2024 marks a special year for Adfam as we celebrate our 40th year. Throughout 2024, we will be reflecting on the past 40 years on the progress that has been made in supporting families affected by substance misuse, as well as looking to the future. Through a series of monthly articles, Adfam is speaking to a range of key individuals active in supporting families through substance misuse.
For our sixth ‘Adfam at 40’ article we speak with Dr Emily Finch, an addiction psychiatrist at South London and the Maudsley (SLaM) NHS Foundation Trust.
Working as an addiction psychiatrist
Dr Emily Finch is an addiction psychiatrist who came into the field during the late 1980s at the height of the HIV epidemic. Working in addiction services for nearly 30 years, Emily has vast experience having worked with a whole range of service users, managed services and engaged in policy work. She currently works in Alcohol Assertive Outreach. Across the services Emily has worked in including crisis services, she has largely worked with individuals that are very badly affected by addiction.
It is often the case that patients affected in this way don’t have family connections, they may have abandoned their families, their families have abandoned them, or they have moved on from toxic family relationships. For Emily, an important aspect of supporting people through recovery is working through these family relationships, so people can begin to reconnect with their families and let them give them the support they need. This can be a difficult process, and often people hold back from talking about their family members.
“Often one of the tasks we have in helping people recover is helping them reconnect, reprocess, and take what they can from their families and in some cases genuinely reconnect.”
Working with individuals in crisis, it can often be unclear if they have people supporting them in their lives. Emily remembers working with a young man, who died in very tragic circumstances from a physical health problem after struggling with multiple challenges including heavy drinking and high doses of methadone. After he died, Emily received a phone call from his mother, learning that she had been calling him once a week for years. They had managed to maintain a relationship with regular contact even after not seeing each other for ten years and having a second family. Emily recalls this contact with his mother as some of the most important therapeutic work she had engaged in. Being the only person who knew the situation he had been in, Emily was able to connect with his mother and talk to her about her son, including the positive memories people at the service had of this individual. It was so important for Emily to be able to support the mother through her grief as part of her work with her son.
Through recovery support, Emily works to help individuals reconnect with their family members. She also describes a current service user who is currently abstinent after being heavily affected by addiction. The service is supporting him through the challenges of trying to reconnect and rebuild some sort of relationship with his family who are also heavy drinkers. Navigating this relationship is not an all-round positive issue and it could bring up challenges and trauma for the individual, and so it is essential for Emily to support them in rebuilding this connection at a manageable and helpful level.
The diversity of family support
Through working with such a range of people in addiction services, Emily has found that many people have developed their own families and support networks. It can be so important for someone going through addiction to have friends who look after them, and it may be these friends who are the closest people in their lives. Emily has worked with both family and friends in order to help them manage these relationships and better support the person in recovery.
And family support does not only go in one direction; people struggling with addiction are often also caring for other family members. Emily remembers an individual who was heavily drinking and on a high dose of methadone caring for his mother with dementia. Being the only person providing this care in her life increased the individuals stress levels and contributed to higher levels of drinking. Through addiction services, Emily supported him to negotiate professional support whilst overcoming the challenges of his reluctance to receive external care. Eventually, being able to provide this wider support to the individual’s family meant that his stress was reduced, and his recovery actually improved.
The role of families in recovery
Emily sees a really important role for families in recovery. Being involved at such an early stage in recovery means that Emily is involved in helping people reconnect or rethink about their relationships, even when individuals don’t think they have family connections. Emily has seen so many positive examples of families helping their loved ones through recovery. Being able to maintain contact, support and dignity even when an individual may be chaotic or out of control can be vital in supporting them through recovery, and Emily has seen families maintain this relationship immensely well.
Although drug and alcohol services are very targeted on the needs of the individual, Emily tells us that in practice, family who are close to the individual become part of the key working and can be central to service user’s recovery. In her current work with Alcohol Assertive Outreach, it is often just as important to work with family as it is to work with the service user, since they have such an essential role to play in recovery.
However, the impact of family is not always positive; many of the service users Emily has worked with have come from damaging families and faced abuse or trauma. In these cases, part of recovery can involve renegotiating certain family relationships, which may include reconnecting with one family member such as a sibling. For Emily, an important process of recovery is working out what sort of relationship service users want with their family and having some control in negotiating this, even if this connection is as little as a Christmas card. An important step can be “establishing…an element of peace in the relationship and resolving some independence”.
Addiction services and support for families
In an ideal world, Emily wants to see community addiction services do more work with families. Services should support family members in their own right, as well as working together with families to support the recovery of service users. However, the current reality is that these services are very stretched, and much of the work provided is practical rather than therapeutic support. Here, Emily tells us that much of the work with families involves referring people to external organisations like Adfam in order to provide more specialist family support to rebuild relationships alongside recovery.
However, many of the service users Emily works with are not at this level of recovery, nor ready to rebuild their family relationships. Emily describes how in some instances she has to encourage family members to be more, rather than less, separate from the service user, supporting the family member to implement important boundaries to maintain their independence. The involvement of families in an individual’s recovery is not always a straightforward issue, and it is vital therefore that services support individuals and families in navigating these relationships in a positive way.
In conclusion, Emily reiterates how important it is “that families are considered, and in the widest sense”. Recovery can be a long and difficult process and it can be hard for families, and everyone involved, to see the end. However, the recovery process can also lead to positive changes in people’s lives, helping service users and families to resolve issues and move away from difficult situations.