families

Psychosocial interventions for family members affected of other members’ substance abuse were found in a systematic review with meta-analysis (Rushton et al., 2023, 19 studies, 10 incl. metanalysis) to have a significant effect on:

• reducing depression (RTCs = 3, SMD= 0.50, 95% CI 0.21 to 0.79) and in non-RTCs (d =0.50, 95% CI 0.17 to 0.82)
• decreasing distress (SMD=0.28, 95% CI 0.03, 0.54) and in non-RTC (d = 0.44, 95% CI 0.13, 0.75)
• improving family functioning (d = 0.51, 95% CI 0.28, 0.73) and coping (d = 0.81, 95% CI 0.29, 1.33).

Interventions to reduce intimate partner violence perpetration by men who use substances (mainly CBT and MI therapies) were found in a systematic review with meta-analysis (Stephens-Lewis et al., 2021, 9 RCTs, N = 1 014 men) to have no effect compared to treatment as usual in:

• reducing substance use or intimate violence partner violence 

Family focused, psychosocial, preventive interventions targeting parents/carers at risk of, or experiencing, parental domestic violence and abuse, mental ill-health, and substance misuse were assessed in a systematic review (Allen et al., 2022, 37 studies, studies were included if they measured impacts on two or more of these issues). Results showed that:

• none had a combined positive impact on all three outcomes and only one study demonstrated a combined positive impact on two outcomes.
• The analysis also found studies that had combined adverse, mixed, or singular impacts.

Psychosocial interventions delivered to people affected by someone else's addiction (problematic alcohol use, substance use, gambling or gaming) were assessed in a systematic review with meta-analysis ((Merkouris et al., 2022). Interventions included therapist interventions, delivered individually, in group and/or self-directed; cognitive–behavioural programmes based on CRAFT methodology that helps affected others to engage treatment-resistant addicted individuals into treatment and improve the affected other’s quality of life; coping skills training and other type of interventions. The results found beneficial intervention effects over control groups at post-intervention:

• on some affected other
  • depressive symptomatology (SMD = -0.48, 95% CI = -0.67, -0.29),
  • life satisfaction (SMD = -0.37, 95% CI = -0.71, -0.03)
  • and coping style (SMD = -1.33, 95% CI = -1.87, -0.79)
• on the addicted person
  • treatment entry (RR = 0.86, 95% CI = 0.75-0.98)
• on relationship functioning outcomes
  • marital discord, SMD = -0.40, 95% CI = -0.61, -0.18) 

No beneficial intervention effects were identified at short-term follow-up (4-11 months post-treatment). The beneficial intervention effects identified at post-treatment remained when limiting to studies of alcohol use and therapist-delivered interventions.

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years.

• There were too few family-level (n=4), individual-level (n=2) and combination level (n=5) studies to draw confident conclusions.

A Cochrane systematic review with meta-analysis (McGovern et al., 2021 a, studies=22, N= 2 274) assessed complex psychosocial interventions targeting substance use in parents of children under the age of 21 years. Interventions were found to be effective in:

• reducing the frequency at which parents use alcohol and drugs
  • low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants) or drug use (6 months: SMD 0.01, 95% CI −0.42 to 0.44; 2 studies; 87 participants and 12 months: SMD −0.08, 95% CI −0.81 to 0.65; 1 study, 32 participants)
•  Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise (low quality evidence)
  • integrated interventions which combined both parenting- and substance use- targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants) and drug use (6 months: SMD −0.39, 95% CI −0.75 to −0.03 and 12 months: SMD −0.43, 95% CI −0.80 to −0.07; 2 studies, 131 participants)

Authors also found 

• that whilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. 
• low-quality evidence from few studies that interventions involving children are not beneficial.

A more comprehensive narrative review (McGovern et al., 2021 b, studies=58) investigating the adverse health and social outcomes derived by the the substance use of a close relative, found behavioural interventions to be effective in:

• improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning) when delivered conjointly with the substance user and the affected family members.
• Also  an affected adult family members may derive psychological benefit from an associated individually focused therapeutic intervention component.

However no interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use and 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.

Ecological family-based treatments (including multidimensional family therapy) delivered in community settings were found in a systematic review without meta-analysis (Hogue et al., 2014, 8 RCTs) and a meta-analysis (Hartnett et al., 2016, 14 studies) to have significant effect in:

• reducing adolescent drug use (mainly cannabis and alcohol)
• reducing adolescent disruptive behaviours

Multi-component programmes, with both family and schools interventions, for preventing smoking by children and adolescents were found in a systematic review (Thomas et.al., 2015, 27 RCTs), to be more effective than school-only intervention in:

• reducing smokng in adolescents who never smoked at baseline (2 RCTs, N = 2 301)  (RR = 0.85, 95 % CI 0.75–0.96)
• reducing smoking in adolescents who were smokers at baseline (1 RCT, N = 1 096)  (RR = 0.60, 95 % CI 0.38–0.94)

Intensive family-based programmes for preventing smoking by children and adolescents were found in a systematic review (Thomas et.al., 2015, 27 RCTs), to be effective in:

• reducing cigarette use in adolescents (9 studies, N=4 810) (RR = 0.76, 95 % CI 0.68–0.84)

Home visitation for families composed of low-income unmarried women was found in a narrative review to be mildly effective at 15-year follow-up (Toumbourou et al., 2007, 1 study, N= 743) in reducing for the parent(s):

• number of cigarettes smoked per day (1.50 versus 2.50, p = 0.10);
• number of days having consumed alcohol in the past six months (1.09 versus 2.49, p = 0.03)