3 rd International Conference on Therapeutic Jurisprudence

Transcription

1 3 rd International Conference on Therapeutic Jurisprudence 7-9 June 2006, Perth, Western Australia Session 4D SUPPORTING THE FAMILY AND ENHANCING DRUG COURT PARTICIPANT OUTCOMES THROUGH THE ROLE OF THE PARENT DRUG INFORMATION SERVICE IN THE PERTH DRUG COURT Heather Jacobson

2 Supporting the family and enhancing drug court participant outcomes through the role of the Parent Drug Information Service in the Perth Drug Court Heather Jacobson, PDIS Coordinator Introduction In a recent lecture at The Thomas Cooley Law School, Wexler (2005) states, One of the things therapeutic jurisprudence tries to do is look carefully at promising literature from psychology, psychiatry, clinical behavioural sciences, criminology and social work to see whether those insights can be incorporated or brought into the legal system. The Perth Drug Court and the Parent Drug Information Service (PDIS) Volunteer Support Network have forged a successful working partnership. This collaboration has brought together the law along with alcohol and other drug (AOD) practice and research in order to ease the distress experienced by the families of drug court participants and encourage them to seek AOD services for themselves. An added advantage of this type of intervention may include enhanced treatment outcomes for drug court participants. This paper will explore the research evidence from the AOD field in relation to the families of drug users. It will describe the Parent Drug Information Service (PDIS) and the unique partnership with the Perth Drug Court then consider how the AOD research evidence is currently applied in this drug court setting. Finally, some suggestions will be made as to how this evidence could be further creatively utilised in order to enhance the court s aims. The AOD field s early responses to the families of drug users Historically the AOD field has treated the drug user s family (as well as the individual user) as pathological. Traditional family theories blamed the family for the cause, development and continuation of the drug problem and later theories tended to focus on the family member s psychopathology as a contributing factor (2000, FSP Vision paper). It wasn t until the mid 70s that several studies began to demonstrate a link between positive treatment outcomes and family and marital relationships (Orford et al, 1975; Orford and Edwards, 1977). Despite the recognition of the families importance in AOD treatment, Orford s early research and the fact that although drug users personal relationships often become strained, most still live within social networks such as the immediate family parents, partners and/or children

3 (Velleman et al, 1993), the field still focussed primarily on the individual drug user. Therefore families did not feature significantly in AOD treatment services. A further result of this focus on the individual was that service funding resources and contracts emphasised outcomes aimed at reducing individual drug use, rather than engaging or supporting the family members (Hamilton, 1994). There was also a lack of research into the impact that having a problematic drug user in the family had on its members (Velleman, Templeton and Copello, 1993). The families experience of living with a drug user Orford (1994) in his article Empowering family and friends: a new approach to the secondary prevention of addiction who began to suggest that considering the family of drug users was important for two main reasons. (1) That family members are experiencing problems that warrant intervention in their own right, and (2) involving family members in a user s treatment could assist with better outcomes. Current research such as Butler and Bauld s (2005) in their paper The Parents Experience: coping with drug use in the family clearly documents the complete disruption, irrevocable changes and stress in the lives of family members. The AOD field now recognises that drug use creates problems for families in four main areas: Physical and psychological health (due to the stress involved in living with a drug using relative); Family relationships (the extreme stress can destabilise other family relationships and interactions); Finance and employment (families often support users by paying debts and looking after their grand children as well as having property stolen and/or damaged); Social life (families may curtail outside activities because they have no energy left for themselves or they feel embarrassed or fearful of leaving the house). (Supporting families and carers of drug users, a review, 2002). In terms of parents physical and psychological health, many will experience serious mental health problems as a result of living with a drug user. These problems are understood as being primarily reactive responses to extreme distress as the symptoms begin to resolve as the situation with the drug user improves (Toumbourou, Blyth, Bamberg and Forer, 2001). A result of parents experiencing extreme distress is, however, that their ability to effectively respond to their son or daughter s drug problems is severely compromised. The reality for most family members is that they swing from one unsatisfactory position to another; they try one method of coping with what is often an intolerable

