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Disrupting Standard Mode: A big picture story of family inclusion in substance use services

 

We hear a lot about patient-centred care in substance use services, but what about family-centred care? Family members are important sources of support for those accessing substance use services. However, family inclusion is not always regular or customary practice within substance use systems and services. In the midst of an unprecedented public health overdose emergency, families are vital first responders who can provide life-saving first aid and are key resources and facilitators in accessing and using substance use services.

With this in mind, Island Health and CARBC partnered to explore family involvement in out-patient substance use treatment services across youth, adult and senior’s programs. The purpose of this research project was to understand, from the perspective of Island Health service providers, the current landscape of family inclusion and what might be possibilities for increasing practitioner and organizational capacity to facilitate responsive family inclusion in substance use treatment services.

What do we mean by family and why is family inclusion important? We found that providers had a broad definition of family. Family was considered to be anyone in a person’s circle of care who contributed love, connection and closeness. Examples of family members were many and included biological relations and chosen relations such as friends, partners, neighbours, and in some cases pets. Family inclusion was described as being a necessary means of reducing consequences of substance use throughout generations, while fostering wellness for the individual accessing services and the broader family system. Families were recognized as being integral sources of support and safety for people involved with substances and vital resources beyond immediate, time-limited formal interventions.

What gets in the way of family inclusion? While we heard service providers emphasizing the importance of family inclusion, in reality working within the health care system meant operating in ‘standard mode.’ Standard mode included dominant structural values privileging individualized and predominantly biomedical service philosophies that often left families out of the picture. In spite of this, service providers described ways of disrupting standard mode and working towards family inclusion. They talked about trying to make time to support families and increasing availability by way of telephone and/or in-person connection. Providers emphasized the importance of offering compassion and presence while maintaining openness to the potentials of expanding the scope of services to involved family members.

How might family inclusion become a regular and customary practice? In order to understand how to change standard mode, we asked research participants to describe their “preferred story.”  They expressed the importance of sparking a broad societal, organization and programmatic culture shift towards family inclusion. Such a shift would include emphasizing the effects of substance use on families and the importance of mitigating ongoing intergenerational ripples of substance use impacts in families affected by substance use. An overarching culture shift would require openness and access to relational, strengths-based and capacity-focused ways of knowing and understanding substance use and working with families affected by substance use.

Read the full report to learn more about recommendations and future directions for increasing family involvement in substance use service.

For further information on this project contact Stephanie McCune at stephanie.mccune@viha.ca or Bernadette Pauly at bpauly@carbc.ca

Stephanie McCune, Manager, Practice Support Program, Island Health

Bernie Pauly, Scientist, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.

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Alcohol health promotion: not just harm reduction

Health advocates, when referring publicly to alcohol use, are inclined to emphasize ways in which it elevates risk for harms. No surprise there. Drinking more on any occasion leads to greater intoxication and increased risk of receiving and causing injury. More frequent regular use increases likelihood of eventually contracting sustained illnesses. Drinking that has become a daily routine, or involves difficulty at times in stopping, raises prospects for developing a detrimental dependence on alcohol. Formal research indicates broadly-applicable consumption thresholds for added risk, so health proponents readily advise moderate patterns of use. Canada’s low-risk alcohol drinking guidelines are one such set of recommendations in regard to maximum use on a weekly basis, on normal days, on special occasions and in certain situations.

The Alcohol Reality Check is a self-screening tool that draws on scientific study and those Canadian guidelines in particular. It provides people with an anonymous online opportunity to see, through personalized feedback, how their regular drinking pattern compares or contrasts with various levels of risk to long-term health, for immediate harms and for developing unhealthy habitual use. We believe it’s a little exercise worth doing periodically.

Encouraging people in healthier use is more than a public social marketing approach broadly exhorting adherence to behavioural guidelines. That approach carries some liabilities. One is the authoritarian air social marketing readily assumes in prescriptively telling people what they should do. By contrast, a consistent health promotion approach seeks to help those who use alcohol to better manage their own wellbeing by becoming more intentional in their drinking. A tool like the Alcohol Reality Check accomplishes more, health promotion-wise, not just by acquainting people with the guidelines, but by going beyond that to prompt reflection, affirm agency and self-efficacy, and encourage adoption of a course of action that will align with the person’s own reconsidered aspirations of wellness.

A further shortcoming to typical social marketing has to do with its isolating orientation in representing health as an individual issue and not also a collective, mutual matter: people tend to be addressed as singular entities separate from and uninfluenced by their relational connections. The framing of health as absence of personal injury or illness is also inadequate. It ignores further, positive dimensions long-recognized by the WHO’s definition of health as encompassing holistic wellness in physical, mental, social and economic respects. People, whether as individuals or in groups, drink (and some deliberately get drunk) to receive certain benefits that enhance their sense of wellbeing. Experience of pleasure, fun, is part of this.

Failure to acknowledge and address this in a way that is appreciative, even when constructively critical (e.g., asking whether there might be more advantageous ways of securing social benefits), is often an obstacle to meaningful, productive conversation that invites contemplation of change. In respectfully attending to cultural considerations for use, qualitative research confirms a real disconnect on the part of young adult drinkers with guidelines that come across as indifferent if not oblivious to common motivations for and gains derived from drinking. Compounding this deficiency is the way in which social media serves to reinforce much of this motivation (with the alcohol industry ably exploiting both this incentive and the popular mechanisms of affirming it, while narrow health messaging is often a stranger to both).

Alcohol Reality Check is not a social networking site, but Hello Sunday Morning is. Health promotion efforts like it support personal interaction and collective dialogue around how people can relate to alcohol in ways that capture benefits and not just avoid harms. While potentially necessary and quite beneficial as a vehicle of communication and an aid to discussion, a social networking platform is not sufficient for building community health. What is vital is to utilize a variety of means to engage people in conversation that helps them to collaborate in joint initiatives to manage their shared health in relation to alcohol (as in regard to other areas of opportunity and challenge in their civic life).

Tim Dyck, Research Associate, Centre for Addictions Research of BC