A gap in treatment services: supporting those bereaved by substance use

Lucy Holmes | December 2020 | 7 minutes

In this blog, we explore the main findings of a research report published today, which was funded by us. The report, by Lorna Templeton (in collaboration with Aquarius Action Projects), evaluates the pilot of an intervention to support family members bereaved through substance use.


Whilst services exist to provide treatment and support for those with alcohol problems, there is less support available to family members, especially after a bereavement. Family members often find it difficult to talk about their loved ones’ substance use due to the stigma surrounding those issues. This project has started to address the gaps in both service provision and research, by identifying the experiences and needs of adults who have been bereaved through a family member’s substance use.

The pilot used an existing, evidence-based model, known as the 5-Step Method and adapted it to be delivered in a service provided by Aquarius.

Figure 1 Adapted 5-Step Method: the Five Steps

Figure 1 Adapted 5 Step Method

These steps involve a practitioner listening to the family member’s story, providing targeted information, and exploring themes of coping, social support and further needs. It has been used in other contexts for family members affected by issues such as gambling or parental substance misuse.

The project aims were to assess the feasibility of recruiting and training practitioners in the adapted 5-Step Method as well as whether it could be delivered within the treatment service setting. The project also explored the perspectives of both practitioners and family members in their experiences of delivering and receiving the intervention.


In interviews with four family members and nine practitioners involved in the project, three themes emerged.

The new service was established in the context of a treatment system under pressure. Long-standing funding cuts to alcohol treatment, short commissioning cycles, and the restructuring of substance misuse services has meant that treatment services are fighting to maintain their current levels of service. Due to the novelty of the intervention, practitioners were hesitant about over-promising support to people. Despite this, the project recruited and trained eleven practitioners to use the intervention. One practitioner said, “the clients who have received this service have been very fortunate indeed, not just with the model but with the staff they’ve had supporting them”.

The intervention enabled family members to become more resilient and work through their grief with a practitioner who was uniquely placed to understand their situation. As one practitioner said, “[bereavement through substance use] is very different to bereavement by any other means”. The family members interviewed had similar demographic backgrounds – all were female in their fifties or seventies and the majority were mothers. Their loved ones who had died were mainly male and under 40, with the cause of death being alcoholic liver failure, overdose or suicide. One family member said that the practitioner working with her “makes me feel that after this terrible tragedy that I’m strong enough and I can carry on”.

The service plugged a clear gap in provision for those bereaved by substance use. One practitioner in the study commented on the lack of this kind of service provision in the past: “there was nothing like this available for me … how wonderful it would have been to have had that kind of support”.


While the number of research participants was small, this study paves the way for further piloting of this method and research on its effectiveness. The interviewees identified key elements which would enable the service to continue, including clear referral pathways, specialist clinical supervision, peer support, staff training in the intervention, sustained funding, and links with other services in the community. Considering support of this kind is rare in existing treatment services, one of the main strengths of this study is that it has illustrated the real need for and positive effects of this form of structured intervention in supporting those who have recently lost a loved one through substance use.

Laura Templeton is an Independent Research Consultant and Visiting Fellow at the Department of Social and Policy Sciences, University of Bath.

Read the report