At the recent ‘Just Ice?‘ Symposium Jane Bowman, Brisbane Program Manager of the Queensland Injectors Health Network (QuIHN) Treatment Team and Niki Parry, Peer/Case Manager of Brisbane’s Treatment Team, spoke about the many complexities of methamphetamine and drug use and the specific needs of parents and families impacted by drug use.
Their topic: Much Bigger than Rehabilitation focused on maximising the various successful intervention options for drugs users and their families. They also noted the importance of understanding the user, family and community in terms of causes, interventions and recovery.
QuIHN’s mission is to provide innovative health services addressing a range of drug related issues to illicit drug users and the wider community throughout Queensland. They provide services in: Brisbane, Southport, Burleigh Heads, Townsville, Cairns, Maroochydore, Redland Bay and Islands, Caboolture and Redcliffe.
They offer a range of services which include: Needle Syringe Programs (NSP’s) focused on safer injecting, drug health education, vein care and safe disposal. They also offer treatment such as Alcohol and Other Drug (AOD) counselling, therapeutic groups, outreach, parenting and family as well as Significant Other Support (SOS) and Pharmacotherapy.
Also involved with their services is medical care. General Practitioners and Nurses offer a fully bulk billing clinic as well as acupuncture. Advocacy, education, workforce development, peer support, resources, a health magazine for injecting drug users are also significant aspects of their work.
In making changes to drug use, QuIHN workers focus on:
- Harm Reduction
- Case Management
- Group work – Therapeutic & Psycho Educational
Dual diagnosis counselling is a significant factor in their work. They focus on substance use as well as working towards client’s goals. These may include abstinence, reduction of substances and/or reduction of harm. They also take into account the many other issues clients present with such as: mental health issues, trauma and abuse and grief and loss. In doing so, they consider the specific needs of those who are parenting as well as those offering other support to drug users, such as families and friends.
In terms of case management, care planning and coordination to this vulnerable population seeking support around alcohol and other drugs, they offer support around housing, parenting and education, employment and general alcohol and other drug support as well as mental health support. In doing so they acknowledge that not all clients want or are ready for counselling.
Groups work is another significant part of what QuIHN offers to clients and families:
- Mud Maps is an open group providing psycho educational AOD and MH support
- MAISE – Mental Health & Illicit Substance Education is an 8 week closed group
- SOS is for Families & Friends
- Treehouse is focused on Parenting
Treehouse is a therapeutic group program for parents who experience substance use and mental health concerns. The group is delivered in a non-judgmental and supportive manner. The aim is to increase parent’s ability to manage substance use and mental health, therefore providing a safe, enriching environment where children and families can thrive. It operates from a strong framework of attachment and encompasses the Circle of Security model.
It supports parents through enhancing their positive parenting skills and through increased parent and child connection. It also addresses parenting concerns and/or child protection concerns whilst providing education on reducing the effects of mental health concerns and substance use on parenting.
Staff of QuIHN remain cognisant that many of their clients have co-occurring AOD (alcohol and other drug) and mental health concerns. The majority have histories of childhood abuse and trauma including physical, sexual and emotional abuse and neglect. It is also evident that the majority also experienced insecure attachment as children, at times leading to problematic relationships in adulthood. They also experience higher rates of physical health issues, homelessness, financial difficulties, criminal behaviour, incarceration, admissions to acute mental health units, self-harm and suicidality.
Of particular note is that most clients have experienced long term loss of power and control stemming from past trauma and abuse, societal stigma and judgements due to mental health or drug use and negative and alienating experiences with a range of services including hospitals, schools, child protection, Centrelink, Department of Housing, Police and the Prison system.
Jane and Niki stressed that not all drug use is problematic. 41% of people in Australia have used an illicit drug. Many who use do not become dependent or high risk users. People who use have families and are part of the community. They also noted that people who use methamphetamine can be capable parents.
Substance use becomes problematic for parents and children:
- When there is no adult able to meet the child’s physical and emotional needs
- When substance use impacts on mental health
- When substance use impacts on relationship dynamics leading to conflict and aggression
- When substance use becomes a priority over the family’s needs
They also focused on facts to ensure methamphetamine myth busting. They again stressed that not all methamphetamine use is problematic or high risk. Methamphetamine is not the ‘worst’ drug around and methamphetamine use is not an epidemic, nor is it more addictive than other drugs. 1 % of the Australian population have used the drug in the past year. There is no instant addiction as is often reported. In fact only 15% of users are at risk of dependency. 25% of people who use methamphetamine regularly will experience some type of psychotic symptoms. That means 75% of people who use it don’t. Treatment for methamphetamine is just as effective as for other drugs, with 50% to 60% of individuals ‘recovering’.
