Research Update (2005 January): Helping Families cope with Substance Dependence

2005·0.23 MB·English

by  Butler Center for Research

HZLDN
Research Update is published bythe ButlerCentei
for Research to share significantscientificfindings
from thefield ofaddiction treatment research.
BUTLER CENTER FOR RESEARCH JANUARY 2005
Helping Families Cope with
THEHAZELDEN EXPERIENCE
Substance Dependence Drs.RobertMeyersandHowardLiddle,whoseworkisreviewed
inthisissue,receivedtheDanAnderson ResearchAwardfrom
theButlerCenterforResearchin2002and2003, respectively.
Alcohol and drugdependence impacts millions of people each year. Notonlydo individuals Hazelden’sMinnesota MentalHealthCentersoffertheCRAFT
with addiction suffer, butfamilyand friends frequently experiencedepression, anxiety, and interventiontoconcernedsignificantothers,andHazelden
stress (Hall & Webster, 2002; MacPherson, Stewart, & McWilliams, 2001). Self-helpgroupsand publishesDr.Meyers’self-helpbook, GetYourLovedOneSober:
professional interventionsare often effective in helpingfamily members and friendscope with AlternativestoNagging,Pleading,andThreatening.
the impactofa loved one’saddiction.
CONTROVERSIES&QUESTIONS
Wherecanfamilymembersfindhelp?
Self-help Groups
Manytreatmentcentersofferprogramsforrelativesand
Family members and significant othersofalcohol and/ordrug dependent peoplefind support
friendsofsubstancedependentpeople.Forexample,
in self-help groups. Al-Anon, the familycounterpartto AlcoholicsAnonymous, isa fellowsf;ip
Hazelden’sFamilyProgramshelpattendeesheifer
of peoplewho have been affected bya loved one’saddiction. Founded in 1951, Al-Anon and
understandaddiction,treatment, recovery,andfamily
its related groupforteenagers, Alateen, have grown to over 26,000 meetings in 115countries
dynamics.Participants learnabouthealthyrelationshipsand
(Al-Anon Family Group Headquarters, 2004). Adult Children ofAlcoholics (ACOA) isalsoa
developskillstochangetheirresponsestofamilysituations.
sourceof help, with over 1,500groups worldwide (AdultChildren ofAlcoholicsWorld Service
Familymemberscanalsoseekhelpfromtherapistsattheir
Organization, 2004).
local mental healthcenters.
Theseorganizationsviewalcoholism and drugdependenceas a diseasethatcan cause fear,
Whathappenstothefamilywhenthesubstancedependent
resentment, anger, and loneliness amongfamily membersand significant others. Based on the
personstopsdrinkingorusing?
Twelve Step philosophy ofAlcoholicsAnonymous, these groups provide relativesand friends
Troubledfamiliesmaybelievetheirproblemswillberesolved
with theopportunity to discusstheirexperiencesand provide supportand encouragement
oncethesubstancedependentpersonstopsdrinkingorusing.
to oneanother. Preliminary evidencesuggeststhese groups are effective in easingthe stress
Recoverycanbringa newsetofissuesandcan beatumultuous
associated with havinga loved onewith alcohol and drugdependence.
timeaseveryoneadjuststoanewwayofliving.Familiesmay
Keinz and colleagues (Keinzetal., 1995) surveyed 77 Al-Anon membersto assesswhether findprofessional counselingorthesupportavailablethrough
program involvementwas related to marital adjustment. Greater length ofmembership was Al-Anon andothergroupstobehelpfulinthetransition.
associated with improved marital satisfaction.
HOWTOUSETHISINFORMATION
McBride (1992) surveyed 50 AlcoholicsAnonymous members aboutfamily participation in
— Family Members: Helpforyou exists, too, and
FIGURE can beeffectivein reducingthestressand other
Changes in depression,physical symptoms, and anxietyamongparticipants intheCRAFTprogram. difficultiesyou maybeexperiencingassociatedwith
a loved one’salcohol and drugaddiction.
intake 3Msnths •tMaeihs — Clinicians: Providesupporttothefamilyand
significantothersofsubstancedependentpeople.
Familiarizeyourselfwith specialized resourcesin
yourcommunityand referwhen appropriate.
— Researchers:Continuetodevelopand evaluate
methodsto provide helpforfamily membersand
significantothers.
Oeeression PhysicalSymsioms Anxiei
*p<.05. p<.01.Nole,Oepressioe,physicalsymploms,asdai,xretyacremeasuredanthreeseparatescales,hencethediffereece
iescaiescenes.
soutcEMeyers,0.J..Miiiier,w.n.,Hill,D.E..&Tenigan,J.S.(1000).comirraniryreinforcementandfamiiyframing(cHAFf),
Engagingeninotivafeddrugesersinfreateneet.JournalofSubstanceAbuse,10,291-308.
‘CONTINUEDONBACK
<CONTINUEDFROMFRONT
Helping Families Cope with Substance Dependence
HZLDN
Al-Anon. Longer Al-Anon attendance bya family memberwas correlated with lowerfamilystress
scores, overall.
In a randomized, controlled study conducted by Barber & Gilbertson (1996), people who
References
attended Al-Anon had significantlygreater reductions in the numberof personal problems
— AdultChildrenofAlcoholicsWorldServiceOrganization.(20041.
experienced compared tothose assigned to a wait-listcontrol condition. In a separate studyof AdultCloldrenofAlcoholics.RetrievedOctober27.2001fromwow.
ACOA participants conducted by Kingree (2000), increases in self-esteem and reductions in adultchildren.org.
