Affected family members (i.e. intimate partners, parents, siblings, children, other relatives) who support a loved one or relative experiencing addiction face many challenges, including social isolation, disrupted relationships, and shame and stigma from within their family and the community (Copello et al., 2009; McCann & Lubman, 2018a, b). This can result in psychological distress, difficulty coping, and other physical and mental health conditions (Hellum et al., 2022; McCann et al., 2017; Orford et al., 2013). Interventions focused on the needs of affected family members emphasize managing the impact of addiction, and include psychoeducation, peer and professional support, and strengthening coping skills. However, the evidence base for the impacts of these programs on affected family members is currently limited (Kourgiantakis et al., 2021; Merkouris et al., 2022).

The stress–strain-coping-support (SSCS) model (Orford et al., 2010) is one approach focused on the needs of affected family members who are supporting a relative experiencing addiction (Kourgiantakis et al., 2021). The SSCS model asserts that when a relative has a serious alcohol and/or drug use problem, this can be highly stressful for the affected family member. Affected family members experience strain as a result of the stressful circumstances of caring for their relative. Coping, the third component, assumes affected family members are not powerless and can improve their health and well-being and have an impact on their relatives’ problems. Coping is closely aligned with good quality social support, in a variety of forms and not necessarily from the affected family member’s existing social network (Orford et al., 2010). The SSCS model has been used as a framework for research in many countries and for relatives with alcohol, drug and gambling problems (Dayal et al., 2020; Horváth & Urbán, 2019; Orford et al., 2010, 2017; Petra, 2020).

A recent meta-analysis of interventions for affected family members found some support for effectiveness on coping, depression, and life satisfaction, yet these findings were limited by the small number of studies included, and inconsistencies in study aims and methodological approaches (Merkouris et al., 2022). Similarly, a scoping review of affected family member interventions, which included quantitative, qualitative, and mixed-methods studies, found only a small number of interventions focused on the impact of addiction on affected family members, in contrast to interventions where the relative and affected family member participated together (Kourgiantakis et al., 2021). Four studies reported on a brief affected family member intervention (the “5-step method”), which is informed by the SSCS model and is delivered through individual, face-to-face counselling in primary care or specialist addiction settings (Arcidiacono et al., 2007; Templeton, 2009; Velleman et al., 2008, 2011). A fifth mixed-methods study reported on an adaptation of the brief intervention for a group-therapy setting (Templeton, 2009). These studies showed support for the “5-step method” in improving participant coping, and feasibility of program implementation.

Involvement of people with lived/living experience, or peers, has been increasing within the addiction treatment system since the 1990s (Eddie et al., 2019). For affected family members, few studies have reported on the role of peers in delivering interventions. Kelly et al. (2017) reported on a peer-led support organization where family members of people experiencing an opioid addiction attended regular meetings supplemented by online resources and additional training. The participants reported gains in understanding and coping with addiction, improved perceived ability to help and communicate with their loved ones, and reduced self-blame and stress. Participants also reported their sense of belonging and emotional support from the group was strong. However, research focusing on family-focused programs where peer support is a core element is only in its preliminary stages.

As such, this paper is among the first to report outcomes from a preliminary study of an online, peer-led support group intervention informed by the SCSS model for affected family members. Our aim was to understand how, and to what extent, the online peer-led support group impacted affected family members’ confidence in their coping abilities (self-efficacy), social support, and general well-being.

Methods

Study Design

We used a mixed-methods quantitative and qualitative design, comprising a quantitative within-subjects analysis of pre- and post-intervention data and qualitative semi-structured interviews. Data were collected between September 2021 and May 2022. The Monash University Human Research Ethics Committee approved this study. Reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (Von Elm et al., 2007) and the Standards for Reporting Qualitative Research (SRQR) (O’Brien et al., 2014) guidelines.

Participants

The study was conducted at Turning Point, a national addiction treatment and research centre in Victoria, Australia. Participants were recruited from an online psycho-education program for affected family members BreakThrough. At the conclusion of the BreakThrough session, potential participants were informed of the online support group and research project, and a registration link was shared with attendees. Potential participants were advised that the support group was for affected family members; however, no other exclusion criteria were applied. After completing an online registration form and providing written informed consent, participants received videoconference link details and a request to complete a pre-participation online survey (“baseline”). Three months after participating in their first online support group session, participants were invited via email to complete a second online survey (“exit”). Participants were free to continue attending scheduled support group meetings after their exit survey. As part of the exit survey, participants were invited to express their interest in completing an additional telephone interview to explore their experiences of the online support group sessions in more depth.

Intervention—Online, Peer-Led Support Group for Affected Family Members

The intervention was an online peer-led support group designed for affected family members delivered by the Self Help Addiction Resource Centre, a non-government organisation that promotes self-help, peer-led approaches to recovery from addiction, in partnership with Turning Point. The support group was delivered weekly via a videoconferencing platform (Zoom). Underpinned by the SSCS model (Orford et al., 2010), the aim of the support group was to build upon the education topics provided in the BreakThrough sessions, by providing opportunities for affected family members to share their experiences and coping strategies, and connect with others. The support group lasted 1 h and was delivered 18 times between September 2021 and March 2022. Groups were led by the BreakThrough facilitators, who have lived experience as an affected family member. The group was “open”, as new participants were able to join at any stage over the course of the research. More information about the support group can be found in the Supplementary Information (TIDIER checklist, Support Group Agenda, and Group Agreement).

Data Collection

Demographic (i.e. age, gender, postcode) information and data relating to their experience as an affected family member (i.e. relationship to the relative, length of time providing support) were collected at baseline. Three measures were administered at baseline and exit: (i) General Self-Efficacy Scale (GSES) (Schwarzer & Jerusalem, 1995), a measure of beliefs in a person’s ability to cope with new or difficult situations. Participants responded to 10 statements (e.g. “I can remain calm when facing difficulties because I can rely on my coping abilities”) on a scale of 1 (not at all true) to 4 (exactly true) (scores range from 10 to 40), (ii) Personal Well-being Index–Adult (International Wellbeing Group, 2013), a measure of satisfaction with various life domains. Participants responded to seven questions related to aspects of their life (e.g. “How satisfied are you with your health?”) on a scale of 0 (no satisfaction at all) to 10 (completely satisfied) (scores range from 0 to 100), (iii) Social Connectedness Scale (Lee & Robbins, 1995), a measure of “belongingness” (p. 234). Participants responded to eight items (e.g. “I feel disconnected from the world around me”) on a scale of 1 (strongly agree) to 6 (strongly disagree) (scores range from 8 to 48). Three additional feedback measures were administered at exit: (i) Client Satisfaction Questionnaire (adapted from (Larsen et al., 1979), participants responded to eight questions (e.g. “To what extent has the Online Support Group met your needs?”) on a scale of 1 (least satisfaction responses) to 4 (most satisfaction responses) (scores range 8–32); (ii) Group Sessions Rating Scale (Quirk et al., 2013) is a four-item visual analogue scale, participants responded on a scale 0–10 to items (e.g. “The leader and group’s approach is a good fit for me”) (scores range 0–40); and (iii) Perceived Personal Benefits Scale (Denomme & Benhanoh, 2017), participants responded to seven items (e.g. “As a result of the online support group, I feel more connected to others in similar situations”) each item scored on a scale 1 (total disagreement) to 7 (total agreement)).

Qualitative interviews were completed by telephone between March and May 2022 by Author 2, using a semi-structured interview guide. Participants were asked questions in relation to their experience of the online support group, including the content, facilitators, online delivery, and impact on their situation. The interviews were recorded using a digital audio recorder and transcribed verbatim by a professional transcription service. All interview participants were provided with a participant ID and pseudonym, and reimbursed for their time with a retail voucher valued at AUD$50.

Data Analyses

Quantitative Data Analyses

Affected family members who participated in at least one online peer-led support group and had at least one pair of baseline and exit outcomes recorded (i.e. self-efficacy, well-being, and/or social connectedness) were considered to have “complete” data and included in the main analyses.

For completed participants, demographic data and quantitative feedback outcomes were presented as frequencies (%) for categorical variables, means (SD) for numeric variables, and medians (IQR) for non-normally distributed numeric variables. The baseline characteristics of completed cases and non-completed cases (i.e. cases without exit data) were compared using independent samples t-test and Pearson’s χ2 analyses. The repeated measures of the outcome variables (general self-efficacy, well-being, social connectedness) from baseline to exit were analyzed by fitting simple linear mixed models, with fixed effect for time and random intercept which accounts for time clustering within participants. A p-value of < 0.05 (two-sided) was used as the level of significance for statistical analyses. Analyses were completed in R (4.2.0;) and Stata Statistical Software: Release 15.

As this was a preliminary study examining this online, peer-led support for affected family members, our sample size was based on the pragmatics of recruitment and resources available. We anticipated there would be demand for the service and aimed to recruit up to 50 participants.

Qualitative Data Analyses

Participant interviews were analyzed following a conventional content analysis approach (Hseih & Shannon, 2005). Conventional content analysis is used to describe a phenomenon, where there is limited existing theory or research on the topic, as is the case with affected family members’ experiences of online support. Preconceived codes or categories are not used; instead, codes are developed inductively from the data. Data analysis was conducted in several stages. First, Author 2 read through and checked each transcript against the audio-recording, then created preliminary codes. Author 1 reviewed the transcripts and preliminary codes, and Authors 1 and 2 discussed and agreed on primary codes and all transcripts were re-coded. Author 2 generated initial themes and, using thematic mapping and repeated discussions with Author 1, developed, defined, and wrote up the themes. Participants were given pseudonyms to report the results of the analysis.

Authors 1 and 2 are experienced qualitative researchers who have undertaken semi-structured interviews with a range of participants across community and health care systems. Author 1 is a registered occupational therapist with clinical experience in rehabilitation settings, including working with families. Author 2 has a psychology degree with knowledge of theories and frameworks underlying coping, group processes, cognition, behaviour, and theories of change. They met frequently during project design, and data collection and analysis, to assist with researcher reflexivity and ensuring rigor of the qualitative methods used.

Results

Of the 78 participants who expressed interest in the online peer-led support group, 54 completed the baseline survey and 31 attended one or more of the support group sessions. Of the 31 attendees, 23 completed the exit survey, were considered completed participants, and were included in the analyses (i.e. completed participants attended at least one support group session and had at least one pair of baseline and exit outcomes recorded). Completed participants attended a median of three sessions (IQR = 4.25, total range 1–18). Characteristics of completed participants are shown in Table 1. The characteristics of completed participants were compared to the characteristics of participants who did not complete the exit assessment (n = 31), with no significant differences found in age, relationship to the relative, length of time supporting their relative, General Self-Efficacy Scale (GSES), Personal Well-being Index (PWBI), or Social Connectedness Scale (SCS) (all p > 0.05, further details are in Table 4 in the Appendix).

Table 1 Characteristics of completed participants
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Sixteen participants of the 23 who completed the exit survey expressed interest in participating in an interview. One declined and four were unable to complete the interview during the data collection period. The remaining 11 participants were interviewed. Interviews were a mean duration of 26.2 min (ranged 17.5–39.2 min). The average age of participants completing an interview was 57.3 years (range 40.0–66.0) and all were female. Six participants lived in metropolitan areas and five in non-metropolitan areas. The most common primary drug of concern for the affected family member’s relative was methamphetamine/ice (n = 5; 45.45%), followed by alcohol (n = 3; 27.27%), and poly-substance use (n = 3; 27.27%). Participants (n = 10 affected family members of an adult or adolescent child; n = 1 affected family member of a partner or ex-partner) had supported their relatives for a mean of 8.8 years (range 1.0–18.0 years).

General Self-Efficacy, Well-being, and Social Connectedness

Findings from the linear mixed models are shown in Table 2. For the primary outcome, there was a significant improvement in mean general self-efficacy from baseline to exit (b = 2.63, 95% CI 0.82, 4.44, p = 0.004). No significant changes were observed for well-being or social connectedness over time (p > 0.05).

Table 2 Findings from linear mixed models for general self-efficacy, personal well-being, and social connectedness regressed onto time
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Program Satisfaction and Perceived Benefits

The majority of participants who completed the exit survey reported their satisfaction and experience of the online peer-led support group as “satisfactory” or “very satisfactory” (overall client satisfaction n = 22, 95.65%; group sessions n = 21, 91.30%). Results for the perceived benefits of the program are shown in Fig. 1. The majority (95.65%) of participants agreed they had experienced one or more benefits from attending sessions. At program exit, 91.30% (n = 21) of participants attending the program reported improved feelings of connection to others in similar situations; 86.96% (n = 20) reported improved ability to apply strategies; 82.61% (n = 19) reported improved knowledge of coping strategies; 82.61% (n = 19) reported improved ability to work through emotions; 73.91% (n = 17) reported improved substance use knowledge; 69.57% (n = 16) reported improved ability to maintain participation in enjoyable activities; and 65.23% (n = 15) reported improved frequency of enjoyable activities (n = 15, 65.23%).

