Transcript Supporting families whose lives are affected by alcohol or drug

Supporting families whose lives are
affected by alcohol or drug problems:
Goa Psychiatric Society meeting
Panjim, Goa, Thursday, 21st June 2012
Professor Richard Velleman
Emeritus Professor of Mental Health Research,
University of Bath / Avon & Wiltshire Mental Health
Partnership NHS Trust, UK
Supporting families whose lives are affected by alcohol or drug problems
I want to ask 5 questions this evening:
• What is known about the effects on
families;
• What are the specific needs that children
in these families have (and is there
evidence of inter-generational transfer of
poor outcomes, including substance
misuse?);
• What can we do to help families;
Supporting families whose lives are affected by alcohol or drug problems
• What can we do specifically to help
children (and how might we break the
inter-generational links); and
• How effective are interventions for
children and which seek to break these
links?
Supporting families whose lives are affected by alcohol or drug problems
Acknowledgments:
In Bath, Lorna Templeton (15 years);
In Birmingham (and Exeter before that), Jim
Orford (35 years), Alex Copello (21 years);
Internationally, In Mexico, Institute of Psychiatry,
Mexico City, Guillermina Natera, Jasmin Mora,
Marcela Tiburcio;
In Australia, Darwin, Northern Territory, Ian
Crundall, Carol Atkinson;
In Italy, Caterina Arcidiacono.
Supporting families whose lives are affected by alcohol or drug problems
1. What is known about the effects on families?
Lots of families have lives which are very
negatively affected by substance misuse, all
across the world – we have studied this in the
UK, in Mexico, in Australia in the aboriginal
outback, in Italy, but others have looked at this
also, and the conclusion is the same:
Family members (especially spouses and parents
and even more so, children) are often very badly
affected by having someone with a serious drug
or alcohol problem living in their midst.
Supporting families whose lives are affected by alcohol or drug problems
There is a solid evidence base for this claim: I list
at the end of this talk many references which
people can follow up if they want to.
In addition, there is a solid evidence base for the
impact of substance misuse on children, both as
children and when adults. There are a very
large number of studies that demonstrate
negative effects on children whilst they are still
young and in early adolescence (again, reviewed
a number of times, see the references at the end).
Supporting families whose lives are affected by alcohol or drug problems
All this work has led to the following conclusions:
Individuals who develop a serious problem with
their use of alcohol or drugs can and often do
behave in ways that have a significantly negative
impact on family life in general, and on other
individual members of the family.
The substance misuse can impact negatively on a
range of family systems and processes, including
family rituals, roles within the family, family
routines, communication structures and systems,
family social life, and family finances.
Supporting families whose lives are affected by alcohol or drug problems
The substance misuse can also often impact
negatively on other individuals within the family,
as well as on family systems: problems such as
• domestic and other types of violence,
• child abuse,
• individuals driving whilst intoxicated,
• or disappearing for days on end,
• or embarrassing family members,
• or spending all the money so that there is
nothing left for the family
are all typical of the types of behaviour which
people have described as stressful and with
which they have to cope.
Supporting families whose lives are affected by alcohol or drug problems
The results of these and other uncertainties are
that family members commonly develop
problems in their own right, often manifested in
high levels of physical and psychological
symptoms.
Supporting families whose lives are affected by alcohol or drug problems
2. What are the specific needs that children in these
families have (and is there evidence of intergenerational transfer of poor outcomes,
including substance misuse?)
These things are often worse for the children.
Many of these children experience negative
childhoods, including
• violence, abuse and living with fear;
• inconsistency from one or both parents;
(more)
Supporting families whose lives are affected by alcohol or drug problems
• having to adopt responsible or parenting roles at
an early age
• having to deal with denial, distortion and
secrecy;
• having problems related to attachment,
separation and loss;
• disturbed family functioning, conflict and
breakdown;
• role reversal and role confusion, both related to
their parents, and themselves.
Supporting families whose lives are affected by alcohol or drug problems
Many of these children subsequently demonstrate
negative effects of these experiences.
