Support for families affected by alcohol use

Adfam welcomes Alcohol Awareness Week and the focus it brings on the harm alcohol can cause individuals, families and communities in the UK. Although there is lots of good work being done and an increased awareness of the possible negative effects of alcohol there is still a long way to go. We would like to add to the debate by highlighting the needs of families affected by alcohol in a call for a whole-family response to be properly implemented.

The experiences and needs of families affected by alcohol use are in many ways similar to those of people dealing with the drug use of a loved one. Many feel anger and resentment towards the user combined with a worry for their health and wellbeing and a desire to see them seek and receive effective treatment. Family members affected by alcohol or drugs also need and deserve help for themselves – for the inevitable stresses and strains of supporting and often living with the substance user.

Historically there has simply not been enough support for families affected by either drugs or alcohol. Although there has been support (not always enough) for the drug or alcohol user themselves, their families have often been invisible in policy terms. Nobody exists in a vacuum – the families of problematic alcohol users need to be supported both for their own sakes and also for the positive role they can play in supporting the alcohol user’s recovery and treatment journey.

But in some ways the needs of families affected by alcohol are different.

As the Government’s drug strategy acknowledges ‘alcohol plays an important part in the cultural life of this country’[1]. Because of the widespread and legal status of alcohol, individuals, their families and society in general may be slower to identify a problem when it does arise and more tolerant of bad behaviour. Research indicates that problematic alcohol users take ‘an average of thirteen years longer [than drug users] to initially recognise their alcohol use as a problem and twelve years longer to access treatment’[2], a huge disparity. This means that families are likely to suffer for longer and face the additional challenges of communities being slow and reluctant to recognise and acknowledge a problem at all.

The workforce itself is not always best prepared for supporting the families of alcohol users. There has been a historic lack of alcohol treatment in general, and many substance use practitioners lack knowledge and expertise around family work. This is therefore a potential double barrier for families of alcohol users, and Adfam suggests that comprehensive training and on-going professional support is the best way to improve the capacity, competency and knowledge of the workforce.

Some family members may mistakenly believe that local support services exist only for families affected by drug use and be slow in attempting to access them, others may be reluctant because of misconceptions or prejudice towards drug users. Services that do support families affected by alcohol use need to make it clear that this is the case and that all types of families are welcome.

Consultation work conducted by Adfam has clearly demonstrated that grass-roots family support services can and do effectively meet the needs of families of both drug and alcohol users. Although the substances are different the behaviour of the users is often very similar and families go through similar stresses and worries, and can certainly empathise with each other. Adfam therefore encourages any measure which helps the continued existence and consistent funding of these support groups.

Lastly, domestic violence may also be a barrier to families seeking support. Although we know ‘there is no simple causal relationship between substance use and domestic violence’[3] domestic violence is manifest as a ‘pattern of abusive and controlling behaviour through which the abuser…seeks power over their victim’[4] in which alcohol may be a contributing or complicating factor. If family members are victims of domestic violence perpetrated by someone who drinks problematically they may be unwilling to seek support and talk to services in case the abuse is uncovered and the perpetrator punishes them through increased abuse.

In addition there are circumstances where survivors have alcohol problems rather, or as well as, the perpetrators. Research has indicated that abused women are 15 times more likely to use alcohol and nine times more likely to use drugs than non-abused women[5]. This means that families where the mother has an alcohol problem are more likely to be families that also experience domestic violence. This violence in turn might discourage children or other family members from seeking support, worrying that they might themselves become victims, or that the mother could be punished by the perpetrator.

We want to do more work understanding the needs of families affected by alcohol use. If you or your organisation would like to be involved or discuss Alcohol Awareness Week with Adfam please get in touch. If you wish to contribute your own experiences to the process please also contact us - your experiences will be treated in complete confidence. Admin@adfam.org.uk- 020 7553 7640.


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[1] Drug Strategy 2008

[2] Accessing treatment for problem alcohol users: Why the delay?, Gloucester Research Unit

[3] Thinking It Through Toolkit, Adfam and AVA, 2011

[4] Ibid

[5] Cited in Barron, J. (2004) Struggle to Survive: Challenges for delivering services on mental health, substance misuse and domestic violence, Women’s Aid Federation England

Adfam comments on the current workforce development needs for the sector

In a world of cuts, closing organisations and a seemingly endless stream of bad news it must be tempting for services to exclusively focus on what seems like the basics – the supply of services by practitioners to service users. Training and workforce development may look like unaffordable luxuries at times like these. Adfam believe, however, that workforce development can play a role in improving service provision in a time of cuts – because a competent, supported and motivated workforce is always going to be more effective than one that lacks competency, support or motivation. Service users get better support, and money and time is saved in the long run by more efficient practice.

So what does the workforce need? They need to feel valued, support and trained.

The Skills Hub is a resource developed by the Skills Consortium – a sector-led alliance of organisations - to bring together the ideas and resources of the drug and alcohol treatment sectors to maximise the effectiveness of the workforce. It is a one-stop shop for practitioners. It’s a free online resource relevant to anyone working in the field and is structured according to the Skills Framework developed by the Skills Consortium and the NTA, which maps interventions to every stage of the treatment journey, and contains manuals, guidance, competencies and much more for each intervention and for cross-cutting issues.

The great advantage of the Skills Hub is that its content is to a certain extent user-generated. It is by the workforce for the workforce – if practitioners feel there are crucial resources missing they can submit them to the Skills Hub. This results in a pool of knowledge that draws from the expertise of the workforce it helps – a virtuous circle where the more the Skills Hub is used the better it becomes.

