Post-its from Practice:
Remembering the family in its own right (Apr 2010)
I first met 44 year old Angela a few months ago in the emergency surgery. I saw from her notes that she was a frequent attendee usually with low grade "stress" and chronic chest problems. She advised me that she thought she had another chest infection. I asked her how many cigarettes she smoked and whether she smoked anything except tobacco. She stopped and thought for a moment and said no, but her son did - he smoked that horrible smelling stuff (crack).
Angela then poured her heart out. Her oldest son David, aged 23, still lives at home. He lost his job due to absenteeism about six months ago and since then has spent most of his time smoking crack. He hasn't signed on and either Angela was paying for his drugs or he was stealing to pay for his habit. Her younger son, Alan, aged 21, moved away partly for work but mainly to get away from his brother. David has been smoking crack for several years but has always refused treatment.
Angela had always tried to support him; twice she even took him to a drug service. She tries hard not to give him money and to get him to sign on but she worries about him going to jail. She mentioned that their father was alcohol dependent and had left the family when the boys were young. She had reached her lowest point only two days previously when returning from a lovely week's break with Alan and his wife, when she had found David had sold her prized laptop which she had saved for a year to buy. Her stress and smoking had increased which had brought her to the surgery.
I let her talk about how she blamed herself - in her eyes she thought his problems had to be a result of his childhood. She was torn as to what to do, especially in terms of money, but she knew that "enabling" him to use crack was also not the answer. We are very fortunate to have an excellent family therapy service nearby. However she declined this, Families Anonymous and all other outside help; I think mainly because of her feelings of shame. We talked some more and she agreed to return. After a few short sessions she said she felt better. She felt heard and was able to see that the best way to support David was by giving him clear boundaries and a firm recommendation that he finds his own flat.
David has now got his own bed-sit and has attended the local open access service. He came to see me to thank me for helping his mother. He is still smoking daily but he has started a back-to-work scheme and feels much better.
Addiction of all sorts is a family disease. When one or more members of a family are using substances or being troubled by another addiction, the whole family is affected. As GPs, I feel we are uniquely placed to manage the individual addictions and support the family unit. And as Adfam's manifesto for families states: families need support in their own right (Ref 1). I feel certain Angela's attendances at the surgery will now decrease and she will be able move forward for herself and continue to love, yet not enable, her son.
1. Adfam's manifesto for families 5 key challenges for supporting families affected by drugs and alcohol use Adfam 2010