Ms Marian Sloan:

I thank the Chair. We are delighted to attend the meeting.

A number of reports have identified the impact of substance misuse on families. These include worry and psychological distress, leading to physical and mental ill-health; exposure to threats and violence associated with drug debts, involvement of a drug-using family member in the illicit market; the financial burden of directly and indirectly supporting the drug user; the impact on employment of stress and caring responsibilities; strain on family relationships; harm from domestic violence and isolation and loss of social life. The FASN is a dedicated support service for family members or concerned persons who are impacted by loved ones' substance misuse.

I refer to the reason for our formation. The FASN is a voluntary organisation covering the four counties of Cavan, Monaghan, Meath and Louth. It grew organically from the needs of family members who were impacted by loved ones' addiction and behaviour. In the north east of Ireland families with a loved one who is addicted to drugs or alcohol do not have resources available to help them understand the impact of addiction or to help them improve their current living situation and coping skills.

Family members are involved at the core of development, management and servicing of the project. Recognising the importance of the needs of families, the founders of FASN set up peer support groups in the area. The people involved found great strength in the union of their voices. These groups led to a formal organisation and a network, which today is known as the Family Addiction Support Network.

FASN is led and run by adult family members and volunteer facilitators who have lived experience of addiction. This peer element is fundamental to FASN as is the training and support provided to facilitators. The mission of FASN is to assist families in the north east to achieve a greater understanding of addiction, empower them to improve their quality of life and to fulfil a positive role in the recovery of their loved one, should they choose to take it. FASN has recruited, trained, supported and retained a group of volunteer peers, both men and women, who facilitate peer-led family support groups. These facilitators meet a trained psychotherapist on a monthly basis for professional support and supervision. The accredited training, and professional support and supervision provided, are important and valued aspects of the model of peer-led services that FASN has developed.

FASN is guided in its work by the National Drug Strategy 2017 to 2025, particularly by goal 4 which is to support participation of individuals, families and communities; to strengthen the resilience of communities and build their capacity to respond through supported, and promoted structures, at local, regional and national level, and measure the impact of drug-related crime on communities; and to enable participation by both service users and their families through building capacity within the problem substance use sector to develop a patient safety approach, and involve service users and families in decision-making structures.

The FASN service straddles tier 1, which is primary, and tier 2, which is secondary, of the rehabilitation pathway of the National Drugs Rehabilitation Implementation Committee, NDRIC. The network is fundamentally based on the principles of partnership, community development, inclusion, participation and the empowerment of families who have been impacted by loved ones with substance misuse. It supports the goals of the national drugs strategy called Reducing Harm, Supporting Recovery 2017-2025 and implements goal 3 of the UN sustainable development goals, which is to ensure healthy lives and promote well-being for all at all ages.

While FASN is about developing services that are based on the knowledge and expertise of the people who are most affected, such as families and communities, they have built strong inter-agency

alliances with other services such as the Garda Síochána, Extern, the HSE, county councils, the Irish Bishops' Drug Initiative and the Family Support National Steering Committee. In particular, they have developed formal links with other projects in the addiction area, including Turas and the RISE Foundation.

The relationship with the RISE Foundation has enabled our service users to access a ten-week educational and therapeutic programme that supports and encourages them to move towards their own recovery of resilience, and good mental health. The programme is delivered by experienced and accredited psychotherapists. The RISE Foundation also delivers one-to-one counselling for family members and-or concerned friends impacted through addiction and runs aftercare.

FASN truly believes that by supporting families to have their needs met they are then able to change the outcomes for themselves. To do this we create an environment where people can learn for themselves and are supported in the choices that they make. Of significance, while family members may initially be defined as service users, they often become trained facilitators working with other family members. This means that families directly have a voice in how services are delivered and managed in a strategic way. In this way community activism is nurtured and proactive in terms of needs on the ground. The service implements the goals of the new strategy.

