The 5-Step Method for affected family members: principles and results

Introduction:

Amongst the principal harms from addiction are harms to affected family members (AFMs) including children, and to family life generally. These family harms have been relatively neglected. Being an AFM is a very common experience and constitutes a major contributor to the burden of ill-health globally. The 5-Step Method (5SM) for AFMs was first developed on the basis of in-depth interviews with AFMs in England and Mexico.

Methods:

5SM has been tested in England, Mexico, Australia, Italy and India, mainly using pre-post and follow-up designs with one medium-sized and two pilot/small controlled trials and one economic analysis. Most studies have involved family members affected by excessive alcohol and/or drug use; one English study has involved those affected by excessive gambling. Regression analyses and qualitative analysis of interviews with AFMs and professionals have been used to study processes of change. A version of 5SM adapted for adolescents has been piloted in Northern Ireland.

Results:

Reductions in AFMs' symptoms following 5SM have regularly been found. Follow-up, up to 12 months, has found changes to be maintained. One controlled trial in England found supervised use of a self-help manual version to be equally as effective as up to 5 sessions of professional-led counselling. A study in Mexico found the method to be cost-effective. Regression analyses suggest that reduction in emotional, controlling and tolerant ways of AFM coping constitutes a key change process. Qualitative analysis points to the importance of AFMs becoming more assertive; increasing focus on their own life and needs; and talking to others about the problem and being listened to.

Conclusions:

5SM is a promising approach for helping AFMs in their own right. It has potential application in many countries, possibly including low and middle income countries.