Why offer programs for family members?

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

Traditionally, service providers have offered treatment to people with mental health or substance use problems, and have often neglected to involve their family members. We believe strongly in the importance of involving family members in treatment, because:

• family members themselves often need treatment
• family members benefit from treatment
• family members can influence the behaviour of their relatives who have substance use problems, and the outcome of their treatment.

Family members need treatment

Problematic substance use has an impact far beyond the person who uses substances (Csiernik, 2002). Partners, children, other family members, friends, neighbours, colleagues and associates of a person with a substance use problem all may experience stressful consequences of the person’s behaviour. The 2004 Canadian Addiction Survey (Adlaf et al., 2005) revealed that many adult Canadians perceived that in the past 12 months, they had been harmed in some way by others’ substance misuse. Of the almost 14,000 respondents to this survey:

• 22 per cent reported having been insulted or humiliated
• 16 per cent had experienced serious arguments or quarrels
• 16 per cent had experienced verbal abuse
• 11 per cent had experienced family or marriage problems
• 11 per cent had been pushed or shoved
• three per cent had been hit or physically assaulted.

In a study conducted in England (Velleman et al., 1993), 50 partners or close relatives of people who misused substances noted ways that they or their families had suffered as a result:

• 94 per cent reported relationship problems such as more arguments, less sex, and less trust and communication
• 88 per cent reported practical problems such as financial difficulties, social isolation and work difficulties
• 82 per cent reported negative emotions such as loneliness, isolation, anxiety, guilt, fear and confusion
• 82 per cent reported mental or physical health problems such as depression, panic attacks, eating disorders, ulcers and raised blood pressure
• 52 per cent reported an increase in their own addictive behaviours such as drinking, smoking, and eating.

Studies in England, Mexico and the United States have found similar negative consequences reported by parents and other relatives of people with substance use problems (Butler & Bauld, 2005; Lewis et al., 2004; Orford et al., 1998).

Nor do the negative consequences disappear—or, necessarily, even decrease—when the person with a substance problem seeks treatment. Despite their wish for the person to recover, family members often experience anxiety and confusion as they deal with the changes and difficulties that occur during the recovery process (Lewis et al., 2004).

It is clear from these data that family members encounter stress from their involvement with the relative with a substance use problem, and that they need help in coping with the negative consequences. Despite this reality, most drug treatment resources in Canada and elsewhere neglect the needs of partners, other family members and friends (Csiernik, 2002; Howells & Orford, 2006). When treatment programs involve family members, they often do so only to help engage the person with a substance use problem in treatment.

Family members benefit from treatment

In a recent review of studies, researchers concluded that:

• family members who receive family treatment (e.g., family coping skills treatment, behavioural therapy, Al-Anon) have reduced emotional distress
• those who receive coping skills treatment experience improved coping
• partners who receive behavioural couples therapy experience happier relationships, fewer separations, a lower risk of divorce and less domestic violence than those whose substance using partners receive no family treatment (O’Farrell & Fals-Stewart, 2003).

In a recent study, researchers in England found that spouses who received individual counselling aimed at improving coping, safety, relational skills, problem solving and emotion management showed significant decreases in psychological symptoms over the course of treatment, and that these changes were maintained for 12 months after treatment (Howells & Orford, 2006).

Another study demonstrated that children affected by familial substance use can benefit from their parents receiving treatment—as evidenced by improved functioning—even when they themselves receive no treatment (Kelley & Fals-Stewart, 2002).

Family members influence the person with a substance use problem

Research has demonstrated that family involvement in treatment both increases the rate of treatment initiation and improves treatment outcomes for the person who uses substances (Stanton, 2004).

Family treatment can help to increase the likelihood of a person with a substance use problem entering treatment, for example by helping to change family patterns or problems that are impeding the person’s motivation to enter treatment (Hser et al., 1998). One successful model is Community Reinforcement and Family Training (CRAFT; Miller et al., 1999).

Family treatment can also help those who are already in treatment. Rowe & Liddle (2003) found that these people demonstrate less substance use, better medication compliance and better family and relational functioning than those whose families are not involved in treatment. One form of family treatment, behavioural couples therapy, has been studied extensively and has proved effective in reducing substance use and improving relationships (O’Farrell & Fals-Stewart, 2003). Another study showed that when family members attended Al-Anon, their relative with a substance use problem was significantly more likely to continue attending Alcoholics Anonymous (McBride, 1991).

No matter how they behave or what choices they make, partners, other family members and friends do influence the person who has a substance use problem, and receiving treatment themselves can help increase the positive impact of their influence. Family members can provide consequences for the person’s behaviour, exert appropriate pressure, encourage and support the person, and provide information. For example, they can:

• learn how to avoid reinforcing problematic substance use (e.g., avoiding telling the person that he or she is more fun after a few drinks) and how to set limits around this behaviour
• learn how to avoid enabling the person’s substance use (e.g., avoiding calling the person’s employer with a story that covers up the fact that he or she can’t make it to work because of substance use) and how to allow the person to experience the full consequences of his or her use
• learn about the recovery process and how to reinforce the person as he or she takes steps toward recovery
• improve their skills in problem solving, regulating their emotions, resolving conflicts and communicating, all of which can improve their relationship with the person who has a substance use problem.

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

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