Drug and alcohol services - improving holistic family support

7. Whole Family Approaches, increasing access, tackling abuse and reducing stigma

"Given that domestic abuse often intersects with substance use, professionals must be adequately trained in the complex interaction of these issues in order to avoid the tendency to prioritise addressing a perpetrator's substance use over their coercive control and abusive behaviours."

(Safe and Together Institute 2010)

This section expands on section 4 and includes:

• Barriers which can be experienced by women in particular
• The need for ongoing support for those involved in the child protection system and/or who have lost children to care
• Intersectionality of Domestic Abuse, Alcohol and drug use and Mental Wellbeing
• Exploitative and abusive familial relationships
• The safe and together model
• A continuum of support from easy access community based support for women, to residential rehab for women and children
• Whole family support workforce development on trauma, loss and grief to ensure effective support to women who are in most need and may be at most risk

7.1 Women in particular with needs relating to alcohol and drug use can face barriers that impede them from entering into treatment and recovery programmes. Such barriers include the lack of childcare, fear of stigma, lack of family or financial support, living in abusive, exploitative relationships and experience of multiple and complex needs. These barriers can intersect in complex ways. For example, abusive partners may interfere with treatment and recovery and the role of fathers who use substances may be less visible compared with mothers.

7.2 Family demands prevent many women who use substances from seeking or completing treatment. Women may not have adequate resources to care for children or other family members for whom they are responsible. They may fear that if they admit to having an alcohol and drug problem, their children will be removed from their care.

7.3 Women entering substance use treatment and recovery can often have survived child sexual abuse or other forms of interpersonal violence such as domestic abuse, sexual harassment and exploitation. The clear links and intersectionality between substance use, domestic abuse and mental ill-health as well as the ability of perpetrators to influence services to focus on perceived deficits of women as mothers, which can work in a siloed or fragmented way, is an area of challenge in delivering effective and safe whole family approaches and working to family inclusive practice. Domestic abuse, as a form of trauma, has unique aspects to it. Often practice around trauma can focus on past experiences, but domestic abuse perpetrators may have a continued presence in the lives of their adult and child survivors.

7.4 To ensure effective whole family approaches, we all need to acknowledge that some family members may also be harming their partner and children. This creates a specific set of challenges when working with the family. Many Local Authority areas in Scotland have adopted The Safe & Together Model designed to help practitioners and systems become domestic abuse informed. A detailed description of this model and approach is described in the supporting document from the Safe and Together Institute: Intersections - Where Domestic Violence, Substance Abuse and Mental Health Meet and focusses on the need for workforce training, knowledge and skills in identifying coercive, controlling and, exploitative behaviour from perpetrators of abuse and described the need to manage risks as well as benefits of a whole family approach.

"My Support Day to me is a safe place that you can vent your feelings without being judged. It's amazing the difference I feel in the matter of weeks."

(Family member, My Support Day)

7.5 Women's access to substance use services can be hindered by violence and stigma. Women can face greater stigma based on alcohol and drug use than men, and women fear disclosing drug use because of the risk of stigma and social sanctions^[33]. This can have direct consequences on the ability and willingness of women to access services.

7.6 Inclusive trauma-informed services which have a focus on family, support with childcare, relationships and practical supports to overcome issues such as poverty, poor housing and promote educational and employment opportunities, such as those very often designed into whole family approaches, may make the possibility of reduced stigmatisation and improved for access for women in particular. This needs to include a broad repertoire and alliance of services from community based, easy access services for women – all the way through to intensive residential support for women, including those who have a parenting responsibility and wish to have continuity of care for children whilst receiving support. Trauma-informed substance use services for men should also consider their role as a parent and, where relevant, their use of coercive control.

7.7 Women who have been involved in child protection and/or legal procedures and who have lost the care of their children have particular vulnerabilities, risks and needs that require sensitive, trauma-informed support. There are widely shared concerns^[34] that these women, alongside other family member's needs, can be ignored or overlooked as the focus shifts to the alternative care of children. These women can be at high risk of self-harm, suicide, overdose and significant emotional impact associated with their experience. Whole Family Approaches, specialist services and mainstream statutory providers need to make sure that particular care is taken to ensure these women's needs are designed into their service responses and comprehensive help and support given to overcome the trauma and loss that they often experience which may leave them at increased risk.