This article presents the results of a detailed interview study with 113 family members (FMs) of people with serious alcohol or drug problems, drawn from three different areas of Italy: Ravenna, a medium-sized town in the North (n = 37), and two large cities, in the Centre (Rome, n = 26), and the South (Naples, n = 50). Interviewers used a semi-structured grid covering a range of areas, including the history of the relative's substance misuse, family member's health and well-being, coping, social support, and hopes and expectations for the future. Interviews were analyzed using Grounded Theory. This qualitative analysis of the data defined core categories, which allowed a multidimensional model of coping to be developed, taking into account participants' motivations, thoughts, plans, and behavior. This model highlights the multiple reciprocal interconnections underlying coping. The results demonstrate that family members of people with alcohol or drug problems in Italy suffer in similar ways to family members elsewhere. However, although there are great similarities between these results and results from other countries (Orford 2005a), the importance of the family, both as a central theme in the interviews and occupying a key role within Italy, stands out, as does the role played by interpersonal and relational bonds within the Italian social environment. A range of areas are discussed further.