Audio transcript (edited)

BRENDAN QUINN: Good afternoon everyone, and welcome to today’s webinar, Working with Families to Minimise Alcohol-related Harm. My name is Dr Brendan Quinn. I’m a Research Fellow at the Australian Institute of Families Studies, or AIFS. I’d like to start with an acknowledgement of the Bunurong and the Wurundjeri people, the traditional custodians of the land on which I’m speaking to you here in Melbourne. I’d also like to pay my respects to Elders past, present, and emerging to the Kulin Nation, and extend that respect to other elders and Indigenous Australians attending this webinar today.

This afternoon we’re talking about the challenges of addressing problematic alcohol use. As you all know, alcohol is prominent in many aspects of Australian life, and with regular drinking as condoned and normalised as it is, it can be difficult for clinicians to raise it as a possible harm with clients. Also clients may not want to acknowledge that alcohol use is resulting in harm for them, and possibly also their families and other loved ones.

So, how do we approach this subject with care and consideration, to reduce the harms it can lead to in Australian families, and also in the wider community? One way is to bring together three great minds, whose work addresses this issue in different ways.

First, we have Dr Trina Hinkley, my colleague, another research fellow here at AIFS who has extensive experience learning about the harms associated with alcohol. Trina worked for many years at the Alcohol and Drug Foundation, where she contributed to state and national programs designed to prevent and reduce the harms from alcohol and other drug use. Trina’s background is in behavioural epidemiology and behaviour change, particularly on the impact of behaviour on well-being and other outcomes. Welcome, Trina.

TRINA HINKLEY: Thanks Brendan. It’s lovely to be referred to as a great mind.

BRENDAN QUINN: You’re welcome. Next we have Anne Tidyman, who has a background in nursing, public housing, community development, out of home care, alcohol and other drugs, and family services. And currently manages Child and Family Services at Odyssey House Victoria. And with over 20 years’ experience working with vulnerable families and communities, I think it’s fair to say that Anne has seen it all, by which I mean the harms, but also recovery. So welcome, Anne.

ANNE TIDYMAN: Thank you Brendan, and welcome everyone to the webinar.

BRENDAN QUINN: And last but certainly not least, we have Monique Yeoman. Monique is a social worker, and currently the practice lead for evidence-informed practice at Kids First Australia, an NGO working with children and families across a range of services, from primary prevention through to tertiary intervention. Monique also has a background in child protection, so she brings a broad experience perspective to this topic. Welcome, Monique.

MONIQUE YEOMAN: Thank you.

BRENDAN QUINN: Because we received so many great questions from everyone when you registered for this webinar, we decided we’d use them to guide a conversation, rather than do separate presentations. Hopefully, this way we’re really getting to the issues and the questions that you want addressed. So let’s jump into the questions.

I first want to start with you, Trina. First off the bat, can you tell us about the evidence on risk factors associated with alcohol-related harm?

TRINA HINKLEY: Thanks, Brendan. Happy to talk to that. There are quite a lot of risk factors associated with alcohol consumption and with harm, so I’m just going to touch on some of the ones that might be a little bit more relevant at the moment. We do know that there are differences in alcohol consumption and harm from alcohol between men and women in some cases, not in all cases. And it’s often women – and this has been prevalent during COVID lockdowns as well – women, when they're juggling added burdens from work and family life, may be more susceptible to consuming more alcohol or experiencing more harm from that alcohol.

People who experience high levels of stress or anxiety, or loneliness, which again we’ve seen quite a lot of during COVID, or other psychological symptoms like depressive symptoms or negative life events, can also increase their alcohol intake, but as well be more susceptible to harm from alcohol. So that alcohol that they consume might actually compound the psychological state that they're already experiencing, to add increased harm into that state.

Some sorts of experience of family violence or abuse might also be exacerbated – or the harm of those might be exacerbated by alcohol consumption, and that can have a reciprocal effect as well. And things like social norms, so where people are in a group or a workplace where alcohol consumption is the norm, or it’s supported, or honoured in some way, which sometimes we do in our society. That can lead to higher levels of consumption and more harm as a consequence.

They're probably the main things that I want to say at the moment Brendan.

BRENDAN QUINN: Sure. We can talk about them throughout the webinar, that’s no problem as well. Also Trina, can you explain a bit about what’s meant by harm minimisation approach to alcohol?

TRINA HINKLEY: Yeah absolutely. I think this is really important for us to understand. Harm minimisation works from the assumption that it’s not necessarily the amount of alcohol that somebody consumes that causes harm. And that even when two people are consuming the same volume of alcohol, the harm that each of those people experiences, might be quite different. So some of those risk factors come into play in that situation. A harm minimisation approach is focused on reducing the harm from alcohol, rather than necessarily reducing the amount of alcohol that people consume, although that might be one strategy.

It’s based on a number of premises. One you already mentioned, alcohol is an intrinsic and inevitable part of our society. People drink alcohol. We use it in social situations, and for all sorts of reasons. And many of us experience some benefits from using alcohol. So it’s inevitable, we’re going to consume alcohol. We’ve seen prohibition does not work, so there’s no point going there.

