Does family intervention for adolescent substance use impact parental mental health?: A systematic review
Eva YN Yuen
School of Psychology, Faculty of Health, Medicine, Nursing & Behavioural Sciences, Deakin University, VIC
John Winston Toumbourou
Centre for Adolescent Health, University of Melbourne, VIC
PP: 186 - 199
Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress.
Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative's substance use, and improved social support.
The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials
adolescents, substance abuse, family intervention, parenting, wellbeing, depression
A growing body of literature suggests that parents and families are likely to experience adolescent substance abuse problems. Recent data demonstrates that between one quarter and over one fifth of Australian secondary school adolescents have either experimented with or are currently daily or weekly users of substances (eg, alcohol, tobacco, illicit substances, see Australian Institute of Health & Welfare [AIHW], 2007). The available research suggests that adolescent substance misuse can result in secondary disorders by undermining the mental health of parents. That is, parents suffer significant distress as a result of living with adolescent substance use (Butler & Bauld, 2005; Oreo & Ozgul, 2007). Adverse effects experienced by parents include psychological, somatic and social stresses which can lead to long-lasting psychological somatic morbidity (Orford, Natera, Davies et al, 1998; Velleman, Bennett, Miller et al, 1993).
For parents, stress-related symptoms can include depression, anxiety, fear of danger, guilt, anger, despair, as well as grief associated with failure in the parental role (Oreo & Ozgul, 2007; Toumbourou, Blyth, Bamberg & Forer, 2001). These stress-related symptoms may undermine parent and family influences that potentially reduce adolescent substance use, such as effective monitoring, family cohesion and positive parent-child relationships (Butler & Bauld, 2005; Dekovic, 1999; Ozechowski & Liddle, 2000).
A growing number of family intervention strategies have been developed and evaluated to reduce youth alcohol and/or drug use and abuse. Strategies include family-based therapy interventions such as counselling sessions involving pre-teens or adolescents currently manifesting behavioural problems, along with parents and/or other family members (Kumpfer & Alvarado, 1998; Toumbourou & Gregg, 2001) and behavioural parent training which stresses parental use of effective discipline techniques (see Kumpfer & Alverado, 1998). Evidence demonstrates that family-based therapeutic interventions can significantly reduce levels of adolescent substance use and behaviour problems, increase the adolescent's involvement with school, and improve family functioning (Ozechowski & Liddle, 2000).
However, only recently has interest widened to explore the effectiveness of family interventions on the mental health of parents with adolescents who abuse substances. Families have been shown to be a potentially important resource for assisting recovery from adolescent substance abuse (Bry, Catalano, Kumpfer et al, 1998; Rowe, Liddle, McClintic & Quille, 2002). However, in order for families to play a beneficial therapeutic role it is important to firstly address the mental health of family members (Toumbourou & Bamberg, 2008).
A growing body of family intervention models aim to directly impact parental and family member mental health using therapeutic interventions such as stress management and cognitive behavioural strategies (Copello, Orford, Velleman et al, 2000; Copello, Templeton, Krishnan et al, 2000). These studies have demonstrated reductions in physical and psychological symptoms as well as family reports of changes in family member substance consumption (Copello, Velleman & Templeton, 2005). Thus it is expected that family intervention models that directly address parental mental health will lead to both improvements in parental wellbeing and changes in adolescent substance misuse.....
The aim of the present paper was to conduct a systematic literature review to identify whether the extant studies evaluating family interventions for adolescent substance use demonstrate impacts in enhancing the mental health of parents and family members. The review sought to identify both direct and indirect intervention effects on depressive symptoms and general distress. Few studies have focused on determining which aspects of family intervention are important in enhancing family member wellbeing where substance use is a concern. Further, there currently exist few systematic reviews that explore the potential for family interventions directed at adolescent substance use to impact positively on family member distress and mental health. Family interventions that aim to directly reduce parental depression or that target logical determinants of parental depression may have greater advantages for mental health compared to interventions that focus on substance use reduction only.
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Arcidiacono C, Velleman R, Fioretti G and De Georgio U (2007) Professionals' evaluation of the '5-step method' for helping family members of substance misusers in the context of the Italian Health Services. Drugs: Education, Prevention and Policy 14 (4), 367-388.
