The preliminary evaluation of Supporting Addiction Affected Families Effectively (SAFE) – a contextually adapted intervention to support family members affected by a relative’s alcohol use: a Pilot Randomised Controlled Trial

Funding agency: Wellcome Trust DBT India Alliance
Duration: November 2016 to November 2018
Research Training Fellow: Ms Urvita Bhatia
Supervisors: Prof Richard Velleman and Dr Abhijit Nadkarni
Mentor: Prof Vikram Patel
Host institute: Sangath, Goa (India)


Apart from the direct consequences of problem drinking on the user, it negatively impacts their family members: including physical and mental ill-health: mood disorders, trauma, stress-related conditions, and reduced quality of family relationships. India, the target of market expansion by producers of alcoholic beverages, has been experiencing a rapid increase in alcohol availability/consumption, lowering the age of drinking onset, and higher levels of alcohol-related problems. This will cause a corresponding increase in the prevalence of affected family members (AFMs), although this will be largely hidden because AFMs are a silent group; who deserve more attention in public health research.

Evidence-based interventions can help AFMs to reduce their symptom levels, and improve their coping methods. One such intervention, the 5-Step Method, empowers AFMs by helping them reduce the strain experienced in living with a relative having alcohol problems, by reducing distress, and facilitating coping.However, in Low-and-Middle Income Countries (LMICs), two major barriers to making such psychosocial treatments accessible are the lack and inequitable distribution of skilled human resources for delivering such treatments and concerns regarding the contextual appropriateness and generalizability of treatments developed in ‘western’ cultural settings. Evidence-based ways of making treatments accessible and acceptable in such low resource settings in LMICs are through adaptation of the treatment to overcome contextual barriers, and task-sharing (redistribution of tasks among health workforce) to address human resource shortages.

The Fellowship project follows the MRC framework for complex interventions, wherein a pilot Randomised Controlled Trial is being conducted to 1) contextually adapt the 5-Step Method using a systematic methodology to make it acceptable and feasible to be delivered by lay counsellors, and 2) to investigate preliminary effectiveness of the 5-Step Method by a primary outcome measure- score on the Symptom Rating Test, and secondary outcome measures- score on the Coping Questionnaire, Family Member Impact Questionnaire, and Alcohol, Drugs and the Family Social Support Scale.

Ultimately, this work aims to help reduce the treatment gap, by taking care into the community in a culturally sensitive manner and giving a voice to a group that has traditionally been underserved.

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