Another premise is that alcohol use might change over time, due to various factors. For instance, some of those risk factors I mentioned before, if people experience more loneliness, they might be more likely to consume more alcohol, and experience more harm as a consequence.

And the third premise is that harms are associated with different types of use and different patterns of use. When I say patterns of use, what I mean is if we think about somebody who’s having 10 standard drinks a week – two people, one person might have two standard drinks on five days of the week on no alcohol on the other two days. But the other person might have their 10 standard drinks all in one day. So that’s the pattern, it’s how they’re using it across the week.

It’s likely that the person who consumes their 10 standard drinks all in one hit, is at greater risk of harm than the person who consumes – certainly of immediate harms, like injuries – than the person who consumes it spread out across the week. So it’s taking this idea of not just how much alcohol you drink, but how you drink that, in what context, that sort of thing.

I might just leave that there. Some other things might come up as we talk through it Brendan.

BRENDAN QUINN: Thanks Trina. I guess just one follow up question to that. What do we define as binge drinking in Australia? Is it you go a certain path for example?

TRINA HINKLEY: I can’t give that level of detail right now. I don’t have that piece of information in my head. Monique or Anne might, but binge drinking is typically when people consume a lot of alcohol in a very short period of time. Like the 10 drinks in one sitting would be considered binge drinking. Whether or not there’s actually a cut-off for what is considered binge drinking, like I said, I’m not sure about that.

BRENDAN QUINN: I’m trying to remember back to the papers that I've written about alcohol, and I can’t remember. I remember writing binge drinking, but I can’t remember if there’s an actual cut-off.

ANNE TIDYMAN: Yeah, I’m not sure. I think it’s the amount in the short amount of time that they're having a drinking session.

BRENDAN QUINN: It’s probably something that we want to consider going into the festive season here in Australia. And summer.

TRINA HINKLEY: And coming out of lockdowns in New South Wales and Victoria as well, where there are likely to be more social activities going on, and people are celebrating the release might be a situation that is conducive to people drinking more in a short amount of time.

BRENDAN QUINN: That’s a good point. Now if I can bring Anne and Monique in. I'm going to ask you both the same question, but I might start with you Anne, just alphabetically. Can you provide us with examples of alcohol-related harm in practice, and why it occurs?

ANNE TIDYMAN: It’s a coping mechanism, as all drug-taking is. And alcohol’s no different to any other drug. And I think that when we look at harm, especially in my practice, it’s the impact on family and children. And the other issues that are sitting within the cohort that I work with, are we looking financial harm? Are we looking an increase in – and I’m going to just say this upfront. Alcohol and drugs isn’t the cause of family violence, but it can increase the severity of family violence. So if the families that I work with often have family violence sitting there it can increase the severity of that. It can increase the intensity of it. It has direct impacts on children.

So financially, if you're spending a lot of money on alcohol then you're not going to have money left over for out-of-school activities, camps, family outings. That has a massive impact on children’s social and emotional well-being. And their involvement in community. And I kind of think with lockdown, the way we drink, the way Australia drinks, has changed. And it’s very much in-house. So there is no leaving the house, drinking, and then coming back and falling asleep. It’s all done in the house. And I think that has a great impact as well.

And we’ll find more out about that when we come out of lockdown, is my sense. Monique, would you like to add to that?

MONIQUE YEOMAN: I agree with that Anne. I think that the way that drinking has been occurring during COVID, is really in a vacuum, and everything’s been happening in that vacuum. So there’s extra stresses, children are at home, have been home learning, and they don’t have an outlet. And then the parents don’t have an outlet except time to be increasing their alcohol use. Or just using alcohol within the home setting. And are unable to leave to go and do that and socialise et cetera.

I also think that in terms of alcohol-related harms, I think about impact on the parental relationship with the child. So that parent-child relationship. And how if parents are using alcohol excessively, then what does that mean for their responsiveness to their child? Does their child then feel like they need to parent the parent? Does the child feel like they have added responsibility for their own care and well-being needs? And also if that parent’s alcohol use plays out in socially inappropriate ways, in terms of their behaviour externally, what is the child then missing out on? For example I’ve been working with a father who has spoken about how he was prevented from going onto his child’s – onto the school grounds because of his behaviour relating to his alcohol use.

And so then his child missed out on him being involved with those activities et cetera. I think for a lot of the people that we work with also, alcohol is intergenerational. The problematic alcohol use is intergenerational, and so for some parents, they have had ruptured relationships with their own parents. And that then impacts on what happens in terms of their parenting, and the relationships that they have with their children.

ANNE TIDYMAN: I agree. I think the other thing to remember in this space as well, if there’s been a history of other drug use, then alcohol can be a gateway. And someone’s remained abstinence from say heroin, or ice, or whatever it is they're using, and they've had some time of abstinence, but they start drinking, it can lead to reusing the other drugs as well. So it’s kind of a gateway. Inhibitions are lowered, they're more easily to go with friends who are still using ice, or still using something else. And so they're back in that and that can happen quite easily.