Australian Institute of Health and Welfare (2007) Young Australians: Their Health and Wellbeing. Canberra: Australian Institute of Health and Welfare.
Bancroft A, Carty A, Cunningham-Burley S and Backett-Milburn K (2002) Support for the Families of Drug Users: A Review of the Literature. Edinburgh: Scottish Executive Interventions Unit.
Barnes H and Olson D.H (1986) Parent-adolescent communication scale. In DH Olson, HI McCubbin, H Barnes, A Larsen, M Muxen and M Wilson (Eds) Family Inventories. St Paul MN: Family Social Science, University of Minnesota.
Beck AT, Steer RA and Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review 8, 77-100.
Blyth A, Bamberg J and Toumbourou JW (2000) Behaviour Exchange Systems Training: A Program for Parents Stressed by Adolescent Substance Abuse. Melbourne: ACER.
Bry BH, Catalano RF, Kumpfer KL, Lochman JE and Szapocznik J (1998) Scientific findings from family prevention intervention research. In R Ashery, EB Robertson and KL Kumpfer (Eds) Drug Abuse Prevention Through Family Interventions (NIDA Research Monograph Number 177), (pp.103-129). Rockville MD: National Institute on Drug Abuse.
Butler R and Bauld L (2005) The parents' experience: Coping with drug use in the family. Drugs: Education, Prevention and Policy 12(1), 35-45.
Capaldi DM and Patterson GR (1989) Psychometric Properties of Fourteen Latent Constructs from the Oregon Youth Study. New York: Springer-Verlag.
Chamberlain P and Reid JB (1987) Parent observation and report of child symptoms. Behavioral Assessment 9, 97-109.
Copello A, Orford J, Velleman R, Templeton L and Krishnan M (2000) Methods for reducing alcohol and drug related family harm in non-specialist settings. Journal of Mental Health 9(3), 329-343.
Copello A, Templeton L, Krishnan M, Orford J and Velleman R (2000) A treatment package to improve primary care services for relatives of people with alcohol and drug problems. Addiction Research 8(5), 471-484.
Copello AG, Velleman RDB and Templeton LJ (2005) Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, 369-385.
Dekovic M (1999) Parent-adolescent conflict: Possible determinants and consequences. International Journal of Behavioral Development 23(4), 977-1000.
Ensel WM and Lin N (1991) The life stress paradigm and psychological distress. Journal of Health and Social Behavior 32, 321-341.
Gilbert P (1992) Depression: The Evolution of Powerlessness. New York: Guilford Publications.
Green BL, Furrer C and McAllister C (2007) How do relationships support parenting? Effects of attachment style and social support on parenting behaviour in an at-risk population. American Journal of Community Psychology 40, 96-108.
Goldberg P and Williams P (1988) A User's Guide to the General Health Questionnaire. Berkshire: NFER-Nelson.
Irvine AB, Biglan A, Smolkowski K, Metzler CW and Ary DV (1999) The effectiveness of a parenting skills program for parents of middle school students in small communities. Journal of Consulting and Clinical Psychology 67(6), 811-825.
James DE, Schumm WR, Kennedy CE, Grigsby CC, Shectman KL and Nichols CW (1985) Characteristics of the Kansas parental satisfaction scale among two samples of married parents. Psychological Reports 57(1), 163-169.
Kellner RJ and Sheffield B (1973) A self rating scale of distress. Psychological Medicine 3, 88-100.
Kumpfer KL and Alvarado R (1998) Effective family strengthening interventions. Juvenile Justice Bulletin (November) 1-15.
Lowman J (1987) Inventory of family feelings. In N Fredman and R Sherman (Eds) Handbook of Measurements for Marriage and Family Therapy (pp.91-99). New York: Brunner/Mazel.
McGillicuddy NB, Rychtarik RG, Duquette JA and Morsheimer ET (2001) Development of a skill training program for parents of substance-abusing adolescents. Journal of Substance Abuse Treatment 20, 59-68.
Meyers RJ, Miller WR, Hill DE and Tonigan JS (1999) Community Reinforcement and Family Training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse 10(3), 291-308.
Meyers RJ and Smith JE (1997) Getting off the fence: Procedures to engage treatment resistant drinkers. Journal of Substance Abuse Treatment 14, 467-472.
Moos RH and Moos BS (1981) Family Environment Scale Manual. Palo Alto CA: Consulting Psychologists Press.