Fig. 1
figure 1

Perceived Personal Benefits Scale results. Note. “Agree” includes responses “total agreement”, “agreement”, and “somewhat agreement”. “Disagree/Neither agree nor disagree” includes responses “total disagreement”, “disagreement”, “somewhat disagreement”, and “neither agreement nor disagreement”. Participants responded to the statement, “As a result of the online support group, I …”

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Qualitative Themes

The themes developed in our analysis, alongside a summary of their characteristics, are described in Table 3.

Table 3 Interview themes and topic summaries
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Theme 1: Connecting with others Who Share the Same World

The first major theme related to participants’ emphasis on connecting with others who share their experience and “world”, through the support group. Participants described feeling alone in their experience as an affected family member, and found it difficult to gain emotional support from non-affected others. Misinformation, perceived stigma, and their low knowledge of addiction all contributed to participants’ isolation and their sense that non-affected others could not understand their experiences.

You wouldn’t really understand it unless you’d been through it [...] People are supportive, but if they haven’t lived through it, it’s different. (Joy, 66 years, mother of son, attended 3 support group sessions)

It’s very hard for anyone to know what it’s actually like when you’re actually there, when I was actually there with [my relative] seeing him using and just all the changes. (Erica, 56 years, mother of son, attended 6 support group sessions)

As Joy and Erica described, participants felt that true and fundamental understanding of their experience could only be gained through lived experience. A core benefit of the support group was recognizing that others shared their experiences and could understand and identify with them. As Dawn (55 years, mother of son, attended 8 sessions) reflected, “you weren’t by yourself [in the support group] … there’s a lot of people, a lot of families, experiencing the same that we we’re experiencing”.

Subtheme: Learning and Contextualizing

Under the theme of “Connecting with others” we identified a subtheme, “Learning and contextualizing”. Through connecting with others, participants described being able to learn new strategies and skills to cope, as well as contextualizing and normalizing their experiences within a broader realm of addiction lived experiences. As Erica (56 years, mother of son, attended 6 sessions) described, “I found it just helps you get your eyes off yourself, […] people just gave good advice, just heard different ways that different people handled things and that was helpful”. Contextualizing their experiences helped participants to feel normal and see their circumstances positively, with many stating that the group “made me realize how lucky I was” (Joy, 66 years, mother of son, attended 3 sessions) and helped them recognize that “my problem wasn’t as bad as others” (Mary, 64 years, mother of daughter, attended 2 sessions).

Theme 2: It Is the Facilitators that Make the Group

The second major theme related to the role of the facilitators in creating a safe, rewarding, and supportive group environment. Participants emphasized that the sensitivity, professionalism, knowledge, and skills of the facilitators were central to the effectiveness of the group. As Walker (54 years, mother of son, attended 15 sessions) described, “[the facilitators] obviously just had a great deal of experience in facilitating and on the subject. They knew a lot more about the topic of addiction”. Effective group management, as outlined by participants, included ensuring equal opportunities for sharing and managing talkative, distressed, or domineering attendees. As Emilia (66 years, mother of daughter, 18 sessions) described, any group will have “people who want to dominate” and “shy people”. Participants noted that “mak[ing] sure everyone got an opportunity to talk” (Erica, 56 years, mother of son, 6 sessions) and “discuss their issues” (Dawn, 55 years, mother of son, 8 sessions) was paramount, and required facilitators to be “really on track with, maybe checking people, but being nice, saying, ‘thank you, and let’s hear from someone else’” (Emilia).

Skilled facilitators were needed to effectively manage the tone of the group and prevent potential distress, with two participants describing previous negative experiences of other support groups. Emilia (66 years, mother of daughter, 18 sessions) stated that she had felt “guilty” and like a “bad mother” for setting boundaries based on the feedback of a support group she had attended several years prior, while Bernadette (50 years, mother of son, 11 sessions) found a past support group to be “distressing”, hearing negative experiences and “think[ing] that that was my future”. In relation to the online peer-led support group, participants emphasized the facilitators’ respectful approach, in which participants could share with and support each other, without judgement of their different circumstances or approaches. Joy (66 years, mother of son, 3 sessions) reported that “it was very sharing. I think that was what was good about it”. Emilia and Marjorie noted the strengths of the facilitators:

[The facilitators] used that thing that, we’re not to tell people what to do, you’ve got to be accepting of others’ situations. We can share information but we shouldn’t force information. (Emilia, 66 years, mother of daughter, 18 sessions)

The facilitators were great and they always worked hard at including everyone and giving everyone the opportunity to speak, […] So yes, it’s the facilitators that worked hard at making it work. (Marjorie, 60-70 years, mother of son, 10 sessions)

Theme 3: Accessing Support When in Crisis

This theme summarized participants’ descriptions of being able to access support provided by the group when they need it. This theme is divided into two subthemes: (i) Needing help in crisis and (ii) Ensuring support is accessible.