And lots of families I've worked with, when they've had a lapse, or a relapse with other drugs, the first drug of choice that they used was alcohol. So just holding that space, it doesn’t mean that every time they have a drink they're going to have a lapse, that’s not what I'm saying. But it’s being mindful of that. And being able to have those conversations with the clients you're working with.

BRENDAN QUINN: What about the context of alcohol in the context of mental ill-health or other ill-health as well?

ANNE TIDYMAN: It can exacerbate so many things. So as it exacerbates the level of family violence, it can exacerbate mental health issues. It can exacerbate other drug use. And I go back to what Trina said earlier. When you talked about context, it’s always being mindful of the context that’s there, and then talking through the impacts of that with your client.

TRINA HINKLEY: And the person themselves. Some people are more susceptible – just genetically and psychologically more susceptible to harms than other people. If they've got more social support around them, they possibly have a bit more resilience. It’s the whole situation as you say, Anne. The whole context.

BRENDAN QUINN: Thank you. Can we talk about some of the barriers that practitioners may face in engaging with clients who may be experiencing, who are at risk or at risk of alcohol-related harm? I might start with you Trina.

TRINA HINKLEY: Thanks Brendan. I really just want to talk a little bit about stigma here. And prejudice and discrimination that can result as a consequence of stigma. We know that stigma is a social process, so that means that one person, or a group of people make a decision that another person or another group of people are less acceptable in some way. And we see stigma come about on a whole lot of different characteristics. They can be innate characteristics like the colour of our skin or our age. Or they can be our behaviours or characteristics that we adopt throughout our life. So it could be people who smoke, people who use alcohol, people who use drugs. People who use certain types of language.

Stigma can apply across a whole lot of characteristics that a person might have. For people who use alcohol and other drugs as well, stigma can be a real problem. It can stop them actually seeking help in the first place, because they may feel the burden of that stigma and prejudice and discrimination, and therefore feel guilty or ashamed, and actually not even reach out to get help. And that can be the case even when they're at the point of knowing that their alcohol use is causing harm, and really wanting help. But not feeling that it’s okay to ask to help because of the stigma and prejudice and discrimination from other people.

One of the ways that stigma is conveyed, is through the language that we use. So one thing that practitioners can do is be really mindful of the sort of language that they're using around characteristics like alcohol use, that could be stigmatising for people. There are a number of anti-stigma language guidelines that exist in Australia and internationally now, and these cover behaviours like alcohol and drug use, blood-borne viruses, mental health, and a range of other - disability, a range of other characteristics, but what they all have in common, is that they talk about this idea of using person-first, or person-centred language.

So that’s avoiding things like putting labels on people. So you don’t say a disabled person, and addict, a druggie. You avoid that kind of language, and instead you use the language around the person. So, a person who uses alcohol, a person who has dependence. So it’s this idea that it’s the person that matters, not whatever the characteristic is that they might be stigmatised for.

Body language comes into this a little bit as well, so maintaining open and relaxed body language, rather than going into a defensive posture can be really helpful for people who are trying to get support their alcohol use.

BRENDAN QUINN: How about Monique, do you have anything to add about barriers that practitioners may face in engaging clients who experience alcohol-related harm?

MONIQUE YEOMAN: I think that we do need to be so aware of our own personal biases. And in terms of what alcohol use means to us, and also what it means in terms of being a parent. And I think about the expectation that societally we place on mothers as a parent, versus the expectations that we have on fathers as a parent as well, and how that plays out, and how we engage with a mother who we believe might be engaging in alcohol use that may be harmful.

And also, in that person’s ability or capacity to engage with us on that same level because of those feelings of shame and guilt around the alcohol use. And feeling that perhaps they're being labelled as a bad mother because of their alcohol use. Did you want to add to that, Anne? I feel like you do.

ANNE TIDYMAN: I’m nodding my head because what you're saying I completely agree with. And just a little bit further, when we look at parenting capacity, and when we look at how drug and alcohol are impacting parenting capacity, as a society we have this thing about mothers and holding them up here around parenting. And they have that as well of course, because they are part of this society. So where we might see a father’s alcohol use as not problematic, we will instantly see a mother’s as problematic, because we consider her – whether we do it consciously or not, we consider her as the main caregiver.

So parenting assessments, we hold mothers up here. And we hold them to a different standard to fathers. And we need to just go, “Fathers and mothers are up here, and it all has an impact on family functioning. And it all has an impact on child social and emotional well-being.” And yes, I’m glad you raised that point. Because it’s all the time. I get referrals all the time, and it’s always the mother on there still, and it’s about her drug use and her parenting capacity, with no context about where Dad is in this space.

And we do a disservice to fathers if we do that too, just quietly. I won’t go on anymore with that because yeah, good point.

BRENDAN QUINN: These are all really good points. Following on from that, what are some strategies – and we’ve touched on this a little bit, but what are some strategies to help practitioners who don’t have a background in alcohol and other drugs, identify and engage families at risk of or experiencing alcohol-related harm?

