« Previous | Contents | Next »
Listen
Effective Interventions Unit Supporting families and carers of drug users: A review
Appendix 3 EIU Literature Review - Support for the Families of Drug Users
This review was conducted by The Centre for Research on Families and Relationships at the University of Edinburgh. The full report is available as an EIU research report and is also available by visiting the EIU website. www.isdscotland.org/goodpractice/effectiveunit.htm
Executive Summary
It is now increasingly recognised that drug abuse affects the whole family and wider kin. There is a growing concern about the needs of families affected by drug use and the best ways of meeting those needs.
A literature search and review was conducted using standard bibliographic search procedures in order to:
- establish what is known about the support needs of families of drug users
- establish what is known about effective ways of addressing those needs
- examine whether, and how, family support groups and services link with other services
- examine whether involving families within the treatment or service offered to the drug user has beneficial effects upon the family and the drug user
Studies were typified as focussing on needs or experiences of families of drug users; descriptive studies outlining particular interventions or services; evaluative studies that assessed the impact of interventions or services; policy/professional guidance literature aimed at improving professional practice; and grey literature. Although 104 articles were found and reviewed, there was little literature that directly related to the needs of families of drug users or how those needs might best be met.
Effects of drug use on family members include: depression; adjustment and behavioural disorder; deterioration in family relationships; increased likelihood of domestic violence; criminal behaviour; isolation; withdrawal; stigma; and concealment. Although some of these effects are reported in research on alcohol abuse, it is important to recognise the diversity of substance abuse and its effects, and explore differences between different substances.
'The family' is often treated as a single unit, although some studies have shown that different family members have different experiences and perceptions depending on their relationship to the drug user. A concern for the child is prominent, and the emotional and behavioural effects of parental drug use are documented. Some children play a caring role in their families. Other research focuses on parenting, although this is almost exclusively on mothers, whether or not they are drug users themselves. Isolation may be a barrier to seeking support and the families of drug users, especially grandparents, are a hidden population.
Coping styles have been identified, such as toleration, engagement and withdrawal. These may relate to different family members and change over time. Coping styles may influence support sought or the nature of the service provided. Most interventions aim to change family dynamics, but there is little reflection in the studies reviewed about what family characteristics or types are important.
A range of supports are described in different studies, although these are seldom generalisable. Although some research identified significant improvement in a person's substance abuse problem and in other measures relating to the family, most improvement was small, and sometimes there was none at all. However, support for parenting seemed to be rated highly by service users, and wraparound services similarly had some positive outcomes. Many services described support for family caregivers, though these were most commonly aimed at mothers or partners. Group or individual interventions may have beneficial effects in different areas of a caregiver's life.
There is almost a complete absence of documentation and research into family support groups. What there is suggests they are effectively in addressing some family issues. Their family focus balances out the priorities of intensive interventions, which tend to prioritise the needs of the user rather than the family. The support needs of grandparents are little documented, although there may often continue to be a parenting role for both their children and grandchildren.
The involvement of family members in treatment programmes has been shown to improve their effectiveness as regards positive outcomes for the substance abuser. There is less research on possible improvement in families themselves. Interventions where the primary focus was on support of the families per se were less common. This reflects the service based focus of many of the studies; it is possible that interventions which develop from family support groups may be oriented more around the family as a whole and less around the behaviour of the drug users, but they are not reported in the literature. Evaluations of unilateral interventions are rare, although such interventions do not directly involve the drug user.
This review of the literature on support for families of drug users suggests that although there is a wide diversity of articles, these are most often descriptive pieces about service provision and development; most of the evaluation studies reviewed fall short of the established methodological criteria for establishing rigour. There was seldom a direct link between assessment of need and service provision, although that may have taken place at an informal level as part of service delivery.
- In terms of establishing what is known about the support needs of families of drug users, the review suggests that the diverse needs of all family members are not well documented, especially those of wide kin such as grandparents but also of siblings.
- In trying to establish what is known about effective ways of addressing those needs, this review suggests that the match between service provision and need it not always explicitly derived from a needs assessment that prioritises users' own views.
- The review could shed only limited light on whether or how family support groups and services link with other services, as few articles reported on the work of family support groups, neither did they take a holistic view of the range of services an individual or family may be accessing.
- In terms of whether involving families within the treatment or service offered to the drug user has beneficial effects upon the family and the drug user, the review suggests some beneficial effects upon the drug user and to a more limited extent upon the family.
« Previous | Contents | Next »