FAMILY INTERVENTIONS FOR ALCOHOL PROBLEMS

Ray Hodgson

Alcohol Education and Research Council, London, UK

Correspondence: Alcohol Education and Research Council, Room 408, Horseferry House, Dean Ryle Street, London SW1P 2A, UK. E-mail: ray.hodgson{at}southerns.net


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A growing body of evidence demonstrates that family interventions should be towards the top of the list of effective alcohol prevention and treatment approaches. A recent conference run by the UK Alcohol Education and Research Council presented some of this evidence (go to: aerc.org.uk then ‘News’ for a summary).

David Foxcroft and colleagues have completed a very comprehensive systematic review of prevention approaches with young people (Foxcroft et al., 2003Go). Over the longer-term, the results of this systematic review point to the potential value of the IOWA ‘Strengthening Families Programme: For Parents and Youth 10–14’ (SFP10–14) as an effective intervention for the primary prevention of alcohol misuse (Spoth et al., 2001Go). The number needed to treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkenness) was nine. In other words, if nine children have been involved in the Strengthening Families Programme then one less child will misuse alcohol in the 4-year follow-up period than would have been the case with a standard school programme. This compares, for example, with an NNT of 24 for school-based life skills training (Botvin et al., 1995Go).

The SFP10–14 was described in detail by Virginia Molgaard, one of its developers (Kumpfer et al., 1996Go). It is designed to reduce adolescent substance misuse and other behaviour problems by increasing parenting skills, building life skills in youth and strengthening family bonds. Parents and youth meet in separate groups for the first hour and together as families during the second hour to practise skills, play games and do family projects. The basic programme is 7 weeks, usually held in the evenings. Four booster sessions, 3–12 months after the basic sessions, are optional. The programme is video-based with most parent sessions and several youth and family sessions using videos that have narrators and portray typical youth and parent situations. Sessions are highly interactive with role-plays, discussions, learning games and family projects. Benefits for youth include a more positive future orientation, better empathy with parents, emotional management skills, willingness to follow rules and peer pressure resistance skills. Benefits for parents include understanding youth development, ability to make and follow through on house rules, using both positive and negative reinforcement, building positive communication, willingness to get help for special family needs, and making specific rules regarding youths' use of substances.

Megan Marsh and Sara Male described the successful adaptation of the SFP 10–14 programme in the UK. The ‘Altogether Now’ project was established in Barnsley in 1999 through Health Action Zone funding to introduce an evidence-based programme involving effective strategies for parents and children. An SFP pilot group was evaluated in April 2002 and the positive response, both from the families and from the group leaders, influenced the decision to invite Dr Molgaard to Barnsley to conduct a group leader training event for multi-agency, professionals and at the same time to train the leaders of the pilot programme as trainers. By the end of 2003, 13 groups had been implemented.

The afternoon session focussed on interventions for families with an already existing alcohol problem. Richard Velleman, Lorna Templeton, Jim Orford, Mya Krishnan and Alex Copello have been involved in a long-running research programme in the UK, developing and testing a brief intervention for use by primary health care professionals (Copello et al., 2000Go). The intervention is based on the stress–strain–coping–support model, developed directly from interviews with family. The model states that the impact of an alcohol (or drug) problem can be stressful for family members. This leads to strain, usually demonstrated through physical and/or psychological ill health. The relationship between stress and strain is mediated by the type of coping the family uses and the level and quality of social support available to the family member. The model is translated into practice via a brief intervention. The five steps are as follows. (1) Listen to the relative's story. (2) Provide information. (3) Explore coping responses. (4) Explore social support. (5) Assess the need for further help.

The intervention has been tested in two studies, with promising results. Preliminary quantitative analyses indicate that delivery of the intervention can lead to a significant reduction in symptoms and changes in coping behaviour. Qualitative analysis supports these findings, giving clear examples of how the interventions have worked for family members.

In the UK in 2002, the National Society for the Prevention of Cruelty to Children (NSPCC) and the Alcohol Recovery Project (ARP) launched a pilot Family Alcohol Service (FAS). John Newman and Wendy Robinson described the FAS approach and future plans for the service. A range of professionals integrate alcohol-focussed and child- and family-focussed interventions. An independent evaluation of the service has concluded that:

‘Family members (children, parents and others) have been enthusiastic in their praise for the service, and both referrers and FAS staff have reported significant success in engaging difficult-to-treat families in the change process. Children have become less anxious, and some have been able to resolve long standing negative feelings about their situations. Coping responses have also improved, as has school attendance, achievement and relationships in some cases.’

Rhoda-Emlyn Jones described the outcomes associated with the Cardiff Option 2 project. This service works with families where childcare professionals are seriously considering the need to remove children from the family home and there is a related parental substance misuse issue. A referral is made by a childcare social worker, directly to a therapist who, if there is space available in the service, will contact the family within 24h. The approach differs from that adopted by the FAS. Very intensive support is given to an at-risk family for 4 weeks with 24-h support when necessary. Since starting Option 2, 71% of goals had been achieved by the end of the 4-week intervention; 12 months after the intervention, 77% of goals had been achieved and 84% of families were still together.

Although this conference did not present the work, there is also high-quality evidence supporting the efficacy of marital behavioural therapy in improving the outcome of alcohol-dependent patients and their families (O'Farrell et al., 1996Go; Slattery et al., 2003Go). Taken together, it appears that family interventions should be at the core of future prevention and treatment provision.


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Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M. and Diaz, T. (1995) Long term follow-up results of a randomized drug abuse prevention in a white middle class population. Journal of the American Medical Association 273, 1106–1112.[Abstract]

Copello, A., Templeton, L., Krishnan, M., Orford, J. and Velleman, R. (2000) A treatment package to improve primary care services for relatives of people with alcohol and drug problems: feasibility and preliminary evaluation. Addiction Research 8, 471–484.[ISI]

Foxcroft, D. R., Ireland, D., Lister-Sharp, D. J., Lowe, G. and Breen, R. (2003) Longer-term primary prevention for alcohol misuse in young people: a systematic review. Addiction 98, 397–411.[ISI][Medline]

Kumpfer, K., Molgaard, V. and Spoth, R. (1996) The Strengthening Families Programme for the prevention of delinquency and drug use. In Preventing Childhood Disorders, Substance Abuse and Delinquency, Peters, R. and McMahon, R., eds. pp. 241–267. Sage, Thousand Oaks, CA.

O'Farrell, T. J., Choquette, K. A., Cutter, H. S. G., Brown, E., Bayog, R., McCourt, W., Lowe, J., Chan, A. and Deneault, P. (1996). Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment. Journal of Substance Abuse 8, 145–66.[ISI][Medline]

Slattery, J., Chick, J., Cochrane, M., Craig, J., Godfrey, C., Kohli, H., MacPherson, K., Parrot, S., Quinn, S., Tochel, C. and Watson, H. (2003) Prevention of relapse in alcohol dependence. Health Technology Assessment Report 3, Health Technology Board of Scotland, Glasgow. (Available at: www.htbs.co.uk).

Spoth, R. L., Redmond, C. and Shin, C. (2001) Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline. Journal of Consulting and Clinical Psychology 69, 1–15.





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