Visions Journal

Stephanie McCune, RCC, PhD

Reprinted from the Families, Friends and Substance Use issue of Visions Journal, 2024, 19 (2), pp. 8-10

Many families have described the experience of loving a family member involved with substances as being like a roller coaster ride.¹ Family members grip with each bend, curve, dip and peak, often impacted by uncertainty, afraid for what might come and holding on to hope for where it might go.

Families are an integral support system for a loved one involved with substances. I have learned from my research and practice that families often hold important understandings of past and present, essential insider expertise and deep investments in the long-term well-being of their loved ones. Within the enduring and escalating drug poisoning catastrophe, families have become first responders, social justice advocates and critical links to harm reduction resources, treatment pathways and care. 

Despite their importance, family members are not always recognized and engaged as core team members in a loved one’s care. Nor do they always have access to the resources they need to support their own health and longevity as carers. 

Hitting walls

Families often describe encountering walls and barriers when accessing resources for, and alongside, a loved one involved with substances. Through my research and conversations with families, I have come to understand these walls as structures of stigma built on a complex foundation that includes:

• politically-informed drug legislation, including criminalization of people who use drugs
• individualistic biomedical treatment approaches 
• inaccessible and expensive resource pathways, including privatized treatment programs

Walls can feel immovable when society narrowly defines who is family and highlights treatment approaches that centre the individual using substances but ignore the richer context around the person (including family). The result? Family well-being suffers. When walls feel impenetrable, families are at increased risk of distress affecting mental and physical well-being, financial hardship, isolation and secrecy.

A way through for families

To begin dismantling these walls, we need a broader, relational definition of family. This definition is shaped by social, cultural and political norms and lenses. Such lenses influence ideas about who:

• who is family 
• who might help a loved one 
• who is recognized as impacted by substance use
• who might hold needed resources or could benefit from services in their own right, regardless of whether their loved one is accessing these

A narrow lens based solely on biological relations overlooks the influence of others who play caring roles in an individual’s daily—and pivotal—life experiences.²

We must understand family as a wide circle that includes both biological and chosen family. Family can be the people in a loved one’s circle of care who contribute love, connection and closeness. To name a few, families can include loved ones in parenting roles, siblings, aunties, uncles, Elders, children, street sisters/brothers/parents and even pets. 

By advocating for recognition of broader circles of support, those named as family can be more easily identified as important contributors to care. They can then play a role in service provision. Finally, they can be supported as essential experts in their loved one’s lives, engaged in treatment efforts and acknowledged for the impacts of caring for a loved one involved with substances.

Updating standard practice

Family inclusion in substance use systems of care must become standard practice. Involving families in substance use services can contribute to positive outcomes for the individual using substances and the family system as a whole. Including families in early treatment interventions can impact loved ones by increasing engagement in substance use programming, contributing to higher program completion rates and reducing rates of relapse.^3,4

However, the term family inclusion is highly nuanced. For it to become standard practice requires organizational commitments to broad cultural shifts. Such shifts would mean expanding from individualistic practices to a wider “relationship-centred” and “withness” lens that sees and seeks  families as their loved ones access care.⁴ Through a withness and relationship-centred lens, families are upheld as insider experts with strengths, knowledge, needs and hopes. In the Sidebar, I describe ways we can put this approach into practice.

Family inclusion is a necessary means to foster wellness for loved ones accessing services. Inclusion helps with resourcing authentic sources of support and safety (e.g., making interventions more accessible, available and culturally meaningful, with therapeutic, family-specific support groups). Family inclusion also proactively addresses the intergenerational impacts of substance use (e.g., exposure to fatal and non-fatal drug poisoning).

Help for carers

Enduring the roller coaster of loving a person involved with substances can have a significant impact on families. Families must have access to services in their own right. They are a distinct population that needs acknowledgement, resources and assistance. 

In my work I have learned from families the invaluable impact of connecting with others, including formal helping professionals and people with living experience. When families engage with others who “get it,” accept and authentically care, a pathway opens to substantial emotional release. Family members experience a safe, meaningful way to receive non-judgment, encouragement and recognition. Holding Hope Canada (holdinghopecanada.org) offers family-centred group resources that foster connection and allow for sharing at any point in a family’s experience of caring for a loved one involved with substances.

Families often need to be heard in their experiences of stress, fear and anxiety. They need to tell their stories and be received with compassion and non-judgment. Efforts to engage families are critical in disrupting stigma and enduring effects from isolation. When family members are heard, without directives or advice, families can be valued for their unique ideas, wishes, beliefs and responses to substance use. Spaces, places, offices and offerings for families to address the impacts of substance use are a necessary component of a robust system of care that positively enhances capacity, ability and resilience.

Bringing families in

For many families, the reality of the roller coaster can be ongoing. However, with family-informed, relevant and accessible support, families can get help to hold on—and hang on to hopefulness. They sense they will have the capacity to react and respond at each point. For me, this has often come through powerful moments of connection and care held by people with shared experiences, To be seen, heard and recognized as mattering is the medicine to the suffering that all too often comes from isolation.

I cannot overstate the importance of a broad cultural shift towards family inclusion. Organizations, programs and direct service experiences should centre relational, strengths-based and capacity-focused ways of working with, and alongside, those in family roles. Families affected by substance use must be viewed as insider experts, invaluable carers and voices to be heard.

Related Resources

The shift towards making families “insider experts” and adopting a relationship-centred approach to drug treatment and support could include the following concrete steps:  

• publicly-funded access to family and couples counselling
• publicly-funded and supported outreach to family homes 
• programs for children affected by substance use, including fatal and non-fatal drug poisonings
• publicly-funded, family-informed treatment programs, including aftercare and post-treatment support
• individual and group counselling for family members impacted by substance use
• follow-up with people and loved ones after non-fatal drug poisoning events, including hospitalizations
• access to culturally-informed, harm reduction–based and trauma-informed programs that centre diverse perspectives on substance use 
• family-centred policies that address barriers in the areas of funding, consent, confidentiality, transportation, childcare, hours of operation and program philosophies, to name a few