Staying silent

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Adfam share new research that reveals why families often struggle for a long time before seeking help with a problem drinker.

Drugs and alcohol are often grouped together in discussions of substance misuse. Although there are many crossovers, there are also some crucial differences, including the impacts on the family and how relatives go about accessing support. Family members interviewed for Adfam’s research often struggled for a long time before accessing help – many over five years, some over 20, and some never at all. The reasons behind this were numerous and complex, but at the heart of it was a difficulty in identifying what constituted an ‘alcohol problem’. This could be linked to the seeking of help by the problem drinker themselves, many of whom wait 12 years longer to access treatment than drug users. This could in turn limit their family members from accessing support too.

Although they may face their own delays in seeking support – not least because of stigma and shame – families who find out a loved one is using drugs may be quick to identify this as a problem, as an illegal activity associated with a number of health and social harms.

By contrast, the legality of alcohol, its widespread use and the societal ambivalence towards (or even celebration of) heavy drinking all mean that concerned others can struggle to classify a family member’s alcohol use as a drinking problem. This was tied up with assumptions and stereotypes of what an ‘alcoholic’ is, and an inability to match this up with their own family member.

Drinking problems can also develop gradually over time, without an obvious tipping point into dependency or alcoholism. This could be exacerbated if the drinker was able to conceal their consumption (one family member recalled finding a stash of empty cans in the attic as a moment of realisation), or if they were able more generally to maintain the pillars of a ‘normal life’ like holding down a job. ‘Tipping points’ were hard to identify, but families said that only when the drinker was unwilling or unable to cut down that the problem really came into focus.

Binge drinking was a topic of interest for families, as it represented a pattern of alcohol use that was not classed as ‘dependent’ but which could still have significant negative impacts on family life and relationships. However, according to the research, GPs and specialist services usually didn’t deem this ‘serious enough’ to warrant official intervention, and families could feel even worse for having broached the topic as it could provide support to the drinker’s claims that there was no problem with their consumption.

Even when trying to open up to friends, families could find themselves in a catch-22: if they focused on the level of consumption alone, then they struggled to get their point across as to how serious things had become; but if they focused on the behaviours associated with their loved one’s drinking – arguments, fights, car crashes, incontinence – then they risked horror, incomprehension and stigma from those around them.

Some family members also showed a lack of awareness of their own needs, and many assumed that getting help for the drinker was the only issue at hand. Even for those who did feel they needed support, they often didn’t know it was available or were doubtful that it would do any good; families were again quite critical of GPs and specialist services, and examples of being signposted towards support were few and far between. These were crucial missed opportunities not just to engage families, but to engage drinkers too.

For the families interviewed who did access support, feedback was generally very positive – they viewed it as a ‘lifeline’ and a ‘godsend’, and valued the opportunity to explore their problems in a non-judgmental environment. However, the range of support tended to be limited to self-help groups, where not all families felt comfortable, or more focused on drug use than alcohol.

Overall, this research shows that families affected by a loved one’s drinking seem beset on all sides by barriers which prevent them from accessing support. They may not have the knowledge to identify a drinking problem in the first place; they don’t always recognise the impact it has on them, and their own consequent needs; they’re often unaware of the existence of family support, or sceptical of the benefits it could bring; and their first step in reaching out may not be a positive one and knock them back even further.

As well as improving the reactions of professionals to families’ queries, there is also a need for families themselves to increase their comprehension of problematic alcohol use so they feel confident and motivated to seek support when they feel that they need it. Perhaps the government’s current focus on the widespread, cheap availability of alcohol may make people confront how much they drink in ways we haven’t seen before, although this remains to be seen; but either way, there is a clear need for expansion and improvement in the number and quality of services which support people struggling with the day-to-day impact of alcohol use in their family.

Out of focus: how families are affected by problem drinking, and how they seek support available from www.adfam.org.uk. 

This article is from the latest issue of Families UpFront, Adfam’s quarterly magazine for professionals working with families affected by drug and alcohol use, which covers important policy developments, the latest good practice news and key issues in family support. For online and print subscriptions visit www.adfam.org.uk or email publications@adfam.org.uk.