Serving Substance Abuse Professionals Since 1993

Last Update: 08.09.11

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Family Therapy

47 citations. January 2009 to present

Prepared: September 2011

Benishek LA; Kirby KC; Dugosh KL. Prevalence and frequency of problems of concerned family members with a substance-using loved one. American Journal of Drug and Alcohol Abuse 37(2): 82-88, 2011. (26 refs.)

Background: Limited research has examined the prevalence and frequency of specific problems of concerned family members and significant others (CSOs) of alcohol- or substance-using individuals (SUIs). Objectives: We surveyed CSOs of SUIs to determine the prevalence and frequency of their problems and explored whether relationship to the SUI, gender of the CSO, or living arrangements altered problem prevalence and frequency. Methods: Non-substance-using CSOs (n == 110) completed the Significant Other Survey, which asks about problems in seven domains (emotional; family; relationship; financial; health; violence; legal). Problem outcomes were compared based on the CSO's relationship to the SUI (partner or spouse vs. parent), gender of the CSO (male vs. female), and living arrangements of the CSO and the SUI (residing together vs. residing apart). Results: Problems were prevalent with at least two-thirds of the participants endorsing one or more problems in all but the legal domain. They also occurred frequently, with CSOs reporting problems on one-third to one-half of the past 30 days, in all but the violence and legal domains. Problems tended to be greater for CSOs who were partners, females, or living with the SUI. Conclusion: CSOs experience frequent problems in a wide range of life domains and the types of difficulties they experience appear to differ based on type of relationship, gender, and their living arrangement relative to the SUI. Scientific Significance: This investigation expands our understanding of the specific problems that CSOs face. The findings have important implications for treatment and health policy regarding these individuals.

Byrnes HF; Miller BA; Aalborg AE; Plasencia AV; Keagy CD. Implementation fidelity in adolescent family-based prevention programs: Relationship to family engagement. Health Education Research 25(4): 531-541, 2010. (55 refs.)

Reliability and validity of intervention studies are impossible without adequate program fidelity, as it ensures that the intervention was implemented as designed and allows for accurate conclusions about effectiveness (Bellg AJ, Borrelli B, Resnick B et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychology 2004; 23: 443-51). This study examines the relation between program fidelity with family engagement (i.e. satisfaction and participation) in family-based prevention programs for adolescent alcohol, tobacco or other drug use. Families (n = 381) were those with an 11- to 12-year-old child enrolled in Kaiser Permanente in the San Francisco area. Families participated in one of two programs: Strengthening Families Program: For Parents and Youth 10-14 (SFP) (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11) or Family Matters (FM) (Bauman KE, Ennett ST. On the importance of peer influence for adolescent drug use: commonly neglected considerations. Addiction 1996; 91: 185-98). Fidelity was assessed by: (i) adherence to the program manual and (ii) quality of implementation. No relationships were found for FM, a self-directed program. For SFP, higher quality scores were related to higher parent satisfaction. Higher adherence scores were related to higher satisfaction for youth, yet surprisingly to lower satisfaction for parents. Parent sessions involve much discussion, and to obtain high adherence scores, health educators were often required to limit this to implement all program activities. Findings highlight a delivery challenge in covering all activities while allowing parents to engage in mutually supportive behavior.

Carr A. Thematic review of family therapy journals in 2008. (review). Journal of Family Therapy 31(4): 405-427, 2009. (105 refs.)

In this paper the contents of the principal English-language family therapy journals, and family therapy papers from other journals published in 2008, are reviewed under the following headings: child-focused problems, adult-focused problems, couples, diversity, developments in systemic practice, training, research, and recent deaths of significant contributors to the field.

Cisler RA; Silverman BL; Gromov I; Gastfriend DR. Impact of treatment with intramuscular, injectable, extended-release naltrexone on counseling and support group participation in patients with alcohol dependence. Journal of Addiction Medicine 4(3): 181-185, 2010. (30 refs.)

Objectives: The impact of intramuscular, injectable, extended-release naltrexone (XR-NTX; Vivitrol) on counseling and support group participation was examined in a post hoc analysis of a 24-week, randomized, double-blind study in 624 alcohol-dependent adults, most of whom were nonabstinent at baseline. Methods: Patients were offered 6 monthly injections of XR-NTX 380 mg, XR-NTX 190 mg, or placebo (n = 205, 210, and 209, respectively) and 12 sessions of manualized brief counseling. Voluntary participation in extramural counseling (eg, couples or family therapy) and self-help support groups (eg, Alcoholics Anonymous) was permitted and assessed. Results: The proportion of patients attending all 12 Biopsychosocial, Report, Empathy, Needs, Direct advice, and Assessment sessions was nonsignificantly greater for XR-NTX 380 mg (45%) than for placebo (39%), as was the proportion attending extramural counseling (10% vs 7%) and support groups (13% vs 10%). Attendance rates were intermediate with XR-NTX 190-mg. Attending self-help groups was significantly (P = 0.04) related to reduced heavy drinking across all treatment groups. Conclusions: XR-NTX is compatible with counseling and support group participation in the treatment of alcohol dependence.