Volunteers are an essential part of the workforce, and Adfam believe that properly nurtured volunteers can work with service users and families to provide vital support. Adfam is running a project to develop a toolkit for volunteers which will provide background information on the law, how benefits are affected by volunteering, as well as case studies and real life stories. It will be aimed at those already volunteering in or out of the sector (whether service-users, ex-service-users of family members) as well as prospective volunteers. There will also be a section for volunteer managers. The toolkit will be released at the end of the year.

As part of this project Adfam consulted people currently volunteering (or volunteer managing) in the sector. Initial findings suggest that volunteers who receive adequate training and effective on-going support and who are valued and feel like an essential part of the team are well placed to play an active role in the organisation they work in. Volunteering can provide the vital experience that ex-service-users need to progress on to paid work. Attendees at the focus group also reported that having something worthwhile to do plays an important role in their recovery. Others volunteer in the same service they had been a service-user and noted that perhaps understandably this brought its own set of challenges and benefits.

Adfam itself is running a range of training courses that will develop the skills of your workforce and increase the efficiency of their practice. Open courses are being run from now until March 2012 for practitioners covering areas of practice including: working with grandparents; working with families involved with the criminal justice system; working with families affected by substance related bereavement; and working with other drug and alcohol practitioners. These courses are all one-day and cost £130 which includes lunch and refreshments. They are being run in Manchester, Leeds, Birmingham and London.

Adfam can also provide in-house training for organisations which want to commission training for 10-20 people. The prices are based on a sliding scale of income which aims to ensure that smaller groups can access the training. To book a course or find out more information on the training please email our training coordinator or ring on 020 7553 7640.

When useful resources (such as the Skills Hub), professional recognition and support for practitioners (including volunteers), and effective training combine they produce a workforce more likely to be effective, dedicated and happy. The workforce delivers service-outcomes – practitioners therefore need and deserve a level of support that allows them to improve the lives and increase happiness for some of society’s most vulnerable people.

Helping develop the volunteer workforce

One of the greatest strengths of our sector is the dedication and diversity of its workforce. We know that it is extremely varied; full of people with unique personal stories and individual experiences and it includes both volunteers and paid staff. Some people may volunteer because they have personal experience of drug and alcohol use, some may have experienced substance use in their families and some may, initially, have no direct experience of it at all. Volunteering can provide a path for anyone who wishes to help their local community. What unites all these people, as well as their paid colleagues, is a desire to help and support people made vulnerable through their own substance use or that of a family member.

But volunteers don’t come for free. They need to be supervised, supported and monitored just like paid staff. Services need to develop support and supervision processes which ensure that volunteers possess the competencies they need to do a good job and that they have the necessary channels for seeking support and feedback when needed. Without proper management and support volunteers can be exploited or left to deal with situations they are not comfortable or trained to deal with.

Helping build support for volunteers is a key part of Adfam’s Drug Sector Partnership’s work. As part of the partnership Adfam has carried out a multistage workforce development project, which started by looking at resources for all practitioners working with families and has now moved towards a focus on volunteering. In the first stage consultation and research was carried out to map the make-up of the workforce. You can read the results of the survey (pdf) on our website. Using this evidence role profiles were then written for use by services supporting families affected by substances use, both paid staff and volunteers. You can read the role profiles (pdf) as well as an explanatory briefing (pdf) online also.

In the current stage of the project Adfam is working on a Volunteering Toolkit. The toolkit will be a resource for volunteers, both current and potential, as well as organisations both inside and outside the sector. It will include all the important background legislation and policy and explain how volunteering impacts on benefits and claiming expenses. It will also contain a series of downloadable information sheets and generic forms for use in supervisions and recruitment.

Lastly, the toolkit will contain case studies and good practice from both volunteers themselves and the services where they work. If you would like to appear as a case study in the Toolkit please get in touch with Oliver Standing. A consultation event will be held on 7 September 2011 in London - if you would like to attend to contribute your experiences and help develop good practice guidelines for the toolkit please do get in touch!

‘Payment by Results’ Could Spring a Leak

In a recent meeting of the Drug Sector Partnership we briefly discussed whether a Payment by Results (PbR) approach to drug treatment would increase stigmatisation of service users. At the time I was thinking about some of the discussions the development of PbR, where it seemed that service users were in danger of being traded like sub-prime mortgages. That seemed to indicate that yes, PbR would worsen stigmatisation.

When I thought about it further it seemed to me that it depends, actually, on whose result is the important one and who makes the decision about it. If the decision about whether treatment has “worked” includes a large input from the service users then it could be an enormously empowering process. In that case providers would need to actively engage with the service user in order to discover what will work best for them and to deliver it.

If the decision about “results” is based on a standard assessment carried out by a hard pressed bureaucrat then the result will be very different.

Even more important would be the involvement of the service user in deciding whether the treatment had worked in the long term. Selfishly, when considering this, my thoughts turned to plumbers; in particular the ones who have now claimed twice that they have fixed a leak in our house only for us to discover a dripping pipe the next day. The form that I signed when I paid them said the job was done to my satisfaction – only later I discovered that satisfaction was short lived.

A service user may believe themselves to be in recovery when they leave a service and then discover six/twelve months down the line that nothing has changed for them, other than that they are no longer dependent on intoxicants. Their view as to whether they have received an effective and lasting solution will depend on factors like their state of mind, the resolution of long term problems like family estrangements, debt or health issues as well as the usually quoted housing and jobs. Providers might take a more careful approach to their aftercare and personal need after leaving treatment if it was the service users’ view of the result that unlocked their payment.

Bill Puddicombe – acting Chief Executive eATA