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Croak B, Archer M, Harwood H, Stevelink SAM, Greenberg N, Rafferty L. Evaluation of Community Reinforcement and Family Therapy in the UK military community. Eur J Psychotraumatol 2023; 14:2282904. [PMID: 38010161 PMCID: PMC10993804 DOI: 10.1080/20008066.2023.2282904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Partners and family can play a key role in encouraging military service and ex-service personnel to seek help for their mental health. Community Reinforcement Approach and Family Training (CRAFT) was developed to equip concerned significant others (CSOs) of those experiencing substance use disorders with skills to encourage their loved one to enter treatment and improve their own well-being. It was adapted in the US for CSOs of ex-service personnel with post-traumatic stress disorder (PTSD) (VA-CRAFT).Objective: This study aimed to evaluate an adaptation of VA-CRAFT for use with CSOs of serving and ex-service personnel experiencing PTSD and Common Mental Disorders in the UK (UKV-CRAFT).Method: Acceptability of UKV-CRAFT was assessed with interviews with experts, namely key stakeholders (n = 15) working in support provision for serving and ex-service personnel. In addition, individuals who took part in a small-scale demonstrative trial of UKV-CRAFT (three CSOs and three facilitators who delivered UKV-CRAFT) provided feedback.Results: UKV-CRAFT was viewed positively, with interviewees highlighting that programmes like UKV-CRAFT filled a gap in provision for UK Armed Forces families as most services were only available to the serving or ex-service personnel. Interviewees praised how UKV-CRAFT enhanced CSO well-being and communication with their loved one. Concerns over the confidentiality of taking part in UKV-CRAFT were raised due to the perceived negative effects of highlighting a loved one's mental ill health, especially for CSOs of serving personnel. Ideas for improvement included broadening access to all CSOs regardless of whether their loved one was seeking treatment.Conclusion: Interviewees regarded UKV-CRAFT as a potentially useful intervention suggesting it could be proactively offered universally to support timely help-seeking if required. We recommend further evaluation of UKV-CRAFT on a wider scale, incorporating our recommendations, to assess its effectiveness accurately.
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Affiliation(s)
- Bethany Croak
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Marc Archer
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | - Hannah Harwood
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Laura Rafferty
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
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Sampogna G, Brohan E, Luciano M, Chowdhary N, Fiorillo A. Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis. Eur Psychiatry 2023; 66:e98. [PMID: 37997647 PMCID: PMC10755580 DOI: 10.1192/j.eurpsy.2023.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed. METHODS This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions. RESULTS In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions. CONCLUSIONS The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.
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Affiliation(s)
- Gaia Sampogna
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Elaine Brohan
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mario Luciano
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andrea Fiorillo
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
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Osilla KC, D'Amico EJ, Smart R, Rodriguez A, Nameth K, Hummer J. Study design to evaluate a web-intervention to prevent alcohol and cannabis-impaired driving and use among adolescents in driver education. Addict Sci Clin Pract 2023; 18:17. [PMID: 36964608 PMCID: PMC10037905 DOI: 10.1186/s13722-023-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Alcohol and cannabis are the most commonly used substances among adolescents in the U.S. The consequences related to using both substances together are significantly higher relative to use of either substance alone. Teens' propensity to engage in risky driving behaviors (e.g., speeding, rapid lane changes, and texting) and their relative inexperience with the timing and duration of cannabis' effects puts them at heightened risk for experiencing harms related to driving under the influence. Use of alcohol and cannabis peak at age 16, the legal age teens may apply for a provisional driver's license in some states. Targeting novice teen drivers prior to licensure is thus an ideal time for prevention efforts focused on reducing alcohol and/or cannabis initiation, use, and impaired driving. METHODS The current study proposes to evaluate the efficacy of webCHAT among 15.5 to 17-year-old adolescents (n = 150) recruited at driver education programs. WebCHAT is a single session online intervention that aims to prevent alcohol and cannabis use and risky driving behaviors. We will recruit adolescents enrolled in driver education programs, and stratify based on whether they used cannabis and/or alcohol in the past 3 months (60% screening negative and 40% screening positive). All participants will receive usual driver education and half will also receive webCHAT. We will test whether webCHAT in addition to usual driver education reduces alcohol and/or cannabis initiation or use and reduces risky driving attitudes and behaviors (intent to drive after drinking/using, riding as a passenger with someone who drank/used) compared to teens in usual driver education over a 6-month period. We will also explore whether variables such as beliefs and perceived norms serve as explanatory mechanisms for our outcomes. DISCUSSION The study has the potential to promote public welfare by decreasing adolescent initiation and use of cannabis and alcohol and reducing risky driving behaviors that can have substantial monetary, personal, and social costs. The study recruits adolescents who are at risk for substance use as well as those who are not and it is delivered remotely during a teachable moment when adolescents receive driver education. Trial registration This study was registered with ClinicalTrials.gov on July 13, 2021 (NCT04959461). https://clinicaltrials.gov/ct2/show/NCT04959461.
