Alcohol and the family
An overview of thinking & research
in this area of work
An introduction and discussion led
by Richard Velleman and Jim Orford
Alcohol and the family
Richard and Jim are part of a long-standing collaboration, working
at understanding and helping family members.
In England, Richard and Jim, plus Alex Copello, Lorna Templeton,
Akan Ibanga
Internationally:
Mexico, Institute of Psychiatry, Mexico City, Guillermina Natera;
Australia, Darwin, Northern Territory, Ian Crundall, Carol Atkinson;
Italy, Caterina Arcidiacono.
And now: Ireland, New Zealand, Nigeria, etc (AFIN, = more later).
Alcohol and the family
Our group has conducted a lot of research on the
impact of substance misuse (both alcohol and other
drugs, and gambling as well) on family members:
• parents, spouses, siblings, adult children, aunts,
grandparents.
• Use of both Quantitative and Qualitative methods.
• Very different cultural and geographic areas:
England (and different places and different ethnic
groups), Aboriginal families in the outback in Northern
Territory, Mexico City slum dwellers, indigenous
peoples in Mexico, different regions of Italy, etc etc.
Alcohol and the family
Some interesting differences (and we’ll say more about
that later this morning when we discuss Nigeria), but
mainly, huge similarities.
• how difficult it is to live with someone (as a spouse,
or as a parent or as a child) when that person
misuses alcohol or drugs.
• the various impacts that the drinker or drug user has
on their lives: about the users changeable moods, or
their aggression, or their violence, or their
disruption of family or social occasions, or the
impact on the family’s finances or of their worries
over the users failing health.
• how this has affected them as family members, who
have to worry and often bear the brunt of any
changes in the substance misuser.
Alcohol and the family
•
•
•
how they often developed symptoms: become
anxious, or depressed, or how the worry seems to
lead to effects on their physical health too: their
sleep is disturbed, or their eating is disrupted or
they develop headaches or gastric problems.
how problematic they find it to work out how best
to cope or deal with these difficulties.
and how the amount and type of social support that
they receive really makes a difference.
From hearing all these stories from so many family
members, we developed a simple model to help
understand better what was going on: a model that was
developed directly from the things that family members
have said.
Alcohol and the family
Family
members
are
stressed
due to the
impact of a
relative’s
substance
misuse
Strain:
usually
physical
and
psycholog
ical health
problems
How the family
member copes with
(responds to) the
situation
and
The level and quality
of social support
available to the family
member
Alcohol and the family
Contrast with other Models:
• Lots if other models can appear to blame the
families, or to pathologise them (eg codependency, family therapy). SSCS model is
non-blaming and non-pathologising.
• In the SSCS model, family members are BOTH
part of the solution, AND who also have needs
in their own right.
• Family members need to be at the heart of the
response. So we have developed a method to
help them in their own right (the 5-Step
Method), and a method where they are
included in therapeutic work with problem
alcohol or drug users (SBNT).
Alcohol and the family
information
Explore and
enhance
social
support
five
Discuss
ways of
responding
and explore
coping
responses
four
Provide
relevant,
specific and
targeted
three
Let the
family
member tell
their story:
Listen,
reassure and
explore
concerns
two
one
The 5-Step Method has 5 steps!
They are:
Discuss and
explore
further
needs
8
Alcohol and the family
• We have researched and evaluated 5-Step
in a number of studies, including one
Cluster Randomised Trial with a 12-month
follow-up;
• Studies have been undertaken in the UK
and other countries,
• and have been done in primary care and
secondary care (both in Statutory and nonStat services),
• and all evaluations have been positive:
family members symptoms reduce and
their coping improves.
Alcohol and the family
Social Behaviour & Network Therapy
(SBNT)
• Aim: To mobilise and/or develop
positive social support for a change in
drinking or drug use, beyond contact
with a service.
• How? By developing a supportive
team of concerned others who will
not only offer support during therapy
but beyond the treatment period; as
such, homework tasks and role play
are key components of the therapy.
Alcohol and the family
• Again, a number of research and evaluation
studies, again all positive.
• So – I’ve said a bit about some of the things
we have been doing in our ADF Group.
• But there are Challenges, and is it those
that we want to share and discuss in this
first session, and then throughout the rest
of today.
• So, Jim is going to join me here for this part:
Alcohol and the family
There are TWO types of challenge:
• How to reach even a fraction of the
people we think are affected.
• How to change policy and practice to be
more family-inclusive.