Social and family approach to drug addiction
Discussion with parents
Parents' discussion groups
Information sessions for parents and teachers
Author: J. Dias CORDEIRO, Nuno MIGUEL, J. Luis CASTANHEIRA
Pages: 43 to 46
Creation Date: 1978/01/01
M.D. Nuno MIGUEL
M.D. J. Luis CASTANHEIRA
Lisbon University Psychiatric Clinic, Development Psychopathology Centre
To understand the drug phenomenon, it must first be borne in mind that a young person taking drugs is a part of society, in particular of a family and a school. To find solutions to the problem, great importance is attached to the social and family approach, not only for cases already under treatment but also with a view to primary prevention.
The authors of this paper often receive visits from parents, especially mothers, who come to talk about the drug addiction of their children, or of their fear that they may take to drugs. These contacts are very valuable, because drug dependence has a highly disturbing effect on the balance of the family, which is sometimes already disturbed, a factor which predisposes its members to drug addition.
Whereas the drug addict himself is seen directly by the doctor, the families are usually seen by one of the social workers of the service. After two or three conversations with the parents, she can give them a certain amount of guidance and can become familiar with their social and economic background and the personal relationships among members of the family. Parents are sometimes in great distress and feel completely helpless. Consequently, they often demand immediate solutions, such as hospitalization. The object of these first talks with the parents is to show an attitude of availability and support for them and thus to prepare the ground for another approach, that of dialogue with the young person and joint consideration with the team. This is not always easy to attain. When parents do not obtain "magic" solutions from us, they may feel frustrated.
Experience shows, however, that once parents feel that they are being informed and supported by a team of qualified therapists, dialogue with their child becomes possible again and this is a decisive factor in the drug addict's treatment. Some addicts who had refused any contact finally accepted treatment once their parents had taken part in such consultations.
* This article is based on a communication submitted to the VII International Institute of the Prevention and Treatment of Drug Dependence, held at Lisbon (Portugal) from 17 to 22 October 1977 and organized by the International Council on Alcohol and Addictions, Lausanne (Switzerland), in co-operation with the Co-ordinating Office for Drug Control, Lisbon.
The authors do not think that the only way to make contact with an adolescent going through a crisis, and specifically a drug addict, is the direct approach, i.e. personal contact with the addict; when natural structures, in particular the family and the school, perform their functions normally - and at this level public health teams have an important role to play - then there is a real base from which to fight drug dependence effectively. After these conversations, the social worker puts the parents into contact either with the psychiatrist or - in the majority of cases - with one of the parents' discussion groups.
These discussion groups meet for one hour every fortnight. They consist of the parents of young drug addicts (there are from 12 to 20 participants, three-quarters of whom are mothers), who join the groups on the advice of a social worker, a doctor or even other parents. The number of people attending varies greatly, perhaps because of the time the group meets (11 a.m. to 12 noon). Lower middle-class families predominate, although other classes are represented. Most of these people are between 40 and 45 years old. Participation in the group's work is spontaneous. The meeting usually begins with a statement by the parents who have recently joined the group. Their distress, sometimes mixed with depression, seems even greater when the addict is a daughter, because of concern over sexual problems. They ask for medical action, disintoxication, hospitalization or advice on what to do. The parents' attitude is one of blaming groups of young people, schools, authorities, unemployment or too much leisure. This attitude becomes less extreme as they become capable of recognizing and expressing their difficulties in their relations with their children. The parents' attitude to the prognosis changes still more during the discussion when they learn that in other cases changes in parent-child relationship have brought about significant improvement.
Some parents have first of all asked the police and/or private detectives to watch their son or daughter. Their participation in the group enables them to describe everything they have done for their child as "good parents" and to extol the virtues of their child before he was "led astray". A young person's emancipation from the family circle is a delicate subject, especially for mothers, who often consider drugs to be the cause of children growing away from their parents. The idea of death is often introduced, expressed in different ways: "Drugs are killing them"; "This situation is gradually killing us"; "I should prefer to see him/her dead rather than taking drugs"; "If I knew that she was leading that life, I would kill her and then kill myself."