These problems include
• higher levels of behavioural disturbance,
• anti-social behaviour (conduct disorder),
• emotional difficulties,
• school problems,
• ‘precocious maturity’,
• and a more difficult transition from childhood
through adolescence,
than children who have not had this upbringing.
Supporting families whose lives are affected by alcohol or drug problems
Other work has also shown that children affected
by parental substance misuse
are more likely to reach the attention of social
services than are children affected by other
issues, and when they do so, and
are more likely to experience problems in the
interaction between their parents and social
services than occurs with other types of problem.
Supporting families whose lives are affected by alcohol or drug problems
There are longer-term impacts on these children:
• more likely to themselves develop problems with
substances,
• often linked to earlier onset of use,
• and therefore at greater risk of developing
problems in other areas of life as adults.
Family factors predominate: family dysfunction
and disharmony in their family of origin seems
most responsible for problems for these children,
both when they are children, and later as adults,
as opposed to problems caused by the drinking
itself.
Supporting families whose lives are affected by alcohol or drug problems
HOWEVER, there is growing evidence that not all
children are adversely affected, either as
children or adults; some children are resilient
and do not develop significant problems.
This has important implications for prevention and
intervention, and I shall return to this later.
SO - family members suffer lots of stresses as a
result of living in this environment, which may
impact on physical and mental well-being and
lead to the development of problems both for
themselves and other family members.
Supporting families whose lives are affected by alcohol or drug problems
This is a world-wide phenomenon: we have found
remarkably similar sets of experiences and
effects across the world.
And these family members need help, both for
themselves, and in relation to dealing with their
substance misusing relation.
And they ask for this help! Between a third and a
half of calls to alcohol advice centres in the UK
come from partners, families and friends.
Supporting families whose lives are affected by alcohol or drug problems
3. What can we do to help families?
There are three sorts of things that can be done to
help families. We can
• work with family members to promote the entry
and engagement of misusers into treatment,
• develop joint involvement of family members
and misusing relatives in the treatment of the
misuser;
• respond to the needs of the family members in
their own right.
All three have been tried, and all three work!
Supporting families whose lives are affected by alcohol or drug problems
Working with family members to promote the
engagement of substance misusers into treatment
• John Donne declared many years ago that ‘No
man is an Island’ and this is true! People
develop problems and maintain them within a
social context, and the family is part of this social
context.
• So, not surprisingly, involving the family
member means that it is more likely that alcohol
or drug misusers will then engage in treatment.
Basically, the family member can influence the
person with the alcohol or drug problem by
helping them to decide to seek or accept help for
the problem.
Supporting families whose lives are affected by alcohol or drug problems
Lots of people have developed ways of doing this,
and many of them have been well researched
(and see my reviews on this, in the reference list). For
example, Barber and Crisp (1995) developed the
‘pressures to change’ approach, which starts by
engaging the family member: work with them is
focused on
• education;
• discussion of their responses to drinking
situations;
• setting up activities incompatible with drinking;
and
Supporting families whose lives are affected by alcohol or drug problems
• and preparing the family member to confront
the person with the drink problem and request
that he/she approaches services to seek help.
In essence the approach aims to create change in
the behaviour of those concerned in order to
achieve treatment entry for the person with the
drink problem.
Supporting families whose lives are affected by alcohol or drug problems
Another example is the CRAFT approach
(Community
Reinforcement
and
Family
Training), developed by Bob Mayer and Bill
Miller.
This also aims to
• work with ‘concerned significant others’
(CSO’s), helping them to reinforce nonsubstance misusing behaviour through a positive
reinforcement process,
• and involves the restructuring of social, family
and vocational aspects of everyday living of those
with substance use problems, so that abstinence
from drugs or alcohol is selectively encouraged.
Supporting families whose lives are affected by alcohol or drug problems
There have been many other interventions such as
these developed, in the USA, Australia and the
UK, all aimed at getting ‘treatment-resistant’
substance misusers into treatment: and lots of
research has shown that these approaches work.
