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Background: The Coping Questionnaire measures affected family members' responses to their relatives' substance misuse related problems. The Coping Questionnaire examines three main coping strategies: engaged, tolerant-inactive, and withdrawal coping. Objectives: The aim of the current study was to compare competing conceptual measurement models across two countries, including one-factor, three-factor, and higher order factor models. Methods: Secondary analysis of data from five previous studies was conducted. Samples of affected family members from England (N = 323) and Italy (N = 165) were aggregated into two country specific groups. Series of confirmatory factor analyses were performed to test the degree of model fit and the effects of socio-demographic variables on the coping factors. Results: A bifactor model fitted the data most closely relative to the one- and three-factor models. High rates of common variance (60–65%) were attributable to the general coping factor, while a high proportion of the variance related to the withdrawal coping subscale score was independent (66–89%) of the general coping factor. Family members' country, age, gender, the type of relationship and the main problematic substance had significant effects on the coping factors. Conclusions: A bifactor model related to coping behaviors is consistent with the theoretical assumptions of the general coping literature. The concept of a general coping factor also fits the theoretical assumptions of the stress-strain-coping-support model, with family members showing a general tendency to cope with the harmful circumstances which arise due to substance misuse. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the attitudes of staff working within mental health settings toward cannabis in general and cannabis use in individuals with severe mental-health problems. Method: Twenty members of staff working within community mental health teams in Birmingham, UK, were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the interrelationship between themes explored. Findings: Staff use an 'individualized' approach when working with cannabis-using clients dependent on a number of key components, including the positive and negative effects of use, wider evidence base, client vulnerability, engagement, professional and personal views and harm reduction. It is suggested that any approach staff may take toward cannabis use at any one time is greatly dependent upon the above factors and these factors are highly client specific. Conclusions: The findings may help to explain why interventions aimed at reducing substance use in people with psychosis might prove less successful when targeting cannabis use. [ABSTRACT FROM AUTHOR]

Qualitative interviews were conducted with 24 women who were heavy drinkers, as part of a larger, longitudinal study of heavy drinking in the West Midlands of England. Critical discourse analysis was used to analyse the interviews, and resulted in the identification of two main discursive constructions: drink as self-medication, and drink as pleasure and leisure. However, women need to resist and negotiate stigmatizing subject positions of the 'woman drinker' in order both to justify their drinking and to protect their moral status as 'good women'. [ABSTRACT FROM AUTHOR]

This paper reports the results of a qualitative analysis of semi-structured interviews with 79 members of the Birmingham Untreated Heavy Drinkers Cohort. The cohort was recruited in 1997 when all participants were drinking 50 or more standard units of alcohol (men) or 35 or more units (women) most weeks. Present interviews were carried out as part of the fourth wave of interviews, held in 2003. The topic was the participants' places of drinking in the community and the functions those places served. The present analysis focused on the relationship between pubs and community. The strongest theme to emerge was that the pub provided for many participants a real sense of community in itself. It did so by enabling participants to meet with like-minded others, in a setting distinct from home or work, where conversing and confiding could take place in a relaxed atmosphere, with a range of other activities and forms of social support available to many. At the same time, participants were discriminating about which pubs they used, and when, and with whom they chose to interact. There was less consensus about whether the pub served a wider function by contributing to a positive sense of community in the local neighbourhood. It is suggested that English pubs, at least in a large conurbation such as the West Midlands, are very varied, sometimes continuing to serve as ‘the local’ for a community, sometimes being part of a variety of drinking places which between them provide people with a diversity of social niches to meet their increasingly diverse choices and preferences, and sometimes reflecting and even contributing to local community disorganisation. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Cocaine/crack-cocaine use is associated with a number of negative outcomes in people with mental health problems. Aims: To explore the extent of use in individuals with severe mental health problems and impact of client use on mental health service staff. Method: Following Graham et al. (2001), care coordinators within community mental health teams in Birmingham, UK completed a prevalence survey of cocaine/crack-cocaine use in clients on their current caseload to determine the extent of use. Findings were compared to those of Graham et al. Interviews with staff explored the impact of cocaine/crack-cocaine on client outcome and effects on staff within the teams under study. Results: An increase in cocaine/crack-cocaine use is reported (from 5.6% to 11.5% over 8 years). Interview data indicate that despite this increase, staff declare themselves more competent and confident in dealing with cocaine/crack-cocaine use. Conclusions: We propose that the integration of substance use treatment within mainstream mental health services is, in part, responsible for this finding. [ABSTRACT FROM AUTHOR]