Jane and Niki spoke to what parents need most when facing drug use. They outlined that stigma is the most significant barrier to people accessing treatment and related services. In QuIHN’s experience, the level of stigma and judgement increases significantly with parents – particularly mothers who use drugs. Parents fear interventions and having their children removed. They noted that substance use during pregnancy and parenthood is an emotionally-charged social problem in need of a compassionate and evidence-based solutions. Punitive policies, lack of services and stigmatisation encourages drug use, increased criminal activity, re-incarceration, and exacerbates family and community health problems. It also discourages women from seeking medical treatment during their pregnancy due to either delaying or avoidance of prenatal care. Women feel confused, vulnerable and in some cases misled or betrayed by treatment professionals.
Of particular concern is the fear of Child Safety interventions and removal which can prevent an honest, open therapeutic relationship which is the key to healing and recovery. Emotional regulation skills and positive coping strategies are needed to decrease substance use and to increase mental health. Parents’ capacity to meet the concerns of child safety include the need for emotional regulation and coping strategies. Given their frustration and mistrust of the system, this capacity is at time thwarted.
Clients also experience professional fatigue when many services are involved, or there are too many appointments which are overwhelming and costly to attend, this includes travel. Hopelessness is another key issue, whereby clients feel that regardless of what they do nothing will change and their efforts won’t make a difference anyway. They often face judgement across the board – from those assisting them, family members, friends and others in their community. Such a lack of support is a major detriment to recovery.
The removal of children is traumatic for parents and children. Parents are more likely to increase substance use post removal to manage this. Mental health will usually decrease post removal. Parents take time to process this trauma through validation and therapeutic support. Parents feel that they have lost their identity as parents and their role in life. Parents fear for their child’s safety. Parents feel isolated. Sometimes this leads to a lack of trust with services and workers. This is particularly relevant with regard to information sharing requirements and subpoenas. Furthermore, complicated access and referral pathways impede progress.
Solutions require a consistent focus on therapeutic engagement between workers and clients. This includes: empathy, respect and no judgement, a belief in the individual’s capacity for change and taking a long term approach wherever possible. Valuing the person outside of the drug use is important, as is an awareness of the impact of systemic disadvantage. It is really important to be aware of the parent’s need to grieve and process their hurt and the situation if removal has occurred.
Providing early information for parents around what services are available and how to access them is necessary. A choice of agencies (where possible) to work with realistic expectations around what can be achieved within established time-frames are also important.
In terms of assistance for professionals, education for both the workforce and management around the needs of parents with substance use is necessary to decrease stigma and to increase confidence in working with this population of parents. Services also need to be accessible, outreach or home visits or longer hours of service to include people who are working or parents without child care. The ability to offer long term service to families with more complex needs is vital. So too is consistency of workers. In supporting parents, respect for their other commitments is also significant. This may involve assisting them with scheduling and working with other stakeholders to reduce their number of appointments. Costs of transportation and assistance with the same is also important in this holistic support process. The endeavour is to work closely with parents and assist them in alleviating the barriers to recovery. Often the drug using parent is seen as either bad, criminal or an incapable parent. Staff moralising drug use is really unhelpful when working toward solutions and recovery.
Jane and Niki assert that what is called for ultimately is a transparent response, building on the therapeutic relationship. This means being honest about concerns, noting limits to confidentiality whilst ensuring a comprehensive risk assessment around family safety that the client is on board with. Also be aware that just like any other relationship, there will be ups and downs and the process won’t always be smooth. Be prepared to work through these conundrums in a respectful way. Always be clear about choices and consequences and do so without judgement. Continued engagement is a priority. So too is valuing the person outside of the drug use issues.
What parents had to say:
“Support needs to be in place from the moment you are told your children are going to be taken. I believe if I had more support I wouldn’t have acted out in so much anger and hostility to the Department”
“They talked me to but I was too upset to understand.”
“My rights were quoted straight out of the Child Protection Act with no explanation…”
“I was asked what I thought and felt. I was able to say what I thought”
Various options for intervention and recovery exist, these include: residential rehabilitation which is structured and longer term. It provides an appropriate environment in which to address drug use. It is most appropriate when users have unstable or no accommodation, have poor or absent social supports, repeated attempts to cease methamphetamine use in the community and are dependent on multiple drugs. The emphasis is on abstinence from all drugs as a treatment goal.
Jane and Niki noted that different approaches work for different people at different times. Rehabilitation is just one treatment modality. Where families and children are involved rehabilitation is not always a possible option. As such other important interventions are available such as:
- Harm Reduction
- Brief Interventions
- Counselling including therapeutic counselling
- Peer support
In conclusion, if we want to change the way we work with parents within the child protection system, we need to get parents with substance use involved in system reform. We also need to access client feedback to inform service planning and delivery and then we need to work in a truly collaborative way with the parent to best meet the needs of the individual and the family. Such insights will allow professionals to improve treatment services and provide a program that is of high quality, meets best practice standards, treats clients with dignity and respect and achieves good outcomes for clients and their families.
For more information about QuIHN services go to, visit their website.