Article

Client Family-Member Participation Is Associated with Improved Residential Treatment Program Completion at an International Drug and Alcohol Treatment Center

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Abstract

Prior research at Crossroads Centre Antigua has shown a 15% increase in long-term abstinence rates of clients if a family member attended the family program. This study examines the association of family program participation on client residential treatment completion. A retrospective review of records of all clients admitted from January 2004 to June 2007 was performed. Participation of client family members in the family program (a 4-day program including didactic material, workshops, group and individual counseling sessions for interested family members) was recorded. Information obtained from a limited client database, in addition to family program participation, included age, gender, country of residence, drug of choice, and 29-day treatment program completion. Data from clients having family members participate in the family program were compared with clients not having family members participate. There were 1,014 clients admitted, 681/1,014 (67%) men, mean age 41years, 733/1,014 (72%) from the United States. There were 187/1,014 (18%) clients using opioids either alone or with other drugs, 330/1,014 (33%) using cocaine or another stimulant drug alone or with other drugs, and 497/1,014 (49%) using alcohol or another non-prescribed sedative drug alone or with other drugs not including opioids or cocaine/stimulants. Of these clients, 207/1,014 (27%) had 416 family members (155/416 [37%] parents or step-parents; 133/416 [32%] spouses, significant others, or partners; 67/416 [16%] siblings or step-siblings; 38/416 [9%] children or step-children; and 23/416 [6%] other individuals) attend the family program. For all clients admitted, 902/1,014 (89%) completed the 29-day residential stay. The clients who had family members participate in the family program were significantly more likely to complete their stay (266/270 [99%]) than those clients who did not have family members participate (636/744 [86%]; chi-square p < .0005. Those with family members attending had no significant difference in other factors that may affect treatment completion, such as age (40 vs. 41 years), gender (65% vs. 68% male), country of residence (73% vs. 71% from the United States), or opioid drug (17% vs. 19%), cocaine/stimulant (34% vs. 32%) or alcohol/sedative as primary drug (49% vs. 49%). These data suggest that participation of a client family member in a family program, independent of other clinical risk factors, is associated with significantly improved treatment retention, a surrogate marker for better long-term abstinence rates following residential treatment.

