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Involving Family Members in Services and Recovery. Prof Alex Copello Consultant Clinical Psychologist Addiction Services Birmingham and Solihull Mental Health Foundation Trust & Professor of Addiction Research The University of Birmingham

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involving family members in services and recovery

Involving Family Members in Services and Recovery

Prof Alex Copello

Consultant Clinical Psychologist

Addiction Services

Birmingham and Solihull Mental Health Foundation Trust &

Professor of Addiction Research

The University of Birmingham

Presented at Society for the Study of Addiction Annual Symposium 2008

Addiction Across the Lifespan

13th and 14th November, Park Inn York, York, UK

involving family members project group
Involving Family Members Project Group
  • Jim Orford
  • Lorna Templeton
  • Akan Ibanga
  • Richard Velleman
  • Substance misuse is associated with a range of social and health problems affecting the individual as well as the family within which the individual lives

[Orford, Natera and Copello et al., 2006]


Ray et al (2007)Compared family members of people with substance misuse problems with family members of similar persons without substance misuse.Samples:Family members n = 45,677 (male/female – 46/54%)Comparison group n = 141,722 (male/female – 46/54%)More likely to be diagnosed with medical conditions most commonly depression and substance abuseRay et al (2007) The excess medical cost… Medical Care

family interventions three broad categories
Family Interventions: Three Broad Categories
  • interventions that work with family members to promote the entry and engagement of drug and/or alcohol users into treatment
  • the joint involvement of family members and the relatives using drugs and/or alcohol in the treatment of the user
  • interventions aimed to respond to the needs of family members affected by drug and alcohol problems in their own right

[Copello, Velleman and Templeton, 2005]

treatments involving family members fms


A. Working with FMs to encourage their relatives’ engagement in treatment

e.g. Family ‘intervention’; Community reinforcement and family training; Unilateral family therapy; Cooperative counselling; Pressures to change

B. Joint involvement of FMs and their relatives in their relatives’ treatment

e.g. Conjoint family group therapy; Behavioural couples therapy; Family therapy; Network therapy; Social behaviour and network


C. Responding to the needs of family members in their own right

e.g. Concurrent group treatment; Al-Anon, Families Anonymous; Supportive stress management counselling; Parent coping skills training; 5 step intervention

nta guide for commissioners and providers 1 1 key messages
NTA Guide for commissioners and providers1.1. Key messages
  • Providing services to meet the needs of families and carers leads to improvements for families, carers, children and drug misusers
  • Areas without provision, or with limited provision, can benefit from developing or expanding services for families and carers
  • Developing a family-friendly focus will assist providers to achieve the best outcomes for users and carers
  • Involving families and carers can improve engagement, retention and outcomes for drug users in treatment
  • Involving families and carers in the planning and commissioning of services improves the effectiveness of services and the drug treatments system

Taken from Supporting and Involving Carers: A guide for commissioners and providers published by the National Treatment Agency 2008, p.7


Addiction and the family: is it time for services to take notice of the evidence? (Copello and Orford, Addiction, 2002)




Treatment focus needs to be broadened

Commissioners and service providers

recognition of broader sets of outcomes

levels of dissemination of family focused work
Levels of dissemination of family focused work
  • Individual volunteer service providers
  • Service providing units or teams
  • Whole services or agencies
  • Dissemination on a motivational level
copello templeton orford et al 5 steps family member focused
Copello, Templeton, Orford et al. (5-STEPS) – family member focused
  • Listen non-judgementally
  • Provide information
  • Discuss ways of responding
  • Explore sources of support
  • Arrange further help if needed
5 step intervention changes in coping behaviours copello templeton orford et al in press addiction
5 Step Intervention: Changes in Coping Behaviours Copello, Templeton, Orford et al., (in press) Addiction
social behaviour and network therapy sbnt user focused
Social Behaviour and Network Therapy (SBNT) – user focused
  • A Manualised time limited intervention consisting of 8 sessions
  • Based on the principle that social behaviour, social interaction and network support for change play a central part in the resolution of addiction problems
percent days abstinent
Percent Days abstinent

