For over 40 years, Adfam has campaigned for better advice, help and support for the carers and family members of those with a substance use disorder (SUD). We are adamant that this help should be available to families irrespective of the support that they themselves can provide to someone struggling with addiction. They are not, in the jargon, someone else’s ‘recovery capital’.
This position is supported by the families we work with and has been validated in research conducted by Dr Catrin Andersson et al, at Sheffield Hallam University. Her report, ‘Understanding recovery from a family perspective: A survey of life in recovery for families’ was based on over 1500 responses from the family members and carers of those in recovery or those with a loved one who had been in recovery but had subsequently relapsed. The report is unequivocal, “It is clear that family members need support not only to assist loved ones dealing with addiction but in their own rights.”
(‘Understanding recovery from a family perspective: A survey of life in recovery for families.’ 2018) https://shura.shu.ac.uk/18890/1/FinalReport_0149.pdf
In tandem with this position we also recognise that families are often desperate to take on a supportive role and to help their loved ones to recover. And we know that the help that family members and carers provide makes a real difference. As Dr David Best the researcher, academic and co-author of the Sheffield Hallam research points out:
“One of the most important things we know about recovery is that other people matter.”
There is a wealth of research that supports this view. ‘Social networks’, a term that encompasses family members, carers and significant others, have been shown to play a pivotal role in recovery. “The resolution of severe alcohol and other drug problems is mediated by processes of social and cultural support.”
(The recovery paradigm: A model of hope and change for alcohol and drug addiction. David W Best, Dan I Lubman. 2012) https://www.racgp.org.au/getattachment/321d4bea-4e01-41e8-90b3-8858ba2fcb72/The-recovery-paradigm.aspx
In their systematic review of social networks and outcomes Kumar et al state that they “…significantly shape effectiveness of opioid use disorder treatments” and add “…positive social support networks can amplify the benefits of medication treatments.”
(The role of social network support in treatment outcomes for medication for opioid use disorder: A systematic review. Navin Kumar, William Oles, Benjamin A Howell, Kamila Janmohamed, Selena T Lee, Melissa C Funaro, Patrick G O’Connor, Marcus Alexander. 2021) https://www.jsatjournal.com/action/showPdf?pii=S0740-5472%2821%2900093-3
In their 2010 study Longabaugh et al make consideration of social networks a central element of treatment planning:
“Systematic assessment of the patient’s social network should be a standardized component in planning tailored treatments for alcohol-dependent patients.”
(Network Support as a Prognostic Indicator of Drinking Outcomes: The COMBINE Study. Richard Longabaugh et al. 2010) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965482/pdf/jsad837.pdf
There is a very important caveat here that is evident across the research. Not all social networks are positive for recovery. The social networks that are helpful are the ones that are aligned with the treatment outcome goals, often ones that encourage and support abstinence.
“…one of the key objectives of a recovery journey is transitioning to networks that are supportive of recovery…”
(An unlikely hero?: challenging stigma through community engagement. David Best. 2016) https://shura.shu.ac.uk/13123/1/Best%20Unlikely%20hero.pdf
The impact of a network that includes people that support recovery can be considerable. “The addition of just one abstinent person to a social network increased the probability of abstinence for the next year by 27%.”
(Changing Network Support for Drinking: Network Support Project Two-Year Follow-up: Mark D. Litt, Ronald M. Kadden, Elise Kabela-Cormier, and Nancy M. Petry. 2009.) https://pmc.ncbi.nlm.nih.gov/articles/PMC2661035
Whilst not all families are able to fulfil the role of a supportive network, we know that many families actively encourage participation in treatment and champion abstinence. Dr Dennis Daley who has published widely on substance use, families and co-occurring disorders has helpfully summarised common elements from the research into the role of the family in supporting recovery: “Families can help their loved one in several ways such as facilitating the involvement of the individual with SUD in treatment; attending sessions together to address the SUD and recovery needs; engaging in ongoing discussions about recovery and about what can and cannot help the member with the SUD; identifying early warning signs of relapse that their loved one may ignore; and help the individual with the SUD stabilize from a relapse should one occur.”
(Family and social aspects of substance use disorders and treatment
Dennis C. Daley. 2013.) https://www.sciencedirect.com/science/article/pii/S1021949813001026
From talking extensively to family members, carers and service users, we have found that families are frequently the only ‘constant’ in the often chaotic and fractured lives led by people with SUD and in many cases the only ones willing to provide a ‘haven’ during a loved one’s recovery journey.
This support, though, comes at a cost. Emotionally it can be draining, putting a huge strain on relationships. Physically it takes a toll on people’s health and well-being, and financially, family members often go into debt after funding, directly or indirectly, a loved one’s treatment journey.
Capturing the role and impact that families have in supporting recovery is not always easy. We hear again and again that family members feel stigmatised by addiction and are understandably reluctant to come forward and identify themselves as ‘carers’. This often leaves them unrecognised, unreported and unfunded in the mainstream ‘carers’ sector. Frustratingly they can also find themselves shut out of the substance use treatment system, which is largely focused on individual drug and alcohol users, too often to the exclusion of all else.
As Laura Lander and colleagues point out this approach undermines the efficacy of treatment:
“Treating the individual without family involvement may limit the effectiveness of treatment for two main reasons: it ignores the devastating impact of SUDs on the family system leaving family members untreated, and it does not recognize the family as a potential system of support for change.”
(The Impact of Substance Use Disorders on Families and Children: From Theory to Practice: Laura Lander, Janie Howsare, Marilyn Byrne. 2013) https://pmc.ncbi.nlm.nih.gov/articles/PMC3725219/pdf/nihms-496858.pdf