ANNE TIDYMAN: I think you need to check your own biases and be very mindful of that. I think open conversations and listen to what the person is telling you. Listen to their story and be curious. And in that curiosity, you will find out what’s happening in that family. And there’s lots of techniques for that. I know Trina, you were going to talk about motivational interviewing and what that looks like. They're the strategies I would use. And my biggest one is curiosity. I just can’t find out enough.

MONIQUE YEOMAN: Yeah, there is something there Anne isn’t there? And just asking the question. Just being genuine and authentic in yourself and asking those questions around, “Do you use alcohol and are you worried about the impact that that alcohol use might be having on the relationship that you have with your children? With your family?” whoever it might be.

ANNE TIDYMAN: With your community.

MONIQUE YEOMAN: With your community, yeah.

ANNE TIDYMAN: And just acknowledging that people use alcohol and drugs because it fulfils a purpose. And there’s good stuff to that. So listening to both sides of that. What do you get out of it that’s positive? And okay, now let’s have a look at maybe at the impact that’s having for this person, this person in your life. What’s it stopping you doing? How is it impacting you? Go. Sorry.

TRINA HINKLEY: Sorry. I was going to just say I might jump in there and just talking really briefly about screening instruments that can sometimes – once you’ve opened that conversation with a client – and I love the curious mindset, I think that’s so important and valuable. So once you've opened that space, then to help get a little bit more information, sometimes a screening instrument can be useful, which can pick up whether or not people are engaging in risky levels of alcohol consumption. And also some of the harms that they might be experiencing, if they are experiencing harm.

One of the most common ones is the AUDIT instrument, which was developed by World Health Organisation, and is just everywhere – all over the place, and I think we’re going to pop a link in the resources for a good online tool for that. There’s a long version and a shorter version. But it’s just – sometimes using – and Anne and Monique, you're very welcome to cut in here. Sometimes just using that sort of a tool can help raise awareness in people about, “Oh, when I look at how much I’m drinking it is actually problematic. And it is causing harm.” So it’s just another piece of information, another way to help guide the conversation around alcohol use and whether or not it’s causing harm.

And then offer opportunities for developing some strategies to manage that.

ANNE TIDYMAN: It might be the very first time they've sat and reflected on what their alcohol use looks like. So a tool is really useful.

BRENDAN QUINN: Would that be a way possibly, of engaging people who are resistant, or possibly in denial about their the extent of alcohol and the harms they might be experiencing, that their family might be experiencing as a result?

ANNE TIDYMAN: Yeah, it can be. You also get people come in who will just go, “I don’t know why they've made me come for a drug and alcohol counselling. I don’t have a problem.” And my standard response to that is, “That’s okay, but this is my role and I’ve got to work this way. So here’s my boundary. We’re going to talk about this because that’s the role I’ve got. So let’s just talk.” And again, just be curious. I cannot say that enough. Because I'm not – I know you called us experts at the beginning and thank you for that. But I’m not an expert in their life. They are. So I need to listen to them.

MONIQUE YEOMAN: I think that’s a really excellent point Anne. It’s that recognition that people are experts in their own lives. It’s so crucial to being able to provide support that works for them in their life.

ANNE TIDYMAN: And not everyone who fronts to a drug and alcohol agency is the same. And to have one kind of treatment that fits everyone is nonsensical really. You need to be with the person who has walked in the door.

MONIQUE YEOMAN: And this is yeah, about being person-centred isn’t it? And very relational. And the work that we do as well.

ANNE TIDYMAN: It’s all relational.

MONIQUE YEOMAN: Yeah. And I think in terms of managing resistance, or working with resistance, I like to think about how we can tap into somebody’s – or lean into their values. And the values that they have as a parent. What are their hopes as parent? And develop some of those discrepancies. So their hope is this, yet at the moment how they're using alcohol, or whatever the behaviour might be, is actually not getting them any closer to that hope or that goal as well. So trusting them to recognise and see that as a strategy to try and springboard off, to think about behaviour change is a very useful and relational approach I think to managing resistance.

ANNE TIDYMAN: And if they don’t have children, what does it mean to be someone’s child? What does it mean to be someone’s partner? What does that look like? What does it mean to be someone’s sister or brother? What does that look like? Just having those conversations and that you learn so much from that.

BRENDAN QUINN: They're terrific points. Trina is there where you would like to touch – Anne mentioned it. Would you like to touch on motivational interviewing here?

TRINA HINKLEY: Thanks for dumping me with that Anne.

ANNE TIDYMAN: Look, it’s going to be in this space, let’s face it.

TRINA HINKLEY: It will be. Feel free to add to this, because I really only wanted to just mention it. Really what I wanted to talk about was brief interventions, and how brief intervention can be a really good strategy for helping people start that process of changing behaviour. So it’s the idea that it’s just a really short conversation, maybe 10 or 15 minutes. And sometimes there might be multiple conversations, but sometimes there might only be opportunity for one conversation. And we do know from evidence that sometimes even only one conversation can be enough to start people changing. So don’t ever discount that you only see them for 10 minutes and nothing’s going to change, because it might.

