Does family intervention for adolescent substance use impact parental mental health?: A systematic review
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
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
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adolescents, substance abuse, family intervention, parenting, wellbeing, depression
PP: 186 - 199
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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