The second facet involved the family member worrying about the relative. Family members were not only experiencing difficulties regarding themselves but also concerned about their relatives whom they viewed as having become the victims of the substance use. Family members were worried about the relative’s health, their appearance and neglect of self care. They also worried about their mental health and general attitude towards others, their state of finances, their performance at work in education and other events in their lives.
Family members also reported worrying about the excessive frequency or quantity of substance use and the relative’s isolation. The third facet involves the threat to home and family life as a result of the relative’s behaviour. It is not only the individual effects which the substance use has on family members but also the very life of the family and the home. One factor which affected family life was the depletion of financial resources as a result of the finances being spent substances.
These effects include loss of assets, poor families getting poorer and very often woman supporting the family economically to the extent which they had not expected. Family members reported more harmful effects which were being put on the children. The final facet describes the signs of strain for family members. Family members described having ‘bed feelings’ which involved feeling helpless, depressed, low, guilty, devalued and angry. Family members also felt their social lives had been affected, for example an English mother said her social life had been restricted because she had ‘felt so sick inside’ (Orford, 2005).
In the majority of the interviews from the three socio-cultural groups family members had reported having symptoms of physical ill health such as headaches, back pain, and made references to poor health in general. However these four facets are what were deemed to be the core experiences of family members and bring together some of the elements of stress, threat and abuse. Family members identified different ways of coping which were identified in three categories.
Putting up with the problem was one of them. Family members had adopted this strategy because they felt helpless, had found it difficult to be hard and felt that the relative needed their support and therefore wanted to keep calm for the family. Another more active way of coping was to stand up to the problem, trying to regain control by talking to the relative, by resisting and refusing and by trying to protect themselves and others in the family. The third category is withdrawing and gaining independence.
Family members would focus on their own quality of life and distance themselves from the problem. Family members had found the best strategy for them by trial and error and reported that being hostile and aggressive tended to yield poor results (Orford et al, 2005). Much of the work detailed within this paper has demonstrated that although there is a significant amount of evidence suggesting that both adults and children are very negatively affected by the problem of substance misuse, very few of them receive appropriate help.
Based on the stress-strain-coping-support model primary care interventions have been developed to help family members cope, coping is the central element in the stress-strain-coping-support model. Most services are strongly orientated towards helping the substance user and those who do involve family members involve them as an adjunct to the treatment of the substance misuse (Velleman and Templeton, 2002).
Two versions of a brief 5-step intervention have been developed, one is delivered over a 5 session period by a professional within primary care and the other which is a minimal version based around one interview with a professional followed by self-directed work using a self help manual. The intervention is based on the basis that if strain is mediated by coping and support then family members should be helped by interventions used to improve their coping responses and offer them an opportunity to receive and improve support.
Through use of the stress-strain-coping-support model to explore coping methods and define which ones were most helpful 5 steps of intervention were developed which are (1) listening to the relative and learning about their problem; (2) providing advice and information; (3) exploring responses and coping mechanisms; (4) exploring the relatives available social support networks; (5) discussing possible sources of future referral (Velleman and Templeton, 2003).
The intervention aimed to shift coping mechanisms away from tolerant inactive methods (the type associated with more negative outcomes) and improve psychological and physical symptoms described by family members throughout the stress-strain-coping-support model. The primary care intervention was tested by primary healthcare professionals with 143 family members with data collected at baseline, 3 months and 12 months.
The results indicated that there was a significant decrease in family member’s physical and psychological symptoms as well as reduction in engaged and tolerant forms of coping in both groups. Results also showed that there was a significant increase in the positive attitude of primary health care professionals who had tested the intervention than those who did not, towards family members (Orford et al, 2005). Interventions were also developed in the City of Mexico and Aboriginal Australia based on the stress-strain-coping-support model.