Oreo A and Ozgul S (2007) Grief experiences of parents coping with an adult child with problem substance use. Addiction, Research and Theory 15(1), 71-83.
Orford J, Guthrie S, Nicholls P, Oppenheimer E, Egert S and Hensman C (1975) Self-reported coping behaviour of wives of alcoholics and its association with drinking outcome. Journal of Studies in Alcohol 36, 1254-1267.
Orford J, Natera G, Davies J, Mora A, Rigby K, Bradbury C, Copello A and Velleman R (1998) Stresses and strains for family members living with drinking or drug problems in England and Mexico. Salud Mental (Mexico) 21, 1-13.
Orford J, Rigby K, Miller T, Tod A, Bennett G and Velleman R (1992) Ways of coping with excessive drug use in the family: A provisional typology based on the accounts of 50 close relatives. Journal of Community and Applied Social Psychology 2, 163-183.
Orford J, Templeton L, Patel A, Copello A and Velleman R (2007) The 5-step family intervention in primary care: I. Strengths and limitations according to family members. Drugs: Education, Prevention and Policy 14(1), 29-47.
Ozechowski TJ and Liddle HA (2000) Family-based therapy for adolescent drug abuse: Knowns and unknowns. Clinical Child and Family Psychology Review 3(4), 269-298.
Ralph A, Toumbourou JW, Grigg M, Mulcahy R, Carr-Gregg M and Sanders MR (2003) Early intervention to help parents manage behavioural and emotional problems in early adolescents: What parents want. Australian e-Journal for the Advancement of Mental Health 2(3), http://amh.e-contentmanagement.com/archives/vol/2/issue/3/article/3394/early-intervention-to-help-parents-manage
Rowe C, Liddle HA, McClintic K and Quille TJ (2002) Integrative treatment development: Multidimensional family therapy for adolescent substance abuse. In FW Kaslow and J Lebow (Eds) Comprehensive Handbook of Psychotherapy: Volume 4. Integrative/Eclectic (pp.133-161). New York: John Wiley & Sons.
Shek DTL (1997) Parent-child relationship and parental well-being of Chinese parents in Hong Kong. International Journal of Intercultural Relations 21(4), 459-473.
Silverberg SB and Steinberg L (1984) Adolescent autonomy, parent-adolescent conflict and parental well-being. Journal of Youth and Adolescence 16(3), 293-312.
Sobell LC and Sobell MB (1978) Validity of self-reports in three populations of alcoholics. Journal of Consulting and Clinical Psychology 46, 901-907.
Spielberger CD (1988) Professional Manual for the State-Trait Anger Expression Inventory (STAXI) (research edition.). Odessa FL: Psychological Assessment Resources.
Spielberger CD, Gorsuch RL, Lushene R, Vagg PR and Jacobs GA (1983) Manual for the State/Trait Anxiety Inventory. Palo Alto CA: Consulting Psychologists Press.
Templeton LJ, Zohhadi SE and Velleman RDB (2007) Working with family members in specialist drug and alcohol services: Findings from a feasibility study. Drugs: Education, Prevention and Policy 14(2), 137-150.
Thoits PA (1995) Stress, coping and social support processes: Where are we? What next? Journal of Health and Social Behavior 35(extra Issue), 53-79.
Toumbourou JW and Bamberg JH (2008) Family recovery from youth substance use related problems: A pilot study of the BEST Plus program. Substance Use and Misuse 43(12), 1829 - 1843.
Toumbourou JW, Blyth A, Bamberg J and Forer D (2001) Early impact of the BEST intervention for parents stressed by adolescent substance abuse. Journal of Community and Applied Social Psychology 11, 291-304.
Toumbourou JW and Gregg ME (2001) Working with families to promote healthy adolescent development. Family Matters 59 (Winter), 54-60.
Velleman R, Bennett G, Miller T, Orford J and Tod A (1993) The families of problem drug users: A study of 50 close relatives. Addiction 88(9), 1281-1289.
Velleman R and Templeton L (2003) Alcohol, drugs and the family: Results from a long-running research programme within the UK. European Addiction Research 9, 103-112.
Voydanoff P and Donnelly BW (1998) Parents' risk and protective factors as predictors of parental well-being and behaviour. Journal of Marriage and the Family 60, 344-355.