It’s really an opportunity to bring in some of the things that we’ve been talking about. Curiosity, reflective listening, these kinds of practices. And use strategies like goal setting, motivational interviewing. So tapping into that idea of what is the outcome that they want? What is the hope, as Monique said, that they for their children, and how are they going to manage themselves and their behaviours and contribute to their family so that their children actually get that outcome? It’s that kind of idea of what are the steps that need to be in place to do that? Sometimes people will need information, so it might be a pamphlet or a website, just to read a little bit more.

The main strategies for brief intervention are providing information or education, simple counselling, goal setting, and a little bit of motivational interviewing, so tapping into that idea of what are the outcomes that people want to achieve, and how are they going to get there? That was all I wanted to say Anne, about motivational interviewing. Would you like to add something?

ANNE TIDYMAN: I think you've done a wonderful job Trina. That’s what I’ll add.

MONIQUE YEOMAN: Can I add just a little bit to that? I have worked in the ‘Caring Dads’ program where we utilise motivational interviewing for fathers who use violence, and some of the work that we have done from the outset now, is agenda mapping with the fathers. So looking at not just what they think they might get out of their engagement in the program, but also what the mother of their children hopes for their engagement with the program. And what they think their child might hope for their engagement with the program as well.

And so being able to translate that obviously over to their engagement in addressing their substance use or alcohol use – what do you think your child might say? If I was to ask your child, what would they say about your alcohol use and their hopes for their relationship with you et cetera. So getting them to think outside of themselves I think, to tap into that change as well.

ANNE TIDYMAN: Yeah. Very important point.

BRENDAN QUINN: They are great points, and is there anything to elaborate on here with what supports and strategies there might be that are recommended to us as children, when parents are experiencing alcohol-related harms?

TRINA HINKLEY: That’s your forte Anne. Go for it Anne.

ANNE TIDYMAN: That’s my forte. That’s my forte. And such a simple thing to answer isn’t it? It goes back to harm reduction. What are the impacts and how you as a parent are going to minimise those impacts? If you can’t stop drinking, then what can we put around it – what can you put around it to lessen the impact on your children? To lessen the impact on your family. And that’s a conversation individually. It could be starting by reducing days, or the amount you drink. I would never go straight to stopping. I don’t work in an abstinence space. There is a space that is abstinence. That’s not the space I work in. It is harm reduction.

It’s going through – and I go back – there’s not one right answer for this. It’s the person in front of you, who you have the conversations with, and they will say how they can. And then implementing other strategies around dealing with their triggers. What causes them to drink? What else can we do in this space that makes you not reliant on alcohol or drugs to manage your emotions? How do we – because they drink or use drugs to manage their feelings. So what can we do in this space? And there’s lots of things that you can recommend. Some things will work for some people and some things will work for others.

Lots of mindfulness strategies. You could be doing yoga. It could be deep breathing. I used to run a parent group, and when we first started - it was a 12-week group, we’d start with a very small one-minute mindfulness exercise, which many of them struggled to get through a minute. By the end of the group, we’d do – depending on how it was going, a five or ten minute one. You’re teaching to manage something that’s really uncomfortable, but in a really nice way. I’m not sure if I answered that, but I think I did.

TRINA HINKLEY: I also wonder about Anne – I don't know whether this is something that you do in the work that you do but engaging the child in the planning around safety.

ANNE TIDYMAN: Yes. Always.

TRINA HINKLEY: And discussion around what their experience is in terms of their parent’s alcohol use.

ANNE TIDYMAN: Always. And it’s really important to get the child’s voice. You know me well. It’s one of the things that I am very passionate about. Children know what are going on, and often that’s a shock for parents. They think they've hid it really, really well. The children’s voice needs to be brought into this space, and especially if you’ve got a combination of something like alcohol and family violence, you have to do safety planning with children. And they will have it. They will already have been doing it. So you just need to make sure that everyone involved in their safety plan is on the same page. That’s critical.

And to think that children aren’t trying to keep themselves safe, we’re doing them a disservice to think that one of the parents in that space isn’t trying to keep the child safe. We’re doing that parent a disservice too. So drugs and alcohol are often used as a way to control your partner. And used in a coercive control way. And understanding that what looks like problematic drinking or drug-taking sometimes, is actually a parent being protective. That just sounds wrong, doesn’t it? But it’s what it is.

And it’s to stop the escalation of violence from the partner. Or the other parent. No, children are huge in this space. And we’ve had cases where parents will say, “How do I describe what’s happening to my child? How do I tell them why they’re not in my care?” And so many of them have been told to say that they're sick. To tell their children they're sick, and when they're better their children will be returned.

And the children get returned, and then mum actually gets sick, and the children just lose it because they think they're being removed again because that’s what happens if Mum’s sick. So honesty. And they're really hard conversations, and they need to be age dependant, so what you’re going to tell a 10-year-old, you’re not going to tell a three-year-old. But those conversations are huge, and they need to happen. They're incredibly important. And it is around repairing attachment. It is around repairing the relationship, for both the parents and the child. And if you want to stop the intergenerational stuff, you need to repair that stuff.

BRENDAN QUINN: This next, I’m aware of the time so I want to move along a little bit, but these have just been couple of points.

