The Family Support Program 2004

paper by Frances Beek, Castle Craig Nederland's Director 2004

Presented at the conference of the International Council on Alcohol and Addictions (ICAA)
Venice October 31 – November 05 2004

Introduction

Alcoholism and drug addiction often affect not just the patient but also those who are close such as family and friends. This may build up over a period of years and it is a gradual process. It is not always easy for the family to understand that they themselves need help and would benefit from some assistance.
UK estimates suggest that about 6 million people drink above the recommended daily guidelines with almost two million drinking at harmful levels (Prime ministers strategy Unit 2004) Evidence also suggests that there are about 4 million users of illicit drugs in the UK, about a quarter of them will go on to have problems associated with their drug use Assuming that each substance misuser will negatively affect on average at least two close family members, there are believed to be many millions of family members who are affected as a result of the problematic alcohol or drug use of a relative. It is also safe to assume that this is a somewhat conservative estimate and that the number of family members is in fact far greater. The experiences and needs of these family members have been well documented, unfortunately service provision remains limited. (Vellerman & Templeton, 2003)

Families Plus – An Evaluation

For over the last 15 years a number of new family treatment approaches have been developed, particularly in the USA, Australia and the UK. One theory to understand and predict changes in family members functioning is the stress – strain – coping – support – model. This theory has been developed by a group of clinicians and researchers in the UK, associated with the Alcohol, Drug and Family Interest Group. Recently, the service Families Plus which is part of a residential treatment centre, “Clouds”, has in conjunction with the Bath University and a NHS trust evaluated their program based on this perspective. Families Plus offers a range of services similar to Castle Craig, like couples and family counselling, support groups and residential family programs.

ADF model (Zohhadi, Templeton & Vellerman, 2004)
The theory suggests that:

• Living in a family where someone misuses alcohol or drugs is stressful
• This stress leads to strain. Family members who live with a substance misuser will show signs of “strain”, physical and psychological ill-health
• The amount of strain is influenced by two key factors: coping and social support
• coping: family members will try all manner of things to try to cope with or respond to their situation. Some forms of coping or responding are more likely to reduce strain, whereas others are more likely to increase it.
• support: Similarly, family members will also have differing levels and quality of social support, and support is more helpful to a family member will again lead to reduced strain at any given level of stress.

This than means that there are two ways of reducing strain (i.e. physical and psychological symptoms)

• One is to reduce the stress (i.e. the family member becomes more successful in dealing with the problem)
• The other is to alter one or both of the mediating factors of coping and support

Results of this study learned that the family members showed a high need for support and understanding of the situation. Almost all changes between baseline data and follow up data were shown to be in the right or hoped for direction. The participants showed that they felt their situation and their attitudes to the situation had changed. A widely positive aspect they felt, is the contact with other family members. Family members received support, guidance and understanding and were able to make these changes. A change of symptoms (guilt – stress) would not be seen unless there was also a previous change in coping or support.

The evidence suggests then that the strain from any given stress is mediated by coping and support and hence strain will not change unless coping or support changes first, and that if coping or support changes, then later this will have a knock on the effect of symptoms (physical and psychological ill-health).

The Family Support Program at Castle Craig

Over the past twenty years the staff of Castle Craig Hospital in Scotland have found that helping relatives can also significantly help the patients to make greater strides in their progress of their own recovery from alcoholism or drug addiction.
It may happen that those who are close to the patient are able to gain some understanding and insight well before the patient does. This is a considerable advantage and can greatly help the patient come to the realisation that they need help and also to enhance the motivation of the patient to seek treatment.

At Castle Craig chemical dependency is viewed as an illness that affects the whole family and as such Castle Craig provides a programme of counselling and education for family members. A lot of the close relatives are relieved to hear we offer a program for them as well. Large numbers of families are suffering in silence.

The family support programme offers the following 3 elements:

One element is conjoint family therapy. Each patient has a focal therapist and they will normally arrange counselling sessions between the patient and the family members. During the family therapy sessions there is an opportunity to explore patterns in the family system, which can prevent recovery and this therapy assists in identifying where change can occur in order to avoid relapse and to improve the quality of the recovery. This is to help them to understand the disease of addiction and its effect on the family. It also helps them to learn how to best support someone recovering from addictions.

The next element is the weekend programme. This takes place on Sunday afternoons at the hospital and it is an opportunity for the family, not only to visit, but also to participate in therapeutic activities and provides an introduction to the self-help groups ALANON and families anonymous. They are invaluable resources for families of the recovering person. We strongly encourage the family members during their visit to take part in the self help groups and experience them themselves.

