The relationship of pretreatment family functioning to drinking behavior during follow-up by alcoholic patients

A Semantic Corpus Comparison Analysis of Couple-Focused Interventions for Problematic Alcohol Use

Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the therapeutic processes that may explain these effects. In a study of partner language use during couple-focused alcohol interventions, we utilized a linguistic corpus comparison tool, Wmatrix, to identify semantic themes that differentiated couples with successful and unsuccessful treatment outcomes and may therefore also reflect potential change processes. Thirty-three couples participated in a randomized control trial of Family Systems Therapy (FST) or Cognitive Behavioural Therapy (CBT). Linguistic comparisons of partners' speech during the therapy sessions suggested that drinks and alcohol was a significant differentiating semantic theme. Specifically, patients and spouses in FST with successful outcomes used more language related to drinks and alcohol than patients and spouses in FST with unsuccessful outcomes. Post-hoc analyses of context suggested that, in FST, successful spouses spoke less about the patient's drinking and more about alcohol in general (without reference to an individual) than unsuccessful spouses. Conversely, spouses in CBT with successful outcomes used less language related to drinks and alcohol than spouses in CBT with unsuccessful outcomes. In CBT, successful spouses spoke more about the patient's and couple's drinking and less about the spouse's and other people's drinking than unsuccessful spouses. Results emphasize the role of spouse behaviour-in this case indexed via language use-in alcohol treatment outcomes. Findings also suggest potentially distinct therapeutic processes in FST and CBT and highlight the utility of linguistic corpus comparison methods in couple-focused intervention research. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the specific therapeutic processes that may explain these effects. Findings from this study suggest that semantic themes such as drinks and alcohol in partner speech during therapy sessions differentiate successful and unsuccessful treatment outcomes among couples participating in two couple-focused interventions for problematic alcohol use. In addition, the context in which partners used alcohol-related language differed by intervention type and treatment outcome, which suggests potential therapeutic processes that are unique to the two interventions (Family Systems versus Cognitive Behavioural Therapy).

The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.

Alcohol treatment outcome methodology: state of the art 1989-1993

This article reviews the 61 alcohol treatment outcome studies published from 1989-1993 with respect to methodology. Although better assessment of subjects' pretreatment characteristics was noted, a minority of studies met even the basic requirements of experimental studies. Further, some reversals of methodological progress were observed in several areas, particularly in collecting outcome data from multiple sources. It is suggested that funding agencies and journal editors require that submissions meet minimum standards for adequate outcome evaluation.

Implications for the alcohol/drug education specialist working with children of alcoholics: a review of the literature from 1988 to 1992

This article reviews the scientific literature on children of alcoholics (COAs) from 1988 to 1992. First the publications were divided into two classifications: practitioner-oriented and research-oriented literature. Each practitioner-oriented article was evaluated on the following criteria: program description, theoretical model, recommendations substantiated by research, behavioral indicators of COAs, suggestions for intervening, and resource lists. For each of the research-oriented articles, the variables measured, sample source, sample size, and number of COAs in the sample are listed. Additionally, those articles are evaluated for research design, instruments, and analytical techniques. Reviews of early research in this area identified severe methodological limitations across the majority of articles. However, results of this more recent review indicate that research on COAs no longer suffers from previously common methodological weaknesses and sampling biases. The research-based literature also indicated that a larger number of COAs are resilient, which calls into question common assumptions about the inevitable negative effects of familial alcoholism. Alcohol/drug education specialists need to be cognizant of the more recent results on non-clinical samples of COAs in designing and implementing sensitive programs.

Changes in family functioning during treatment and drinking outcomes for high and low autonomy alcoholics

Alcoholics' level of autonomy was hypothesized to have a moderating effect on the relationship between changes in family functioning and subsequent drinking behavior. Functioning of families of patients in outpatient alcoholism treatment was assessed prior to the onset of treatment and again 6 months later. For alcoholics who were low in autonomy, perceptions of improvements in functioning predicted better drinking outcomes during a subsequent 6-month follow-up, while changes in family functioning were unrelated to drinking behavior in high autonomy alcoholics. The areas of family functioning in which change was a significant predictor of later drinking primarily concerned the quality of interactions between family members. Alcoholics' gender, psychiatric comorbidity, and the type of treatment they received did not moderate the relationship between changes in family functioning and drinking outcomes. Implications for the treatment of alcoholic patients and the limitations of the research are discussed.

Does adding conjoint therapy to individually focused alcoholism treatment lead to better family functioning?

This report examines functioning in the families of alcoholics undergoing outpatient treatment. Alcoholic patients were randomly assigned to two social-learning-based alcoholism treatments, one of which contained a conjoint therapy component. Patients (Pts) and significant others (SOs) provided ratings of family functioning before treatment and at a 6-month follow-up. According to the perceptions of both Pts and SOs, there were significant improvements in family functioning in a number of areas at posttreatment. Contrary to what was expected, however, the improvements were not greater in the conjoint condition. The usefulness of alcoholics' level of autonomy as a matching variable also was explored. According to the perceptions of both Pts and SOs, posttreatment family functioning was better when low-autonomy alcoholics were treated without other family members. There also was evidence that conjoint treatment was more effective with high-autonomy alcoholics and their families, although it was less convincing and limited to the SOs' perceptions. Implications for alcoholism treatment and the limitations of the findings are discussed.