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Affiliation(s)
- Karen Chan Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
| | | | - Katherine Nameth
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Justin Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407‑2138, USA
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Knobloch LK, Monk JK, MacDermid Wadsworth SM. Relationship Maintenance among Military Couples. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2023; 40:734-772. [PMID: 37200941 PMCID: PMC10191153 DOI: 10.1177/02654075221105025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A burgeoning body of research on the relationship maintenance of military couples over the past two decades suggests the time is right to organize, assimilate, and critique the literature. We conducted a systematic review informed by the integrative model of relationship maintenance (Ogolsky et al., 2017) that considered issues of intersectionality (Crenshaw, 1991). Our literature search identified 81 relevant journal articles representing 62 unique samples. With respect to theory, 59.3% of the journal articles employed one or more formal theoretical frameworks. In terms of research design, 88.7% of the studies focused on the U.S. military, 83.9% of the studies recruited convenience samples, 54.8% of the studies utilized quantitative methods, and 30.6% of the studies collected longitudinal data. Among the studies reporting sample demographics, 96.8% of participants were married, 77.2% of participants identified as non-Hispanic White, and only one same-sex relationship was represented. Our narrative synthesis integrated findings about relationship maintenance from studies examining (a) relationship maintenance overtly, (b) communicating to stay connected across the deployment cycle, (c) disclosure and protective buffering, (d) support from a partner, (e) dyadic coping, and (f) caregiving and accommodating a partner's symptoms. We interpret our results with an eye toward advancing theory, research, and practice.
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Affiliation(s)
| | - J. Kale Monk
- Department of Human Development and Family Science, University of Missouri
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Merkouris SS, Rodda SN, Aarsman SR, Hodgins DC, Dowling NA. Effective behaviour change techniques for family and close friends: A systematic review and meta-analysis across the addictions. Clin Psychol Rev 2023; 100:102251. [PMID: 36716584 DOI: 10.1016/j.cpr.2023.102251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
This systematic review aimed to determine whether the use of specific behaviour change technique (BCT) groups are associated with greater effectiveness for psychosocial interventions delivered to family and close friends (FCFs) impacted by addiction. A systematic search of peer-reviewed and grey literature published until August 2021 identified 32 studies in 38 articles. An established BCT taxonomy (93 BCTs clustered into 16 groups) was adapted (inclusion of seven additional BCT groups) and applied to 57 interventions. The meta-analyses indicated that some, but not all, FCF outcomes were improved by the exclusion of BCTs within several groups (Reward and Threat, Scheduled Consequences, Confrontation of the Addicted Person to Engage in Treatment, and Goals and Planning) and inclusion of BCTs within the Restoring a Balanced Lifestyle group. Addicted person outcomes were improved by the inclusion of some BCTs within several groups (Repetition and Substitution, Reward and Threat, Scheduled Consequences, and Restoring a Balanced Lifestyle). Relationship functioning outcomes were improved by the inclusion of BCTs within the Confrontation of the Addicted Person to Engage in Treatment group. Future research involving the development and evaluation of numerous interventions or comprehensive multi-component interventions that can address the various needs of FCFs, without counteracting them, is required.
