Al-Anon Intensive Referral (AIR): A qualitative formative evaluation for implementation

A Transformative Journey Through Support Group Participation: Narratives of the Wives of Individuals With Alcohol Use Disorder

The issue of alcohol use disorder (AUD) has received significant attention, with a primary focus on individuals directly afflicted by the disorder. This extensive focus, while necessary, often overlooks the profound impact that AUD has on the family unit, particularly on spouses who play a crucial role in the dynamics of coping and recovery. However, the psychosocial and emotional challenges encountered by wives of those with AUD have been largely neglected in both research and therapeutic interventions. This oversight not only minimizes their suffering but also overlooks their potential contribution to the recovery process, underscoring the need for a more inclusive approach to understanding and addressing AUD. Building upon this foundation, the current study delves into the less explored terrain of the psychosocial and emotional ramifications borne by wives of individuals suffering from AUD. By highlighting the pivotal role that these women fulfil in family dynamics, it seeks to shed light on the transformative effects of their engagement in support groups, aiming to demonstrate how these networks promote resilience, empowerment, and healing for both the women and their families, thus offering a more comprehensive perspective on AUD's impact on society. Employing a qualitative narrative research design, the study utilized purposive sampling to select 36 participants from the northern, southern, and central regions of Kerala, India. Data collection was conducted through in-depth interviews using a semi-structured interview guide. The interviews, conducted initially in the local language, were transcribed into English and analyzed using the constant comparative method, ensuring that ethical considerations were upheld throughout the research process. The results of the study illuminate the multifaceted challenges faced by wives of individuals with AUD, including financial burdens, domestic violence, marital discord, and psychosocial issues. Notably, the participants reported a significant positive shift in their lives following their involvement in support groups, experiencing enhanced mental peace and tranquillity. This transformation enabled some participants to resume their education, engage with the community as role models and leaders, and reconstruct their lives. Most participants viewed their support group participation as a pivotal moment of hope restoration in their lives. The study reveals the necessity for integrating culturally sensitive support mechanisms into rehabilitation programs for families affected by AUD, advocating for broader adoption of support groups that cater to the specific sociocultural dynamics of affected communities.

Al-Anon Intensive Referral to facilitate concerned others' participation in Al-Anon Family Groups: a randomized controlled trial

AIMS

To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon).

DESIGN, SETTING AND PARTICIPANTS

Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%).

INTERVENTION AND COMPARATOR

AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs.

MEASUREMENTS

Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months.

SECONDARY OUTCOMES

number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition.

FINDINGS

There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [β = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (β = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition.

CONCLUSIONS

Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship.