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Effective Interventions Unit Supporting families and carers of drug users: A review
Appendix 4 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 and also of those who provide support. The study was conducted by Marion Fisher Associates. Copies of the study are available on request from EIU.
Executive summary
The aim of this study is to elicit the views, attitudes and experiences of families affected by drug use and the providers of family support, to identify the needs of family members and the most effective methods of support. The study addresses a number of key areas: issues for family members; issues for support agencies; issues for drug users. The research also looked at issues facing families affected by HIV/Hepatitis.
The geographical spread of the research was determined by the Scottish Executive and a wide range of consultees were contacted. A combination of focus groups and one to one interviews were conducted with the issue groups.
The response from families to the consultation process was high and resulted in 50% more focus groups being held than was intended.
Families tended to describe the impact of drug use in the family in terms of the internal and external impacts. Internal impacts include how families feel about themselves and the drug user. This included feelings of guilt and stigmatisation by the community. External impacts included the financial costs incurred both by the loss of property, often stolen by the drug user and costs for care and rehabilitation.
Support provided by family support groups was seen as very valuable and ranged from help with childcare to active prevention work. Some groups/family members were critical of the professional support which they received with reasons ranging from the attitudes of professionals to the lack of knowledge about drug users behaviour and the effect this has on families.
Whilst families were generally against closer integration of services for families and drug users some did feel that joint work on relationship building and anger management would help them deal more effectively with the problems.
The knowledge of families and family members about the services available to support them seemed to be at odds with the views of professionals about what is available.
Interviews with individual family members raised many similar issues to those highlighted by family support groups. However the feeling of isolation seemed to be more acute than for those supported by other affected families. Some of these issues were brought more sharply into focus by families looking after the children of their drug using family members. Many grandparents said that there was no available support but this has to be balanced against the fact that many said they did not have enough knowledge about where to go for support. Financial costs were also highlighted in relation to the drug user and to looking after their grandchildren. They also pointed out that other family members feel rejected and that all the family's emotional and financial resources are directed towards the drug user.
For families affected by HIV/Hepatitis the impact on families is understandably focussed around specific health and attitudinal issues together with significant emotional distress and anxiety about loss and bereavement. Isolation and loss of social contacts and friend also features highly for those affected by Hepatitis and HIV. Specialist support services were well thought of but it must be acknowledged that there are not many of these around and that the groups consulted do have access to what is available.
A clearer understanding of the disease and the treatments available would be beneficial. Also training in stress management and counselling including bereavement counselling would be beneficial. Some families also felt that they would benefit from help on how to support others within the family. All felt that joint work would be beneficial to families and the affected person. Agencies supporting families including medical services were broadly in agreement with the views of families.
There are specific issues around access to services for Ethnic minority families which include the thin spread of specialist services, and language and cultural issues.
The difficulties expressed by Family Support Development Workers in working with families are family support services are often poorly funded or funded on a short term basis. The funding available often does not allow for all the needs which families present with and premises are often not appropriate for the needs presented e.g. often no crèche facilities. They felt that there is a wide range of practical, emotional and professional support available to all family members. Existing service providers are overstretched and young carers may be an under served group.
Service providers felt that there was a significant range of services available to families. As previously stated, this is at odds with the views of families. Many service providers felt the advantage of working with families is that it allows them to develop a clearer, more objective understanding of what is happening to them, including a better understanding of the nature and manifestations of drug using behaviour. This can be essential when difficult decisions have to be made about the service offered to the drug user. By so doing this can help to bring a consistent approach to working with the drug user.
Social Workers highlighted that a major barrier in engagement with families was their statutory role within child care and the suspicion that caused. Other difficulties were reported - sexual abuse, stealing, with second generation drug users.
In looking at improvement of service to families, G.P.s felt that training of professional staff, plus a team approach would help. They also felt that a Family Needs Assessment should be commissioned.
Drug users are clear that their use has significant impacts on their relationships with their parents, their siblings and their own children. Some drug users were able to articulate that their drug use created inconsistent responses in relation to their children - sometimes spoiling them and at other times neglecting them. Generally the attitudes of many professional to the drug user and to their children were seen as a barrier to securing support.
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