4 situation, and then reject that method as not working and try another. Even those who do not swing so violently and attempt to be consistent have the problem of knowing what to be consistent about (Toumbourou, Blyth, Bamberg and Forer, 2001:301). Involving families in users treatment AOD research and clinical practice has demonstrated that family members who become involved and informed regarding AOD treatment issues can begin to experience a reduction in their stress levels (The Family Sensitive Practice Development Project, 2000). As a result of decreased stress, they are more likely to experience improved relationships within the family, between themselves and the user and themselves and the AOD treatment staff. This can eventually lead to positive and consistent family support of the user and the treatment process/staff. The family plays a key part in both preventing and intervening with substance use and misuse the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people (Velleman, Templeton & Copello, 2005:93). Copello, Velleman and Templeton (2005) reviewed the evidence of familyfocussed interventions and broadly categorized them into three areas: (1) working with family members with the primary aim of motivating their using relative to seek treatment; (2) working with the family and the user to facilitate the user s treatment; and (3) working with the family as clients in their own right. The first approach of working with family members with the primary goal of motivating their using relative to seek treatment, aims to change the behaviours of family members in order to influence the user to seek treatment. It also has the additional benefit of reducing the family s stress and increasing their ability to cope, which also influences the user s experience. This type of intervention is supported by research evidence (Szapocznik, Perez-Vidal and Brickman, 1988 and Liddle, 2004). The second approach of working with the family and the user to facilitate the user s treatment builds upon the first and aims to change the users drug taking behaviour and reduce levels of consumption and associated problems. Copello, Velleman and Templeton (2005) noted that despite problems inherent in the research studies making it difficult to draw conclusive results, all the treatments that were reviewed resulted in either equal or usually better outcomes than approaches that do not involve the substance misuser s family (p 375).

5 In the third approach of working with the family as clients in their own right, the family is the primary focus of the intervention. Again, although the studies reviewed in this area suffered from some methodological problems, the results suggest that family symptoms of stress, depression and other psychological problems can be reduced following relatively brief family member-focused interventions (Copello, Velleman and Templeton, 2005: 379). Copello, Templeton and Velleman (2006) have also reviewed family studies over the past 12 months and found that some recent interventions have included a focus on a user s social networks. An increasingly robust evidence base supports family-focussed and social network-focussed interventions in substance misuse treatment. Recent studies have continued to show that family and network approaches either match or improve outcomes when compared with individual interventions (p 271). Although the AOD field has made significant changes in the way it responds to families of drug users, Copello, Velleman and Templeton (2005) caution that there is still a major challenge ahead; that of routinely implementing family approaches into service provision. They believe that these changes should not be left solely to the treatment agencies. Policy makers and commissioners of services need to clearly recognize that the evidence suggests a move away from individualistic approaches towards the ones more grounded within people s social context and social networks. They, too, have a responsibility to support and encourage services to shift from their individualistic stance towards a more socially inclusive provision (Copello, Templeton & Velleman, 2005, p. 275). The Western Australian AOD field Western Australian AOD treatment agencies have a long history of providing a range of services to family members of drug users. These services include individual and group counselling programs for parents and significant others, partners and children. This trend was further consolidated in the WA Strategy Against Drug Abuse Plan where family support was given high priority and family services were significantly enhanced. In 1998, the WA Drug Abuse Strategy Office (WADASO) conducted its own research into the major issues faced by families impacted by a relative s drug use. The families interviewed reported a number of concerns. From their point of view, there appeared to be a lack of information and adequate support from professional services; they felt isolated and disempowered and they wanted greater involvement in youth

