Summary

There is highly processed and review-level evidence that involving families in recovery care plans for affected individuals and providing support for family members themselves is beneficial to improve outcomes for both parties

Rationale

For the person in recovery and to meet needs of (adult) family member

NICE Clinical Guidance 51 [1] general considerations include the following:

• If the service user agrees, families and carers should have the opportunity to be involved in decisions about treatment and care.
• Staff should ask families and carers about, and discuss concerns regarding, the impact of drug misuse on themselves and other family members, including children.
• Staff should also:
  • Offer family members and carers an assessment of their personal, social and mental health needs
  • Provide verbal and written information and advice on the impact of drug misuse on service users, families and carers.

Where the needs of families and carers of people who misuse drugs have been identified, staff should:

• offer guided self-help or support groups
• provide information about, and facilitate contact with, support groups that are specifically focused on addressing families and carers needs or, alternatively
• offer individual family meetings.
  

There is review level evidence that community reinforcement and family training (CRAFT) is effective in engaging treatment resistant substance-abusing individuals. Included studies were small scale but assessed as good quality with high programme fidelity. Evidence also suggests that irrespective of treatment engagement by the affected individual these programmes are beneficial to families and significant others. [2]

In their Scottish-Government-commissioned review for the Scottish Child Care and Protection Network, Mitchell and Burgess (2009) identify evidence from one US- based study (Gregoire and Schulz 2001) examining drug treatment outcomes that found support from significant others emerged as having a strong, positive relationship with assessment completion and treatment outcomes, and custody outcomes. It is worth noting that this support was more commonly received by males as women in the study sample were more likely to have significant relationships with men who were themselves misusing substances.

There is review-level evidence from UK-based qualitative studies to suggest that where drugs (and/or alcohol) use exists, targeted family support interventions have a positive influence on the lives of parents and children. These include remaining together as a family despite previous child protection concerns at referral, although evidence of effect on child welfare outcomes is not known. Projects were characterised as child-focused with a strength-based approach to assist families (individuals and as a whole) to identify their issues and how to address them. Interventions were community-based with substantial contact time.

There is review-level evidence that integrated substance treatment and family support services may be successful in assisting women to reduce their drug and alcohol use, and to bring about changes that support their parenting and family life. Both programme completion and length of stay within treatment appear to be key factors in influencing positive outcomes for women. [3]

There is review evidence to suggest that interventions based on the stress-strain- coping-support theoretical model: the 5-Step Intervention is effective in reducing stress symptoms and improving family member coping responses. [4]

Scottish policy and practice note

Quality Principles: Standard Expectations of Care and Support in Alcohol and Drug Services(2014) [ www.scotland.gov.uk/Publications/2014/08/1726/downloads] The underlying philosophy of a ROSC is that treatment and aftercare are integrated, and priority is given within the system to sustaining individuals in their recovery journey. The distinguishing features of a ROSC include being person-centred, inclusive of family and significant others, as well as providing individualised and comprehensive services across the lifespan with systems anchored in the community. At its core it has strength-based assessments and interventions that are responsive to personal belief systems, a commitment to peer recovery support services, is inclusive of the voices and experiences of people and their families in recovery and provides integrated services. It also provides for system-wide education and training, ongoing monitoring and outreach, is outcomes driven and evidence based.

The Adult Support and Protection (Scotland) Act 2007 (www.scotland.gov.uk/Topics/Health/Support-Social-Care/Adult-Support-Protection) seeks to protect and benefit adults at risk of being harmed. The Act requires councils and a range of public bodies to work together to support and protect adults who are unable to safeguard themselves, their property and their rights.

It provides a range of measures which they can use. Public bodies are required to work together to take steps to decide whether someone is an adult at risk of harm, balancing the need to intervene with an adult's right to live as independently as possible.

References:

1. National Institute for Health Care Excellence (NICE, 2011) Clinical Guidelines 51: Drugs Misuse: Psychosocial Interventions. London: NICE.

2. Roozen, H.G. Waart van der Kroft, P. (2010) Community reinforcement and family training: an effective option to engage treatment resistant substance- abusing individuals. Addiction. 2010, page105.

3. Mitchell, F. Burgess, C. (2009) Working with families affected by parental substance misuse: a research review. Edinburgh: Scottish Child Care and Protection Network, Scottish Government.

4. Copello, A. Templeton, L. Powell, J. (2009) Adult family members and carers of dependent drug users: prevalence, social cost, resource savings and treatment responses. London: UK Drug Policy Consortium.