Project Lead(s): Abhijit Nadkarni
Millions of family members worldwide are affected by the addictive behaviour of a relative (alcohol, drugs, gambling, etc.), which usually has a highly stressful impact on affected family members (AFMs). AFMs experience high levels of physical and mental health symptoms, with negative indirect effects on finances, employment performance, parenting skills, etc.
Using evidence-based interventions, AFMs can be helped to reduce their levels of symptoms and improve their methods of coping. One such evidence-based intervention is the 5-Step Method, which empowers AFMs by exploring concerns, providing relevant information, exploring coping responses, developing greater social supports and exploring further needs.
Developed in the UK, the 5-Step Method is now being used in a number of developed countries, with studies demonstrating that it has significant positive effects.
The objective of the SAFE (Supporting Addiction-affected Families Effectively) project was to contextually adapt the 5-Step Method to make it acceptable, safe and feasible for delivery by lay health workers in Goa, India.
Key activities of the project included:
· Conducting a systematic review of existing approaches
· In-depth interviews with AFMs
· Treatment development workshops with AFMs, lay health workers, community gatekeepers and mental health professionals, to use the data from the above activities to understand the potential adaptations that would have to be made to the 5-Step Method
· Systematic translation of the four standardized outcome tools
· Recruitment, training and supervision of the lay counsellors in counselling skills
· Delivery of the intervention with AFMs, assessment of outcomes at baseline and follow-up, and a nested qualitative study
· Piloting a randomized controlled trial (RCT) with AFMs.
The SAFE project showed use of the 5-Step Method led to an improvement in the health of AFMs, changed their coping style and increased the support they received.
In the case series (preliminary analysis), a total of 44 AFMs were referred to the program, with 22 being eligible for inclusion and 16 completing all five sessions.
In the pilot RCT (preliminary analyses), 115 affected family members (AFM) were referred to the program, with 101 being eligible for inclusion in the project and all consenting to participate. These subjects were allocated equally to the intervention and control arms of the trial.
At week 15 of the pilot RCT, 47 (92.2%) of those in the intervention arm had already started treatment and 13 (27.7%) had completed treatment.
Knowledge of the project will be widely distributed through publications.
After demonstrating proof of concept and refining the study procedures, the next step in the development of this complex intervention will be testing its cost-effectiveness in another RCT.
The team has applied for a Medical Research Council (MRC) UK grant to conduct a definitive RCT of the SAFE program at two sites in India. Simultaneously, they have also applied for a grant to scale up SAFE across two districts in India.