Effects of family therapy for substance abuse: A systematic review of recent research

A randomized controlled trial of effectiveness of brief structured family intervention for patients with opioid dependence and their family members

INTRODUCTION

A family intervention program for opioid dependent patients with a few sessions can be highly beneficial in resource limited settings. This study aims to assess the effectiveness of a three-session family intervention program in enhancing family functioning and reducing opioid use.

METHODS

The study design was an open, parallel, randomized controlled trial, which included 100 males, who were randomized to receive a three session intervention based on psychoeducation, supervision, relapse prevention, communication and coping; and a control group (treatment as usual) in a 1:1 ratio. The participants and their families were assessed through a semi-structured pro forma, McMaster's Family Assessment Device at baseline and 12 weeks, and substance use section of Maudsley Addiction Profile at baseline, 4 weeks, 8 weeks and 12 weeks.

RESULTS

The two groups were mostly comparable in socio-demographics and substance use pattern. The intervention group had a higher retention than the control group (64 % versus 42 %). There was improvement in overall family functioning of the patients, the time effect was significant (F = 41.203, p < 0.001), but not the time x group effect (F = 2.925, p = 0.090). Similarly, for the family group, the time effect was significant (F = 45.629, p < 0.001), but not the time x group effect (F = 0.680, p = 0.412). No significant group differences in opioid use were observed.

CONCLUSION

The family intervention program was associated with a higher retention, but was not significantly associated with a greater improvement in overall family functioning and reduction of opioid use days. The study highlights the potential of systematic, time-limited family interventions to enhance patient retention in treatment programs for opioid use disorders.

Narrative Review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy

OBJECTIVE

In 2014, the US National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018)1 updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices.

METHOD

The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research.

RESULTS

Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research.

CONCLUSION

These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.

PLAIN LANGUAGE SUMMARY

In this review article and building upon previous work in this area, the authors describe principles and practices for adolescent substance use treatment and identified areas of treatment in need of further research. The authors also outline recommendations for policy changes and support for funding to implement these principles and practices to further improve the standard of care for adolescent substance use disorders services.

Collaborative work processes in establishing a MiniMaria treatment center for youth substance addiction: a qualitative inquiry of county council healthcare and municipal efforts

BACKGROUND

This article is part of a larger study exploring the collaborative dynamics between key stakeholders in providing care to youths suffering from alcohol or substance use and their families in formulating policies and operational practices for county and country-wide application in similar settings. The focus of this article is to describe the collaborative processes between two stakeholders, a municipality, and a county council, in establishing a MiniMaria treatment center. While collaborative efforts between municipalities and county councils in health service provision are often acknowledged, little is known about how communication and decision-making processes between these entities shape the success of such initiatives. This study aims to fill this gap by providing insights into the communicative processes that foster organizational cohesion, agility, and innovation. The guiding research question is: What communicative processes occur between the county council and municipal stakeholders during the planning phase of the MiniMaria treatment center?

METHODS

The municipality and county council were selected based on purposive sampling, owing to the proximity and accessibility of the field. An exploratory and descriptive design, incorporating a participatory research approach, was employed for this qualitative investigation.

RESULTS

Two central themes, each underpinned by specific subthemes sum up the essence of our findings. The first theme underscores the collaborative dynamics and shared objectives that have emerged through the project, thus showing the importance of a unified vision and mutual understanding in driving the initiative forward. The second theme points to the practical aspects of implementing the project, including recruitment strategies, and the significance of interpersonal communication.

CONCLUSIONS

This article sheds light on the establishment of a MiniMaria treatment center through collaboration between a municipality and county council, using the Four Flows Model to interpret communicative processes. Membership negotiation was crucial for defining roles and building a unified team identity, while activity coordination ensured aligned stakeholder efforts. Self-structuring facilitated internal organization and operational clarity, and institutional positioning aligned the initiative with broader healthcare norms, enhancing its credibility and impact. These communicative practices were central to get a grip on inter-organizational complexities, emphasizing communication's constitutive role in organizational development and innovation.

The Translated and Adapted Brazilian Version of the Behavioral Enabling Scale for Family Members of Psychoactive Substance Users: An Analysis of the Factorial Structure and Internal Consistency

OBJECTIVE

The enabling behaviors of family members of psychoactive substance users can be crucial in maintaining addiction. There are no psychometrically evaluated instruments to measure the frequency of the enabling behaviors of family members of psychoactive substance users. Therefore, this study aimed to assess the internal consistency and factor structure of the Behavioral Enabling Scale.

DESIGN

A cross-sectional study was carried out, with a secondary analysis of data collected from 400 family members of psychoactive substance users that used a hotline service in Brazil. Exploratory factor analysis was conducted with an initial sample of 200 protocols, and with the remaining 200 protocols, a confirmatory factor analysis was conducted.

RESULTS

The internal consistency estimate proved entirely satisfactory in both samples, where the first presented a Cronbach's alpha of 0.76 and the second had a consistency estimate of 0.79. Factor analysis was conducted using a shortened version of the instrument, with 15 items, during which six factors that cover 65% of the scale's explained variance were extracted. KMO = 0.68 and Bartlett's test of sphericity = X2 (gl = 153) 497.201, p < 0.0001, were significant.

CONCLUSION

The Brazilian version of the Behavioral Enabling Scale is a valid tool that measures the frequency of the enabling behaviors of family members of psychoactive substance users. The measurement instrument enables further investigations into the behavior of family members regarding the use of psychoactive substances by their relatives.

Expanding single-venue services to better engage young people who inject drugs: insights from India

BACKGROUND

Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally.

FINDINGS

Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation.

CONCLUSIONS

In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.

Family Intervention Models for Young Adults with Substance Abuse: A Systematic Review

Background

Substance abuse among young adults is a significant public health concern with detrimental consequences for individuals, families, and society. Family interventions have emerged as promising treatment approaches for addressing substance abuse in this population. This systematic review aims to synthesize the existing evidence on the efficacy of family interventions for young adults with substance abuse.

Methods

A comprehensive search of electronic databases (PubMed, EBSCOhost, and Scopus) was conducted to identify relevant studies published between 2000 and 2023. Studies were included if they met the following criteria: (a) focused on family intervention for young adults (aged 10-25) with substance abuse; (b) employed a randomized controlled trial (RCT) or quasi-experimental design; and (c) reported on substance use outcomes.

Results

A total of 41 studies were included in the review. The findings suggest that family interventions are effective in reducing substance use among young adults. Specifically, family interventions were associated with significant reductions in behavioural problems and improvements in family functioning.

Unlocking the age-old secrets of reward and substance use

Although substance use is widespread across the lifespan from early adolescence to older adulthood, the prevalence of substance use disorder (SUD) differs between age groups. These age differences in SUD rates necessitate an investigation into how age moderates reward sensitivity, and consequently influences the risks and consequences related to substance use. This theoretical review integrates evidence from the literature to address the dynamic interplay between age and reward in the context of substance use. Overall, increasing evidence demonstrates that age moderates reward sensitivity and underlying reward system neurobiology. Reward sensitivity undergoes a non-linear trajectory across the lifespan. Low levels of reward sensitivity are associated with childhood and late adulthood. In contrast, high levels are associated with early to late adolescence, followed by a decline in the twenties. These fluctuations in reward sensitivity across the lifespan contribute to complex associations with substance use. This lends support to adolescence and young adulthood as vulnerable periods for the risk of subsequent SUD. More empirical research is needed to investigate reward sensitivity during SUD maintenance and recovery. Future research should also involve larger sample sizes and encompass a broader range of age groups, including older adults.

Towards a New Dynamic Interaction Model of Adolescent CUD Manifestation, Prevention, and Treatment: A Narrative Review

Background

Cannabis is one of the most popular drugs of the 21st century, especially among adolescents and young adults. Evidence of a variety of lasting neuropsychological deficits as a result of chronic cannabis use has increased. Furthermore, regular cannabis use is found to be a predictor of mental health problems, less motivation in school, and school dropout.

Aim

Our goal is to propose a theoretical model of adolescent cannabis use disorder (CUD) based on Zinberg's drug, set, and setting model and explicated by a review of the literature on adolescent cannabis use to improve the prevention and treatment of CUD for adolescents.

Methods

PubMed and Web of Science were searched for relevant publications as part of a hypothesis-based and model-generating review.

Results

Individual (set) and environmental (setting) risk factors play important roles in the development of CUD in adolescents. School performance, motivation, and attendance can be negatively influenced by persistent cannabis use patterns and adolescent brain development can consequently be impaired. Thus, cannabis use can be understood as both being the cause of poor school performance but also the consequence of poor school performance. To prevent and reduce adolescent CUD the drug, set, and setting must all be considered. It is important to notice that the multiple feedback loops (indicated in our dynamic interaction model) are not mutually exclusive, but offer important intervention focus points for social workers, addiction professionals, parents, and other care takers.

Conclusion

We argue that the three dimensions of drug, set, and setting contribute significantly to the eventual manifestation of CUD. Based on our dynamic interaction model, recommendations are made for possible preventive and therapeutic interventions for the treatment of adolescents and young adults with CUD.