The introduction of the first residential Family Program in The Netherlands
The final element and the subject of this paper is the Castle Craig Nederland residential family programme which takes place in the Netherlands.
For many years the hospital has been treating Dutch patients and now offers counselling and aftercare for these patients in the Netherlands through her associate company Castle Craig Nederland. This year Castle Craig Nederland has introduced the 3 day residential family program in The Netherlands, in con-junction with The Mirage Unit which is part of the Parnassia clinic, a major institution in mental health field in the Netherlands. Mirage is the first unit in the Netherlands, which has incorporated a 12 step abstinent based model into their treatment program.

Goals of the program are:

• To receive education through lectures and therapy
• To learn about alcohol dependence and other substance use disorders. A doctor specializing in addictions will provide a lecture about the physiological aspects of alcohol and drug misuse
• To receive education on the family dynamics of addiction

If a family member is dependent, the whole family, in an attempt to restore the balance within the family, will take up a certain role. We let the family member explore which role they have been adapting.

• To identify and explore behaviours and attitudes that may hinder or enhance the recovery process.
• To learn how to “detach with love” and define their personal boundaries.
• Benefit from the professional support of qualified staff and the support of programme participants.
• Are introduced to Al Anon and/or Families Anonymous groups.

How do we reach these goals?

The 3 day residential programme is facilitated by experienced therapists who help the participants deal with issues associated with having a chemically dependent family member. The participants take part in group discussions led by therapists, lectures and educational video’s and educational sessions on the 12 steps and related topics We stress that confidentiality is of the utmost importance. It enables everyone participating to share openly and honestly and we stress that participants do not discuss anything shared by others in this programme with those not attending. We provide a literature pack and the lectures and literature will be regarding topics as
Alcoholism – a merry go round, letting go of the need to control, the disease of alcoholism, co-dependency, effective Communication

Treatment Plan

The first day we discuss with the participants their very own treatment plan. It involves 4 aspects;

1. The three C’s. Gaining acceptance that they:
   1. do not cause addiction
   2. cannot control addiction
   3. cannot cure addiction
2. Goal: To find out who you are, what your wants and needs are and how to meet them.
3. Gaining and understanding of the disease of addiction.
4. Accepting that people are responsible for their own recovery.

During these three days they will learn some of the fundamental principles to apply in order to constructively cope with the illness of alcohol and drug dependency. The emphasis will be on “detachment” – i.e. distancing one self in a compassionate way from the pathological behaviours of active addiction, acceptance of their own inability to change a loved ones drinking or drug using behaviour and exploring new creative alternatives which can enhance their own quality of life.

Evaluation Dutch program

We offer this residential program on a two monthly basis and to date we have run in total two courses, with in total 23 participants
At the end of the program we ask them to fill in a questionnaire and it summarizes as follows.

Q1- which lecture was the most helpful?
The participants showed that they benefited the most from the personal stories and from the lecture and discussion around co-dependency and “detachment”. Next in line was the lecture regarding: getting insight into the family roles they had adapted in order to cope with the situation.

Q2- Did group therapy help you?
From the 23 participants 19 expressed yes and 3 said no.
Comments as:
“the compassion of other members and sharing the problems at home””.
“this was my first group therapy experience. Fantastic that everybody is so open to this!”
“the message is getting clearer and clearer”

Q3- How did the program benefit you?
We got the following remarks:
“further developing the concept of “letting go of my daughters problem”
“insight in myself and the disease concept”
“I do understand I need to develop this further through f.e. Alanon”
“more insight into the family dynamics”
“ a lot of recognition and comfort”
“that I am not as cool as I thought I was, I also have emotions”

The participants were overall very positive about the program and clearly appreciated and benefited from the help that they received. They felt less alone and that they were listened to. The answered questionnaires demonstrated that the family members showed a high need for support and understanding of the situation. A widely positive aspect they felt was the contact with other family members. Much of the experience described by the UK study seems to be similar to what our Dutch families describe. This coincides with previous research in which was demonstrated hat many of the experiences by families when there is a drinking problem seems to be universal. (Orford et al, 1999, 2001)

Finally, one true story which demonstrates the change of behaviours and coping within a family:

A young alcohol dependent lady had left treatment and after a few weeks she started relapsing Her parents had attended the family program. The way the parents coped with the situation had drastically changed.

Before she entered treatment we had talked to the parents numerous of times. They were anxious and wanted to know what they could do to fix the situation.

After they had attended the family program course, they said to their daughter: “yes sweetheart, we understand but you need to call your therapist.” And they let her get on with it, and attended their own ALANON meeting, thus taking care of their own needs first. Their daughter was baffled by this new behaviour, she told me, she couldn’t manipulate them and finally she understood she needed to go back into treatment, which she did.

Future perspective

Although Castle Craig Hospital has many years of experience in treating families, the Dutch Family Program is still very young. I do believe that we are already contributing in a positive way to our Dutch families. It is my hope to see more Dutch families receive treatment and find support programs.
Few such services exist and for that it is vital to evaluate these services, maximizing their potential and demonstrating their need and effectiveness. In a few years we will evaluate our Dutch program.