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Alcohol use disorders (AUDs) affect not only the person struggling with alcohol but also their family. This substance use disorder is similar to that of someone having a disability or [...], Introduction: Despite the large burden of a relative's drinking on their family members, the latter's perspectives and experiences are largely neglected. The aims of this article are to assess the coping strategies used by affected family members (AFMs) in Goa, India, and to examine the nature of the support they have for dealing with their drinking relative. Method: In-depth interviews were conducted with adult AFMs selected through purposive and maximum variation sampling. Data was analyzed using thematic analyses. Results: The commonly used coping strategies included accommodating to the relative's behavior, financially adapting to their means, self-harm, attempting to reason with the drinking relative, covert intervening, and avoiding fights and arguments. There was a general reluctance to seek support, and the type and quality of support that was available was also limited. Support from neighbors or relatives was primarily through providing a "listening ear" or financial support. Religious and spiritual pursuits were commonly used to seek solace, and to manage negative thoughts and feelings. Formal support was sought for themselves or the relative through existing health services and Al-Anon, and occasionally from the police. Discussion: AFMs experience a considerable amount of strain in relation to their relative's drinking, and have to rely on different ways of coping and social support, as is available to them. Although there is a universality to the experiences of families affected by addictions, this must be interpreted with caution, as it is also accompanied by variations in cultural factors related to these experiences. Keywords: alcohol, family, India, qualitative

This study provides analysis of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or who had used a betting exchange in the last 12 months (6% of the total sample) were compared with all other gamblers who had not gambled via the Internet (62% of the sample). Results showed that Internet gambling and non-Internet gambling had a significant association with smoking (nicotine) and drinking (alcohol). Self-reported general health status was not significantly associated with Internet gambling but was significantly associated with offline gambling. Analysis of DSM-IV scores showed that problem gambling prevalence rate was significantly higher among Internet gamblers than non-Internet gamblers (5% versus 0.5%) and that Internet gamblers were significantly more likely to endorse individual DSM-IV items compared to non-Internet gamblers.

This article is based upon the collective findings of a number of studies conducted in a number of countries during the past 20 years. Female partners and mothers are the family members who have been most represented in the study samples, but the latter also included sizeable numbers of male partners, fathers, sisters, brothers and adult sons and daughters. Citing examples taken from the studies, the article describes some of the most prominent elements of the stressful experience of living with a relative who is drinking or taking drugs excessively, notably: the relationship with a relative becoming disagreeable and sometimes aggressive; conflict over money and possessions; the experience of uncertainty; worry about the relative; and home and family life being threatened. The reasons why family members may put up with substance misuse are described, and the ways in which family members may either withdraw and gain independence or stand up to substance misuse, as alternative ways of coping, are outlined. Examples of the strain experienced by family members are given. The kinds of social support valued by family members are explained, as is the finding that good quality social support for family members is often lacking. The article concludes by offering an integrated view highlighting the disempowered position in which family members usually find themselves and the importance of good social support for family members in their coping efforts. Although the picture is coloured by factors such as sociocultural group and the ages and genders of family members and their relatives, we believe the core experience for affected family members is a universal one. (Contains 2 tables and 3 figures.)

In this article we describe our work in trying to influence whole service teams to move their practice towards greater involvement of affected family members. Work with five teams is described. The process varied but in all cases it included recruitment of the team, training, continued support and evaluation of results. Use of a standard questionnaire for assessing attitudes towards working with affected family members showed significant changes in team members' knowledge, confidence and team support for working with family members. Records of all project events and meetings suggested that change takes time but that a "cultural change" can take place whereby earlier misgivings are dispelled and positive attitudes towards involving family members become embedded in a team's approach. Diary audit indicated that the frequency of involvement of family members in sessions can be increased three- to five-fold, with teams beginning to carry out work with a diversity of family members, in diverse ways and with diverse positive outcomes. In a number of cases, teams were encouraged to institute new family-friendly procedures, for example changes to appointment letters, assessments and design of waiting and counselling rooms. Lessons have been learnt, including the need to accommodate different levels of initial experience of working with family members, and the need to be clear about project aims and objectives. Sustainability of change remains an issue. A general conclusion is that the capacity of services to take on work with family members affected by substance misuse of close relatives varies greatly. Where organizations already have a mission to involve family members, capacity is good. Where alcohol and drug services have previously been focused on individuals who are misusing substances, change is difficult but can be achieved. For most non substance-specialist organizations, such as primary care health centres and most non-statutory organizations, capacity is very limited. In addition to training and continued support for practitioners, explicit commissioning of work with family members combined with management support is necessary. (Contains 5 tables and 1 figure.)