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Affiliation(s)
- S S Merkouris
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia.
| | - S N Rodda
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia; Department of Psychology and Neuroscience, Auckland University of Technology, Auckland 1010, New Zealand
| | - S R Aarsman
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia
| | - D C Hodgins
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Victoria 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Parkville, Victoria 3010, Australia
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Rushton C, Kelly PJ, Raftery D, Beck A, Larance B. The effectiveness of psychosocial interventions for family members impacted by another's substance use: A systematic review and meta-analysis. Drug Alcohol Rev 2023; 42:960-977. [PMID: 36744608 DOI: 10.1111/dar.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Family members affected by another's substance use disorder experience physical health problems, breakdowns in relationships and reduced psychological wellbeing. This review examines the effectiveness of psychosocial interventions for improving the wellbeing of family members. METHODS A systematic review of randomised-controlled trials (RCT), non-RCTs and pre-post studies examining group or individual interventions for affected families. Five databases were searched (PubMed, PsycINFO, Medline, Web of Science, Cochrane Library). Outcomes included psychological functioning, quality of life, physical health and substance use, family functioning and coping. Outcomes were analysed by study design and mode of delivery (individual or group). Risk of bias was assessed using the Cochrane tools (RoB2, ROBINS-I). The review followed PRISMA reporting guidelines and was prospectively registered with the PROSPERO database (CRD42020200260). RESULTS Nineteen studies were included (k = 10 included in meta-analyses). In k = 3 RCTs, individually administered interventions significantly reduced depression (standardised mean difference [SMD] 0.50, 95% confidence interval [CI] 0.21, 0.79) and distress (SMD 0.28, 95% CI 0.03, 0.54). In k = 2 pre-post studies, individual interventions improved family functioning (d = 0.51, 95% CI 0.28, 0.73) and coping (d = 0.43, 95% CI 0.24, 0.61). In k = 3 non-RCTs and k = 2 pre-post designs group interventions significantly reduced depression (d = 0.50, 95% CI 0.17, 0.82) and distress (d = 0.44, 95% CI 0.13, 0.75), and improved coping (d = 0.81, 95% CI 0.29, 1.33). DISCUSSION AND CONCLUSIONS This review summarises the contemporary literature evaluating interventions for affected families, with both individual and group interventions demonstrating favourable outcomes. However, small sample sizes and methodologically weak-quality studies limit conclusions.
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Affiliation(s)
- Clare Rushton
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Dayle Raftery
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison Beck
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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McCarthy JM, Wood AJ, Shinners MG, Heinrich H, Weiss RD, Mueser KT, Meyers RJ, Carol EE, Hudson JI, Öngür D. Pilot development and feasibility of telehealth Community Reinforcement and Family Training (CRAFT) for early psychosis and substance use. Psychiatry Res 2022; 317:114804. [PMID: 36030701 PMCID: PMC10127150 DOI: 10.1016/j.psychres.2022.114804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
Substance use is associated with poor outcomes for individuals with early psychosis. Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that helps families to reduce substance use, engage in treatment, and improve family wellbeing, but it has not yet been studied for psychosis and substance use. The present study aimed to develop and evaluate a telehealth intervention utilizing CRAFT for families experiencing early psychosis and substance use. Twenty family members completed six to eight telehealth sessions of CRAFT adapted for early psychosis (CRAFT-EP). Participants completed an assessment battery at baseline, mid- and post-intervention, a three-month follow-up, surveys after each session, and a focus group to measure mean percentage of sessions completed, mean program satisfaction ratings, telehealth preference, and qualitative feedback. Participants had 100% session completion, and program satisfaction was at or near excellent for 99% of sessions. Half of participants preferred a primarily virtual hybrid program, whereas 45% preferred exclusively virtual visits. Communication was the most helpful topic, and participants requested additional written examples and resources. CRAFT-EP is feasible and acceptable to serve as the active intervention in a pilot randomized controlled trial comparing treatment as usual plus CRAFT-EP to treatment as usual.
