Launched on 4 April 2007, the report of research by the National Advisory Committee on Drugs (NACD) supports the inclusion of the families of heroin users in the overall treatment response. The main goal of this study by Duggan1 was to develop a greater understanding of the ways in which families, and in particular primary carers, seek support in coping with heroin use in their families. The research also examined carers’ expectations and perceptions of the effectiveness of the support provided. 

The research used in-depth interviews with the primary carer, in most cases a parent, and usually the mother, in 30 families coping with heroin use. These were augmented by interviews with another family member in the case of seven families. The families were accessed through existing family support groups. 

Coping with heroin use in the family

The study identified seven different stages of families’ engagement with heroin use in their family. The overall direction of this process was from powerlessness to empowerment. The different stages were:  

1. Ignorance, confusion and denial
2. Coping alone
3. Desperately seeking help
4. Learning about heroin use and getting personal support
5. Supporting non-heroin-using family members
6. Supporting the heroin user in recovery
7. Supporting the community response to heroin use

 Seeking help to cope with heroin use in the family

Three specific ways of interacting with services were identified, reflecting three different roles that families occupied. These were: 

·            As victims: non-heroin-using family members sought support for themselves in coping with the problems experienced due to heroin use in the family.  

·            As carers: families, particularly the primary carers, sought support for the heroin user.

·            As agents of recovery: families sought to support the user into recovery and address their own needs as a family. 

Experiences of generic health services

Hospitals were complimented on their responses to the crisis needs of drug users, their children and other family members. However, interviewees reported that hospitals were poor in providing follow-up support or information on referral to support services. 

Interviewees reported that general practitioners were often the first point of contact for family members seeking help. Responses from GPs varied, with some being of little assistance and others giving valuable information and advice to family members and, often, the heroin user. These responses demonstrate the need for standardised protocols governing the provision of information and support to families seeking help with heroin use through their GPs. 

Experiences of the criminal justice system

Families reported their contact with the criminal justice system to be ongoing and generally favourable. Gardaí in rural areas and judges were seen as sympathetic. The probation service was complimented for its constant and effective support for both the heroin user and the family. 

Experiences with specialist drug services

Drug counsellors were considered helpful and effective for both the heroin user and the family. Treatment centres were acknowledged for treating the user, but the effectiveness of the treatment was not always evident to the families. In addition, there was a perception among family members that treatment centres did not favour including the family in the treatment process and often maintained a distance from the family. 

Families acknowledged the role played by methadone treatment in reducing anti-social behaviour among heroin users. However, in general, families were critical of methadone treatment services and were of the view that not enough information was provided about the implications of going on methadone. Families criticised the absence of alternative treatments and expressed the view that methadone maintenance programmes were not conducive to progression to abstinence and reintegration. 

Community Drug Teams (CDTs) were highly regarded by those who reported contact with them; however, the view was expressed that CDTs should be available for longer hours and at weekends. Family support groups were also highly rated by families; contact with these groups often marked a turning point in empowering the families to respond to heroin use in their family. 

Barriers to accessing support

The stereotypical view of heroin use as a problem primarily associated with urban disadvantage often meant that rural families were slow to recognise the problem in their own families and less inclined to accept the problem as something prevalent in their communities. 

When initially faced with the problem of heroin use by a family member, families often experienced shame and denial due to the perceived social stigma that surrounds heroin use. This had implications for the speed with which they sought help from external sources. 

At almost every stage of coping with the problem of heroin use, family members were confronted with a lack of information on the type of help they needed, where they could access it and how they could assess its effectiveness. 

This is an important and relevant piece of research as it identifies both the difficulties experienced by families seeking to cope with heroin use and access services and the positive role that families can play in the treatment of the heroin user. Clearly, families need better information and support when confronted with heroin use in their family. Also, specialist drug treatment providers, including general practitioners, need to consider the role that families can play in the treatment plans of clients. 

Report’s key recommendations to policy makers and practitioners

·            Recognise, value and resource the role of peer-led family support groups in assisting families in coping with heroin use.

·            Deploy specialist personnel at local level to provide ongoing support to drug users and ongoing liaison with their families.

·            Establish formal links between family support groups and drug treatment specialist personnel.

·            All generic service providers should develop codes of practice in relation to information provision to families affected by heroin use.

·            Acknowledge, in policy and practice, the spatial and social diversity of heroin use. 

1. Duggan C (2007) The experiences of families seeking support in coping with heroin use. Dublin: Stationery Office.