Alcohol treatment aids wives and children too

Whether families benefit from alcohol treatment as well as the patients has rarely been studied. A new US analysis has demonstrated that they do, positioning alcohol treatment as also contributing to child and family welfare policy agendas.

The patients were 301 men living with female partners (all but a few were married) and seeking treatment at two US outpatient alcoholism clinics. Therapy was 12-step oriented with no particular emphasis on marital or family systems. How patients and their families fared was compared against men and women drawn from a national sample
closely matched to each patient and partner, but with no known serious drinking problems.

At treatment entry two-thirds of patients and their partners reported serious relationship problems, virtually all reported verbal aggression, and over half violence. Among the 125 couples with 4–16-year-olds at home, the mother’s reports indicated that 26% exhibited clinically significant behavioural or psychological problems. The proportions of
couples reporting violence or high levels of verbal aggression, and the frequency and severity of violence, fell significantly and substantially from the year before treatment to the year after it had ended
Severe violence (hitting or threatening with a weapon), experienced before treatment by a fifth of the women and a quarter of the men, became a relative rarity, affecting 5–6% of respondents

A similar analysis of the sub-sample with children found that the proportion of children exhibiting clinically significant problems was halved from before treatment to the year after it had ended and the frequency/extent ofthose problems also fell. On both measures and regardless of whether the father had relapsed, the patients’ children were now no worse off than children in the comparison families.
Post-treatment aggression and child welfare outcomes improved more when the patient had sustained their remission, but also improved among patients who relapsed.

In context Earlier studies found similar improvements, but the featured study is the first to do so with an adequate sample size, before and after treatment measures, and a non-alcoholic comparison sample. One earlier study found improvements in child functioning and marital harmony following cognitive-behavioural therapy focused on the male substance user, but these were greater and more lasting if the programme had included couples therapy sessions.

In general it seems that intervening with one family member (whether the problem substance user or not) affects the rest of the family, but impacts are greater when interventions address both the user and their family. Without an untreated comparison group of alcoholics, the featured study could not prove that treatment contributed to the improvements, but this seems highly likely.

Practice implications Though the focus has been more on users of illegal drugs, the welfare of the children of substance users has been highlighted in Britain by recent official reports which recognize that effective treatment of the parent can have major benefits.

Couples and family-based treatments, or patient-focused treatments which at least involve the family, have the greatest impacts on children and on marital harmony. Such services need to be sustained, but where they are unavailable or unacceptable to the families, providers and commissioners can nevertheless expect normal patient focused alcohol treatments to contribute to the reduction of domestic violence and to help intercept the creation of a new generation of
troubled youngsters.

Source: Drug & Alcohol Findings 2006


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