Eg:
• ARISE programme
• Network Therapy
• co-operative' counselling service
• The Johnson’s intervention
Supporting families whose lives are affected by alcohol or drug problems
Research consistently shows that working directly
with those concerned about someone else’s
substance use can lead to engagement of the user
in treatment, and stress the influential role of
family members in relation to treatment entry of
the substance user.
These results have been replicated across various
groups of family members using a range of
substances, although more, and more rigorous,
controlled evaluations have been conducted in
the alcohol area than in the drugs area.
Supporting families whose lives are affected by alcohol or drug problems
These findings challenge the powerful myth, widely
held within the substance misuse problems and
therapy field: that family members concerned
about a relative’s substance misuse cannot
influence someone with a substance misuse
problems to change.
It is true that family members cannot make an
individual stop drinking or using drugs, but they
can change their own behaviour in ways that will
help the misuser recognise that the substance use
is problematic, and that change is desirable.
Supporting families whose lives are affected by alcohol or drug problems
Further, if interventions are offered to family
members in their own right (eg to help them
cope better, or help them develop improved
social networks), there are significant effects in
terms of reduced symptoms and altered coping
mechanisms which in turn impact on the
drinker’s behaviour.
Supporting families whose lives are affected by alcohol or drug problems
Joint Involvement of family members and
substance misusing relatives in treatment
OK – involving family members means that
reluctant substance misusers are more likely to
be drawn into and engaged within treatment
services.
That’s great, but what about the effectiveness of
these treatments: are treatments more or less
effective if family members are involved?
The answer is that family involvement leads to
more effective services: there are greater
reductions in levels of both consumption and of
problems.
Supporting families whose lives are affected by alcohol or drug problems
Some more detail.
It has been known for some time that the quality of
family relationships impacts on someone’s
substance misuse and that positive marital and
family adjustment is related to positive
treatment outcomes.
There are also a number of examples of studies
showing that involvement of ‘concerned others’
in behavioural, community-reinforcement and
family approaches leads to improved outcomes
in both alcohol treatment and drug treatment.
Supporting families whose lives are affected by alcohol or drug problems
Basically, lots of systematic reviews have shown
that treatments which involve people’s social
context
(eg
Community
Reinforcement,
Behavioural Marital Therapy) are both highly
effective, and also more cost-effective.
In fact, family involvement leads to better
outcomes even if the substance misuser does not
attend!
One of the most interesting approaches (and one
which demonstrates how much families do work
as a system) is Unilateral Family Therapy.
Supporting families whose lives are affected by alcohol or drug problems
UFT uses a systemic model that suggests it is
possible to alter the ways that a family works,
without all members of the family system being
present in therapy sessions,
and they have shown that it is possible to alter
someone's substance misuse even if that person
never presents for treatment.
This approach was designed to be most suitable for
attracting the most "unmotivated, treatmentresistant [misusers]".
Supporting families whose lives are affected by alcohol or drug problems
Working with other members of the system and
helping them to change their behaviour impacts
on the user's behaviour as well.
This approach uses the concerned family member
alone, aiming to affect change through working
with the family member (often a spouse) in the
absence of the person with the problem.
Supporting families whose lives are affected by alcohol or drug problems
And it works: one study showed a 53% reduction
in alcohol consumption in those users whose
family members received the intervention, and a
slight increase in consumption in the control
group; and that for over 50% of the problem
alcohol users whose family member received
treatment, the drinking was reduced or the
drinker entered treatment compared to none in
the control group. In another study, 57% of
misusers entered treatment compared to 31% in
the no-treatment control condition.
Supporting families whose lives are affected by alcohol or drug problems
All this suggests that there are a set of therapeutic
strategies which can help the family respond
constructively to a family member's substance
misuse problem and motivate the misuser to
change or seek treatment, even if they themselves
do not attend for help.
Of course, most family interventions do not work
by working with the family member alone, and
many do not aim solely to reduce substance use:
Supporting families whose lives are affected by alcohol or drug problems
they focus on improving relationships, decreasing
behaviours that facilitate substance misuse, and
increasing marital or family stability and
happiness.
