Richard McVey
Service Manager (Family Services), Aquarius, Birmingham
Workshop at the BASW SIG Conference,
27th April 2011
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Introductions, overview of working with families, intro
to 5-Step and watching round table discussion – 15
minutes
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Step One – 15 minutes
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Step Three– 20 minutes
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Step Four- 20 minutes
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Final slides and time for questions – 5-10 minutes
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There are estimated to be millions of family members
affected by a relative’s substance misuse.
All domains of life can be severely affected.
Strong correlations with mental health problems,
violence/abuse, neglectful parenting and social exclusion,
all of which puts families at greater risk of harm.
Children can be particularly affected.
Familial (usually parental) substance misuse is one of the
most common characteristics of social workers caseloads.
Many family members believe the only way things will get
better is if the alcohol or drug misuse ceases.
Family members are usually very isolated; in many areas
there is little help available; for others, they do not know
where to go for help, or are too ashamed, embarrassed or
frightened to seek help.
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Family members have a wide range of needs.
Historically, there has been a big gap in services for
families which help them in their own right.
Recently, the needs of families have received much
greater attention – drugs strategy, Hidden Harm,
Families Green paper, NTA and NICE guidance, the
recovery agenda, and the Think Family agenda.
 Currently unclear how this might change under the
Coalition Government and the Big Society agenda.
The 5-Step Method is one intervention which has
been developed to help family members in their own
right.
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A brief, structured, psycho-social intervention.
Derived from the ‘stress-strain-coping-model’, which
describes what family members have said about what
it is like to live with a substance misuser.
Differs from other theories of addiction and the
family.
◦ Most importantly they are not blamed or
pathologised, but are seen as part of the solution,
who also have needs in their own right.
It can help family members regardless of the
treatment status of the user.
It can be delivered flexibly; by a range of
practitioners in a range of settings.
Developed from what family members told us:
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Families are stressed by someone else’s problem
drinking or drug use; this has an impact on them.
The strain of dealing with the substance misuse
leads to physical and psychological ill health. There
can also be problems in other areas.
The strain is influenced by:
◦ Method(s) of coping
◦ Level and quality of social support
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Watch DVD discussion
What are the key principles of the 5-Step
Method?
How might the intervention be useful in
social work practice?
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Step One
◦ How the problem affects family members
◦ Listen, reassure and explore concerns
Step Two
◦ Provide relevant information
◦ About alcohol and drugs but also other issues
Step Three
◦ Explore coping responses
Step Four
◦ Explore social support
Step Five
◦ Explore further options for help & support
◦ Involvement of others in the family
◦ Scope for joint working
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One day training
Delivery guided by manual for professionals
Options also to use self-help manual, online selfhelp materials or integrate intervention with group
programme
Adhere to core principles of the intervention, but
plenty of scope for flexibility and creativity
Usually 5 sessions but there is a lot of flexibility
here as well.
Can sit alongside other ways of working and be part
of joint working arrangements
Issues of safe practice (particularly in relation to
domestic violence and safeguarding need to be
considered)
Outcomes of the intervention – core questionnaires
suggested
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Watch DVD
What do you think is most important about
Step One?
How could you see this step being useful to
your practice?
What else might you, as social workers,
need to consider?
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Explore how the substance misuse affects
family members.
Setting boundaries and goals for the rest of
the intervention.
What family members tell us is most
important to them.
Normalising.
Basic counselling skills.
May take more than one session.
Step One is incredibly important and must
not be rushed.
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The importance of having accurate
information e.g. reducing stress & feeling
more in control.
Information
about
drugs,
alcohol,
addiction and treatment.
But also about other things, e.g. housing,
benefits, debts, college courses.
Using links with other local contacts.
◦ Joint working might be useful here.
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Watch DVD
What do you think is most important about
Step Three?
How could you see this step being useful to
your practice?
What else might you, as social workers,
need to consider?
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FMs will probably have tried everything.
Uncertainty about how to cope?
Is there a ‘best’ way to cope?
Reassurance. Empowering change.
Consider 3 broad categories of coping:
◦ Engaged
◦ Tolerant
◦ Withdrawal
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Engaged- Standing up to it
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Trying to control my relatives behaviour
Being emotional
Being assertive
Being supportive
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Tolerant- Putting up with it
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Not doing anything
Putting my relatives needs before my own
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Withdrawal- Withdrawing from it
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Avoiding my relative
Being independant
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Drawing a network diagram
In pairs take it in turns to draw a network
diagram; think of a case you are currently
working with, or consider in relation to a
personal goal and how you might need to
engage social support to help you achieve your
goal.