To date, FASN provides the following services: a 24-7 out-of-hours telephone helpline; one-to-one crisis support; a 5-step brief intervention; peer supported groups; access to one-to-one counselling; access to respite care; and an educational programme that is delivered by the RISE Foundation; it also led the way in the north east with the drugs intimidation reporting programme.

The Family Addiction Support Network commissioned its own research and presented findings from a study on how families are impacted by substance misuse in the north-east region of Ireland. The research was funded by the HSE's community healthcare organisation, CHO8 region, to look at the impact that substance misuse has on families. On 14 May 2019, the report was launched by the then Minister of State at the Department of Health, Catherine Byrne, who had special responsibility for communities and the national drugs strategy. A key backdrop to the study was the national drug strategy entitled Reducing Harm, Supporting Recovery, which for the first time included families as service users in their own right. The study acknowledged the interface between changes in social policy and families.

This study was the first to look at that interface in the context of adult family members affected by substance misuse in the north-east region of Ireland. The report was largely driven by the narrative of families being valued as experts by virtue of their experience. It gives voice to the chaos, trauma and distress visited on families impacted by the addiction of a family member. We had hoped that the key findings of this study would help formulate changes in service provision and practice and would improve the opportunities for families to engage meaningfully in their own recovery and well-being.

With regard to the findings of the report, within the report, families spoke about the psychological and physical ways they had been impacted by substance misuse. Participants discussed stress, anxiety, fear, not sleeping, feeling sick, not being able to eat, wanting to run away, anger, resentment, frustration, blaming themselves, a feeling of failure, guilt and shame. Participants were not aware of or able to give voice to their feelings at first. It was not until they found support, such as contact with the Family Addiction Support Network, FASN, that they began to understand and allow themselves to see what was going on. Families also spoke about exposure to criminal activity and its impact. They expressed fear and intimidation and spoke about having to take out loans, getting into debt, being threatened by drug dealers, not being able to sleep in their own houses because of threats, having pipe bombs put under their cars, being threatened with petrol bombs, threats by their loved one who would put massive pressure on the family, having to take out protection and barring orders to have them excluded from the home, the impact on siblings and other family members and on neighbours, villages and local communities, and the link to shame, guilt and stigma.

However, there was considerable frustration at what was seen as sensationalist media reporting on drug gangs and gangland feuds, notwithstanding that this phenomenon is part of the issue. Participants were keen to correct this balance by reporting their experience of intimidation perpetrated by local drug dealers, who may be drug users themselves and trying to get money to buy their own drugs. It should be acknowledged that the participants were aware of and had experience of using the drug-related intimidation reporting programme. This programme is seen as very helpful and its confidential nature is trusted and valued. The flexibility around the venue and time of meetings was appreciated. The limits to the programme and the reality of what could and could not be provided was well understood.

With regard to mental health, a variety of studies across Europe have estimated that between a third and half of patients being treated for substance abuse have an independent concurring psychiatric illness. These findings have been replicated in studies that have focused on cohorts of Irish patients. Psychiatric illnesses found to concur with substance abuse problems range from anxiety and depressive disorders to attention deficit hyperactivity disorder, paranoia, schizophrenia and other mood or personality disorders. It is possible that a variety of issues lead to comorbidity as described. Drug use may cause users to experience symptoms of psychiatric illness or may lead to the triggering of an underlying psychiatric illness, sufferers of psychiatric illnesses may use drugs to alleviate the symptoms of those illnesses and both problem substance use and psychiatric illness may be triggered by common factors such as environmental stress or genetic predisposition.

