Design and Implementation of
Web-based Support for
Passive Drinkers
by
Akan Ibanga, Alex Copello, Jim Orford, Lorna
Templeton and Richard Velleman
The Riddle
“If I do not drink (or my drinking is so
inconsequential it would go unnoticed), but
will still be feeling the effects of a hangover
long after it has worn off the binge drinker,
Who Am I ? “
More importantly “Is There Help For Me?”
The Ripple Effect
Individual
Family
Friends
Society
Family
Friends
Larger Society
Out of court settlements
Should Affected Others be the
Focus?
 Cross cultural evidence
 Behaviour of individuals with a
drug problem
 Impact is irrespective of age or
gender
 Difficulty to cope in ways that
makes life more manageable
Taking Census: of passive drinkers?
Current Treatment focus
Focus almost solely on issues of screening, identifying, and intervening
briefly or otherwise, with the individual alcohol and drug misuser.
Only involve the family members, to encourage or provide support to
the user for entry into and retention in treatment (Velleman & Templeton,
2002, Copello and Orford, 2002).
When considering brief interventions for alcohol or drug problems,
this gap in service provision for family members is much wider
FAILURE TO INCLUDE FAMILY AND NETWORK
Theoretical failure
•Individual Models
•Critical, pathologising
models
•Ambiguous models
•Partial models
Practical failure
•Attitude of SDA worker
•In working with FNM
•To enlist family and
network support
for change
ADF Perspective
Stress-strain-coping-support model.
Stress –living in a family where someone misuses alcohol or
drugs is commonly very stressful
Strain- Family members who are concerned are likely to show
signs of strain including physical and psychological ill-health
Coping-Family members will seek to understand what is going on
and what to do about it
Support from others -These members can be help or
hindered depending on how other people react
Contrast with other Models
• Family/affected others are seen differently
• Places affected others, and not the substance user at
the center of interest
• Focus on present circumstances and actions
• Focuses on the needs of the affected others
• Provides a model of intervention
Copello, Templeton et al. (5-STEPS) – family
member focused
Step 1
Listen non-judgmentally
Step 2
Addresses fears and misunderstandings
Step 3
Explores responses and coping mechanisms
Step 4
Examines available social support
Step 5
Probes further help and referral
Our Work So Far
• Face-to-face delivery where the various health professionals (Gps,
Health Nurses, Counselors) were trained to delivery of intervention
evaluated.
• Delivery to special populations (BMEs) was evaluated
• Whole teams/ organisations were trained and supported to make
changes in delivery of services to include or be more focused on the
affected other.
• Self-help manual was later developed, a version of which was
tested in a clustered randomized trial in primary care.
Encouraging results were obtained at each of these stages
Is this intervention currently
accessible to family
members?
www.alcoholdrugsandfamilies.nhs.uk
Advantage of a web-based approach
• It would provide an approach to intervention that is currently not
readily available.
• It would be accessible to much wider number of family
members.
• It could be accessed by anyone anywhere in the world.
• Accord a level of privacy for family members and their relations.
• Would empower individuals.
• The timing is flexible enough to fit each individual’s program.
Self-Help (SH)
Manual
Transformation
Of SH into
Web Format
Data
Collection
Appropriaten
ess
Ease
Pilot /Limited
Access
Usability
Outcome
evaluation
Analysis
Review
World Wide
Web
Outcome
evaluation
Outcome Measures
 The Family Member Impact (FMI) scale This is a 16 item scale
that measures the perceived impact that alcohol and other drug use
by a relative is having on the family as a whole.
 Coping Questionnaire (CQ) Assess ways in which family members
have over the previous 3 months been coping with the problem
drinking or drug taking relative.
 Symptom Rating Test (SRT) Consist of 30 questions used to
assess the extent of physical and psychological ill-health
experienced each of them within the past 3 months
www.alcoholdrugsandfamilies.nhs.uk
Enter your
username and
the password
that was sent
to your email
box.
Then click on the
login button
Self- Help Programme
Registration
Patient information sheet, privacy policy, informed consent, Demographic
questions, Assessment battery, registration
Step
1
Step 2
Step 3
Step 5
Step 4
Introduction
Introduction
Introduction
Introduction
Introduction
Examples of
Stress
Exercise 4
Exercise 6
Exercise 8
Related Issues
More Information
on Alcohol/ Drugs
Ways of
Responding
Kinds of Support
Exercise 12
My support
Recap
Exercise 9a, b, c
Getting Additional
Help
Exercise 2
Health
Experiences of
Family Members
Exercise 5a
Exercise 5b
Exercise 7
Recap
Exercise 10
Exercise 3
Recap
Exercise 13
Recap
Recap
REVIEW
Demographics for WWW participants
Variable
%
Gender

Male

Female
Age of Family Member
11 (15.9%)
58(84.1%)
Mean=44.64 (10.07)
Age of User
Mean=39.09 (13.29)
Relationship with User

Father/Mother

Spouse/Partner

Brother/Sister

Son/Daughter

Other
Gender of User

Male

Female
Main Substance Consumed by User

Alcohol

Drugs

Both
Duration of Problem

< 1Year

1-2 Year

3-5 Years

6-9 years

10 years
4.3
47.8
5.8
27.5
14.5
58(84.1%)
11 (15.9%)
62.3
17.4
20.3
4.3
10.1
21.7
13.0
50.7
”The programme helps challenge me to think about the specifics of what I
think or feel about the issues. Providing answers to questions asked in the
programme caused me to pause and think how I might feel or put into words. It is
kind of difficult to put into words but it was generally positive”.
“It makes you feel supported that somebody knows what you are
going through”
”This (web-programme) makes available so much
needed social support that is just not always available
with every door being closed on you wherever you go.
Just knowing that there is something out there is
helpful”.
”The programme is quite easy to use, intuitive and
the instructions and pretty straight forward”.
”It was a therapeutic experience online for
me”.
 ”In using this site you get the feeling that you are not alone that
someone understands what you are going through. Further more
that, the site went into how you feel and really makes you open up,
it is nice to let it all out. It does not present you with a ‘yes’ and
‘no’ situation but ask you questions and requires you to think
further than this, which is actually quite revealing”.

”It helped me to see that as a person I needed help”.

”Having it online is obviously the way to go as many things are now
available online and people search the net for a lot of things, and
as many more people are having access to the internet finding a
way to provide that on the internet is a way forward”.

”It made you feel you were still a person…that you have
rights….that you have a life to live as well”.
Include Social Networking,
& Dating Functions?
The results of this work so far points to
the fact with slight modifications to this
web-based programme, one can conclude;
as stated by one of the family members
that:
“Having this (support) online is
obviously the way to go”
ADDICTION AND THE FAMILY (ADF) GROUP
• The University of Birmingham/Birmingham and Solihull Mental Health
NHS Trust Substance Misuse Service
Akan Ibanga
Alex Copello
Claire Hampson
Jim Orford
• The University of Bath Mental Health R&D Unit/Avon & Wiltshire
Mental Health Partnership NHS Trust
Lorna Templeton
Richard Velleman
and other colleagues who have been part of this group over the years.