Twenty-four British Sikh wives of men with identified alcohol problems, plus ten of their husbands and seven of their daughters, were interviewed using a semistructured procedure that focused upon the ways in which wives and daughters had attempted to cope with their husbands'/fathers' excessive drinking. In addition each completed the Coping Questionnaire (CQ) which has the same focus (husbands were instructed to indicate ways in which their wives had coped). Interview data were analyzed according to the grounded theory approach, and a model was constructed depicting the ways in which wives and daughters accommodated over time to the drinking problem. The general pattern was for inactive resignation (approved of by husbands/fathers), replaced by a phase during which wives and daughters stood up to their husbands/fathers in various ways (disapproved of), followed by active resignation and partial independence (also disapproved of). Despite the success that the women had achieved in being active in the face of men's excessive drinking, there remained a commitment on the part of wives to continue to care domestically for their husbands (and a similar commitment on the part of daughters to support their mothers); and CQ scores showed wives to have higher engaged and tolerant coping scores than a comparison sample of white British wives. The results have implications for service providers—for example, in recognizing the oversimplicity of some stereotypes about how Sikh women cope with their menfolk's drinking. [ABSTRACT FROM AUTHOR]

A self-completion questionnaire containing items about recent gambling and problem gambling used in the British Gambling Prevalence Survey (BGPS) was completed by 274 clients of alcohol and drug problems services in the English West Midlands. Compared to BGPS data, matched to the client sample for age and sex, clients were significantly more likely in the previous 12 months to have engaged in forms of gambling carrying a high risk of problems, to have engaged in four or more separate forms of gambling, and to have scores on a brief form of the South Oaks Gambling Screen (SOGS) indicating problem gambling. A self-completion scale on attitudes towards working with problem gamblers, with good psychometric properties according to present data, was completed by 91 members of staff of the same services. With the exception of a sub-scale measuring perceived adequacy of knowledge and skills for working with problem gamblers, staff expressed moderately positive attitudes. It is concluded that British substance misuse services are appropriate locations for the development of services for problem gambling. [ABSTRACT FROM AUTHOR]

The difficulties in engaging and treating people with severe mental health problems who also use alcohol/drugs problematically have been highlighted in several studies. The present study sought to assess the training and support requirements of staff within mental health and substance misuse services who work with this client group in an inner city area of the UK. A questionnaire was completed by 136 staff members across community based services. The results showed that the majority of the staff surveyed: already had experience of working with clients with combined severe mental health and substance use problems; rated the importance to their clinical practice of issues in this area very highly; expressed a high level of interest in working with this client group; and very much felt it was part of their role to do so. However, staff identified a number of training and service needs to help them in working with these clients. The findings strongly suggest that staff within the mental health and substance misuse services need information and training about combined severe mental health and substance use problems and access to specialist support and consultation. Establishing better links between the mental health and substance misuse services was seen as essential to provide integrated care. [ABSTRACT FROM AUTHOR]

Two members of staff at an alcoholism rehabilitation halfway house were found to employ, as a major dimension for describing residents of the halfway house, an evaluative dimension to which both professional and personal constructs contributed. There was a significant tendency for the two members of staff to evaluate the same residents positively and the same negatively, and positive evaluations of residents by staff were correlated significantly with positive evaluations by residents of the halfway house programme. It was concluded that social worker—resident relationships in the context of an alcoholism halfway house could not be fully understood as relationships between neutral skilled technicians and their clients, but rather had to be understood in terms of the same processes affecting normal, every-day social relationships. Neither initial evaluations of residents by staff, nor early evaluations of the halfway house by residents, were predictive of either length of stay or type of discharge. [ABSTRACT FROM AUTHOR]