Many approaches focus on interactions between
family members and substance misusers more
directly, maybe by using Behavioural or
Cognitive-Behavioural Couples Therapy or
Family Therapy (lots of evidence to show that
both of these are often very effective).
Supporting families whose lives are affected by alcohol or drug problems
Major components of substance-focused behavioural
couples therapy include:
• Cognitive-behavioural strategies that will help the
misuser stop using and acquire coping skills to respond
to both substance-specific and general life problems;
• Strategies that teach family members to support the
misuser’s change efforts, reduce protection for
substance-related consequences, develop better skills to
cope with negative emotions, and communicate around
substance-related topics;
• Strategies to improve the couple's relationship by
increasing
positive
exchanges
and
improving
communication and problem-solving skills;
• Behavioural contracts between intimate partners to
support the use of medication.
Supporting families whose lives are affected by alcohol or drug problems
Approaches which involve family members to help the
whole family (including the substance misuser) to change
positively include:
Network Therapy, and Social Behaviour and Network
Therapy (SBNT), developed in the UK by my
collaborators, Alex Copello and Jim Orford.
SBNT is a synthesis of many of the family and social
network ideas I have just outlined, and is based on the
premise that to give the best chance of a good outcome
people with serious drinking problems need to develop
positive social network support for change, and this
involves getting members of their networks who will
support them in changing their behaviour involved in the
therapy.
Supporting families whose lives are affected by alcohol or drug problems
All these treatments have resulted in either equal
or usually better outcomes than approaches that
do not involve the substance misuser’s family;
most show positive increases in the long term,
compared to interventions which do not involve
spouses and other family members, or involve
them only minimally.
Certain approaches stand out.
• The Behavioural Marital or Couples Therapy approach
• Social Behaviour and Network Therapy (SBNT)
• The Community Reinforcement and Family Training
(CRAFT) approach
Supporting families whose lives are affected by alcohol or drug problems
So – involving family members in Users’ treatment
leads to better outcomes.
But the focus of all of these approaches I’ve
outlined so far is the substance misuser, not the
family member. Many of us argue that, because
of the harm that is done to family members (both
adults and children) family members deserve
help in their own right.
Interventions aimed at supporting those family
members affected by the substance misuse of a
relative
Supporting families whose lives are affected by alcohol or drug problems
Generally, even in treatments which use family
members (to engage substance misusers into
treatment, or to effect positive therapeutic
change), little or no attention has been paid to
the family members, as opposed to the problem
drinker or drug user.
As examples, until recently most studies of family
interventions which aimed at treating substance
misusers did not measure changes in symptoms
in family members, or change in the family
members’ coping behaviours, following a family
intervention.
Supporting families whose lives are affected by alcohol or drug problems
In addition, the needs of the families of substance
misusers have been largely ignored in service
provision: there are many services for problem
drinkers or drug takers: very few for family
members.
This is because the primary focus has been on the
outcomes for the substance user, with family
members being conceptualised (if at all) as
adjuncts in the treatment process or agents who
can influence the substance user’s behaviour.
Supporting families whose lives are affected by alcohol or drug problems
Much of this is due to a hangover from old
fashioned models of family functioning which
cast family members in a negative light – as the
villains, or the cause of the problem.
Lots of these theories, usually actually being very
gender biased: suggesting that the alcohol or
drug problems of men are cause by the ‘bad
women’ in their lives: their bad mothers or their
bad spouses.
Supporting families whose lives are affected by alcohol or drug problems
There is some evidence in England that this is
slowly changing: a survey conducted by Alcohol
Concern, the English National alcohol agency, in
2004 found 59 agencies which offered some level
of help families and/or children and affected by
alcohol misuse.
This is a marked increase over the numbers in a
previous survey in 2000, which found only 14
such agencies in their survey. However, even in
this more recent work, 78% of respondents felt
that the work that they were able to work with
children and families was not meeting the needs
which were apparent.
Supporting families whose lives are affected by alcohol or drug problems
Although there is such a lack of direct work with
families affected by substance misuse, evidence is
emerging for the effectiveness of interventions
aimed at these family members in their own
right.
