Constantly Just Holding It Up and Together

Family support is an area of increasing interest yet much of the evidence around families, their support experience and what this offers for families in their own right is often limited. ‘Constantly just holding it up and together’ by John Holleran, Families and Communities Manager for Scottish Families, seeks to address some of the gaps in our understanding by exploring the experiences of families in their own words.

Family support for people living with problematic substance use is an area of increasing interest for a number of reasons including reducing harms, supporting routes to treatment and maintenance beyond services for people who use alcohol and other drugs. Much of the evidence around families, their support experience and what this offers for families in their own right is

This research attempts to address the gap in our understanding of family member experiences of support in Scotland.

We would like to extend our gratitude to the families that came forward to participate in this research. Thank you for your time and for sharing your personal experiences with such openness and honesty. Without you all, this study would not have been possible.

At the time it was just survive-survive-survive. …You’re worried [husband] is going to die, in your daily list of things that are gonna happen you’re like… oh shit, he’s gonna die today and it’s constantly on your list of things to consider in today’s shopping list – husband’s dead! … Constantly just holding it up and together. Participant 1

Results and Key Findings

  1. 14 years was the average length of time spent living with problematic substance use, with the average time taken to access support being 11 years.
  2. Family dynamics and relationships being impacted by substance use was a consistent theme with the whole family network representing 41 people in total (50 if we include those using substances).
  3. Families were often the first (or only) people to respond in crisis when services were not able to offer help or those using substances were not in contact with any services.
  4. Support was the last resort when families were no longer able to cope alone, when their own support network had been exhausted, or life was so difficult that external help was needed to stay safe.
  5. Most said family support gave them a sense of relief. With some specifically saying they felt good knowing they could talk to someone who was ‘speaking their language’.
  6. The majority said having support made them feel less isolated.
  7. Many participants strongly valued the opportunity to learn as part of the support.
  8. Learning helped families to find new ways to work better with those using substances, maintain positive relationships or keeping people safer than before even when they were not engaged in treatment or services.
  9. For most, there was more acceptance of people using alcohol or other drugs and wherever they were in life with their substance use as a result of the learning from support accessed.
  10. Since receiving support, all but one has put strategies in place to improve their own health and wellbeing and found ways to work better with those using substances in their lives than before, even when were not engaged in treatment or services.

‘I reached out 4 months ago for specialist family support and that has made such a difference… I do live with it every day and have done but it just got to the stage where I felt so overwhelmed by living in fear and worry that I had to reach out.’ Participant 2

Learning And New Insights For Policy And Future Practice

  1. There is not ‘one type’ of family impacted by substance use. If we consider what Smith (2009) and Brown & Hohman (2006) say about the focus of family support to reduce risk to children (often linked to attachment and Adverse Childhood Experiences (ACES)) it is possible many families remain hidden or give the impression that everything is fine to avoid such interventions from statutory services. Does this represent the most effective approach given the potential for added shame, guilt, fear and anxieties to impact on the whole family system? This is a significant area to consider for further research and reaching families sooner.
  2. The onus for accessing support fell to all families to initiate in this study with many opportunities to support families missed in dealings with health and care services. This raises questions around gaps in our understanding about routes to support for those in need and those who lack the capacity or means to find help. This is an area to be considered for further research. How can underrepresented communities or specific demographic groups be reached?
  3. The experiences of families in this study and the literature reviewed offers some insight for improved engagement with families. Moving support beyond treatment and increasing opportunities and interventions with people engaged in services may help to reduce the impact of substance use on the whole family. The focus should shift to improving relationships, whilst limiting crisis as the point of intervention for families and people using substances.

Download Report

You can download and read ‘Constantly Holding It Up and Together’ here.

Please help us get the word out of our report by sharing on social media with the hashtag #HoldingItTogether!


If you’d like to talk or hear more about our research, please contact our Families and Communities Manager John Holleran on

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