Nyhet
See the family member too – not just the person with a substance use problem
Adult family members of people with harmful substance use need access to nuanced support that also addresses their own well-being. Better coordination and clearer division of responsibilities are also needed among social workers, family support counsellors, and alcohol and addiction therapists. This is shown in new research on social work services that provide support to family members.
As a family member, it is common to focus first on the person who drinks too much alcohol or uses drugs, while overlooking your own wellbeing. Findings from a Forte-funded study show that many family members experience stress, anxiety and depression.
– There is empirical evidence that family members are often negatively affected by a loved one’s substance use problems,” says Lisa Skogens, Professor of Care and Treatment of Alcohol and Drug Misuse at Stockholm University.
The relationship with the person experiencing harmful substance use is often characterised by a constant readiness to provide support, while at the same time struggling with feelings of shame and guilt. This psychological distress can make it difficult for family members to take steps to care for their own wellbeing.
The area remains under-researched – both in terms of family members’ own support needs, the role of being a family member, and how support services are organised and delivered in practice.
The concern and care that family members show for a loved one can risk being framed as a condition resembling an illness – something that is rarely done in relation to other groups of family caregivers.
Lisa Skogens
Professor of alcohol and drug addiction treatment, Stockholm University
Even professionals can overlook family members
The study shows that professionals in social work, such as social workers and family support workers and alcohol and addiction therapists, who provide support to family members can also overlook their needs. In the study, Lisa Skogens and her research team conducted interviews with these professionals. The team also includes Professor Ninive von Greiff, doctoral student Hans Fagerström and Dr Sofia Huusmann Härd, all based at the Department of Social Work at Stockholm University. The researchers found that, in support sessions, family members are often given information about what is considered the “correct” way to understand their loved one’s addiction.
The professionals in social services who work with people experiencing substance use problems and their family members may also pathologize the family member.
– in other words, view them as part of the problem. Compared with other groups of family caregivers, such as those caring for older people or people with disabilities, family members of people with substance use problems face a higher degree of stigma.
– Family members’ concern for, and care of, a loved one risk being explained and described as a condition resembling an illness – in a way that is not seen among other groups of family caregivers, says Lisa Skogens.
When a family member’s situation is understood through the lens of a family disease or codependency, the emphasis may shift towards helping them understand their own role and responsibility in relation to their loved one’s addiction, setting boundaries and changing their own behaviour.
– Although this can help reduce feelings of guilt and provide family members with useful coping strategies, it can also mean overlooking the fact that their concern and care may be reasonable responses to a difficult situation. In turn, this may make other forms of support, such as financial assistance or respite care, seem less relevant or less necessary. In this respect, this group differs from other groups of family caregivers, says Lisa Skogens.
Nuanced support for family members is needed
The researchers call for a more nuanced approach to supporting family members, one that takes into account how they themselves understand and describe their situation. Support needs to be based on family members’ own needs while also recognising their relationship with the person experiencing harmful substance use. This means that family members should not be reduced to being merely a resource for their loved one. Nor should they feel that they must distance themselves from, or shut the door on, that person.
The researchers also call for better coordination and a clearer division of responsibilities among professionals such as social workers, family support counsellors, and alcohol and addiction therapists who work with people experiencing substance use problems and their family members.
– This is necessary to ensure that family members’ own needs and their relationship with their loved one do not fall between the cracks of different professional responsibilities, says Lisa Skogens.
How municipalities organise support matters
A study involving social services, along with interviews with social workers, treatment providers and family support workers, showed that the way municipalities organise support for family members has a significant impact on the type of support they receive. Three-quarters of Sweden’s 290 municipalities responded to the survey.
The findings showed that municipal support for family members of people with harmful substance use often focuses on the problems of the person using alcohol or drugs, rather than on the needs of the family member. Support is frequently provided by professionals working in addiction services. Where family support workers are responsible for support, they often work with all types of family caregivers rather than specifically with those who have a loved one with harmful substance use.
CRAFT is a support programme recommended by Sweden’s National Board of Health and Welfare. CRAFT stands for Community Reinforcement and Family Training and is designed to support family members of people with alcohol or drug problems. Its aim is both to improve the family member’s own situation and to increase the likelihood that their loved one seeks or accepts help. However, the researchers see a risk in CRAFT’s focus on changing the behaviour of the person with the substance use problem. When relationships are marked by conflict, or when the loved one is unwilling or unable to change, it becomes particularly important that support also creates space for the family member’s own recovery.
– This requires sensitivity to how family members themselves perceive their role in the relationship, and what kinds of changes they have the capacity and motivation to engage in, says Lisa Skogens.
The benefits of supporting family members
When family members are doing well, they are better able to provide support to a loved one with harmful substance use.
– Support that is tailored to the specific circumstances of family members would likely benefit society as well, says Lisa Skogens.
Organisations supporting family members
Two examples of organisations that shift the focus towards family members are the Swedish National Family Caregivers Association (Anhörigas Riksförbund) and Al-Anon.
The Swedish National Family Caregivers Association
- Has a general focus on family caregivers and family members, not only those affected by a loved one’s harmful substance use.
- Seeks to ensure that family members also receive support, regardless of the diagnosis or needs of the person they support.
- Argues that healthcare services often ask family members for information about the person receiving care, treating them as a resource for the service. However, services also need to understand how the family member is coping and how everyday life is affected by their loved one’s needs.
- Believes that professionals should view family members as natural and resourceful partners in collaboration with the person receiving care.
- Wants services to show respect for and trust in family members’ perspectives during assessments, decision-making and interventions concerning their loved one.
- Link: The Swedish National Family Caregivers Association External link.
More sources of support for family members
Stockholm Centre for Dependency Disorders (Beroendecentrum Stockholm) provides links to additional sources of support for family members on its website.
TEXT: Lena Lindkvist (translation by Forte)
