Snapshot of the Sector: Support for families affected by substance use
Earlier this year Adfam published results from the most comprehensive survey ever undertaken into the support provided to the families and carers of people with drug or alcohol problems.
Local authorities are required to help residents who are harmed by substance misuse and receive funding from central government to do so, and Adfam sought to establish the extent to which this help extended to families and carers. Through a series of Freedom of Information (FOI) requests Adfam asked all 154 local authorities in England how they used their substance misuse budget to help families and carers. With 95% of areas responding, for the first time we are able to paint a picture of the resources that local authorities in England commit to substance misuse focused family support.
Worryingly half of England’s councils were unable to tell us what, if anything, they spent from their substance misuse budgets helping families and carers. In the areas that were able to provide a figure, the average spend amounted to just 1.58% of their substance misuse budget, while 13 local authorities reported that they spent nothing at all. This is the first time that these figures have come to light and the fact that it has taken a charity to undertake and fund this work is troubling.
For decades central government has routinely collected extensive data about individuals using drugs and alcohol and accessing services. This information is widely used by journalists, campaigners, politicians and budget holders to scrutinise the work undertaken locally and nationally. However when it comes to children and family members, government does not currently collect even basic information, nor does it require local authorities to do so. This needs to change and Adfam is calling on the government to address this obvious gap.
In the absence of this data collection, results from Adfam’s survey of local authorities, evidence from Adfam’s regular research reports and insights and anecdotal evidence from Adfam’s regular conversations with family members and practitioners, gives us a snapshot of the state of the family support sector.
The clearest finding is that the sector is not funded to meet the size of the challenge. Spending less than 2% of substance misuse funding on the many hundreds of thousands of people most directly impacted by a family member’s drug or alcohol use is never going to be sufficient to provide the help and support needed. While we acknowledge that more money on its own won’t always lead to better services, we also recognise that funding matters and a lack of funding is causing real harm.
Dame Carol Black’s 2021 Review of Drugs pointed to a substance misuse sector that was suffering long term decline linked to many years of real term cuts and the government accepted the report’s assessment and provided hundreds of millions of pounds in additional funding to boost performance. While the impact of that uplift is still being assessed, it is absolutely clear that services for children and families are still suffering from chronic underfunding. We understand that a considerable amount of this additional spend has been directed towards outcomes relating to individual opiate users, including further staff training, increased outreach, expanded provision for people who are street homeless and greater use of residential facilities. Based on the findings from Adfam’s series of FOI requests to local authorities in England, it would appear that it has not been spent to any significant degree on improving support for families. Until this information is collected, we cannot know for certain the extent to which children and families have missed out on additional resources.
What we do know however, is that the number of people affected by someone else’s substance use, the people who are allocated less than 2% of local authority substance misuse budgets, is greater compared to the number of people seeking support for their own drug or alcohol problems (c300k adults in contact with treatment services).
Without requirements in place for local authorities to report on spend and support delivered to families affected by substance use, current support provision would appear to be reliant on buy-in and good will from local commissioners. With support for families in some areas provided through existing treatment providers and standalone family support services, many other areas either don’t provide any or minimal support for families and carers, thus resulting in the continuation of the postcode lottery.
Existing standalone family support services also face an ongoing challenge to continue with the vital support they provide too. Adfam’s State of the Family Support Sector 2023 reported that while the majority of funding in the family sector comes from local authority public health grants and sub-contracts with drug and alcohol services, the money they receive from local authorities is insufficient to maintain the level of service they currently provide let alone expand to try to meet unmet need. A number of respondents reported that their organisations had to raise additional money from Trust and Foundation grants, private donations and corporate partnerships, in order to deliver support to families beyond what local government funding alone would allow. One respondent reported local authority grant funding totalling £116k for a service that cost £330k to run, with the shortfall being made up by grants from charitable sources.
Furthermore, in 2018 the Children’s Commissioner estimated that 470,000 children grow up in a family where a parent uses substances problematically and a 2021 YouGov survey commissioned by Adfam estimated that 5 million adults are negatively affected by someone else’s substance use. While not all those adults will want, or need, local authority funded services, we believe that children and families should at the very least be considered within scope for help and support. Currently the figures suggest that is not the case.
The 2021/22 Government annual adult substance misuse treatment statistics (section 7), reported that “Sixty-five per cent of children of people starting treatment were receiving no early help. Early help services provide support to children and their families as soon as problems emerge.” Perhaps that wording looked a little too stark on the page, as the following year’s report flipped the figures round to say, ”Thirty-five per cent of children of people starting treatment were receiving early help”. The 2023/24 report said “Thirty-seven per cent of people starting treatment who were parents had children receiving early help.”
Perhaps this looks more palatable but the point remains the same, over 60% of children in this situation are not receiving the Early Help services which Government says “…provide support to children and their families as soon as problems emerge.”
How is it that no-one is noticing these substance misuse related problems emerging? Indeed many people only arrive at a treatment agency after years of increasingly harmful behavior, yet the majority of children and families impacted by this are not on the radar for support. Prevention is key and preventative services such as Early Help are vital in addressing potential problems or difficulties for children, young people, and families before they escalate into more serious issues.
We believe that this is a symptom of the lack of focus on children and families. By framing the problem posed by substance use as essentially one of an individual drug or alcohol user in need of treatment, and by viewing the success or failure of the treatment system through that lens, we fail to spot the huge damage being done to the very many people around that person. There is a clear need to reframe the landscape, so that more attention is given to the wider circle of people affected by substance use; children, parents, friends, partners, siblings and grandparents.
This is how we end up with a system that spends less than 2% of its budget on family services, that misses over 60% of the children of parents going in to drug and alcohol treatment, and collects swathes of data about individuals but almost nothing about children and families and the specialist services needed to support them.