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Watch DVD
What do you think is most important about
Step Four?
How could you see this step being useful to
your practice?
What else might you, as social workers,
need to consider?
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Network diagram
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What is support?
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Who or what can be supportive?
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Improving positive social support
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Decreasing negative social support
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Can facilitate links with other services
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Other services and websites
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Further reading
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Help for the family member
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Help for the misuser
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Help for others, e.g. children
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Joint working arrangements
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Studies in primary & secondary care with a range of professionals
in the Bristol/Bath & Birmingham/West Midlands areas.
Questionnaire and interview data collected from several hundred
family members.
Family members (usually female and mothers or partners) have
been living with the situation for an average of 8-10 years and
are generally very isolated.
The intervention can contribute to:
◦ A positive and significant change in coping behaviour.
◦ Statistically significant reduction in symptoms.
◦ Lessening of the impact of the problem.
◦ Insights from qualitative interview data.
◦ Improvements in therapeutic commitment for practitioners
e.g. confidence and knowledge, and increased awareness of
the importance of working with family members.
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“It’s just nice to talk to someone who’s not
involved…family & friends are too close I think”
“It was about the first time I felt somebody had
listened to me….someone was interested in how I
was feeling”
“She let me find my own way….she helped me to
arrive at ways of dealing with things”
“It did me good, it was helping me….that was my
time…..I felt like I was spoiling myself”
“I can’t solve the problem; I’ve got to stand back
and that’s helped me”
“I feel privileged to have had this help, I can’t
thank you enough”
“As a Mum, I’m used to only thinking of others”
“Personally, I found the sessions a positive professional
experiences. I have learnt so much from this client”
“It gave me confidence to know that the stuff I had
done was actually okay”
“I had a fear of working with family members…I’ve
crossed that bridge”.
“…how important it is to engage with family members in
people’s treatment”
(if we have time)
 Watch DVD ‘talking heads’
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How do you think the 5-Step Method could
enhance social work practice?
Acknowledgements
 Lorna Templeton-Independent Research Consultant (Bristol)
 Professors Alex Copello, Jim Orford, Richard Velleman
 Akan Ibanga
 and many others who have worked with us over the years
Further information and reading:
 Publication of special supplement of the academic journal D:EPP
focussed on the 5-Step Method (December 2010).
 Other research publications and a book (see next slide, D:EPP
special issue or contact us)
You can contact me:
 [email protected]
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Orford J, Natera G, Copello A, Atkinson C, Tiburcio M, Velleman R, Crundall I, Mora J, Templeton L & Walley G
(2005) Coping with Alcohol and Drug Problems: The Experiences of Family Members in Three Contrasting Cultures.
London; Taylor and Francis.
Orford J, Templeton L, Copello A, Velleman R, Ibanga A & Binnie C (2009). Increasing the involvement of family
members in alcohol and drug treatment services: the results of an action research project in two specialist agencies.
Drugs: Education, Prevention and Policy 1-30 iFirst.
Copello A, Templeton L, Orford J, Velleman R, Patel A, Moore L, MacLeod J & Godfrey C (2009). The relative efficacy
of two levels of a primary care intervention for family members affected by the addiction problem of a close
relative: a randomised trial. Addiction; 49-58.
Velleman, R., Arcidiacono, C., Procentese, F. and Copello, A. and Sarnacchiaro, P. (2008). A 5-step intervention to help
family members in Italy who live with substance misusers, Journal of Mental Health, 17, 643-655.
Orford J, Templeton L, Patel A, Copello A & Velleman R (2007). Qualitative study of a controlled family intervention
trial in primary care: I The views of family members. Drugs: Education, Prevention and Policy 14 (1); 29-47.
Copello A, Velleman R & Templeton L (2005). Family interventions in the treatment of alcohol and drug problems.
Drug & Alcohol Review 24(4); 369-385.
Velleman R & Templeton L (2003). Alcohol, Drugs and the Family: A UK Research Programme. European Addiction
Research 9(3), 103-112.
Copello A, Orford J Velleman R, Templeton L & Krishnan M (2000). Methods for reducing alcohol and drug related
family harm in non-specialist settings. Journal of Mental Health, 9, 329-343.
Templeton L, Velleman R & Russell C (2010). Psychological Interventions with Families of Alcohol Misusers: A
Systematic Review. Addiction Research & Theory (forthcoming).
A special issue of ‘Drugs: Education, Prevention and Policy’ (later in 2010) will be devoted to our
programme of research and the 5-Step Method .