Copello A. Commentary on Roozen et al. (2010): Involving families in addiction treatment-the way forward. (editorial). Addiction 105(10): 1739-1740, 2010. (12 refs.)

Copello A; Ibanga A; Orford J; Templeton L; Velleman R. An introduction to the supplement. (editorial). Drugs: Education, Prevention and Policy 17(special issue): 6-7, 2010. (0 refs.)

The 15 articles in this special issue are devoted to interventions with family members of those with an alcohol or drug abuse/dependence problem. The focus is upon the needs of the family members, rather than on enlisting their efforts in the treatment of the affected family member.

Copello A; Ibanga A; Orford J; Templeton L; Velleman R. The 5-Step Method: Future directions. Drugs: Education, Prevention and Policy 17(special issue): 203-210, 2010. (25 refs.)

The final contribution to this special supplement of Drugs: Education, Prevention and Policy draws together some of the points that have been made in the other contributions regarding future directions which are needed in the further development of the 5-Step Method. These include: more detailed theoretical developments; testing the suitability of the method for particular groups of affected family members, including young people and those experiencing particularly complex problems including domestic violence; further study of different ways of delivering the intervention including those that are web based; new research with larger samples and longer follow-up; the inclusion of types of families missing from the studies so far, including reconstituted families, gay and lesbian families, and families with more than one substance misuser; and further investigations of the costs associated with the family impacts of alcohol and drug problems, as well as cost-benefit studies of the 5-Step Method. Although much remains to be done, the programme of research carried out to date in the UK, Mexico and Italy has only strengthened our commitment and passion for this area of work. We believe the evidence accumulated in support of approaches such as the 5-Step Method is already sufficiently compelling that they should be implemented without waiting for further detailed research evidence.

Corless J; Mirza KAH; Steinglass P. Family therapy for substance misuse: The maturation of a field. (editorial). Journal of Family Therapy 31(2): 109-114, 2009. (0 refs.)

Denning P. Harm reduction therapy with families and friends of people with drug problems. Journal of Clinical Psychology 66(2): 164-174, 2010. (12 refs.)

This article describes and illustrates the ongoing development of a treatment for working with families and friends of drug users using harm reduction principles. The author was instrumental in applying harm reduction principles to substance abuse and has used these same principles to help families deal with the pessimism, pain, and grief that accompany their relationship to a person with an active substance abuse problem. The treatment involves learning decision-making processes based on both self-care and love for the substance abuser and is based on the values of harm reduction, caring, and incrementalism, rather than those of codependency, tough love, and abrupt behavior change. A long-term family therapy group and two family consultations illustrate the treatment and its applications.

Fals-Stewart W; Clinton-Sherrod M. Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy. Professional Psychology: Research and Practice 40(3): 257-263, 2009. (23 refs.)

This study examined whether participation in couples therapy, compared with individual therapy, had a differential effect on the day-to-day relationship between substance use and occurrences of intimate partner violence (IPV) among married or cohabiting substance-abusing men. Patients (N = 207) were randomly assigned to either partner-involved behavioral couples therapy (BCT; included non-substance-abusing female partners in conjoint sessions) or individual-based treatment (IBT; male partners only). Couples in BCT reported lower levels of lPV and substance use at a 12-month posttreatment follow-up compared with couples with male partners in IBT. Moreover, treatment assignment was a significant moderator of the day-to-day relationship between substance use and IPV. Likelihood of nonsevere and severe male-to-female partner violence on days of male partners, substance use was lower among couples who received BCT compared with IBT. These findings indicate couples therapy may play an important role in the treatment of IPV among substance-abusing couples.

Fals-Stewart W; Lam WKK; Kelley ML. Learning sobriety together: Behavioural couples therapy for alcoholism and drug abuse. Journal of Family Therapy 31(2): 115-125, 2009. (27 refs.)

Among the various types of partner- and family-involved interventions used to treat adults with substance use disorders, Behavioural Couples Therapy (BCT) has garnered the strongest empirical support for its efficacy. During the past thirty years, multiple studies have consistently found married or cohabiting substance-abusing patients who engage in BCT, compared to traditional individual-based counselling or partner-involved attention control treatments, report significantly greater (1) reductions in substance use, (2) levels of relationship satisfaction, and (3) greater improvements in other areas of relationship and family adjustment (e.g. reductions in partner violence, improvements in custodial children's adjustment). In addition to discussing the theoretical rationale for BCT as a treatment of substance abuse, this article describes specific therapeutic techniques used as part of this intervention and summarizes the relevant evaluative empirical literature.

Fang L; Schinke SP; Cole KCA. Preventing substance use among early Asian-American adolescent girls: Initial evaluation of a web-based, mother-daughter program. Journal of Adolescent Health 47(5): 529-532, 2010. (10 refs.)