Subtheme 1: Needing Help in Crisis

Participants described a pattern of seeking support during periods of heightened stress or crisis, and then stepping away from support when the crisis eased. For example, Mary (64 years, mother of daughter, 2 sessions) stated that, “normally, I just go along, and try not to kind of think about it too much, but then something will happen […] that will start me off again, and then I will seek help”. Dawn (55 years, mother of son, 8 sessions) similarly explained she had stepped away from the support group when her circumstances improved; “My son now is in long-term rehab, and so I don’t need the support at the moment […] But certainly, if things escalated again, I would be looking [for support]”.

Subtheme 2: Ensuring Support Is Accessible

Participants described barriers to accessing care and the ways the online setting made the group more accessible. Balancing everyday demands while caring for their relative often left limited time for seeking support for themselves. As Walker (54 years, mother of son, 15 sessions) stated, “you’ve got enough to do when you’ve got full-time work and a drug addicted other, it’s hard to get to things”. Participants emphasized that attending the peer-led support group online made it more accessible, especially during crisis periods when they most needed help. Attending online meant “you don’t then have to try and get there at a certain time” (Dawn, 55 years, mother of son, 8 sessions) and “you don’t have to take time off work to get to the meetings” (Walker). The online format provided choice and flexibility:

You can just use your laptop, you can just use your phone, you can just kind of go move places, turn your camera [off or on]. (Erica, 56 years, mother of son, 6 sessions)

As Orana (40 years, wife of male partner, 1 session) noted, new or returning members “could feel a little bit self-conscious”, in the unfamiliar group environment, and “trying to find how it all runs and everything”. New group members, who may have joined due to worsening circumstances, may experience heightened emotional responses during meetings. Being able to attend with their camera off made participation less challenging for these members: “when you’re doing something new, like – total strangers, it’s difficult […] I found the Zoom was really good, because you could just sit and listen, if you feel a bit teary” (Joy, 66 years, mother of son, 3 sessions). As Dawn (55 years, mother of son, 8 sessions) explained, “you’re in the comfort of your home, […] you have privacy, you don’t have to be up on the screen, but you can still listen”.

Discussion

To our knowledge, this is the first preliminary mixed-methods study of an online, peer-led support group intervention for affected family members of persons living with addiction. There was a significant improvement in mean general self-efficacy (i.e. their confidence to cope with situations and challenges in their life) for participants who completed baseline and exit surveys. No significant changes were detected for general well-being and social support over time. Our results contribute to the small body of research that supports the utility of peer support models for improving affected family members’ confidence and strategies to cope with their relative’s addiction (Gethin et al., 2016; Kelly et al., 2017; Merkouris et al., 2022; Templeton, 2009). These results align with past research suggesting that peer-led support groups for family members are feasible (Templeton, 2009), and extend the current literature by indicating that the benefits of peer-led group programs can be achieved when programs are delivered online.

Survey data indicated that most participants were satisfied with the intervention and reported it to be beneficial across a range of psychosocial outcomes. In particular, most participants perceived benefits related to social connectedness to similar others, ability to cope and knowledge of coping strategies, working through emotions, as well as improved addiction-related knowledge and increases in and maintenance of enjoyable activities. While participants rated increased social connectedness as a perceived benefit, baseline-to-exit improvements in the SCS were non-significant. The social connectedness perceived benefit asked participants about increased feelings of connectedness to others in similar circumstances, due to the online group. In contrast, the SCS focuses on the emotional distance or connectedness between the self and others (friends and society) (Lee & Robbins, 1995). Therefore, our results may relate to two different areas of connectedness: connectedness with society and friends not affected by addiction (SCS), and connectedness with others affected by addiction (perceived benefits of the group). While peer-led support groups assist affected family members to feel connected to others with shared experiences, the groups may not address affected family members’ sense of isolation from broader society. This distinction and the small though non-significant pre-post changes in the SCS and PWI warrant further investigation in a larger study.