ANNE TIDYMAN: Okay, sorry.

BRENDAN QUINN: No, I really appreciate it. If you are a generalist practitioner, how do you know when to refer to a specialist alcohol and drug service? How do you know what alcohol and other drug services to refer clients to as well? Who wants to go?

MONIQUE YEOMAN: I guess that if you're a specialist practitioner and you've identified that there are alcohol or other drug concerns, then that’s kind of telling you that it’s probably time to have a conversation with a specialist alcohol and other drug practitioner. So there are opportunities for that consultation to occur prior to facilitating that referral. Here, in Victoria, we have the conversation with the client, and they need to be the ones that actually do refer themselves for specialist counselling. We need to be open and honest with them that these are the conversations that we’re having.

And this is then about us having strong collegiate relationships within the sector as well so that we can identify and can make contact with – and consult with the appropriate people around concerns that we may have, and around families that need the support – the specialist support.

ANNE TIDYMAN: Yeah. Networking is key to that. And a lot of my work is secondary consults. I get a lot of secondary consults around problematic drug use, which includes alcohol. And families. And next steps. It’s one of the reasons we work together, Monique. I’m AOD, Monique’s Child Services, or Family Services, and having that strong relationship, especially for us I think, because of MARAM and the information sharing, and the context in Victoria has really helped to break down some of the siloed work. And the importance of that is just key to good practice.

MONIQUE YEOMAN: And traditionally there have been many siloes within

ANNE TIDYMAN: Massive amounts of siloes.

MONIQUE YEOMAN: And that is an ongoing challenge within the sectors, I guess. And so it is very much about relationship, relationship, relationship. Understanding where your limitations might be, and where another practitioner’s expertise may lie, and how you can work together collaboratively for the outcomes of the family. Or of the child. Or whoever your client might be, that’s the end goal. And so being able to manage those differences perhaps for those outcomes that you're wanting to achieve for and with your client. Really important.

ANNE TIDYMAN: Yeah, the best outcomes come with great collaborative practice.

BRENDAN QUINN: So we’ve gone for about 45 minutes, and we’ve had a great – a stack of great questions have been coming through from the audience. The first one that I might ask is – and this again I think Anne and Monique, if you can speak to this. And Trina, obviously you're allowed to chip in at any point. What are some ways of asking about alcohol-related harms for workers who might have limited contact with the client? And this I guess might be particularly relevant during the last couple of years.

ANNE TIDYMAN: Just open and honest. Monique said it before, “So, are you drinking? Has your drug use changed? What does it look like now? Describe it to me. Describe what it looks like to your partner. Is it interfering with finance?” I mean you're just curiosity and without judgement. Yeah without -

MONIQUE YEOMAN: I also think premising those questions with, “You may find this difficult. This might be a difficult topic to have a conversation about.” Maybe even saying, “Look, I feel a little bit uncomfortable asking these questions.” Being a bit authentic, “However, I need to ask them, because this is either part of my role,” or, “This is something that I’m a little concerned about. And so I would like to just give you the opportunity to have a conversation with me about your alcohol use. And what I’ve seen in the relationship changes that have been occurring in your family.” Or something like that. Those really authentic engagement strategies.

ANNE TIDYMAN: And I think it’s really important to acknowledge that they've been really open and honest, and to thank them for that. Because they're sharing something that is, as you said earlier Trina, quite shameful. And, “This makes me a bad person. This makes me a bad parent. This makes me a failure.” No. No. This doesn’t make you any of those things. This is a conversation we’re just having.

MONIQUE YEOMAN: And again, couching it in terms of what they want for themselves, their family, their children. So bringing back in that element of their values and how they want to see their children grow up, can be really important to take the emphasis off the negative behaviour and place it more on the outcome and how we’re going to get to that outcome that we want. And how, as a practitioner, how can I support you to get to that outcome?

ANNE TIDYMAN: And acknowledging that there’s positives to drug-taking and alcohol use. Because there is, otherwise people wouldn’t do it. So, acknowledging the positives and then looking at some of the things that aren’t positive about it. And that’s the impacts that it has.

BRENDAN QUINN: Thank you all. This next one, it’s quite a complex question, but it’s definitely important for a lot of people. How do you support families from culturally and linguistically diverse backgrounds experiencing alcohol-related harm? It’s a very broad question, but I think it’s also very complex.

ANNE TIDYMAN: It’s really complex, and really broad. And the same principles sit there but acknowledging the culture that sits behind it as well. It’s another layer. So you've got all these layers. You’ve got family, you've got community, you've got culture, you've got religion. It’s just another layer, and again, I’m not an expert in anyone’s culture but my own, which is very limited. But they're the experts. So listening and being curious about their culture and where this fits into their culture. And what does that look like?

And not making assumptions about people's culture. Not looking at someone and saying, “Oh, they're going to have all this cultural stuff behind them,” because maybe they won’t. Maybe they will. So leaving assumptions aside, and just asking them. “What does this look like for you in this space?”