My research group in the UK has undertaken a
number of studies of interventions aimed at
reducing family members stress and strain. We
developed a model of why alcohol & drug
problems caused family members problems: the
stress-strain-coping-support model (SSCS).
Supporting families whose lives are affected by alcohol or drug problems
This suggested that ….
Family
members
are
stressed
due to the
impact of
a
relative’s
substance
misuse
Strain:
usually
physical
and
psycholo
gical
health
problems
How the family
member copes with
(responds to) the
situation
and
The level and quality
of social support
available to the family
member
Supporting families whose lives are affected by alcohol or drug problems
Using this, we developed a simple and brief (so it
could be delivered in primary care) 5-step
therapeutic intervention which worked at each
stage of the model.
The 5-step approach involving
1) giving the family member the opportunity to talk about
the problem;
2) providing relevant information;
3) exploring how the family member responds to their
relative’s substance misuse;
4) exploring and enhancing social support; and
5) discussing the possibilities for onward referral for
further specialist help.
Supporting families whose lives are affected by alcohol or drug problems
In the UK we’ve conducted studies of this 5-Step
Intervention in Primary care, and also with a small
sample in a specialist Secondary care setting, and in
primary and secondary care in Italy.
Results from all of these studies are positive. We
have demonstrated that the intervention is
effective in reducing family members’ signs of
strain (a significant reduction in both physical
and psychological symptoms) and positively
altering
and
enhancing
their
coping
mechanisms; and in improving their social
support.
Supporting families whose lives are affected by alcohol or drug problems
Qualitative data have shown that family members
greatly appreciate the opportunity that the
intervention provides for them to talk about and
reflect upon their situation, and consider how
positive change can be achieved.
Further, we also showed an improvement in the
attitudes held and motivation towards working
with relatives of substance misusers, in the
primary health care professionals involved in
delivering the intervention.
Supporting families whose lives are affected by alcohol or drug problems
There is also some evidence that the intervention
can, in some cases, lead to a change in the
problem alcohol or drug consumption of the
relative and that this in turn can lead to
improved family relationships.
Our work is not alone: other work has been
undertaken to engage and help family members
affected by the excessive drinking or drug taking
of close relatives, mainly in other countries: the
USA, Australia, Canada and former Yugoslavia.
Supporting families whose lives are affected by alcohol or drug problems
One example is the CRAFT approach I described earlier:
although designed as a method of improving the
engagement of people with substance misuse problems
into treatment, it also showed positive effects directly on
family members:
significant reductions in family conflict, depression, anxiety,
anger, and physical symptoms, with average scores
dropping into the normal range on all measures, as well
as improvements in family cohesion.
And these direct and personal benefits to the family
members occurred regardless of whether or not their
relative did or did not enter treatment.
Supporting families whose lives are affected by alcohol or drug problems
Another example is the ‘Parent coping skills
training’ programme which aims to teach more
effective coping skills in responding to
adolescents’ substance use. This work showed
greater improvement in parental coping skills,
parents’ own functioning, family communication
and their adolescent’s drug use compared to
waiting list controls.
And there have been other successful approaches
helping parents to cope with their children’s
alcohol and drug use and problems.
Supporting families whose lives are affected by substance misuse
OK, to sum up, I asked the question: what can we
do to help families.
The answer is lots: we can use family members to
get resistant substance misusers into treatment
and to engage them there, and if we then involve
family members in their treatment, both the
family members and the users have better
outcomes. And if we develop services for family
members in their own right, these are often very
effective and family members show improved
physical and psychological symptoms, better
coping, more social support.
Supporting families whose lives are affected by substance misuse
4. What can we do to help children ?
The material I have reviewed so far looks at adults:
how can we help children?
Well, one way is by helping their parents!
Most children do not want anything other then someone to
come in and help put their family ‘right’.
If we can do this, if we can help parents to sort out their
lives, stop misusing alcohol or drugs, deal with their
relationship problems, become better parents, then the
children probably will be resilient.
