A national newsletter on substance misuse management in primary care NETWORK
that most family members are registered with the same practice. We need to use our everyday skills: listen, support and ask for help when we need it. Families’ responses to problem substance use can be remarkably similar and by supporting them to see addiction as a family illness and to explore possible avenues of help,
we can guide them to take an enormous first step to improve their situation.
Encourage Susan to see that the best way to support Michael is by giving him clear boundaries and a firm recommendation that he finds his own flat. Support her to be able move forward for herself and
continue to love, yet not enable, her son. From my experience in families such as the McDonalds, Michael will come and ask you for help and I know you are well equipped to do that!
Answer by Dr Chris Ford GP and Clinical Lead for SMMGP
SMMGP’s top tips for working with families
We have summarised points of policy and practice to outline some top tips when working with the families of drug and alcohol users
u Think family! If a patient presents with low mood, stress, or poor sleep, ask not only about their drug and alcohol use but about that of other members of their family.
u Provide advice on the impact of substance misuse on families to patients, if they are a substance user, or a family member.
u Assess the family member in their own right – how is the substance use impacting on them? Explore and promote problem solving. Remember to assess their own substance use.
u Remember that family members’ needs will be distinct, and may conflict with the substance user’s needs.
u Be careful not to breach confidentiality.
u Remember that the family member may not want to support the person using substances, and may not be in contact with them.
u When working with drug users, remember to discuss reproductive planning.
u Avoid taking sides.
u Provide information about self-help and support groups in your area for families and carers.
u For those with family members in treatment, provide information about treatment and the settings in which it may take place.
u Where possible and appropriate, involve family members in the treatment of drug and alcohol users. Make your service as family friendly as possible.
u Remember harm reduction. Give families advice about overdose, hepatitis and HIV transmission, and hepatitis A and B vaccination. Advise them of local naloxone schemes where they exist.
u When working with a drug user, consider behavioural couples therapy- NICE recommends this should be considered for people who are in close contact with a non-drug-misusing partner and who present for treatment of stimulant or opioid misuse1
u Consider whether a carer might be eligible for more structured support. Under the Carers and Disabled Children Act 2000, all carers who provide “regular and substantial care” are entitled to receive a local authority carer assessment, which should lead to a care plan and possibly access to relevant support and funding where carers meet the Fair Access to Care criteria . Some carers of people who have refused help will be eligible for an assessment. Carers also do not have to ask for an assessment; they have the right to be offered it by local services.
u If services for families are patchy in your area, campaign to improve them!
u Remember that families have the strength and expertise to deal with many of their problems but sometimes need help to recognise it!
1 National Institute for Clinical Excellence (2007) Drug misuse: Psychosocial interventions Clinical guideline 51
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