ALCOHOL. Cocaine. Benzos. When it comes to Scotland’s drug problem, heroin is often the substance that comes to mind.

Yet for the desperate people who contact Scottish Families Affected by Alcohol and Drugs (SFAD), it is alcohol, cocaine and benzodiazepines, such as street valium, that are wrecking their lives.

Families feel much of the media “noise” is about heroin and street valium, points out the charity’s helpline development officer Suzie Gallagher. Perhaps as a result of the pressure, rehabilitation and treatment tends to focus on opiates.

“Families struggle with the divide that has grown between the urgency for support for drugs like heroin and the urgency around alcohol related deaths and alcohol related harm,” she says.

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“Families really struggle with what they perceive to a lack of priority around other substances, especially alcohol.”

It is the number one substance that is causing problems for the families who contact the helpline, and the top three are always now alcohol, cocaine and benzodiazepines.

“It causes concern for families as the medication assisted treatment standards are heavily weighted towards opiates and opiate substitute therapy,” says Gallagher. “Families don’t see how they will support someone who has a cocaine, street valium or alcohol problem.”

However, no matter whether it is heroin, benzos, cocaine or alcohol, many families living with people who use substances are struggling to find support.

A report last week concluded there had been a “collective failure” in the care and treatment of people using drugs and alcohol despite “abundant policies, guides and standards at a national level”.

The research by the Mental Health Commission found that alcohol and drugs were a factor in between 48-56% of all suicides in Scotland between 2008-18.

It also found that services are not meeting the needs of people who have both mental ill health and problems with substance use.

Another survey carried out by SFAD in partnership with other family support organisations, found that it took nearly one third (31%) more than 10 years to access support while just more than half (51%) were unsupported for more than six years. Only one in eight (13%) of family members accessed support the same year they became concerned about alcohol or drug use within their family. One told the researchers that without support “despair becomes your friend”.

“When addiction knocks on your door it turns your whole life upside down,” said the woman. “You forget what’s important and get caught up trying to help your loved one, but you forget about yourself. You eventually run out of steam and feel there’s no hope, nowhere to turn and nobody who can understand what your life is like.”

When it comes to family support there is a postcode lottery across Scotland, according to Gallagher.

Even if someone who uses substances is engaging with a treatment service, many families are struggling with the cost of getting them to their appointments.

“For families on no income, or practically no income, that is going to be difficult,” she says.

Crises can arise if someone who uses alcohol has taken so much they need hospital treatment but are then discharged with little guidance for families on what to do next, for example with regard to acute withdrawals. Problems also arise if someone who uses substances is suffering from a psychotic episode.

“Families know their loved one’s behaviour very well and often believe their loved one is having a psychotic episode and unable to make conscious decisions to keep themselves or others safe – but we regularly hear families telling us they have contacted addiction services and been told that if the person is not prepared to engage with them there is nothing they can do,” says Gallagher.

Dealing with these issues has a “significant impact” on the mental health of those trying to cope, but although Scottish Government policy recognises that families need support, accessing any again depends on where you live as some areas have better services than others.

“When families are having to wait more than ten years for support there is obviously a long way to go to ensure families have early intervention to minimise harm and instil hope,” Gallagher says. “Yet the more support there is the less damage is going to be suffered by that family and the individual with the problematic substance use.”

SHE argues that there needs to be dedicated, commissioned, evidence-based, family support services in every locality.

“Every health board partnership should have a centrality funded, ringfenced family support service which provides peer support and evidence-based interventions,”

she says.

“A lot of areas do provide family support but it is in addition to a case load of people who have got problems with alcohol and drugs. They are going to take priority because they are the person most at risk of harm.”

There also needs to be a “no wrong door” policy, Gallagher says.

“If a mum phones a treatment service worried about her son, their response should not be that they can’t help unless he is willing to engage with them himself. If they can’t help him, they can help the mum and point her to where she is going to get support.”

The stigma surrounding addiction also has to be overcome, according to Gallagher.

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“Stigma is a huge thing for families and for the individuals who have the problems,” she says. “We are trying to get the message across that preventing deaths is not one person’s responsibility. It is a societal responsibility.”

Much of the talk about reducing the death toll is about safer injection and using drugs safely but Gallagher argues that harm reduction is any measure of support that can be put in place to make people’s lives easier.

“People are using drugs and alcohol to self-medicate because their life is difficult,” she says.

“We need to look at how we support all the things they are struggling with. They need good housing, physical health checks, access to mental health support and access to family support. All of that is going to be a buffer and the more buffers there are round an individual the less likely they are to experience drugs or alcohol death.”