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Affiliation(s)
- Julie M McCarthy
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Andrea J Wood
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - M Grace Shinners
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Hadley Heinrich
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert J Meyers
- Center on Alcoholism, Substance Abuse and Addiction, University of New, Albuquerque, NM, USA
| | - Emily E Carol
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James I Hudson
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Merkouris SS, Rodda SN, Dowling NA. Affected other interventions: a systematic review and meta-analysis across addictions. Addiction 2022; 117:2393-2414. [PMID: 35129234 PMCID: PMC9543616 DOI: 10.1111/add.15825] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Individuals impacted by someone else's alcohol, illicit drug, gambling and gaming problems (affected others) experience extensive harms. To our knowledge, this is the first systematic review and meta-analysis to determine the effectiveness of psychosocial interventions delivered to affected others across addictions. METHODS This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic database search (PsycInfo, Medline, Cinahl and EMBASE) of randomized controlled trials (RCTs) published until August 2021 was conducted. RCTs with passive control groups, evaluating psychosocial tertiary interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) that did not require the involvement of the addicted person, were included. RESULTS Twenty included studies, published in 22 articles, mainly evaluated interventions for alcohol use, followed by gambling and illicit drugs, with none investigating gaming interventions. The interventions mainly targeted partners/spouses and focused upon improving affected other outcomes, addicted person outcomes or both. Meta-analyses revealed beneficial intervention effects over control groups on some affected other (depressive symptomatology [standardized mean difference (SMD) = -0.48, 95% confidence interval (CI) = -0.67, -0.29], life satisfaction (SMD = -0.37, 95% CI = -0.71, -0.03) and coping style (SMD = -1.33, 95% CI = -1.87, -0.79), addicted person [treatment entry, risk ratio (RR) = 0.86, 95% CI = 0.75-0.98] and relationship functioning outcomes (marital discord, SMD = -0.40, 95% CI = -0.61, -0.18) at post-intervention. No beneficial intervention effects were identified at short-term follow-up (4-11 months post-treatment). The beneficial intervention effects identified at post-treatment remained when limiting to studies of alcohol use and therapist-delivered interventions. CONCLUSIONS Psychosocial interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) may be effective in improving some, but not all, affected other (depression, life satisfaction, coping), addicted person (treatment) and relationship functioning (marital discord) outcomes for affected others across the addictions, but the conclusion remains tentative due to limited studies and methodological limitations.
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Affiliation(s)
| | - Simone N. Rodda
- School of PsychologyDeakin UniversityGeelongVICAustralia,School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Nicki A. Dowling
- School of PsychologyDeakin UniversityGeelongVICAustralia,Melbourne Graduate School of EducationUniversity of MelbourneParkvilleVICAustralia
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Sayers SL. An Introduction to a Special Issue: Interventions for Military Service Members, Veterans, and Their Families. COUPLE & FAMILY PSYCHOLOGY 2022; 11:1-3. [PMID: 36247489 PMCID: PMC9557983 DOI: 10.1037/cfp0000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Steven L Sayers
- University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center
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10
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Osilla KC, Rodriguez LM, Neighbors C, Pedersen ER. Effects of a Web-Based Intervention in Reducing Drinking among Concerned Partners of Military Service Members and Veterans. COUPLE & FAMILY PSYCHOLOGY 2022; 11:4-14. [PMID: 36448033 PMCID: PMC9701542 DOI: 10.1037/cfp0000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Military personnel and their partners report greater alcohol use and related problems compared to their civilian counterparts. We designed a web-based intervention (WBI) called Partners Connect individualized for a military spouse or partner concerned about their service member/veteran's (SMV) drinking and conducted a secondary data analysis to examine the effect of the WBI on participant drinking and their perceptions of their SMV partner's drinking. Participants were concerned partners (CPs) recruited through social media and randomized to Partners Connect or waitlist control. They completed online surveys at baseline and three months post-intervention. CPs who reported any past-month drinking were included in the current analyses (n=161; 94.4% female, 77% White, 5% Hispanic, 32.0 (SD=6.5) years old). There was no significant effect of the intervention on CP drinking. However, the intervention effect was moderated by CP drinks per week, such that heavier drinking intervention CPs reported significant reductions in their number of drinking days at follow-up. Heavy drinking CPs who reduced their drinking also reported perceived reductions in SMV drinking. Military spouses and partners participated in Partners Connect out of concern for their SMV partner's drinking. In doing so, heavier drinking CPs reduced their own drinking frequency, which was also associated with perceptions of SMV drinking.