Supporting families whose lives are affected by substance misuse
But although we try to do this, many parents will
not sort themselves out. Does this mean that
their children are doomed?
Luckily, the answer is ‘No!’.
I mentioned earlier that some children are
resilient: negative impact on children if they
grow up in a family where one or both parents
misuse alcohol or drugs is not a forgone
conclusion.
Supporting families whose lives are affected by substance misuse
Clearly, if we could help children to become more
resilient, then even if their parents still continued
to misuse alcohol or drugs, they would be much
more likely to grow up unharmed.
So, how do we develop more resilience?
In 2 ways: we focus
• on reducing the risk factors,
• and on increasing the protective ones.
Supporting families whose lives are affected by alcohol or drug problems
Reducing the risk factors:
We know from lots of research what all the main areas are,
which lead to major negative impact.
We know that these areas are NOT the drinking or the
drug-taking, or even the drunkenness or the intoxication:
they are the family problems which arise because of this
intoxication.
This means that, even if the drinking or drug-taking itself is
not amenable to change, it is these risk factors which are
the prime areas for intervention with families where one
parent drinks or uses drugs problematically.
Supporting families whose lives are affected by alcohol or drug problems
We know that the major negative impact comes
from:
• family disharmony, and within this, from
• family violence,
• parental conflict,
• parental separation and loss,
• and inconsistent and ambivalent parenting,
So, these are all areas ripe for intervention!
Supporting families whose lives are affected by alcohol or drug problems
Similarly, we also know that there are some clear protective
factors: factors which, if they are there, are much more
likely to mean that the children will not develop
problems as children, or as adults, even if their parent(s)
still misuses substances as they grow up.
So, if we understand some of the positive elements which
make up resilience in children, again we can work with
families to develop these characteristics. This means that
we can work with
• First, the other parent, enabling them to provide a stable
environment and give the time and attention which so many
children require;
Supporting families whose lives are affected by alcohol or drug problems
• Second, the parental relationship: the important issue to
children is the quality of the family environment, as opposed
to the parental problem drinking. We can work with the
parents, enabling them to retain their cohesive relationship
and present a united and caring front to the children;
• Third, the family relationships: even if the parents do not
manage to retain the cohesion within their own relationship,
risk will be reduced if family relationships, family affection,
and family activities are maintained.
• Fourth, other adult figures outside of the nuclear family,
ensuring that there is at least someone who can provide the
necessary stabilising influence; and
Supporting families whose lives are affected by alcohol or drug problems
• Fifth, these adult figures (either inside or outside of the
family), to encourage the child to develop those aspects of
their lives which will give them a sense of success,
achievement, mastery, competence – all things which enable
a young person to develop the self esteem and self
confidence necessary to enable them to become resilient.
• Sixth, the child him- or her-self, helping to
– remove him- or her-self from the disruptive behaviour of
the problem drinker or drug-taker;
– disengage from the disruptive elements of family life and
engage with stabilising others outside the family,
– or with stabilising activities (school, clubs, sports,
culture, religion) within which the child can develop a
sense of self and self-esteem.
Supporting families whose lives are affected by alcohol or drug problems
So there are many protective factors,
• Both ones relating to positive family functioning,
• and ones relating to external support and outside
interests,
As well as having fewer or less intense risk factors
[eg violence]).
These all lead to resilience, because they can
produce attachment and security as opposed to
unpredictability, insecurity, exclusion and
isolation;
• Attachment and Security are the key elements
that lead to resilience.
Supporting families whose lives are affected by alcohol or drug problems
And this means that there are lots of things that
people can do to help
• reduce the risks to these children,
• and to increase the probability of children being
resilient.
And most of these are unrelated to substance
misuse.
There is much more about this in a paper Lorna and I
produced a few years ago which is in the reference list I
am leaving for you all:
Velleman, R. & Templeton, L. (2007) Understanding and
modifying the impact of parental substance misuse on
children. Advances in Psychiatric Treatment, 13, 79-89.
Supporting families whose lives are affected by alcohol or drug problems
This is not just theory: services exist which do
these things.
