Family Climate and Expressed Emotion in the Course of Alcoholism

Abstract

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. "Expressed Emotion" (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: "Critical Comments," "Emotional Overinvolvement," and "Warmth." A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the "survival function" of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.

Familial expressed emotion among heroin addicts in methadone maintenance treatment: Does it matter?

“…In the field of substance use disorders research, EE is studied by some researchers only. Fichter, Glynn, Weyerer, Liberman, and Frick (1997) enrolled 100 patients with alcohol abuse problems who participated in a 12-week treatment program and were followed up for 18 months. Less EE, especially less scores on criticism subscale from relatives, and greater warmth were associated with a lower risk of relapse; however, contrary to the findings among those with eating disorders, emotional over-involvement from the significant other was associated with more abstinence (Fichter et al, 1997).…”

“…Fichter, Glynn, Weyerer, Liberman, and Frick (1997) enrolled 100 patients with alcohol abuse problems who participated in a 12-week treatment program and were followed up for 18 months. Less EE, especially less scores on criticism subscale from relatives, and greater warmth were associated with a lower risk of relapse; however, contrary to the findings among those with eating disorders, emotional over-involvement from the significant other was associated with more abstinence (Fichter et al, 1997). O 'Farrell, Hooley, Fals-Stewart, and Cutter (1998) investigated the influence of EE on alcoholic patients and found that subjects with high-EE spouses had a higher relapse rate, shorter time to relapse, and drank more during the treatment (O 'Farrell et al, 1998).…”

Understanding and managing expressed emotion in the couples treatment of alcoholism

“…A second study found weaker support for the EE-relapse link, with high EE associated with shorter time to relapse but not to other measures of relapse (Fichter, Glynn, Weyerer, Liberman, & Frick, 1997). Contrary to predictions, emotional overinvolvement, (an example of so-called codependent behavior) of the nonalcoholic partner was reported infrequently, and was not related to relapse.…”

Expressed emotion and its relationship to anxiety and depression after traumatic brain injury

“…High EE is a reliable psychosocial predictor of relapse in schizophrenia, mood disorders (Butzlaff & Hooley, 1998), and alcohol dependence (Fichter, Glynn, Weyerer, Liberman, & Frick, 1997). High EE also predicts poorer outcomes for patients with anxiety (Fogler, Tompson, Steketee, & Hofmann, 2007) and eating disorders (Zabala, Macdonald, & Treasure, 2009), and increased depression and anxiety in patients with medical conditions such as epilepsy (Bressi et al, 2007), diabetes (Wearden, Tarrier, & Davies, 2000), myocardial infarction (Bressi et al, 2009), and stroke (Weddell, 1987).…”