This article outlines the stress-strain-coping-support (SSCS) model which underpins the whole programme of work described in this supplement. The need for such a model is explained: previous models of substance misuse and the family have attributed dysfunction or deficiency to families or family members. In contrast, the SSCS model assumes that having a close relative with a substance misuse problem constitutes a form of stressful life circumstances, often longstanding, which puts affected family members at risk of experiencing strain in the form of physical and/or psychological ill-health. Coping and social support are the two other central building blocks of the model. Affected family members are viewed as ordinary people faced with the task of coping with such stressful life circumstances. It is an assumption of the model that, difficult though the coping task is, family members need not be powerless in maintaining their own health and helping their relatives. Good quality social support, in the form of emotional support, good information and material help, is an invaluable resource for affected family members, supporting their coping efforts and contributing positively to their health. The 5-Step Method, to be described later in the supplement, is based on the SSCS model. It can be seen as a way of increasing the positive social support available from professional sources. (Contains 1 table and 1 figure.)

The article begins by making the point that a good assessment of the needs and circumstances of family members is important if previous neglect of affected family members is to be reversed. The methods we have used in research studies are then described. They include a lengthy semi-structured interview covering seven topic areas and standard questionnaires for assessing the impact of substance misuse on the family member and whole family, and the family member's symptoms of psychological and physical ill health and ways of coping. Also described are two methods for assessing social support (SS) available to a family member: drawing a SS network diagram; and a recently developed family member social support scale. The remainder of the article discusses the challenge of introducing standard family assessment and outcome monitoring into routine service practice, including the need for shorter versions of those assessments that have been used in research. (Contains 4 tables.)

This article includes a description of the 5-Step Method. First, the origins and theoretical basis of the method are briefly described. This is followed by a discussion of the general principles that guide the delivery of the method. Each step is then described in more detail, including the content and focus of each of the five steps that include: listening non-judgementally; providing relevant information; exploring ways of coping; discussing social support and establishing the need for further help. Finally, issues of training, supervision and on-going support are discussed. It is concluded that the 5-Step Method offers a flexible response that can be delivered to family members affected by addiction problems by a range of helpers and in a range of settings and health systems. (Contains 5 tables and 2 figures.)

Aims: To investigate UK university student drinking in terms of social and motivational factors. Design: Quantitative and qualitative studies. Participants: Undergraduate students at a UK university: 50 "heavy drinkers" and 49 "light drinkers", equally distributed in terms of sex and year of study. Data: Questionnaire measures of drinking expectancies, perceived benefits and drawbacks of drinking, important people and activities; semi-structured interviews. Findings: Heavy drinkers scored higher than light drinkers on measures of tension reduction, sexual enhancement and dependency drinking expectancies. The top three reported benefits of drinking were social life, fun/humour, and self-confidence. Heavy drinkers perceived "a lot" of drawbacks to their finances as a result of drinking, whereas for light drinkers the main drawbacks concerned physical wellbeing. Heavy drinkers were found to interact with a heavier drinking social network, receive more encouragement to drink from important people in their lives and to participate in more heavy drinking activities than light drinkers. A tentative model was developed from the qualitative study suggesting that social factors are important influences in the maintenance of heavy student drinking, in particular subtle forms of "peer pressure", and increased self-confidence. Conclusions: Motivational factors, particularly the expectation of increased self-confidence, play an important role in the maintenance of heavy student drinking, but social factors are probably equally significant. The levels and patterns of heavy drinking found in the present sample are worrying and the findings have implications for attempts to reduce alcohol consumption by university students.