6 drug use prevention and treatment. It was also noted that similar feedback had been reported in other Australian states (Hands, 1998). This evidence, together with other family systems and research studies in the AOD area, supported a move toward a more holistic, family inclusive approach and informed the second WA Strategy Against Drug Abuse Action Plan ( ). Working in Partnership with Parents was a key initiative of this plan and aimed to provide continuous improvement to the government s own and contracted AOD services. Two inter-related projects funded under this strategy were (1) the appointment of a project officer to the Parent Drug Information Service (PDIS) and (2) the development of a Family Sensitive Practice project. Prior to the appointment of the PDIS project officer, PDIS provided a 24 hour, 7 days a week professional telephone counselling, information, referral and support service in order to address the needs of families impacted by the drug use of a child/relative. The project officer s role was to develop an additional volunteer support network which would provide parent-to-parent support to families and thus enhance the work already being carried out by the professional PDIS counsellors (FSP Vision Paper, 2000). The primary criterion for becoming a PDIS parent volunteer was that these parents had been through their own experience of living with a drug using son or daughter. This meant that family members accessing PDIS could choose to seek support from a professional AOD counsellor, an experienced and trained parent volunteer, or both. The aim of the FSP project was to promote best practice in AOD agencies that supported families of drug users through the use of the FSP framework and principles. FSP, compared to traditional AOD approaches, focuses on family s coping strategies and strengths rather than looking at causes and pathology. It is a systemic approach which acknowledges that the drug user is one member of a larger family system and each member s actions and reactions impact upon each other. The Perth Drug Court and PDIS partnership The WA Strategy Against Drug Abuse Plan, responsible for enhancing AOD services to families of drug users, also included a comprehensive diversion strategy. The then Department of Justice and WA Drug Abuse Strategy Office formed a partnership to initiate a drug court pilot in the Perth Magistrates Court. The pilot program was launched in December 2000 with the aims of (1) reducing recidivism and rearrest rates; (2) reducing substance abuse; (3) reducing imprisonment rates of drug users; (4) reducing post treatment supervision requirements; (5) reducing the

7 costs incurred by the government and the community; and (6) improving participants life circumstances. The first Drug Court magistrate, Julie Wager, had witnessed initially as a lawyer, then as a magistrate, the visible bewilderment and distress displayed by many family members in the court. Family members are not formally involved in the drug court proceedings and until the PDIS parent support was established, there was no court-related support available for families. Family members also cannot access the services of the Victim Mediation Unit (unless they have formally charged their relative) despite the fact that, as a PDIS parent volunteer pointed out, families have been victims of their relatives drug use long before it came to the attention of the courts. A family member s experience of distress could be further compounded if, for example, the drug court participant s lawyer was instructed not to speak to family members. Therefore the stress, confusion and isolation those family members were likely to be already experiencing would in all probability be reinforced. It was through the vision of Magistrate Julie Wager who quickly realised that the holistic approach advocated by the proponents of the Drug Court must include support for family members, if they themselves are to be a supportive factor in the participant s treatment regime (Alcock, 2003:14). Magistrate Wager and Lynton Piggott, manager of the Court Assessment and Treatment Service (CATS), approached the PDIS Project Officer in order to discuss the type of support PDIS could offer. It was agreed that the most appropriate family intervention by PDIS volunteers would be to offer support to families as clients in their own right when they attended the drug court with a relative. Soon after commencing work in the adult Drug Court PDIS volunteers also began to offer support to families in the Children s Court. According to Judge Wager (personal discussion, 2006), PDIS has enjoyed a successful working partnership with the Drug Court team because both agencies have approached the issue from the stand point of how do we solve this together. She states that PDIS was prepared to speak the court s language. The Drug Court and PDIS learnt about each other s policies and procedures and mutual protocols were developed. The result of this partnership and collaboration is that family members are now empowered to work with the court system through the support and understanding of the PDIS volunteers, even though they are not formally part of the proceedings. The lack of formalised involvement however does mean that the opportunity to engage with parents, partners, and/or other relatives is not guaranteed. A family member or significant others engagement

8 depends upon the volunteers availability, as well as the relative attending court being willing to speak with the PDIS parent. It is an informal process which means that there will inevitably be gaps and inconsistencies in the service. Therapeutic jurisprudence and the AOD field As Wexler has stated Current therapeutic jurisprudence thinking encourages us to look very hard for promising developments, even if the behavioural science literature itself has nothing to do with the law. It also encourages people to think creatively about how these promising developments might be brought into the legal system (2005). The Perth Drug Court and PDIS partnership has already begun to apply research evidence from the AOD field to a legal setting. The question that could be asked now is, can this development be progressed further? Could the families and significant others (given their suitability and that all parties agreed) be involved more directly in the drug court process in order to strengthen social supports and enhance treatment and post graduation outcomes? Suggestions for more formal involvement of family and significant others might include: (1) Court supported family mediation. Families, as secondary victims, do not receive access to services such as the Victim Mediation Unit. (2) Written handouts/drug court information sessions for families and significant others. Families and significant others could have access to a drug court information pack or session specifically tailored to this audience so that they could be informed, less stressed and more supportive of the process. They could also be educated about the benefits of seeking their own support and be encouraged to contact appropriate agencies. (3) An agreed upon family member/significant other who could be invited to attend the court proceedings as is done in the Koori courts in NSW. each defendant is invited to bring family to the hearing. Members of the defendant s family sit at the table with the magistrate. (King and Auty, 2005). In considering such suggestions however, Wexler states that questions need to be asked such as, should the courts be involved in this? Will it be too time consuming? Will it work in this setting? Will it add extra value to what is already being done? The legal system could argue that families and significant others are not their core business and that the most appropriate setting for them to