MONIQUE YEOMAN: And I think also going back to that discussion around collaborative practice as well, is bringing in professionals who have a good understanding of working with whatever cultural group that this client might be from. There’s power imbalances. There’s so many layers to this work. And so if we can bring somebody in that has greater knowledge than us, and greater understanding of how to engage with this person. Or what’s going to be an appropriate intervention? Then that’s surely going to support the work with the family.

ANNE TIDYMAN: You can ask the client. You might be working with a Muslim family, so you would ask the client, “Is it appropriate if we talk to the Imam? Can we bring that person into this space?” You might ask if there’s elders we can bring into the space if we’re working with Aboriginal and Torres Strait Islander communities. Who they're connected to. You might be working with a Vietnamese family. You might ask if they know about the Vietnamese Women’s Centre, and whether that’s an appropriate place too. But always asking client, what is appropriate in this space? And who would you like to bring into this space to help us? And to help me understand where the problematic use sits within your culture, your community.

BRENDAN QUINN: Excuse me. This other question I’m not particularly familiar with this therapeutic approach, but someone has asked, when would you use family systems therapy in this cases? Would you include family members in a first session with an AOD client?

ANNE TIDYMAN: I would say no, not until I’ve talked no, not until I’ve talked to the client. What does the client want? And I need to know the context of what’s sitting there as well. What does the family unit look like? Is it problematic? Is it just going to – you know. And there’s ways to bring family in, and I think with client’s permission, single session family work is probably something I would go to in that space. I’m thinking of a family that we worked with in Kids in Focus, where it was quite problematic. Grandparents had the child. There was a lot of blame. There was a lot of guilt. There was a lot of anger. Lots of anger. And grandparent didn’t want to give the children back. It was just messy.

Single session family work helped move that through. We did a couple of sessions, you don’t just have to do one. And the outcome was really positive. Far more than I thought it would be to be honest. And there was some repair work done. There was understanding brought to the space. So that would be my go-to. But never without asking client first. And I wouldn’t do a first session. Unless the client has brought the person into the room. And then I’d still want a little conversation on the side. Just to make sure.

BRENDAN QUINN: This refers back to one of the points that was raised before. What are some examples of how to describe to young children, so three to six years old, about their parent or parents not being able to care for them due to mental health and alcohol and other drug use, without describing them as sick?

ANNE TIDYMAN: I would have a conversation with the parent and work through what conversation would work for their child. You can say three to six, but age ranges are there for a specific reason. Developmental milestones, all the rest of it. But some of the trauma impacts children’s capacity. So working out who the child is, what sort of information they can deal with, and talking to the parent about how to have that conversation with their child, that it’s very necessary. I, in the past have talked about parents wanting to be the best parent they can be and learning to do that.

Because kind of that’s what they're doing. If it’s a 10 or 11 or a 12-year-old, then I think you can talk about drugs and the impacts on families. But younger children, I think using terms like ‘the best parent I can be for you’ is what I want to learn. Monique, you might have some more on that one.

MONIQUE YEOMAN: I think there’s something there around a child’s safety as well. And so that Mum or Dad, whoever it might be, needs to go and learn how to be a safer parent. And make some changes because at the moment, they're unable to be that safe parent of the child. And so being able to be truthful in that sense, and not just talk about being sick, because like Anne said earlier, the connotations of that, and the fallout from that can be – not only could the child experience that as, “Oh my goodness, next time’s Mum’s sick am I going to be taken away again?”

But also when they're more cognisant of the fact they were lied to. And so there’s a breach of trust that happened there as well.

ANNE TIDYMAN: So it needs to be honest. It needs to happen. Lots of parents don’t want it to happen. They just want to pretend none of it happened and they’ll forget about it. They won’t. And it’s about repair. That’s why it needs to happen. And repair will lead to safety. And children will feel safe in what their parents are telling them. So I think they're the sorts of conversations you have with the parent. And I think it’s up to the parent to do. I think our job is to help facilitate that, and practice with them so they feel comfortable saying what they need to say.

BRENDAN QUINN: That’s a good point. We got time for a couple more questions. What about the concept of high functioning alcoholism? No family violence, no financial impact, no impact on ability to perform family and work tasks. What is the harm, and do we need to address it?

TRINA HINKLEY: Can I kick in some of the evidence around -

ANNE TIDYMAN: Please, please Trina. Because I go straight to what’s happening on someone’s – so physical harm.

TRINA HINKLEY: Yeah. That’s what I’m thinking too. And I think the term that you used Brendan, was high functioning alcoholism? Is that the term?

BRENDAN QUINN: Yes.

TRINA HINKLEY: So that would suggest that there’s probably a large volume of alcohol being consumed, and that the person may have a dependence on alcohol. What we know from the evidence is that even if there are no immediate harms – even if there’s no domestic or family violence, no impact on family functioning. Even if there’s none of that, there are long-term physical harms, heart disease. I was trying to remember this morning – I think 37 cancers, or something like that – a huge number of different types of cancers have been linked directly to alcohol consumption.

ANNE TIDYMAN: A lot of gastrointestinal stuff.