Purpose: This study examined the efficacy and generalizability of a family-oriented, web-based substance use prevention program to young Asian-American adolescent girls. Methods: Between September and December 2007, a total of 108 Asian-American girls aged 10-14 years and their mothers were recruited through online advertisements and from community service agencies. Mother-daughter dyads were randomly assigned to an intervention arm or to a test-only control arm. After pretest measurement, intervention-arm dyads completed a 9-session web-based substance use prevention program. Guided by family interaction theory, the program aimed to improve girls' psychological states, strengthen substance use prevention skills, increase mother-daughter interactions, enhance maternal monitoring, and prevent girls' substance use. Study outcomes were assessed using generalized estimating equations. Results: At posttest, relative to control-arm girls, intervention-arm girls showed less depressed mood; reported improved self-efficacy and refusal skills; had higher levels of mother-daughter closeness, mother-daughter communication, and maternal monitoring; and reported more family rules against substance use. Intervention-arm girls also reported fewer instances of alcohol, marijuana, and illicit prescription drug use, and expressed lower intentions to use substances in the future. Conclusions: A family-oriented, web-based substance use prevention program was efficacious in preventing substance use behavior among early Asian-American adolescent girls.

Graff FS; Morgan TJ; Epstein EE; McCrady BS; Cook SM; Jensen NK et al. Engagement and retention in outpatient alcoholism treatment for women. American Journal on Addictions 18(4): 277-288, 2009. (72 refs.)

Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (ie, completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.

Harwin J. Applying the 5-Step Method to children and affected family members: Opportunities and challenges within policy and practice. Drugs: Education, Prevention and Policy 17(special issue): 179-192, 2010. (42 refs.)

The main aim of this article is to consider how the 5-Step Method could be developed to meet the needs of affected family members (AFMs) with children under the age of 18. This would be an entirely new development. This article examines opportunities and challenges within practice and policy and makes suggestions on how the Method could be taken forward. It argues that there is a strong rationale for developing the 5-Step Method and considers a range of settings where it could be introduced. Early intervention settings such as Sure Start Centres and schools are considered particularly promising, but children's services, particularly targeting 'children in need', could also benefit considerably from this approach. This article counsels against its usage, at least in the first instance, in serious child protection cases. After considering implications for training and support, a number of practice barriers are identified and suggestions made as to how to address them. This article considers the policy opportunities and challenges and finishes with a brief discussion of some future avenues of inquiry to maximize the potential of the 5-Step Method evidence base in general.

Henderson CE; Dakof GA; Greenbaum PE; Liddle HA. Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: Report from two randomized controlled trials. Journal of Consulting and Clinical Psychology 78(6): 885-897, 2010. (37 refs.)

Objective: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. Method: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive-behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age = 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT-detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age = 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. Results: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. Conclusions: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes.

Henderson CE; Rowe CL; Dakof GA; Hawes SW; Liddle HA. Parenting practices as mediators of treatment effects in an early-intervention trial of Multidimensional Family Therapy. American Journal of Drug And Alcohol Abuse 35(4): 220-226, 2009. (30 refs.)

Background: Contemporary intervention models use research about the determinants of adolescent problems and their course of symptom development to design targeted interventions. Because developmental detours begin frequently during early-mid adolescence, specialized interventions that target known risk and protective factors in this period are needed. Methods: This study (n = 83) examined parenting practices as mediators of treatment effects in an early-intervention trial comparing Multidimensional Family Therapy (MDFT), and a peer group intervention. Participants were clinically referred, low-income, predominantly ethnic minority adolescents ( average age 14). Assessments were conducted at intake, and six weeks after intake, discharge, and at 6 and 12 months following intake. Results: Previous studies demonstrated that MDFT was more effective than active treatments as well as services as usual in decreasing substance use and improving abstinence rates. The current study demonstrated that MDFT improves parental monitoring -- a fundamental treatment target -- to a greater extent than group therapy, and these improvements occur during the period of active intervention, satisfying state-of-the-science criteria for assessing mediation in randomized clinical trials. Conclusions and Scientific Significance: Findings indicate that change in MDFT occurs through improvements in parenting practices. These results set the foundation for examining family factors as mediators in other samples.

Hogue A; Liddle HA. Family-based treatment for adolescent substance abuse: Controlled trials and new horizons in services research. (review). Journal of Family Therapy 31(2): 126-154, 2009. (140 refs.)

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.

Ibanga A. Web-based 5-Step Method for affected family members. Drugs: Education, Prevention and Policy 17(special issue): 129-153, 2010. (62 refs.)