9 access treatment is through PDIS and the other AOD services. The downside of this argument however is that the ability of families to access AOD services or their willingness to become involved may be compromised due to a number of factors. (1) The drug court participant may not want their family involved in any way and so fail to pass on any relevant information. (2) The family may believe that it is only the participant who needs treatment and support. (3) Families may believe that drug court will provide the solution to their relative s drug problems so they will not have to take any further action. (4) The family or significant others may have severed ties with the drug user and no longer be available. The legal system could also argue that it has already been documented, for example, in the North Queensland Drug Court pilot final report (Payne, 2005) that many graduates report significant improvement in family relationships as a result of their participation in the drug court, therefore the system is already working and there is no need to do anything more. These benefits, however, were not universal. For some, continuing stressful personal issues did lead to relapses. Conclusion As the evidence shows, the inclusion of family and social networks in prevention and treatment regimens encourages improved outcomes for those clients and family members attending services seeking support for their own or another s substance misuse problems. If the court were to take the view that family involvement should be left to other services, they may be passing up the opportunity to exert some influence over what could arguably be considered a significant therapeutic tool. Greater family enlistment in the court process can contribute to the aims of both supporting the family in motivating their drug-using relative to engage and comply with court requirements, and could also alleviate some of the family distress through improved collaborative court/family relationships.

10 References Alcock, J. The Drug Court a Fresh Approach in Drugwise, Autumn, 2003, Butler, R. and Bauld, L. The Parents Experience: coping with drug use in the family in Drugs: education, prevention and policy, 2005, 12:1, Copello, A.G., Templeton, L.J. and Velleman, R. Family interventions for drug and alcohol misuse: is there a best practice? Current Opinion in Psychiatry, 2006, 19, Copello, A.G., Velleman, R.D.B., and Templeton, L.J. Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 2005, 24, Hamilton, M., Barber, J.G. and Banwell, C. Alcohol and other drugs a family business in Drug and Alcohol Review, Editorial, Hands, M., Parent Drug Support Project Consultation Paper, Consultation Paper, WA Drug Abuse Strategy Office, July, King, M. S. and Auty, K. Therapeutic Jurisprudence. An emerging trend in courts of summary jurisdiction. Alternative Law Journal, 30:2, April 2005, Orford, J., Guthrie, S., Nicholls, P., Oppenheimer, E., Egert, S., and Hensman, C. Self-reported coping behaviour of wives of alcoholics and its associations with drinking outcome in Journal of Stud Alcohol, 1975, 36, Orford, J., and Edwards, G. Alcoholism: a comparison of treatment and advice, with a study of the influence of marriage. Maudsley Monograph, 1977, no. 26. Oxford: Oxford University Press. Orford, J. Empowering family and friends: a new approach to the secondary prevention of addiction in Drug and Alcohol Review, 1994, 13, Payne, J. No. 17: Final report on the North Queensland Drug Court, Technical and Background Report, Australian Institute of Criminology, Supporting families and carers of drug users, A review (EIU November 2002):

11 The Family Sensitive Practice Development Project, paper prepared for the FSPDP Advisory Group, October Drug and Alcohol Office. Toumbourou, J.W., Blyth, A., Bamberg, J. and Forer, D. Early Impact of the BEST Intervention for Parents Stressed by Adolescent Substance Abuse Journal of Community & Applied Social Psychology, 2001, Velleman, R., Bennett, G., Miller, T., Orford, J., Rigby, K. and Tod, A. The families of problem drug users: a study of 50 close relatives in Addiction, 1993, 88, Velleman, R.B.D., Templeton, L.J., and Copello, A.G. The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people in Drug and Alcohol Review, 2005, 24, Wexler, D. Therapeutic Jurisprudence: An Overview (2005).