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... Family members who are involved in treatment and who find recovery for themselves may also benefit the recovery of their addicted loved one (Martin, Lewis, Josiah-Martin, & Sinnott, 2010;O'Farrell & Clements, 2012). Family members' participation in the intervention and treatment process can have positive effects on the addict's recovery (O'Farrell & Clements, 2012). ...
... Family members' participation in the intervention and treatment process can have positive effects on the addict's recovery (O'Farrell & Clements, 2012). Having a family member or members as part of a family program in addiction treatment has been associated with a 13% higher program completion rate for people being treated for addiction and a 15% higher rate of client abstinence at 20-month follow-up (Martin et al., 2010). ...
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... Family members who are involved in treatment and who find recovery for themselves may also benefit the recovery of their addicted loved one (Martin, Lewis, Josiah-Martin, & Sinnott, 2010;O'Farrell & Clements, 2012). Family members' participation in the intervention and treatment process can have positive effects on the addict's recovery (O'Farrell & Clements, 2012). ...
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Women (N=171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism.
Article
The outcome of a 29-day residential addiction treatment programme for persons from Antigua and Barbuda with addiction to drugs or alcohol was assessed. All 100 patients entering the drug and alcohol treatment programme at Crossroads Centre Antigua between November 1998 and October 2002 were included. All patients were assessed with regards to drug or alcohol use or abstinence in November 2002 using telephone and mail follow-up as well as informal follow-up with families and other community contacts. Crossroads Centre Antigua is a 35 bed, 29-day residential treatment centre for drug and alcohol addiction serving patients from developed countries (85%) and from the Caribbean region (15%). Patients records were also reviewed to obtain age, gender, ethnicity, drug of choice, years of problematic use, completion of the 29 day programme, family member participation at Crossroads Centre Antigua (a four-day programme) and acceptance of halfway house placement. Of the 100 Antiguan patients admitted, 46 (46%) were abstinent (non-relapsers) at average 20.7+/-14.7 months after treatment. Abstinence did not have to be continuous. Forty-nine were known to be using drug or alcohol (49%) and five (5%) were lost to follow-up and considered to be using drugs (relapsers). Age (37.5 vs 41.1 years), gender (28% vs 22% female), ethnicity (87% vs 87% Afro-Caribbean), years of harmful use (12.7 vs 12.5 years) did not differ significantly between relapsers and non-relapsers. Crack cocaine use (67% vs 65%) and alcohol use (26% vs 31%) as primary addiction did not differ significantly between relapsers and non-relapsers. Relapsers were significantly less likely to complete the 29- day programme (81% vs 100%, p < 0.01), have family members participate at Crossroads (32% vs 54%, p < 0.05) or accept halfway house placement (4% vs 54%, p < 0.001). In conclusion, abstinence was achieved in 46% of those entering treatment, in 51% completing treatment, in 60% whose families participated and in 92% of those accepting halfway house placement.
Article
Alcohol and drug problems affect not only those using these substances but also family members of the substance user. In this review evidence of the negative impacts substance misuse may have upon families are examined, following which family-focused interventions are reviewed. Several family-focused interventions have been developed. They can be broadly grouped into three types: (1) working with family members to promote the entry and engagement of substance misusers into treatment; (2) joint involvement of family members and substance misusing relatives in the treatment of the latter; and (3) interventions responding to the needs of the family members in their own right. The evidence base for each of the three types is reviewed. Despite methodological weaknesses in this area, a number of conclusions can be advanced that support wider use of family focused interventions in routine practice. Future research needs to focus on (1) pragmatic trials that are more representative of routine clinical settings; (2) cost-effectiveness analyses, in terms of treatment costs and the impact of interventions on costs to society; (3) explore treatment process; and (4) make use of qualitative methods. In addition, there is a need to define more clearly the conceptual underpinnings of the family intervention under study.
Article
To describe a set of standard questionnaire measures for the assessment of the needs of family members of relatives with alcohol, drug or gambling problems, and to present evidence of their reliability and validity from a series of related studies. Includes cross-sectional and repeated-measurement studies. Family members affected by and concerned about the problem drinking or drug-taking of close relatives in treatment and non-treatment samples in the United Kingdom (white and Sikh) and Mexico City; family members of untreated heavy drinkers; and family members of problem gamblers. Four measures derived from a stress-strain-coping-support model of alcohol, drugs and gambling problems and the family: Family Member Impact scale (FMI), Symptom Rating Test (SRT), Coping Questionnaire (CQ), and Hopefulness-Hopelessness scale (HOPE). FMI, SRT and CQ assess stress, strain and coping, respectively. The exact role of HOPE in the model remains to be determined. The support component remains unmeasured. Results from a number of studies support the internal reliability, discriminant and construct validity and sensitivity to change of the SRT and its two constituent scales (psychological and physical symptoms) and at least two subscales of the CQ (engaged and tolerant-inactive coping). Although showing evidence of satisfactory reliability and some evidence of discriminant validity, further work may be required on the CQ withdrawal coping subscale. Evidence suggests that the FMI is reliable and valid and may have a factor structure that will support future research (distinguishing worrying behaviour from active disturbance). HOPE is a new measure showing promising characteristics. A set of standard measures is available for helping to assess the needs of concerned and affected family members, derived from an explicit model of the family in relation to excessive drinking, drug taking or gambling. It may have a role to play in correcting the current neglect of the needs of such family members, estimated to be in the region of nearly a million adults in Britain alone.
Article
Recent developments in research and practice have highlighted the effectiveness of family interventions in substance misuse treatment. The present paper will critically review studies of family approaches published over the past 12 months, assess the current state of this field and suggest future directions. Family interventions lead to positive outcomes for both misusers and family members. Some recent interventions have widened the focus also to include other members of the user's social networks and have focused on a range of treatment goals. An increasingly robust evidence base supports family-focused and social network-focused interventions in substance misuse treatment. Recent studies have continued to show that family and network approaches either match or improve outcomes when compared with individual interventions. Research needs (and is starting) to consider a broader set of outcomes relevant to family and network interventions, besides simply making an impact on substance use. The major challenge involves implementation of family approaches in routine service provision; interventions with most evidence supporting them are not used routinely in practice. Research studies and policy initiatives need to focus on dissemination of family approaches and their integration into treatment services.
Article
Through the use of published literature and empirical research, the authors explore the differing conceptual frameworks, techniques, and effectiveness of various family interventions for change-resistant, substance-abusing adults. The 2 dominant programs in place to help families and friends deal with the addiction of an adult loved one are the Johnson Intervention and Al-Anon. Research on these 2 programs is presented, followed by an outline of promising alternative approaches. These include A Relational Intervention Sequence for Engagement, Community Reinforcement Training, Community Reinforcement and Family Training, Unilateral Family Therapy, and Pressures to Change. The effectiveness and appropriateness of these approaches in different situations are discussed. In addition, areas in need of further study are pointed out.
Article
Because "substance abuse" is a "family disease" of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programs should be included in all comprehensive substance abuse prevention activities. This article presents reviews of causal models of substance use and evidence-based practices. National searches by the authors suggest that there is sufficient research evidence to support broad dissemination of five highly effective family strengthening approaches (e.g., behavioral parent training, family skills training, in-home family support, brief family therapy, and family education). Additionally, family approaches have average effect sizes two to nine time larger than child-only prevention approaches. Comprehensive prevention programs combining both approaches produced much larger effect sizes. The Strengthening Families Program (SFP) is the only one of these programs that has been replicated with positive results by independent researchers with different cultural groups and with different ages of children. Few research-based programs have been adopted by practitioners, partly because of technology transfer issues. Overall, research on ways to improve dissemination, marketing, training, and funding is needed to improve adoption of effective prevention programs.
Article
Effective parenting is the most powerful way to reduce adolescent problem behaviors. Dissemination of research-based family interventions has been slow, with most practitioners still implementing ineffective programs. This article reviews 2 federal studies that involved national searches for effective family interventions targeting pre-birth to adolescence: Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches (Center for Substance Abuse Prevention, 1998) and Strengthening America's Families (R. Alvarado, K. L. Kumpfer, K. Kendall, S. Beesley, & C. Lee-Cavaness, 2000). Results identified 3 effective prevention approaches, 13 principles of effectiveness, and 35 programs. Recommendations include increased dissemination research on training and technical assistance systems, adoption with fidelity and quality, and gender-, age-, and culturally sensitive adaptations.
No more letting go: The spirituality of taking action against alcoholism and drug addiction
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A comparison of Caribbean clients failing to complete and those who did complete a 29-day residential drug treatment program in Antigua
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More research to establish the " best practice " for family interventions and family treatment is needed
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In-home family support has been proposed recently for drug use-affected fam-ilies (Gruber & Fleetwood
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