I will now move onto substance use and family members. When responsibility for addiction moved to social inclusion services from mental health services, it was seen as a significant acknowledgment of the many and complex issues involved that required a multi-agency and multidisciplinary co-ordinated response. However, the mental health expertise required to manage the complexity of dual diagnosis is currently lacking. When those in addiction experience a psychotic episode while using illicit substances, the mental health services cannot assess their mental health due to the impact of the substances. Individuals may be referred to an accident and emergency department. A busy accident and emergency department is not the place to manage a deeply distressed and often fairly aggressive individual. While there is talk of a national programme and the HSE developing and rolling out a dual-diagnosis programme, we in the north east have not seen this development as yet. This has implications for a concerned parent or family member bringing an individual for help. Such people will already be distressed and feeling powerless. In short, accessing appropriate addiction services in a timely manner causes a great deal of distress and anxiety for family members. The literature does not recognise the difficulties for families seeking to access comprehensive specialist treatment services. It should also be acknowledged that there are too few addiction services offering information or support and that those working in these services may have limited training and knowledge to work with family members.

On living with addiction in the family, one of the key recommendations in Advancing the Shared Care Approach between Primary Care and Specialist Mental Health Services, a guidance paper prepared for the HSE national A Vision for Change working group, had regard to care and treatment in addiction services. It stated:

i. The effect and impact of alcohol and drug misuse on a person’s mental health needs to be highlighted. The preventive role of the Primary Care Team in this area needs to be supported by training and resources from Specialist Services.

ii. Clarity needs to be provided on the organisation, delivery and alignment of substance misuse services to Primary Care and a national standardised model of service agreed and implemented.

iii. Strong links should be established with local addiction services as well as links with local addiction support groups such as AA & Narcotics Anonymous etc.

We would include family support groups in that latter point.

The preventative role of the primary team in this area needs to be supported by training and resources from specialist services. Clarity needs to be provided on the organisation, delivery and alignment of substance misuse services to primary care, and a national standardised model of services must be agreed and implemented. Strong links should also be established with local addiction services, as well as links with local addiction support groups, such as Alcoholics Anonymous, Narcotics Anonymous and family support groups.

With the onset of Covid-19, the additional pressures of lockdown had a really negative of families living with addiction. Families often found themselves in lockdown with the individual in addiction and homes became a pressure cooker. The families were unable to utilise or have access to other interests and outside distractions which may have helped them keep their mental health stable. However, FASN did not stop its work, and adapted appropriate general data protection regulation, GDPR, guidelines to establish an online platform to support the service users, whose needs were greater than ever. FASN secured training to work an online Alcatel-Lucent Rainbow platform to deliver its supports. One of the most remarkable achievements of 2021 was that the level of service provision was maintained and, in some services, increased, and that no family or family member who contacted services for support was turned away. This was down to the incredible dedication of the volunteer staff facilitators, who believe that the service they provide is essential for the emotional, psychological and physical well-being of families impacted by addiction.

On funding, the network receives funding from the northwest regional drug and alcohol task force and the HSE of €7,500 per annum and some small once-off funding from statutory services to run particular aspects of the service. However, no core funding is received to ensure the continuance and expansion of the service. This funding was secured nearly 18 years ago, when FASN was in its infancy. The network has grown exponentially since then. FASN was very dissatisfied to receive confirmation, in January 2022, that it was not successful in the tendering process with the HSE to provide supports to families in counties Louth and Meath. This is despite a long history of providing cost-effective, evidence-based supports using a peer-led approach and utilising accredited counsellors to provide one-to-one support. In partnership with the Rise Foundation, we also deliver a ten-week family education and recovery programme twice yearly. FASN is ultimately about empowering families by providing opportunities to move out of the chaos of addiction into their own recovery, positive well-being and good mental health. This is consistent with the vision set out in the national drugs strategy, Reducing Harm, Supporting Recovery 2017-2025. In keeping with this strategy, family members are not only involved in service provision but are involved deeply in service development. We believe a vital opportunity to continue to implement best practice while proactively responding to needs has been severely impaired because of the ongoing lack of core funding. Organisations such as FASN and the Rise Foundation have invaluable experience and expertise in working with families and require appropriate funding to maintain this life-transforming work.