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Affiliation(s)
| | | | | | - Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences
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11
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Timko C, Rossi FS, Grant KM, Lor MC, Cucciare MA. Concerned others' help utilization and patients' alcohol treatment outcomes. Drug Alcohol Depend 2021; 228:108983. [PMID: 34507007 PMCID: PMC8595707 DOI: 10.1016/j.drugalcdep.2021.108983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study of dyads composed of patients in treatment for alcohol use disorders (AUDs) and their Concerned Others (COs) examined (1) COs' attendance at three types of help (educational sessions, treatment sessions with the patient, and treatment sessions without the patient) during a 3-month period after patients' admission, and (2) whether COs' use of help was associated with better treatment outcomes reported by COs about patients, and patients about themselves. METHODS Dyads (n = 277) were assessed when patients entered AUD treatment and 3 months later (80 %). COs rated their patient's AUD, and patients rated their own AUD, on the Brief Addiction Monitor. At 3-month follow-up, COs answered three items about help (education, treatment with patient, treatment without patient) from their patient's treatment program. Main analyses were analyses of covariance to examine associations between COs' help use and patients' outcomes. RESULTS At 3-month follow-up, COs who had obtained one type of help were significantly more likely to have also obtained the other two types of help. However, relatively few COs (39 %) obtained any type of help. COs who obtained help rated their patient as having more protection against future substance use. And, when COs had obtained help, patients rated themselves as having less risk of future substance use, and had attended a greater number of AA meetings, than when COs had not obtained help. CONCLUSIONS Findings suggest that COs' use of help can benefit patients in AUD treatment. Clinicians and researchers should increase the availability and use of help among COs.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Fernanda S Rossi
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Kathleen M Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, 68105, USA; Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Streets, Omaha, NE, 68198, USA.
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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McGovern R, Smart D, Alderson H, Araújo-Soares V, Brown J, Buykx P, Evans V, Fleming K, Hickman M, Macleod J, Meier P, Kaner E. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1793. [PMID: 33673199 PMCID: PMC7918716 DOI: 10.3390/ijerph18041793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Debbie Smart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Vera Araújo-Soares
- Faculty of Behavioural, Management and Social Science, University of Twente, 7522 Enschede, The Netherlands;
| | - Jamie Brown
- Institute of Epidemiology & Health, University College London, London WC1E 6BT, UK;
| | - Penny Buykx
- School of Humanities and Social Science, University of Newcastle, Callaghan 2308, Australia;
- School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK
| | | | - Kate Fleming
- Public Health Policy and Systems, Liverpool Centre for Addiction Research, University of Liverpool, Liverpool L69 3BX, UK;
| | - Matt Hickman
- Population Health Sciences Institute, University of Bristol, Bristol BS8 1TL, UK; (M.H.); (J.M.)
| | - John Macleod
- Population Health Sciences Institute, University of Bristol, Bristol BS8 1TL, UK; (M.H.); (J.M.)