TRINA HINKLEY: Yeah. So there are a whole lot of physical problems that if somebody – if there are no immediate impacts ion the family, a person may still experience longer-term physical and health issues, which can then have an impact on the family. So if you think about the impact that a parent who has cancer might have on the family, that if the cancer’s caused by alcohol, then that’s alcohol indirectly having an impact on the family and causing harm. So there’s that longer-term view that needs to be considered as well.

ANNE TIDYMAN: I would also ask about what job they're doing. What do they do for work, and does it impact there? Are they operating heavy machinery? Are they sitting in airport control towers? I mean where is this person sitting, and what could be the consequence of that apart from the physical harms?

TRINA HINKLEY: I think it’s very unlikely that if a person is consuming a really high level of alcohol, to the point of having an alcohol dependence, that there would be no harm.

BRENDAN QUINN: On the surface, but -

TRINA HINKLEY: I can’t imagine it.

BRENDAN QUINN: Yeah. This is probably going to be the last question, then we can sign off. What do you think are the impacts of increased availability of online alcohol delivery? What do you think they've been on increasing the incidents of alcohol-related harms? I know this has been in the news recently.

MONIQUE YEOMAN: Yeah, I was just thinking that.

ANNE TIDYMAN: It’s the behind closed doors stuff that really worries me.

TRINA HINKLEY: We know from the evidence that when you make something more available, it’s going to be consumed more. More people are going to consume it, and they're going to consume a higher volume of it. When you put barriers in place like higher taxation, or more difficult to access. So when you have to go somewhere to get something, people consume less. If it costs them more, they’ll consume less. And cost can be time, energy, all those sorts of things. When you make alcohol available online, it’s so – like online shopping, really, it’s just so easy. You remove all of those barriers that might be there if somebody has to get in the car and drive down the street.

If they've already had a few, that might be a real barrier to them going and getting anymore. But if it’s available online, they can just order it and it can arrive, and they can keep drinking alcohol, which increases the harm.

ANNE TIDYMAN: I think – my sense is if people are meeting after work, and meeting for drinks, they will only have one or two, because yes, they have to drive. That doesn’t exist anymore. And you can just keep ordering more and more.

BRENDAN QUINN: Yep. Anne, this question refers to something you talked about earlier. I think Anne mentioned that substance use from one parent can be used to prevent the escalation of violence from the other parent. Would you speak a little bit more to this please?

ANNE TIDYMAN: I think that where there’s family violence, and there’s alcohol and drug use, the affected family member, which includes the children, has spent a long time keeping themselves safe. And they will know how to de-escalate the parent who is utilising family violence. So they might know that if they sit and have a few drinks with their partner, it deflects the partner from the children. It de-escalates him and it will keep him calm. It will stop him from being violent.

So we might look at a mum and think, “Problematic drug use,” but what we need to be doing is looking at her and seeing protective parent.

MONIQUE YEOMAN: Can I just add to that as well? Is that we also need to be looking at the person who uses violence and their pattern of abuse. It may be in fact that he’s coercing her to use by telling her that if she doesn’t use with him, he will go to the authorities and tell them that she is a substance user, and have her children removed from her. So there are a lot of complexities relating to family violence and substance use.

ANNE TIDYMAN: It could be he’s the one that is bringing the alcohol into the house knowing that she has an alcohol issue. That’s the other part of that scenario. So he is interfering with her sobriety. That’s what I mean by that.

BRENDAN QUINN: That’s good. Last question. If there’s a situation where there’s domestic violence and alcohol dependence, how do we start those conversations about the harms?

ANNE TIDYMAN: We start by triaging risk. In my practice, it’s risk to child first and foremost. It’s child safety, family safety. Alcohol use does not cause family violence. It can exacerbate it, but you need to deal with child safety first and foremost, so you deal with the family violence. Monique, would you like to add to that?

MONIQUE YEOMAN: I’m going to again talk about patterns of behaviour.

ANNE TIDYMAN: Oh yes, patterns of behaviour. Yes.

MONIQUE YEOMAN: So if we’re having a conversation with someone who uses violence, talking about what they did, and what harm they have caused engages that conversation. So it’s not about, “Oh, the alcohol made me do it,” but more, “These are the things that I did do.” And so that can then just remove again – it removes the person from the behaviour and is something to move on and gets rid of that shame-based talk I guess. Does that make sense?

ANNE TIDYMAN: Yeah, we’re concentrating on the behaviours. And the behaviour mightn’t be when that person is alcohol effected. It might be the following morning when they're feeling rubbish and the kids are running around and making noise. And that could be when the violence escalates. But it’s always around safety of children for me.

BRENDAN QUINN: Thank you. I think that’s all that we have today. I really appreciate all of you. I’m sure what all of us appreciate all of your expertise, sharing it. It was such a useful and important seminar so thank you very much for coming along and sharing your expertise today.

ANNE TIDYMAN: Thank you.

MONIQUE YEOMAN: Thank you.

TRINA HINKLEY: Thanks.

BRENDAN QUINN: Have a great day.

ANNE TIDYMAN: Thanks. You too.

WEBINAR CONCLUDED

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