Participant experiences with Supporting Addiction Affected Families Effectively (SAFE): a qualitative study of the 5-Step method in Goa, India

Background: Harmful use of alcohol has demonstrated negative effects on not only the individual engaging in the use, but also their family members. The Supporting Addiction Affected Families Effectively (SAFE) Project aimed to systematically adapt the 5-Step Method, an existing evidence-based intervention intended to support affected family members (AFMs) by focusing on their concerns, coping responses, social supports, to the Indian context with delivery by lay counsellors. The aim of this study was to examine AFM experiences with the SAFE intervention to understand its acceptability in this context as well as how AFMs perceived the impact of the intervention on their lives. Methods: We conducted in-depth interviews with 30 adult family members affected by their relative’s problematic drinking who had received the SAFE intervention. We applied an interpretivist theoretical framework to the analysis and used thematic analysis to synthesize the data. Results: The participants largely reported positive interactions with the counsellors delivering the intervention, appreciated the flexibility of scheduling the sessions according to their availability, and approved of the content of the sessions. Many participants reported a positive impact of the intervention citing feelings of relief, reduced fights as a result of new coping strategies, increased social support, and reduced stress. However, some AFMs reported little or no benefit, citing a lack of changes in their relative’s drinking behaviours, a lack of adequate external support, or the experience ongoing domestic violence, or a combination of these factors. Conclusion: While there was evidence of intervention acceptability, SAFE will require further contextually-informed adaptations to enhance its relevance and make it responsive to the contextual reality to have sustained impact for AFMs in this setting.