Findings from the qualitative component of this study served to expand upon the quantitative findings. In our interviews with affected family members, we identified three themes and three related sub-themes, focusing on connection with others who share the same experiences, the expertise of facilitators, and accessing support when in crisis. Participants reported the online peer-led support group provided them with new strategies and skills to cope, as well as assist them to contextualize and normalize their experiences within a broader realm of addiction lived experiences. These findings are consistent with previous research, indicating that core benefits of face-to-face peer support groups for affected family members were increased support and information from others who share their experiences, enhanced by the expert status of the facilitator and their knowledge (Hoeck & Van Hal, 2012). In addition, with the increasing use of digital platforms for online meetings, and the benefits as described by our participants in terms of access and convenience, these findings are useful for existing face-to-face groups to consider for providing groups online (Hoeck & Van Hal, 2012).

The online support group intervention and our findings indicate general alignment with the SSCS model; for example, participant reports of improved knowledge of coping strategies and ability to apply them, and accessing support through the group (Orford et al., 2010). Similar interventions for affected family members have used the “5 step method”, yet these are based in existing primary care or community organizations (Arcidiacono et al., 2007; Velleman et al., 2008, 2011). The online support group intervention reported here was open to anyone who identified as an affected family member, regardless of whether their relative was currently receiving treatment. This flexibility, alongside being provided online, was found to empower participants to receive support outside of the formal health care system, and attend on their own terms.

A strength of this study was the use of a mixed-methods quantitative and qualitative research design, which permitted the assessment of change in key outcomes and an exploration of participants’ experiences of the intervention and the meaning they made of their experiences. However, except for general self-efficacy scores, we did not have a sufficiently sized sample to determine meaningful change in relation to our quantitative data measures, the PWI and SCS. In addition, the majority of our surveyed sample and all of our interview participants were female, and the majority of survey and interviewed participants were midlife aged, meaning the sample is unlikely to reflect the experiences of fathers, male partners, other male family members, and family members of other ages affected by addiction. Our sample, however, is consistent with other research with help-seeking affected family members, where participants have predominantly been female and midlife aged (Maltman et al., 2020; Orford et al., 2013; Wilson et al., 2019).

We did not use a control group in this study; therefore, improvement may have occurred naturally in this participant group. We observed higher than anticipated attrition, with 57.4% of the baseline sample not completing the intervention (i.e. attending at least one group and completing at least one pair of baseline and exit outcomes). Due to this attrition, it is possible that completed participants were more motivated than non-completers to attend the group and provide feedback or report positive changes, potentially biasing the results. However, we did not find any significant differences between the completers’ and non-completers’ characteristics at baseline, including demographics and baseline well-being, social connectedness, and general self-efficacy. The fact that participants were recruited from a psychoeducational program implemented prior to the online support group may have influenced the results. A further limitation is that we did not collect primary drug of concern (PDOC) data for all completed participants (n = 10 missing data). However, our focus was the experiences and outcomes of the group for affected family members, regardless of the primary substance of concern.

Interventions for affected family members show some potential for benefits (Merkouris, et al., 2022), and our preliminary findings warrant further investigation using a powered sample size and randomised study design. In addition, the use of peer (affected family member)-led groups requires further research. While the sense of connectedness was of benefit to participants, further research is required to explore the specific mechanisms of how this connection was experienced, particularly when the group is peer-led. For example, one of our notable qualitative findings was the central role that facilitators played in participants’ experiences of the group. Further research on what elements of facilitation were key to that success, for example, lived experience of facilitators, specific skills, and knowledge sets, is required.

Our findings contribute to the field of research into affected family member interventions. Participants in the online support group described feelings of connection and the flexibility to access support as needed. For alcohol and other drug policy-makers, building flexibility into similar programs would allow affected family members to access the support they need at a time and location to match their needs. Further research exploring the barriers and facilitators to online and face-to-face interventions would assist in tailoring these interventions for affected family members.

Conclusion

In this preliminary study of an online support group for affected family members, the provision of education, alongside a supportive online group environment comprising skilled lived experience facilitators, was found to provide an important opportunity for affected family members to share and learn coping strategies, and may assist with improving connection with others. Further investigation of this model is warranted to inform broader addiction service delivery in Australia and internationally.