self-stigmatization—thetendencyto negatively evaluate oneselfas a resultof beinga child ofan — Al-AnonFamilyGroupHeadquarters,Inc.(20041.Factsheetfor
professionalslnforeoationshoot4/-AnonsodA/steen.Refrieced
alcoholic—were observed. October27,2001fromwww.aI-a000.alafeeo.org
— Barber,J.C.,&Gilhertson,0.11996).Anexperimentalstudyofbrief
Whilethe majorityofstudies lackcontrol groups, which makes itdifficulttoform scientificconclusions unilateralinterventionfurthepartnersefheavydrinkers.Researchon
SocialI/orbPractice,601,325-336.
regardingAl-Anon orACOA, the preliminarydata discussed above areencouraging becausethey
— Cooper,A.,&McCormack,W.A.11992).Slrorf-teriogrouptreatment
suggesta positiveimpactfrom attendanceatsLlpportgroupssuch as Al-Anon and ACOA. foradultchildrenofalcoholics.JournalofCooosehingPsychology,
39)31,350-355.
— Hall,C.W.,&Webster,0.[.120021.Traumaticspinpfomafology
Professional Intervention characteristicsofadultchildrenofalcoholics.JournalofDrug
Education,32131.195-211.
Professionally led groups and programsare also helpful forthe relatives ofalcohol and drug — Keinz,L.A.,Schwartz,C.,Trench,B.M.,&Houlihan,0.0.11995).
depende’ people. One studyfound significant reductions in loneliness, anxiety, and depression AnasseosmneirtofmnenibershipbenefitsirrfloeAl-Anonprogram.
AlcoholismTreatmovmmtQuarterly.12(41.31-38.
symptomsamongadultchildren ofalcoholics participating in an eight-weekgrouptherapy
— Kingree,J.B.120001.Predictorsandby-productsofparticipation
program offered ata university counseling center (Cooper & McCormack, 1992). inamutualhelpgroupferadultchildrenofalcolrolmcs.Alcohmolisnr
TreatmentQvatterly,18)2),83-94.
Treatmentofalcohol and drugabusingyouth within a familycontext has been found to benefit — Liddle,H.A.,Dakof,C.A.,Parker,K.,Diamond,C.S.,Barrett,K.,&
Tejeda,M.(2001).1,lulfidiinnnsionalFamilyTlmerapjforadolescent
thefamily as a whole. In a randomized studyof Multidimensional FamilyTherapy (MDFT) drugabuse:Resultsofarandomizedclinicaltrial.AmericanJoorxralof
conducted by Liddle and colleagues (2001), 182 adolescentswere assigned to MDFT, a DrugandAlcoholAbuse,27(4),651-688.
— MacPhersen,P.S.R.,Stewart,S.H.,&McWilliams,L.A.120011.
standard grouptherapy condition, ortoa mLiltifamilyeducation group. Significant improvement Parentalproblem drinkingandanxietydisordersymptomsinadolf
in familyfunctioningwas noted forthe MDFT group, which moved from “incompetent” offspring:Examiningtfmemediaflogroleofamrxietysensitivity
components.AddictiveBehaviors,26,917-934.
functioningto “competent’ ratings. Families in the standard group showed no changeand those
— McBride,J.L119921.AssessingffreAl-AnonconmyonentofAlcolrolico
in theeducation-onlycondition worsened overtime. 0000ymnoas.Alcoholism TreatnrentOoarterly.0(41.57-65.
— Miller,W.R.,Meyers,R.J.,&Tonigan,1.S.(1999).Engagingthe
Meyersand colleagues (1999) developed Community Reinforcementand FamilyTraining unmotivatedintreatmentforalcohxfprxblems:Acomparisonof
threestrategiesforinterventionflmrooglifamilymembers.Journalof
(CRAFT), a professionally led method specificallyforfamily members. CRAFT assistsfamily ConsultingandClinicalPsychmolvgy,6715).688-697.
membersand partners in helpingtheiralcohol and drugabusing loved ones get intotreatment. — Meyers,R.J.,Miller,W.R.,Hill,0.E.,&Tenigan,IS.119991.
CamnmunifyReinforcementandFamilyTraining(CRAFT):Engaging
In addition to behavioral skills trainingdesigned specificallyto facilitate their loved one’s entry unmotivateddrugusersintreatment.JoorimalofSubstanceAhose.
into treatnient, concerned significant others (CSOs) learn adaptive skills designed to improve the 1013),291-308.
qualityoftheir own lives. — Meyers,R.I.,Miller,W.R.,Smith,i.E.,&Tonigan,I.S.12802).A
randonmizedtrialoftwemnethedsforengagingtreatment-refusingdrug
usersthroughconcernedsignificammfotlmers.JournalofConsultingamId
Notonly isthe CRAFTapproach effective in getting people intotreatment, it helps family ClimmicalPsychology,70(5). 1182-1185.
membersand significant others. In one studyof62 CSOs. significant drops in depression, anger,
physical symptoms, and anxietyoccurred amongCSOs duringand followingthe course ofa
12-session CRAFT program (See Figure; Meyersetal.. 1999). These improvementsoccurred
regardlessofwhetherthealcohol ordrugabusing loved one entered treatment or not. These
positive effects have been replicated in largertrials testingthe benefits ofthe CRAFTapproach
(Meyers etal., 2002; Miller, Meyers, & Tonigan, 1999).
Summary
Familyand friends ofsubstance dependent people are often negatively impacted by the
disease ofalcohol and drug dependence. Research showsthattherapyand self-help groups
are a helpful resource. Whetherthrough professional treatment, a self-help program of mutual
support, ora combination of both, help is availableto ease stressand improvethe livesforthose
copingwith the substance dependenceofa loved one.
hazelden.org
BUTLER CENTER FOR RESEARCH JANUARY 2005
INc BLII cl Ccnmel’liii’ Rr’sc,orj informs ,mnd improves recrsverv scr’.iccsand producesresc,no’ch
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