The regular presence of three or four families gives a certain stability to the group. At the end of a meeting, the parents are more optimistic, more capable of talking to their children. There are very few parents who attend only one meeting.
These sessions are organized on the initiative of young people, parents or even teachers. Between 200 and 300 people attend the meetings, including an almost identical number of mothers and fathers, some teachers and a number of young people.
The sessions are usually directed by a team of two doctors and one social worker. They begin with a cartoon film, describing' the difficulties of dialogue between parents and young people, as well as the lure of drugs. The participants' speeches usually reflect great anxiety with regard to drug addiction, accompanied by requests such as: to emphasize the dangers of drugs and describe the different types; to obtain technical information which would enable them to supervise children better, to discover if they are taking drugs, to know the possibilities of a cure. As at the parents' meetings, the latter usually complain about the authorities, the school, bad parents, bad company, etc., and regard drug addiction as a development quite outside family relations. They want to avoid becoming personally implicated; they are not in the wrong; the solution does not depend on them. Solutions which do not implicate them are proposed, such as:
Social solutions of a repressive nature; increased family authority and discipline; schools to be made more authoritative institutions; certain publications and films to be banned; cafés with a doubtful reputation to be closed; effective action to be taken against drug peddlers and users.
Solutions which call for action by doctors; request for checking of symptoms and analyses (someone even suggested that an analysis should be required for admittance to a school); request for intensive treatment, if necessary compulsory, with hospitalization and disintoxication.
What does the team do when faced with this situation? The team tries to avoid the meeting concentrating on the various types of drugs and their dangers, tries to help the parents to understand how this state relates to family life, to relations between parents and adolescents and to the difficulties young people have in becoming integrated into society, thus placing the problem in the framework of the relation of the young person with his family, school and the general environment, and always proposing as a solution greater integration and participation of young people.
The team also tries to show that all forms of control - constant questioning, watching how a young person looks, searching pockets and drawers, selecting friends, punishments and threats - destroy the dialogue, which is the chief way of ensuring that young people do not take drugs or that they stop doing so.
The team also tries to help the parents, who are frustrated at being refused the two types of immediate solutions they propose - repressive and medical - by giving them specific information concerning the working of the hospital consultations and providing the support which they need; the problems should also be rendered less dramatic by emphasizing the great possibilities of a cure. Lastly, the team stresses the fact that the problem of drug addiction cannot be considered a technical health problem, to be solved only by doctors, nurses, etc., but should be viewed in a wider context, thought about and solved by young people, teachers, parents, etc. Throughout this discussion, the team tries to avoid excessive conflict, to manage to sustain the dialogue, to help the parents to question their own motives and alter their behaviour without feeling guilty.
From a methodological point of view, we think that we should respect people's distress and fear when confronted by this problem. With this in mind, and in order to separate the drug phenomenon from the substance itself and to present it as an eminently social problem which involves the persons who take drugs and the groups among which they live, we think it important to give a certain amount of medical information - symptoms of drugs, dangers and possibilities of treatment and cure, and the existence of support structures for parents and young people. This first phase of discussion, seems to be the sine qua non for the effectiveness of such a session, because of two basic facts:
The problem of drugs and the difficulty of parent-children relations is a real and serious problem which naturally causes parents great distress; it is therefore essential at the first stage to answer the specific questions they ask;
The lack of correct information concerning drugs, young people and health in general.
These two facts lead parents to seek the support of judicial and psychiatric solutions. Our experience shows that only when the parents feel sure of themselves and are supported by a comprehensive medical team, capable of responding to their specific needs, is it possible to reflect together on the various factors involved in the drug phenomenon.
We consider this type of public health activity to be a primary preventive measure in psychiatry and a priority means of tackling the drug phenomenon.