Though affected others probably outnumber those actually misusing alcohol and drugs, the services that are available to them are marginal and do not adequately meet the needs of this growing population of concerned family members (FMs). Evidence available suggests that the 5-Step Method is effective in supporting FMs who are concerned about their relatives' drinking or drug misuse. However, not all evidence-based treatments are being used by health care practitioners. The challenge of the 5-Step Method would thus be making it available to the FMs in need. This article looks at the development and experience of providing this intervention in a format that can be accessed on the internet by FMs. Preliminary results show that the internet is viable for the dissemination of the 5-Step intervention with the potential of reaching many affected FMs. FMs reported this online version as straight forward, easy to use and helpful. Ways in which the delivery of the programme might be improved for the increased benefit of FMs are discussed.

Lee AJ. An investigation of scale effects in family substance abuse treatment programs. Substance Abuse Treatment, Prevention and Policy 5: article 14, 2010. (6 refs.)

This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

Liddle HA; Rowe CL; Dakof GA; Henderson CE; Greenbaum PE. Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology 77(1): 12-25, 2009. (84 refs.)

Research has established the dangers of early onset substance use for young adolescents and its links to a host of developmental problems. Because critical developmental detours can begin or be exacerbated during early adolescence, specialized interventions that target known risk and protective factors in this period are needed. This controlled trial (n = 83) provided an experimental test comparing multidimensional family therapy (MDFT) and a peer group intervention with young teens. Participants were clinically referred, were of low income, and were mostly ethnic minority adolescents (average age = 13.73 years). Treatments were manual guided, lasted 4 months, and were delivered by community agency therapists. Adolescents and parents were assessed at intake, at 6-weeks post-intake, at discharge, and at 6 and 12 months following treatment intake. Latent growth curve modeling analyses demonstrated the superior effectiveness of MDFT over the 12-month follow-up in reducing substance use (effect size: substance use frequency, d = 0.77; substance use problems, d = 0.74), delinquency (d = 0.31), and internalized distress (d = 0.54), and in reducing risk in family, peer, and school domains (d = 0.27, 0.67, and 0.35, respectively) among young adolescents.

Logan DE; Marlatt GA. Harm reduction therapy: A practice-friendly review of research. (review). Journal of Clinical Psychology 66(2): 201-214, 2010. (92 refs.)

Harm reduction is an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Although harm reduction was originally and most frequently associated with substance use, it is increasingly being applied to a multitude of other behavioral disorders. This article reviews the state of empirical research on harm reduction practices including alcohol interventions for youth, college students, and a variety of other adult interventions. We also review nicotine replacement and opioid substitution, as well as needle exchanges and safe injection sites for intravenous drug users. Dozens of peer-reviewed controlled trial publications provide support for the effectiveness of harm reduction for a multitude of clients and disorders without indications of iatrogenic effects. Harm reduction interventions provide additional tools for clinicians working with clients who, for whatever reason, may not be ready, willing, or able to pursue full abstinence as a goal.

Marvel F; Rowe CL; Colon-Perez L; DiClemente RJ; Liddle HA. Multidimensional Family Therapy HIV/STD risk-reduction intervention: An integrative family-based model for drug-involved juvenile offenders. Family Process 48(1): 69-84, 2009. (49 refs.)

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.

McAdam E; Mirza KAH. Drugs, hopes and dreams: Appreciative inquiry with marginalized young people using drugs and alcohol. Journal of Family Therapy 31(2): 175-193, 2009. (48 refs.)

Drugs and alcohol misuse in young people is a major public health problem with substantial levels of morbidity and mortality. Social, economic and cultural factors play a major part in the initiation and maintenance of substance misuse in young people. Many young people who misuse drugs have multiple antecedent and co-occurring mental health problems, unrecognized learning difficulties, family difficulties and deeply entrenched social problems. Given the heterogeneity of the patterns of substance misuse in these young people, and the potential for persistence of serious problems into their adult lives, a range of interventions should be developed to address the risk factors across biological, psychological and social domains. Family/systemic interventions provide the best outcomes for young people with substance misuse, though even the most intensive forms of systemic therapies may fall short of producing enduring changes, especially for marginalized young people and communities. Appreciative inquiry (AI) is one of the most significant innovations in action research in the past decade and a method of producing long-lasting changes to the larger social system. AI is an attempt to generate a collective image of a new and better future by exploring the best of what is and has been. We describe an anecdotal experience of using AI in producing long-lasting changes in a group of marginalized young people in South Africa, who were engaged in drug and alcohol misuse and antisocial behaviour. The principles and practice of AI are described in detail, followed by a discussion of the implications of these findings for a UK population.

Mcvey R. A practitioner's commentary. Drugs: Education, Prevention and Policy 17(special issue): 170-178, 2010. (3 refs.)

