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?”

Society Larger Society Friends Family Individual The Ripple Effect

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

Theoretical failure Individual Models Individual Models Critical, pathologisingCritical, pathologisingmodels Ambiguous modelsAmbiguous models Partial modelsPartial models Practical failure Attitude of SDA workerAttitude of SDA worker In working with FNMIn working with FNM To enlist family andTo enlist family and network support network support for change for change FAILURE TO INCLUDE FAMILY AND NETWORK

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 ADF Perspective

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 Step 2 Step 3 Step Step 4 Step 5 Listen non-judgmentally Addresses fears and misunderstandings Explores responses and coping mechanisms Examines available social support 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?

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 Review World Wide Web Outcome evaluation Pilot /Limited Access Ease Usability Analysis Data Collection Appropriaten ess 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

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Self- Help Programme Patient information sheet, privacy policy, informed consent, Demographic questions, Assessment battery, registration Registration Step 2 Introduction Exercise 4 More Information on Alcohol/ Drugs Exercise 5a Exercise 5b Recap Step 3 Introduction Exercise 6 Ways of Responding Exercise 7 Recap Step 1 Introduction Examples of Stress Exercise 2 Health Experiences of Family Members Exercise 3 Recap Step 4 Introduction Exercise 8 Kinds of Support My support Exercise 9a, b, c Exercise 10 Recap Introduction Related Issues Exercise 12 Recap Getting Additional Help Exercise 13 REVIEW Step 5

Variable% Gender  Male  Female 11 (15.9%) 58(84.1%) Age of Family MemberMean=44.64 (10.07) Age of UserMean=39.09 (13.29) Relationship with User  Father/Mother  Spouse/Partner  Brother/Sister  Son/Daughter  Other Gender of User  Male  Female 58(84.1%) 11 (15.9%) Main Substance Consumed by User  Alcohol  Drugs  Both Duration of Problem  < 1Year  1-2 Year  3-5 Years  6-9 years  10 years Demographics for WWW participants

 ”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 was a therapeutic experience online for me”.  “It makes you feel supported that somebody knows what you are going through”  ” The programme is quite easy to use, intuitive and the instructions and pretty straight forward”.  ”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”.

 ” 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.