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 Strain: usually physical and psycholog ical health problems How the family member copes with (responds to) the situation The level and quality of social support available to the family member and Family members are stressed due to the impact of a relative’s substance misuse

Alcohol and the family Contrast with other Models: Lots if other models can appear to blame the families, or to pathologise them (eg co- dependency, 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).

one Let the family member tell their story: Listen, reassure and explore concerns two Provide relevant, specific and targeted information three Discuss ways of responding and explore coping responses four Explore and enhance social support five Discuss and explore further needs Alcohol and the family The 5-Step Method has 5 steps! They are: 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 non- Stat 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.