I have been delivering the flexible family work approaches outlined in this supplement at Aquarius for the past 8 years. Aquarius is an English Midlands-based addictions charity working with people who have problems with alcohol, drugs, or gambling and supporting their family members/concerned others. I have been a practitioner participating in the Involving Family Members Action Research Project 2002-2004, whilst at the North Birmingham Aquarius team [Orford, J., Templeton, L., Copello, A., Velleman, R., Ibanga, A., & Binnie, C. (2009). Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agencies. Drugs: Education, Prevention and Policy, 16, 1-30; and see Orford, J., Templeton, L., Copello, A., Velleman, R., & Ibanga, A. (2010). Working with teams and organizations to help them involve family members. Drugs: Education, Prevention and Policy, 17(S1), 156-166]. I am now a service manager and part of the action research team for Involving Family Members across the Organization developing family-focused work across the whole of the Aquarius organization. In this chapter, I will outline some of the barriers to more family-focused work, offering the view that in practice these initial concerns about family-focused work do not need to be barriers. I will also provide some strategies to overcome some of these barriers. I will then outline what I see as the main benefits I have experienced as a practitioner in implementing family-focused work.

Mirza KAH; Corless J. Life beyond empirical science and evidence-based practice. (editorial). Journal of Family Therapy 31(2): 206-210, 2009. (10 refs.)

Mitrani VB; McCabe BE; Robinson C; Weiss-Laxer NS; Feaster DJ. Structural ecosystems therapy for recovering HIV-positive women: Child, mother, and parenting outcomes. Journal of Family Psychology 24(6): 746-755, 2010. (47 refs.)

This study presents results of a subgroup analysis from a randomized trial to examine whether Structural Ecosystems Therapy (SET), a family intervention intended to improve medication adherence and reduce drug relapse of HIV-seropositive (HIV+) women recovering from drug abuse, provided benefits for families with children. Data from 42 children and 25 mothers were analyzed at baseline, and 4, 8, and 12 months post-baseline. Results of longitudinal Generalized Estimating Equations analyses suggested that SET was more efficacious than the Health Group (HG) control condition in decreasing children's internalizing and externalizing problems and reducing mothers' psychological distress and drug relapse. Children in SET reported improvements in positive parenting as compared to the children in HG, but there were no differences in mother-reported positive parenting, or parental involvement as reported by either the children or mothers. These findings suggest that family interventions such as SET may be beneficial for mothers and children. An adaptation of SET specifically for families with children could further enhance benefits and improve acceptability and cost-effectiveness.

Morgan TB; Crane DR. Cost-effectiveness of family-based substance abuse treatment. Journal of Marital and Family Therapy 36(4): 486-498, 2010. (60 refs.)

In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.

Najavits LM. Treatments for PTSD and pathological gambling: What do patients want? Journal of Gambling Studies 27(2): 229-241, 2011. (30 refs.)

This study explored the treatment preferences of 106 people with posttraumatic stress disorder (PTSD), pathological gambling (PG), or both. It is the first know study of its type for this comorbidity. Sixteen different treatment types were rated, with a broad array of modalities including manualized psychotherapies, medication, self-help, alternative therapies, coaching, and self-guided treatments (use of books and computerized therapy). A consistent finding was that PTSD treatments were rated more highly than PG treatments, even among those with both disorders. Further, of the sixteen treatment types, the sample expressed numerous preferences for some over others. For example, among PG treatments, self-help was the highest-rated. Among PTSD treatments, psychotherapies were the highest-rated; and individual therapy was rated higher than group therapy. For both PG and PTSD, medications were rated lower than other treatment types. Non-standard treatments (i.e., computerized treatment, books, coaching, family therapy, alternative therapies) were generally rated lower than other types. Discussion includes implications for the design of treatments, as well as methodological limitations.

Nattala P; Leung KS; Nagarajaiah; Murthy P. Family member involvement in relapse prevention improves alcohol dependence outcomes: A prospective study at an addiction treatment facility in India. Journal of Studies on Alcohol and Drugs 71(4): 581-587, 2010. (20 refs.)

Objective: The aims of this study were to test if outcomes would be different when family members of alcohol-dependent individuals were included in intervention and to examine the factors associated with relapse during a 6-month follow-up period. Method: Ninety male participants admitted for 3 weeks at an inpatient facility in India were randomly assigned to individual relapse prevention (IRP), dyadic relapse prevention (DRP), and treatment as usual (TAU), with 30 participants in each group. In IRP, intervention was administered to the individual participant. In DRP, both the participant and a family member were included in intervention. In all three conditions, family members stayed in the facility with participants. Participants were followed up for 6 months after discharge from the treatment center. Results: DRP consistently performed better than TAU on all of the outcomes (reduction in quantity of alcohol, drinking days, and number of days with dysfunction in family, occupational, and financial dimensions). DRP participants also reported a significant reduction in the quantity of alcohol, drinking days, and family problems, compared with IRP. Results of Cox regression showed that being in IRP/TAU groups, early-onset dependence (<25 years), and paternal history of alcohol dependence were associated with relapse after adjusting for baseline alcohol use and other covariates. Conclusions: Findings provide evidence for the effectiveness of Western-based family-oriented intervention for alcohol-dependent patients in India; also, findings might help to alert treatment providers that some subsets of alcohol users might need more tailored interventions and rigorous monitoring during follow-up.