There are not many: in a similar way as with
affected adults, few services and few
interventions have been developed to assist these
children who are having to cope with a relative’s
(usually a parent’s) drinking or drug taking,
• either in dealing with their current distress
• or in trying to prevent future problems.
Some examples in the UK:
Supporting families whose lives are affected by alcohol or drug problems
FAS
Option 2
Strengthening Families
M-PACT
Breaking the Cycle
STARS
Young Addaction Plus
Base Camp – Turning Point
Blackpool Substance Misuse Family Intervention
Project
Family Drug & Alcohol Courts
and many more
Supporting families whose lives are affected by alcohol or drug problems
5. How effective are interventions for children and
which seek to break these links?
1. All research and evaluation so far provides
indications, not conclusive evidence
(small samples, insufficient length of time,
evaluation of pilots etc)
2. All indications are positive.
• Strengthening Families – best evaluated, over
some years, in USA and elsewhere – strongly
positive findings.
• Our work, evaluating many of the others (FAS,
M-PACT, Base Camp, BtC, YAP, etc) …
Supporting families whose lives are affected by alcohol or drug problems
Some extracts:
Young Addaction Plus:
• young people: 82% had attempted to reduce their engagement in harmful
behaviours; 96% had attempted to reduce or avoid their involvement in
crime; 91% were making important changes in their lives in an attempt
to secure stable housing, and 78% were attempting to engage in
activities such as accessing education or taking up sports or hobbies.
• families, 80% improved their ability to cope more effectively; 78% were
successfully taking steps to address problematic family functioning, and
85% of families were beginning to re-establish their relationship with the
young person.
Breaking The Cycle
• 88% showed a reduction in: substance use, and in harmful behaviours;
and an improvement in social and parenting skills; and that they were
more successfully prioritising the wellbeing of their children ….
Supporting families whose lives are affected by alcohol or drug problems
Breaking The Cycle (cont)
Clients who have been involved with Breaking the Cycle for some time felt
that:
• They had a clear future; They had goals they were working towards;
They felt that change was possible and sustainable
Overall,
83% of clients achieved some level of progress in working towards their
treatment goals;
81% of parents stabilised, reduced or stopped highly problematic substance
use that was impacting negatively on their and their family’s lives
82% of parents reduced their involvement in harmful behaviours including
involvement in unresolved disputes, domestic violence and engagement
in crime
84% of parents acknowledged the benefits of engaging in a meaningful
occupation
87% of mothers and/or fathers increased their efforts to prioritise their
children’s healthy development.
Supporting families whose lives are affected by alcohol or drug problems
Option 2 significantly reduced the time children spent in care,
and was significantly cheaper, saving thousands of pounds
per child.
M-PACT programme empowered families to make positive
changes.
• The biggest change was in what the families communicated
about, and how they communicated – the group and family
work allowed them to learn to listen to each other and accept
different feelings and points of view, leading to an enhanced
understanding of each other, the addiction and its impact.
• Being supported to set realistic and relevant goals was also
valued.
Supporting families whose lives are affected by alcohol or drug problems
Conclusion
I cannot emphasise enough the fact that there are
a huge number of ways of intervening with
children, parents, and family members, even if
the drinker or drug misuser is unwilling to
address their alcohol or drug consumption.
It is important is that we professionals are not left
feeling powerless to help these families and
children, and I hope I have shown that there is
lots we can do:
Supporting families whose lives are affected by alcohol or drug problems
With adult family members:,
• by listening to family members and allowing them the
chance to talk about how things are affecting them,
• by providing information,
• by helping them think through how they are coping and
alternative ways of coping,
• by doing the same with social support and allowing them
to explore ways of getting more social support,
and with children,
• by focusing on reducing risk factors,
• and building up resilience ones.
Supporting families whose lives are affected by alcohol or drug problems
So, let me by conclude by stating that
• These families and children clearly do need our
help,
• they have a right to expect it,
• and there are (many) things we can do;
• so it is all of our responsibilities to ensure that
this help is provided.
Thank you.