodation, funding, access to resources such as facilitation and accurate information

Drugs Agencies - can provide help with accurate information and other Resources.

Community workers - can provide support in forming committees, constitutions, accessing funding, accommodation, publicity, training etc

Voluntary sector - can provide support in forming committees, constitutions, accessing funding, accommodation, publicity, training etc.

The Church - can provide accommodation, financial support and access to other resources.

Other family support groups - can provide knowledge of their experience in how their group operates and also moral support.

Social Inclusion Partnerships - can provide funding and access to other resources (only applies within SIP areas - see Chapter 9 Resources)

Politicians - can provide support and lobby for the issues affecting families to be addressed. Can also challenge attitudes and stigma at a high level.

National organisations

• Scotland Against Drugs - can assist with funding, development of groups and projects
• ADFAM - provides specific resources to establish and maintain family support groups, training for support groups and information resources
• PADA - provides accredited training for volunteer members in family support groups, help and advice on obtaining charitable status
• GAFSG - can provide assistance with becoming established, committees, constitutions etc. Also can provide peer support to maintain motivation and helpful hints.

(full details of services available from the above organisations are in Chapter 9)

The EIU mapping exercise asked family support groups what agencies etc had given them assistance, either in first becoming established or, in maintaining the support group:

8. Strengthening support to family support groups and their members

From the EIU interviews, conference survey and the qualitative study we identified a number of areas that support groups felt could strengthen the work they do:

Access to wider range of types of support

These include opportunities to share experience within group and one-one settings. Opportunities for self development including stress management, assertiveness skills and increased knowledge regarding drugs and treatments were also seen as being of benefit.

Agencies should seek to establish relationships with local support groups and develop links to offering support.

Easier access to information

Accessing information regarding support for families, drugs, support for drug users is a frequent concern for families and carers. Some support groups also state that they receive little communication from DATs and forums, which means that both families and support groups are isolated. All agencies should ensure that information on supporting families is easily available and in jargon free language. DATs should ensure that local support groups are kept informed about their work, what they can do to support local groups and develop a point of contact between the DAT and local support groups They should also attempt to involve groups and families through consultation and involvement.

Increased resources and financial support

Support groups often stated how a lack of financial support sometimes left family members who were coping with the financial hardship of living with drug use, also financially affected from assisting the group to function. Often this was associated with telephone and administrative costs. Groups often state that they seek support also in practical terms such as accessing premises, transport and childcare. Agencies should examine if they are in a position to offer support either in accessing funding or sharing resources.

Local coalitions

An interesting development towards strengthening family support groups has been in the development of 'coalitions' of locally based groups. There are significant benefits to be gained through groups coming together:

• It can reduce the isolation that groups can often experience, especially if they are unrecognised by other agencies.
• It can also strengthen the voice of family members and make it more difficult for their plight to be ignored by decision makers.
• Joint funding can be obtained to provide area wide service such as counselling
• Larger initiatives can be developed such as a helpline which is staffed by members from all groups, thereby sharing the workload and responsibility
• Training can be organised involving all groups rather than groups struggling to obtain training independently

The forming of a national network of family support groups

The Family Support Scotland Conference 2002 identified the development of a national association or network as a key issue to take forward. Such a body has the potential to act as a vehicle for sharing of good practice between groups, access to resources and training and raise the profile of support for families at a national level. It would also assist in ensuring the experiences and needs of families and carers are taken on board at a strategic and national level.

Development of training

Support groups could benefit in their practice from the development of a range of training opportunities. These include personal development skills as noted above. Other areas include listening skills, facilitation skills and engaging with decision making structures such as DATs. Support groups can also be also highly motivated in learning skills that they can then utilise in offering as support to others. A range of training provision is included in Chapter 9.

Monitoring and evaluation

As has been highlighted within the EIU literature review there has been very little research into the workings and benefits of family support groups. This has no doubt contributed to the difficulties that support groups can sometimes face, in that they have very limited resources with which they can utilise in addressing such difficulties. Groups could benefit significantly if there is clear aims and outcomes to the work they do. This can only be assessed for its success if there is a form of evaluation to see if the work of the group is achieving its aims. The EIU Evaluation Guides are available at: http://www.isdscotland.org/goodpractice/effectiveunit.htm

« Previous | Contents | Next »