Orford J; Templeton L; Copello A; Velleman R; Ibanga A; Binnie C. Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agencies. Drugs: Education, Prevention and Policy 16(5): 379-408, 2009. (43 refs.)

An evaluation of a two-year project that aimed to move the practice of two specialist substance misuse treatment teams towards greater involvement of family members. Success was evaluated using a combination of: detailed process notes of all project meetings and events, collection of practice case examples, an inventory of new team procedures, individual interviews with team members, end of project focus groups, a final auditing of the involvement of family members, and completion of the attitudes to Addiction-Related Family Problems Questionnaire (AAFPQ) before and after the project. AUDIT and AAFPQ data were also obtained from comparison teams. The conclusion is drawn that the project was successful in changing team practice in the desired direction: by the end of the project both teams were capable of acting as demonstration sites for family-oriented alcohol and drug problems treatment. The paper includes details of the family work conducted and its perceived benefits. Also discussed are the initial barriers to family involvement, a number of issues that remained unresolved, and the question of whether such changes are sustainable.

Painter K. Multisystemic Therapy as community-based treatment for youth with severe emotional disturbance. Research on Social Work Practice 19(3): 314-324, 2009. (63 refs.)

Objective: This study compares multisystemic therapy (MST) to family skills training combined with case management in community mental health for emotionally disturbed youth. Method: A pre-post quasiexperimental design was used. Results: Youth who received MST experienced more improved mental health symptoms, less juvenile justice involvement, and improvement across the linear combination of school functioning, family functioning, mental health symptoms, substance abuse, risk of self-harm, and disruptive or aggressive behavior than did youth who received usual services. Both groups experienced significant improvement in youth functioning. Conclusions: The use of MST in community mental health could prevent families from relinquishing custody of their children to receive effective treatment for them and avert juvenile justice involvement.

Rey GN; Mora-Rios J; Sainz MT; Aguilar PM. An international perspective: Constructing intervention strategies for families in Mexico. Drugs: Education, Prevention and Policy 17(special issue): 193-202, 2010. (23 refs.)

In this article, the authors comment on the contribution of the Alcohol, Drugs and the Family research group to draw public and scientific attention to the suffering and needs of families coping with addiction problems. The article also describes the impact of the stress-strain-coping-support model and the 5-Step Method on the research, intervention and education domains in Mexico. Some of the limitations to positively influence public policy are underscored; these include the nature of the sociocultural context which favors the view of addictions as private problems that must be solved within the family. The experience of delivering the 5-Step Method to Mexican urban population and its adaptation to indigenous communities and web-based format are discussed as well. Overall, the development and implementation of the 5-Step Method in Mexico has been positive, as demonstrated particularly by a cost-effectiveness study carried out with indigenous communities. Based on this review, the scope and challenges for family intervention in Mexico are outlined considering: (1) the dissemination of the 5-Step Method in both the rural and urban contexts; (2) extensive training of family counsellors; and finally (3) policy making to fulfil the needs of families facing addictive problems.

Robbins MS; Feaster DJ; Horigian VE; Puccinelli MJ; Henderson C; Szapocznik J. Therapist adherence in brief strategic family therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology 79(1): 43-53, 2011. (44 refs.)

Objective: Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study. Method: Participants were 480 adolescents (age 12-17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis. & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies. Results: Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Conclusions: Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy.

Robbins MS; Szapocznik J; Horigian VE; Feaster DJ; Puccinelli M; Jacobs P et al. Brief strategic family therapy (TM) for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials 30(3): 269-278, 2009. (31 refs.)

Brief strategic family therapy (TM) (BSFT) is a manualized treatment designed to address aspects of family functioning associated with adolescent drug use and behavior problems (J. Szapocznik, U. Hervis, S. Schwartz, (2003). Brief strategic family therapy for adolescent drug abuse. (NIH Publication No. 03-4751). Bethesda, MD: National Institute on Drug Abuse). Within the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network, BSFT is being compared to treatment as usual (TAU) in a multisite, prospective randomized clinical trial for drug using adolescents and their families in outpatient settings. The effectiveness of BSFT is being compared to TAU in reducing adolescent drug use, conduct problems, and sexually risky behaviors as well as in improving family functioning and adolescent prosocial behaviors. This paper describes the following aspects of the study: specific aims, research design and study organization, assessment of primary and secondary outcomes, study treatments, data analysis plan, and data monitoring and safety reporting.

Romero V; Donohue B; Allen DN. Treatment of concurrent substance dependence, child neglect and domestic violence: A single case examination involving family behavior therapy. Journal of Family Violence 25(3): 287-295, 2010. (16 refs.)

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were "blind" to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.

Roozen HG; Blaauw E; Meyers RJ. Advances in management of alcohol use disorders and intimate partner violence: Community reinforcement and family training. Psychiatry, Psychology and Law 16(Supplement S): S74-S80, 2009. (50 refs.)