This article presents a qualitative exploration of the relationship between life events and reduction in drinking. The 17 participants were all heavy drinkers who had experienced a life event in the previous two years and who had decreased their alcohol consumption. They were selected from a cohort of 500 untreated heavy drinkers in the English West Midlands. Data were obtained through in-depth interviews and subjected to thematic analysis. Participants discussed the decision to decrease in terms of: "needing to" decrease in order to prevent harm, "having to" decrease because of responsibilities, and "being able to" cut down as a by-product of other changes. It is argued that drinking change may occur for diverse reasons, and needs to be seen, not only as an individual decision-making process, but in relation to the discursive, social and environmental context in which drinking is embedded. [ABSTRACT FROM AUTHOR]

This paper offers a conceptual overview of a neglected field. Evidence is presented to suggest that, globally, addiction is sufficiently stressful to cause pain and suffering to a large but uncounted number of adult affected family members (AFMs), possibly in the region of 100 million worldwide. A non-pathological stress-strain-coping-support model of the experience of AFMs is presented. The model is based on research in a number of different sociocultural groups in Mexico, England, Australia and Italy and aims to be sensitive to the circumstances of AFMs in low and middle income countries and in minority ethnic and indigenous groups as well to those of majorities in wealthier nations. It highlights the social and economic stressors of many kinds which AFMs face, their lack of information and social support, dilemmas about how to cope, and resulting high risk for ill-health. The public sector and personal costs are likely to be high. Attention is drawn to the relative lack of forms of help designed for AFMs in their own right. A 5-Step form of help aiming to fill that gap is briefly described. Family members affected by addiction have for too long been a group without a collective voice; research and action using the model and method described can make a contribution to changing that state of affairs., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: A randomized trial to compare two levels of an intervention (full versus brief) for use by primary health-care professionals with family members affected by the problematic drug or alcohol use of a close relative., Design: A prospective cluster randomized comparative trial of the two interventions., Setting: A total of 136 primary care practices in two study areas within the West Midlands and the South West regions of England., Participants: A total of 143 family members affected by the alcohol or drug problem of a relative were recruited into the study by primary health-care professionals. All recruited family members were seen on at least one occasion by the professional delivering the intervention and 129 (90 %) were followed-up at 12 weeks., Main Outcome Measures: Two validated and standardized self-completion questionnaires measuring physical and psychological symptoms of stress (Symptom Rating Test) and behavioural coping (Coping Questionnaire) experienced by the family members. It was predicted that the full intervention would show increased reduction in both symptoms and coping when compared to the brief intervention., Results: The primary analysis adjusted for clustering, baseline symptoms and stratifying variables (location and professional group) showed that there were no significant differences between the two trial arms. The symptom score at follow-up was 0.23 [95% confidence interval (CI): -3.65, +4.06] higher in the full intervention arm than in the brief intervention arm, and the coping score at follow-up was 0.12 (95% CI: -5.12, +5.36) higher in the full intervention arm than in the brief intervention arm., Conclusions: A well-constructed self-help manual delivered by a primary care professional may be as effective for family members as several face-to-face sessions with the professional.

Interviews were held with nine peripatetic professionals-district nurses, health visitors and social workers-working in New Deal for Communities (NDC) urban areas in the English West Midlands. They spoke of health in the community in three distinct ways: health as individual and family lifestyle; the local environment and health; and ;life is a struggle for some'. Those who emphasized the individual and family lifestyle approach expressed frustration in their professional role. The two alternative discourses, while recognizing the influence of social determinants of health, were problematic in different ways, reflecting the lack of a clear alternative to the individual and family lifestyle model for public health professions.