The Families CARE program

From the Introduction to Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

What is Families CARE?

Families CARE is a program that aims to help family members Cope And Relate Effectively with the person who has a substance use problem, not only to support the person’s recovery but also to enhance their own well-being. The program offers education, support and skills development. Though eclectic, Families CARE is rooted in a cognitive-behavioural approach. Family members learn about, discuss and practise such skills as coping, grieving, dealing with emotions, solving problems, setting goals, communicating, setting limits, supporting and responding to the person with a substance use problem, and helping children affected by a family member’s substance use.

Families CARE is not an “intervention.” There has been a great deal of publicity about intervention approaches, particularly the Johnson Institute Intervention, and many family members ask about this method. We do not use or recommend this approach for several reasons:

• The research data do not support the intervention method, which engages only 20 per cent of potential clients in treatment, a significantly lower percentage than other approaches (Stanton, 2004). This low rate of success seems to derive from the fact that most family members who begin the process are not able to follow through on the intervention.
• Research suggests that clients who do engage in treatment following an intervention are at higher risk of relapsing than are clients who engage in treatment through less confrontational methods (Loneck et al., 1996).
• The intervention approach focuses on getting the person with a substance use problem into treatment, and may do nothing to help family members reduce their distress or cope better with their situation. (In fact, if the intervention is aborted prior to completion or if it fails, family members may actually become more emotionally distressed.) In addition, a treatment designed only to get a person into treatment does not help family members support the person and deal with issues arising from the person’s treatment and recovery.
• While the goal of the intervention approach is only to help a person begin treatment, Families CARE helps family members of people who may be at various stages of treatment and recovery, not just pre-treatment. (This is also true of other documented and researched treatment methods for family members, such as CRAFT and behavioural couples therapy, which—though otherwise successful models—are not relevant to groups of family members who may have differing needs with regard to the person in their respective families who has a substance use problem.)

Who can benefit from Families CARE?

Families CARE is intended for adult family members—including partners, adult children, parents, siblings, or even friends or ex-partners of people who are engaging or have engaged in problematic substance use, and who may or may not be in treatment. For the sake of simplicity, we will refer to these concerned others as “family members” or, in the context of the treatment sessions, as “group members” or “participants.”

Relationship of family members to the person with a substance use problem

Family members may vary in their level of current involvement with the person who uses substances, ranging from living with the person to having little contact with him or her. Given this, the Families CARE program may be offered by a substance use treatment agency to families of its clients (though the person with a substance use problem does not participate in the group), or may be offered as a service for family members even when the person with a problem is not a client of the agency.

Mental health of family members

Many family members may be struggling with mental health issues, often in part because of the stress of their relationship with the person who has a substance use problem. Prior to beginning the program, family members should be screened to determine their mental health status. If they have serious mental health problems (e.g., severe depression or anxiety, bipolar disorder, a personality disorder or an eating disorder), have substance use problems, or are at risk of violence or suicide, they will need additional services and should be given appropriate referrals before beginning the program. They may need to increase their level of stability in order to participate successfully in the group treatment. Family members who have mental health problems may also be helped by treatment from an individual therapist while completing the Families CARE program.

Involvement of the person with a substance use problem

The Families CARE program is intended only for family members, and not for the person in the family who has a substance use problem. This is because the treatment of family members should not depend on:

• the willingness or ability of the person who uses substances to participate in treatment (some people with substance use problems may not co-operate or may not be ready to engage in treatment; others may not be able to attend treatment because they live far away, are in jail or a residential treatment facility or hospital, or have schedule conflicts)
• the amount of contact the family members currently have with the person who has a substance use problem (family members who have ended their relationship with a person who uses substances may still need and benefit from treatment)
• where a person who uses substances is in his or her substance use or recovery (family members may benefit from treatment when a family member is just beginning to exhibit symptoms of substance use problems, is experiencing severe problems, is beginning treatment, is in early or later recovery, or has relapsed).

As mentioned earlier, family members themselves typically struggle to cope and may be experiencing mental health difficulties. Consequently, their treatment is important: it may help to reduce their preoccupation with the difficulties, needs and goals of the person who has a substance use problem, and may enable them to identify their own difficulties, needs and goals. Further, as we have noted, their treatment—with or without the involvement of the person who uses substances—may lead to positive changes for that person (Miller et al., 1999; Stanton, 2004).

Family therapy including the person with a substance use problem can be helpful, but should be done outside of this program.

When running the program, you may discover that the family members themselves vary in their use of substances, from no use ever, to past use, to current problematic use. Some family members use substances themselves to cope with their relationship to a person who has a substance use problem. Although the program can help family members learn healthier methods of coping, family members who have significant substance use problems should be excluded from the program and be directed instead to substance use treatment.

Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

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