POWERPOINT ASSIGNMENT

Facts show that this program offers specific serves, program and support relevant outcomes, coping and drug support to aid each family member in the home. Stepping- Stones is primarily designed for people who have been dealing with another's chronic long‐term addiction; around 90% of participants are parents of adult children, with an average age around 50, of which approximately two‐thirds are mothers.

Outcome measures

The main outcome measures used to assess family member coping were the Coping Questionnaire (CQ) [ 18] , and the FDSQ. In addition, the Client Satisfaction Questionnaire (CSQ‐8) [ 25] was used as a client satisfaction measure.

The study involved pre‐testing participants on the CQ and re‐testing at 3 months follow up to assess changes on measures of coping; the FDSQ was administered at the start of the Stepping Stones program, and at the end of the program, and at 3 month follow up. The FDSQ was also administered to a group of 48 participants when registering for the course. This group had at least 6 weeks to wait before being able to attend a course; all went on to complete the program and evaluation study. The CSQ‐8 was administered immediately post course.

The Coping Questionnaire

This questionnaire asks family members about their responses to their relative's drug or alcohol consumption, and asks 30 specific questions about their coping actions over the previous 3 months [ 18] . Coping actions relate to the three scales of Engaged, Tolerant and Withdrawal coping. For each question, respondents are given four options as to how often they acted particular ways in the 3 months: ‘no’, ‘once or twice’, ‘sometimes’ and ‘often’, with responses scored at 0, 1, 2 and 3, respectively.

Scores can range between 0 and 90, and a lower overall score, and lower scores on the Engaged and Tolerant subscales generally indicate fewer symptoms (such as feeling anxious or frightened), less negative coping (e.g. cleaning up after the drug user, secrecy) and fewer negative incidents in the family [ 16] . The Withdrawal subscale is more complex as it includes items of positive coping, such as pursing one's own interests; thus this subscale tends to increase as coping improves.

Support for the validity of the CQ has been provided from a number of sources. Consistent means and standard deviations have been observed across populations undertaking the CQ [ 18] , and higher negative coping scores have been correlated with poorer health outcomes, also across a range of settings [ 11] . Evidence for the discriminant validity for the CQ subscales has been provided in that differences in subscales vary in expected directions, for example by subcultural group (i.e. wives in some cultural groups show higher tolerant‐inactive coping), relationship to drug user (parents show less withdrawal or tolerant coping), or by degree of the family member's addiction. The CQ measure has also demonstrated sensitivity to change following interventions to help families cope more effectively [ 6] , and has good internal reliability (a = 0.85) [ 18] .

The Family Drug Support program Questionnaire

The FDSQ is designed to measure changes in coping across seven domains (anger, boundary, control, denial, family, self‐esteem and trust). It includes 28 statements with four survey items relating to each domain. Scoring is on a 5‐point scale from ‘usually’ through to ‘never’; and a score of between 4 and 20 is given for each domain, with an overall coping score calculated between 28 and 140. Examples of statements in the FDSQ include: ‘I often hide the drug user's activities from family and friends’; ‘I feel like unloading my anger on the drug user’; ‘I need to take responsibility for the drug user as they are not capable of managing day‐to‐day affairs and drug treatment’; ‘My personal space is respected by the drug user.’

Low domain scores indicate that a person is struggling with particular issues (e.g. feeling constantly angry, or hiding the problem); higher scores indicate more positive coping. An overall low score suggests negative coping across several domains, whereas a high overall score, that a person is coping more positively. The FDSQ has good internal reliability (a = 0.82).

The FDSQ differs from the CQ in a number of respects, apart from the scoring direction and the number and nature of subscales. It includes for example, questions about a person's self‐esteem and about how angry a person is feeling, neither of which are in the CQ. Even so, at baseline, there was a moderate negative correlation between scores on the FDSQ and CQ, r = −0.42, P < 0.0001. There was also a correlation between the two most similar subscales (‘Tolerant’ from the CQ and combined ‘Boundary’ and ‘Family’ from the FDSQ) r = −0.49, P < 0.0001. The other subscale correlations were small or non‐significant.

Gethin A, Trimingham T, Chang T, Farrell M, Ross J. (2016). Coping with problematic drug use in the family: An evaluation of the Stepping-Stones program. Drug Alcohol Rev 2016;35:470–476, DOI:10.1111/dar.12327

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