Substance use disorders are associated with life-threatening behaviours and substance use is found to strongly trigger criminal behaviour, including intimate partner violence (IPV). Although intimate partners are often subject to aggression and injury, most substance-using offenders refuse to enter formal treatments. Community reinforcement and family training (CRAFT) was developed to help intimate partners to (a) recognize and safely respond to potential violence, (b) improve communication with the substance user; (c) decrease stress, (d) improve self efficacy, and (e) assist in encouraging the unwilling substance user to enter therapy. The underlying operant-based belief is that environmental contingencies are key in encouraging or discouraging substance use. This article discusses why CRAFT may be effective in engaging treatment-resistant patients with Substance abuse disorders in formal treatment and to diminish IPV. It is asserted that intimate partners, family members and close friends can make important contributions to assist substance-using offenders.

Roozen HG; de Waart R; van der Kroft P. Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. (review). Addiction 105(10): 1729-1738, 2010. (60 refs.)

Aims: Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs. Methods: The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model. Results: CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11-5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28-3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window. Conclusion: CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.

Rowe CL. Multidimensional family therapy: Addressing co-occurring substance abuse and other problems among adolescents with comprehensive family-based treatment. Child and Adolescent Psychiatric Clinics of North America 19(3): 563+, 2010. (61 refs.)

Adolescent substance abuse rarely occurs without other psychiatric and developmental problems, but it is often treated and researched as if it can be isolated from comorbid conditions. Few comprehensive interventions are available that effectively address the range of co-occurring problems associated with adolescent substance abuse. This article reviews the clinical interventions and research evidence supporting the use of Multidimensional Family Therapy (MDFT) for adolescents with substance abuse and co-occurring problems. MDFT is uniquely suited to address adolescent substance abuse and related disorders given its comprehensive interventions that systematically target the multiple interacting risk factors underlying many developmental disruptions of adolescence.

Slesnick N; Prestopnik JL. Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital and Family Therapy 35(3): 255-277, 2009. (91 refs.)

Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents (N = 119) and their primary caretakers from two runaway shelters and assigned them to (a) home-based ecologically based family therapy (EBFT), (b) office-based functional family therapy (FFT), or (c) service as usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared with SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome.

Steinglass P. Systemic-motivational therapy for substance abuse disorders: An integrative model. Journal of Family Therapy 31(2): 155-174, 2009. (45 refs.)

Although recent reviews of the literature on families and substance misuse offer compelling evidence that inclusion of families significantly improves treatment engagement, retention and outcome, family therapy remains peripheral in most substance abuse treatment programmes. Furthermore, many of the treatment approaches that have been included under the term 'family therapy' continue to focus on the substance abuser as the sole target of treatment. Still conspicuously absent are treatment models based on family systems approaches, with outcomes targeted at non-abusing family members as well. This article presents an overview of one such family-focused substance abuse treatment model - systemic-motivational therapy - that combines a family systems approach with techniques derived from motivational interviewing, but this time is applied to work with the family as a unit. The background for the development of the model will be described, as well as the assessment/consultation, family-level action plan, and aftercare/relapse prevention phases of the treatment approach.

Stormshak EA; Dishion TJ. A school-based, family-centered intervention to prevent substance use: The Family Check-Up. American Journal of Drug And Alcohol Abuse 35(4): 227-232, 2009. (45 refs.)

Background/Objectives: The Family Check-Up (FCU) is a selected intervention model that can be delivered in contexts such as schools that serve at-risk children and families. It is grounded in developmental theory and targets salient risk factors for the development of later problem behavior such as substance use, family management deficits, deviant peer affiliations, and problem behavior at school. Methods: The FCU model has been implemented in schools across several randomized trials. The model includes the development of a family resource center in the schools and interventions that target youth at risk for problem behavior and substance use. Results: Twenty years of research associated with the FCU have produced outcomes that show that the model is effective for enhancing family management skills, reducing risk behavior, and reducing the long-term risk for substance use in adolescence. Conclusions and Scientific Significance: Implications for public policy and the delivery of interventions to prevent substance use in public schools and communities are discussed.

Suchman NE; Decoste C; Mcmahon TJ; Rounsaville B; Mayes L. The mothers and toddlers program, an attachment-based parenting intervention for substance-using women: Results at 6-week follow-up in a randomized clinical pilot. Infant Mental Health Journal 32(4): 427-449, 2011. (48 refs.)

Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e. g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.

Templeton L; Velleman R; Russell C. Psychological interventions with families of alcohol misusers: A systematic review. (review). Addiction Research & Theory 18(6): 616-648, 2010. (140 refs.)

