Psychosocial Interventions to Improve Psychological, Social and Physical Wellbeing in Family Members Affected by an Adult Relative’s Substance Use: A Systematic Search and Review of the Evidence

Abstract

It is estimated that over 100 million people worldwide are affected by the substance use of a close relative and often experience related adverse health and social outcomes. There is a growing body of literature evaluating psychosocial interventions intended to reduce these adverse outcomes. We searched the international literature, using rigorous systematic methods to search and review the evidence for effective interventions to improve the wellbeing of family members affected by the substance use of an adult relative. We synthesised the evidence narratively by intervention type, in line with the systematic search and review approach. Sixty-five papers (from 58 unique trials) meeting our inclusion criteria were identified. Behavioural interventions delivered conjointly with the substance user and the affected family members were found to be effective in improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning). Affected adult family members may derive psychological benefit from an adjacent individually focused therapeutic intervention component. No interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the substance user and the affected family member.

The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: a systematic review and meta‐analysis

“…However, it is unlikely that providing treatment to substance using parents only will be enough to ameliorate vulnerability in affected children. Rather, children whose parents use substances may require support in their own right [69, 70] to mitigate risk coming from genetic vulnerability [71], reduce intergenerational trauma [72] and the impact of the adversity [5]. Supportive interventions for children who experience maternal and/or paternal substance use may also be needed to meet their needs as young carers [73].…”

Few interventions support the affected other on their own: A systematic review of individual level psychosocial interventions to support those harmed by others’ alcohol drinking

“…Group interventions directly working with individuals such as Al Anon, were also excluded, as they rely other people for the therapeutic bene t. We also excluded interventions which have a family orientation; others have noted family being particularly important in certain cultures when it comes to health change and behavioral interventions (Rane et al, 2017). Whilst there has been criticism levelled at the alcohol treatment eld and its commissioners for not adequately including family members in service delivery (Orford et al, 2013), the health and wellbeing of the affected individual cannot depend on the change of behavior of another and it has been shown that increasing the treatment engagement of the drinker may not bene t the affected other (McGovern et al, 2021).…”

“…It is not clear if or how affected others' experience might differ depending on whether alcohol or drugs were used. Similarly, they concluded interventions which are solely designed for the affected other but contain some component of behavioral modi cation directed at the person who is experiencing alcohol harm rarely served the needs of the affected other (McGovern et al, 2021). In another recent systematic review with meta-analysis, Merkouris et al (2022) explored affected other interventions across different addictions, demonstrating some effectiveness in improving some characteristics of the experience of harm to others such as depression, life satisfaction, and coping.…”

“…Other negative consequences, include physical harms (e.g, injuries; tra c accidents; harm from interpersonal violence, aggression and crime; harm to families, including domestic violence and harm to a developing foetus), psychological harms (e.g., psychological distress, marital disharmony), and changes in other aspects of life (e.g., separation and divorce, child or household neglect; nance, work, parenting, and the meeting of other obligations) ( Several high-quality reviews exist which summarize the nature and effectiveness of interventions for family members affected by an adult relative's substance use. For example McGovern et al (2021) summarized the ndings in a systematic narrative review of sixty-ve trials which aggregated both those which include family members in the intervention and those that do not, and with those who use alcohol, and those who use drugs. Overall, they summarized behavioral interventions delivered with the substance user and the affected other could improve outcomes, but the complex 'multidimensional adversities' experienced by the drinker and their affected other are rarely covered effectively.…”

An Innovative Approach to Delivering a Family-Based Intervention to Address Parental Alcohol Misuse: Qualitative Findings from a Pilot Project

“…Taking a family-centred approach to address alcohol use is not a new concept [10], and it has been advocated in response to complex social problems, which aim to recognise the family as a unit, focus on a strengths rather than a deficits perspective, and maximise the choices available to families [11]. However, in the UK, treatment for alcohol use is traditionally commissioned through an individualistic lens, with the cause, effect, and intervention focusing upon the individual who uses/misuses alcohol [12]. Due to clear evidence of alcohol-related harm to children [13] and affected family members, there has been a growing recognition of the importance of involving family members in the treatment of alcohol users and an acknowledgment that affected family members may benefit from treatment in their own right [14].…”