Ukatt – United Kingdom Alcohol Treatment Trial: BMJ, 2005, 331, 541-544 & 544-548

drinks per drinking day
Drinks per drinking day

Ukatt – United Kingdom Alcohol Treatment Trial: BMJ, 2005, 331, 541-544 & 544-548


The four most important people: how were they related to the problem drinker? (from UKATT, N = 742)

This graph shows how the participants were related to their four most important people. Percentages of named relationships are shown for the 1st, 2nd, 3rd and 4th most important people to the focal drinker:

key aspects of a network approach
Key aspects of a network approach
  • Identify network
  • ‘Think network’
  • Agree goals
  • Explore and enhance (if possible) communication
  • Explore coping
  • Joint activities
  • Relapse management and responses


To obtain agreement of two specialist treatment teams

To establish organisational standards for the engagement of families

To train managers and frontline staff

To evaluate the results:

Establishment of standards

Take up of training

Change in frequency of engagement of family members

Changes in attitude

methods of evaluation
Methods of evaluation
  • Process Notes
  • Collection of practice case examples
  • Inventory of new practices
  • Individual interviews with team members
  • Focus groups
  • Attitude change
  • Auditing involvement of family members
some initial concerns
Some initial concerns
  • Negative for FC if limited network
  • FMs don’t want to get involved
  • Takes more time and logistic problems
  • Lack of experience of working with more than one person
  • Concern about confidentiality
  • Danger of conflict or FM taking over
  • May be conflict of interest for counsellor
  • Might open Pandora’s box of family issues
seeing the benefits of ifm
Seeing the benefits of IFM
  • FC appreciates who might be supportive
  • Counsellor can get a fuller, clearer picture
  • FMs help as co-workers
  • FMs feel listened to and have a role
  • FMs are better informed
  • Conflict can be managed and eased
  • Family support extends beyond treatment
diversity of family members

Diversity of family members

Wife... Husband… Fiance…

Mother & father of 18 year-old…

Brother &15 yr-old son… Daughter of 70 yr-old… Son & daughter… Mother & sister… Wife, sister & brother-in-law…

Mother & brother… Sister, aunts & uncles… Mother & two brothers…

Uncle & brother’s wife… A friend…

Two neighbours

diversity of form sequence of work with family members
Diversity of form & sequence of work with family members
  • Brief meeting before session with FC
  • 4 sessions with FC followed by one joint
  • 3 sessions with a couple followed by several with FC alone
  • 1 session with FC & partner followed by large family meeting
  • Home detox: 5 sessions joint with spouse and sometimes other FMs
  • FC alone, then with mother, then with father, then alone
  • Arrest referral: 1 joint session, 1 FC alone
diversity of outcomes
Diversity of outcomes
  • FM calmer, reassured
  • Support for FC; mutual support
  • Clear joint goals and plans
  • Conflict handled in a safer environment
  • FM less tolerant, more assertive coping
  • Joint planning of alternative activities
  • FM increased knowledge of alcohol problems
  • Better communication and mutual understanding
  • Realising children also affected
  • FM decided to stay
system level changes did they happen
System-level changes: Did they happen?
  • New initial appointment letter
  • Leaflet for FMs
  • New client assessment form
  • New family-oriented records
  • Log of informal family contacts
  • Recording family work in the new electronic data base

Notes: 1Significantly greater than before the project (confidence, knowledge, support, impact, legitimacy and total at p<0.001; self-belief at p<0.01; motivation at p<0.05). 2Significantly greater than comparison teams (support at p<0.01; knowledge and total at p<0.05).

lessons we learnt
Lessons we learnt
  • Be clear about aims
  • Be sensitive to differences in people’s levels of previous training and experience of family work
  • Be aware of limitations in the organisation’s capacity to record family work
some continuing issues
Some continuing issues
  • Striking a balance between seeing different members of the family together or separately
  • How best to explain to FCs and FMs why involving FMs is being recommended
  • Whether to involve FMs when cases appear complex
  • Involvement of children and young people
  • Joint work with other agencies
  • Representativeness of teams
  • Length
  • Methods of evaluation
  • No family member outcomes