Few would disagree that adult family members of people with substance problems rarely receive consistent responses across frontline agencies. Dealing with substance users leaves little space for working with ‘others’ who continue to be viewed, primarily, as providing potential support systems for recovery or as allies in dealing with childcare concerns. Lacking training, practitioners may be wary of engaging more fully with relatives. It is easier to signpost them to self-help groups; these will not suit everyone or may not provide a forum for addressing all their difficulties. However, a model has been developed which concentrates entirely on helping relatives to cope.
The 5-Step Method is present-focused. It discards the notion that the causes of substance problems inevitably lie in past family problems and views relatives as ‘ordinary people facing highly stressful circumstances’. As such, family members tend to adopt one of three coping styles – ‘standing up to it’; ‘putting up with it’; ‘becoming independent’. Each of these has advantages and disadvantages and the practitioner’s task is to help the person explore what is best for him/herself and then adopt effective coping strategies and build supportive networks. The practitioner style mirrors that used in motivational interviewing: non-judgemental; use of open questions; reflective listening etc.
The ‘steps’ are themes to be worked through with the family member:
Step 1 – listening; exploring stresses
Step 2 – providing targeted information
Step 3 – discussing coping responses
Step 4 – enhancing social supports
Step 5 – exploring what else might be needed.
The method is readily learned, and can be adapted to various settings and delivered flexibly over a shorter or longer number of sessions. It is important, however, that sufficient time is given to step 1 and that step 3 is not addressed too early.
The 5-Step Method chimes with guidance given by NICE. As the gold standard for working with relatives, commissioners should build it into every contract for services for substance users so that their family members receive due attention.
The application of the model is fully described in The 5-Step Method: Principles and practice. Coppello, A., Templeton, L., Orford, J. and Velleman, R. 2010. Drugs: Education, Prevention and Policy, 17 (s1). This supplement to the journal also contains papers exploring the development of the model and is well worth accessing in full.
George Allan is chair of Scottish Drugs Forum and author of Working with Substance Users: a Guide to Effective Interventions (2014; Palgrave)