It is estimated that over 100 million people worldwide are affected by the substance use of a close relative and often experience related adverse health and social outcomes. There is a growing body of literature evaluating psychosocial interventions intended to reduce these adverse outcomes. We searched the international literature, using rigorous systematic methods to search and review the evidence for effective interventions to improve the wellbeing of family members affected by the substance use of an adult relative. We synthesised the evidence narratively by intervention type, in line with the systematic search and review approach. Sixty-five papers (from 58 unique trials) meeting our inclusion criteria were identified. Behavioural interventions delivered conjointly with the substance user and the affected family members were found to be effective in improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning). Affected adult family members may derive psychological benefit from an adjacent individually focused therapeutic intervention component. No interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the substance user and the affected family member.

Parental substance use is highly prevalent worldwide, presenting major child safeguarding and public health concerns. Qualitative research enables in-depth understanding of how young people experience parental substance use and helps inform practice and policy through illustrative cases of experiences. This review aimed to synthesize published qualitative evidence exploring the lived experiences, perceived impact, and coping strategies of children and young people whose parents use substances. International literature databases including Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, International Bibliography of the Social Sciences, Social Science Database, Sociology Collection, and Scopus were searched from inception to 2022, alongside grey literature searching and relevant websites. Qualitative accounts were included, provided by participants aged below 25 years. No language, date, or geographical limits were applied. A thematic synthesis of 35 studies, across 49 papers, covering over 700 children and young people’s voices, identified five overarching themes. These themes included, (a) living with the unpredictable: insecurity within the family; (b) social and emotional impact of parental substance use; (c) controlling the uncontrollable: creating safety within the family; (d) coping with and resisting the emotional and social impacts; and (e) formal and informal support. The findings emphasize that children and young people who experience parental substance use are trying to manage and mitigate vulnerabilities and be resilient to unpredictable, adverse, and often stigmatizing experiences, usually without formal support in place. Further research is needed to coproduce child-centered interventions that promote children and young people’s social and emotional resilience.

The 5-Step Method provides a valuable addition to the existing menu of services for families, bridging the gap between informal support and structured intervention, and fitting well with the 'recovery agenda'.Adfam is the national umbrella organization working to improve the quality of life for families affected by drug and alcohol use, working across the UK. We do this by working with a network of organizations and individuals who come into contact with families, friends and carers affected by drug and alcohol use. Our key objectives include consulting, listening and responding to the needs of families; addressing the professional issues of concern of those who work with them; providing information and training; and influencing policy and practice accordingly and appropriately.The plight of families where drug or alcohol use is a problem has only recently come to the attention of researchers and policy makers. For too long, drug policy and treatment has focused on the individual user, but this is beginning to change. The positive role which families can play in supporting a drug user is now increasingly recognized. This is a positive move forward, but with recognition come problems. The purpose of working with families tends to be driven by one of two objectives: to safeguard children whose parents are drug users, or to involve families in helping a user to access treatment, be maintained through a treatment Correspondence: Vivienne Evans, OBE, Adfam, (Families, Drugs and Alcohol),