Aims: To review the literature on psychological interventions for families affected by alcohol misuse, with a focus on outcomes for family members. Methods: A comprehensive and systematic literature review. A detailed search strategy was developed and implemented with no date, language or time restrictions. Two reviewers screened all identified titles and abstracts, and then independently assessed the eligibility and quality of all potential studies. The studies were analysed according to whether or not the alcohol misuser was involved in the primary intervention under investigation and analysed thematically. Results: Forty-three publications (34 studies) were included in the review. All were in English, covered the period 1979-2009, were mainly published articles in peer review journals and included 2500-3000 family members. Research with female family members (particularly spouses or partners), and 'white' family members dominated. The included studies show how the field has moved from primarily focussing on how family members can engage and support the user through treatment to adopting a wider holistic focus which considers the needs of family members in their own right. Studies in both categories demonstrated positive outcomes for family members across a range of domains. Conclusions: Adopting a broader review methodology has brought a fuller understanding of a field where few such reviews have been conducted, and offers direction for future research. Further work is needed in terms of broadening the reach of such interventions and embedding them more firmly into routine therapeutic practice.

Unger JB; Ritt-Olson A; Wagner KD; Soto DW; Baezconde-Garbanati L. Parent-child acculturation patterns and substance use among Hispanic Adolescents: A longitudinal analysis. Journal of Primary Prevention 30(3-4, special issue): 293-313, 2009. (46 refs.)

Acculturation discrepancy theory predicts that conflicting cultural preferences between adolescents and their parents will increase the adolescents' risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1683 Hispanic students in Southern California who completed surveys in 9th and 10th grade. Measures included the students' own cultural orientations and their perceptions of their parents' preference for their cultural orientations ("Perceived Parental Cultural Expectations''-PPCE). Hispanic PPCE in 9th grade was a risk factor for lifetime, but not past-month, cigarette, alcohol, and marijuana use in 10th grade. The adolescents' own Hispanic orientation in 9th grade was protective against lifetime and past-month smoking and marijuana use and lifetime alcohol use in 10th grade. The effects of the acculturation variables did not vary according to generation in the U.S. Change in acculturation between 9th and 10th grade was statistically significant but small in magnitude. Increases in parent-child Hispanic acculturation discrepancy (i.e., the difference between the adolescents' own cultural orientations and their PPCE, with adolescents perceiving that their parents wanted them to be more Hispanic oriented than they actually were) from 9th to 10th grade were associated with an increased risk of substance use. Family-based interventions for acculturating Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.

Velleman R; Orford J; Templeton L; Copello A; Patel A; Moore L et al. 12-month follow-up after brief interventions in primary care for family members affected by the substance misuse problem of a close relative. Addiction Research & Theory 19(4): 362-374, 2011. (42 refs.)

Following the publication of initial and 3-month data from a prospective cluster randomised comparative trial [Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., Moore, L., . Godfrey, C. (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: A randomised trial. Addiction, 104, 49-58.], an opportunistic 12-month follow-up was undertaken. The trial compared two brief interventions for use by primary health care professionals with family members (FMs) affected by the problematic substance use of a close relative. Ninety out of 143 (63%) FMs in the trial were followed up at 12 months. Three validated self-completion questionnaires were re-administered: Symptom Rating Test, Coping Questionnaire and Family Member Impact Scale. At 12 months there were still no significant differences between FMs depending on which of the two brief interventions received. The initial improvements at 12 weeks on all of the measures (symptoms, coping and impact) were maintained, and further improved (FMs reported that their symptoms, their coping behaviours and the impact on them of their relatives'' substance misuse problem all continued to reduce). These improvements were unrelated to a range of demographic variables. FMs also reported a gradual improvement in their relatives'' misusing behaviour over the three time periods. In conclusion, following a brief intervention for affected FMs, either delivered in full via professional intervention or via a self-help manual following a brief introduction from a professional, both groups improve equally; there are significant and positive changes which are both maintained and further increased over a 12-month period, without any further formal delivery of the intervention.

Weisner C; Parthasarathy S; Moore C; Mertens JR. Individuals receiving addiction treatment: Are medical costs of their family members reduced? Addiction 105(7): 1226-1234, 2010. (35 refs.)

Aims: To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members. Design: Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without AOD disorders on age, gender and utilization, identifying family members of each group. Setting: Kaiser Permanente Northern California. Participants: Family members of abstinent and non-abstinent AOD treatment patients and control family members. Measurements: We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size. Results: AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2-5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls. Conclusions: Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health.

Witkiewitz K; Marlatt GA. Behavioral therapy across the spectrum. Alcohol Research & Health 33(4): 313-319, 2011. (34 refs.)

Numerous effective behavioral therapies have been developed that can bring the treatment to the patient rather than bringing the patient to treatment. These behavioral therapy techniques, which can provide effective treatment across the spectrum of severity of alcohol abuse disorders, include facilitated self-change, individual therapies, couples and family approaches, and contingency management. New methods of delivery and successful adjuncts to existing behavioral treatments also have been introduced, including computerized cognitive behavioral treatments, Web-based guided self-change, and mindfulness-based approaches. Although a wide variety of behavioral approaches have been shown to have good efficacy, choosing the treatment most appropriate for a given patient remains a challenge.