| | - Petra Meier
- Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
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Osilla KC, Becker K, Ecola L, Hurley B, Manuel JK, Ober A, Paddock SM, Watkins KE. Study design to evaluate a group-based therapy for support persons of adults on buprenorphine/naloxone. Addict Sci Clin Pract 2020; 15:25. [PMID: 32653029 PMCID: PMC7353769 DOI: 10.1186/s13722-020-00199-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Opioid use disorders (OUDs) have devastating effects on individuals, families, and communities. While medication treatments for OUD save lives and are increasingly utilized, rates of treatment dropout are very high. In addition, most existing medication treatments for OUD may often neglect the impact of untreated OUD on relationships and ignore the potential role support persons (SPs) could have on encouraging long-term recovery, which can also impact patient treatment retention. Methods/design The current study adapts Community Reinforcement and Family Training (CRAFT) for use with SPs (family member, spouse or friend) of patients using buprenorphine/naloxone (buprenorphine) in an outpatient community clinic setting. The study will evaluate whether the adapted intervention, also known as integrating support persons into recovery (INSPIRE), is effective in increasing patient retention on buprenorphine when compared to usual care. We will utilize a two-group randomized design where patients starting or restarting buprenorphine will be screened for support person status and recruited with their support person if eligible. Support persons will be randomly assigned to the INSPIRE intervention, which will consist of 10 rolling group sessions led by two facilitators. Patients and SPs will each be assessed at baseline, 3 months post-baseline, and 12 months post-baseline. Patient electronic medical record data will be collected at six and 12 months post-baseline. We will examine mechanisms of intervention effectiveness and also conduct pre/post-implementation surveys with clinic staff to assess issues that would affect sustainability. Discussion Incorporating the patient’s support system may be an important way to improve treatment retention in medication treatments for OUD. If SPs can serve to support patient retention, this study would significantly advance work to help support the delivery of effective treatments that prevent the devastating consequences associated with OUD. Trial registration This study was registered with ClinicalTrials.gov, NCT04239235. Registered 27 January 2020, https://clinicaltrials.gov/ct2/show/NCT04239235.
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Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Liisa Ecola
- RAND Corporation, 1100 South Hayes Street, VA, 22202, Arlington, USA
| | - Brian Hurley
- LA County Department of Health Services, UCLA Department of Family Medicine, 10780 Santa Monica Blvd., Suite 105, Los Angeles, CA, 90025, USA
| | - Jennifer K Manuel
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.,San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - Allison Ober
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Susan M Paddock
- NORC at the University of Chicago, 55 East Monroe St, 31st Floor, Chicago, IL, 60603, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
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Archer M, Harwood H, Stevelink S, Rafferty L, Greenberg N. Community reinforcement and family training and rates of treatment entry: a systematic review. Addiction 2020; 115:1024-1037. [PMID: 31770469 DOI: 10.1111/add.14901] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/29/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry. METHOD Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe. RESULTS A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP-CSO relationship, CRAFT modality and integration of treatment for IP. Meta-analysis found CRAFT to be twice as effective as controls/comparison groups. Multi-modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5-71%), group (60%) and self-directed workbook (13.3-40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5-23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. CONCLUSIONS Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success.
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Affiliation(s)
- Marc Archer
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Hannah Harwood
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Sharon Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK.,Department of Psychological Medicine, King's College London, De Crespigny Park, London, UK
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK.,Academic Department of Military Mental Health, King's College London, Weston Education Centre, London, UK
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Rodriguez LM, Neighbors C, Osilla KC, Trail TE. The longitudinal effects of military spouses' concern and behaviors over partner drinking on relationship functioning. Alcohol 2019; 76:29-36. [PMID: 30553122 DOI: 10.1016/j.alcohol.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022]
Abstract
Among those in close relationships, the perception that one's partner has a drinking problem is more strongly related to detriments in relationship quality than are the actual rates of the partner's drinking. The current study extends this work by examining the effects of this perception on relationship functioning longitudinally and whether this association is mediated by changes in how one behaves in response to their partner's drinking. Spouses and partners of military service members who were concerned about their partner's drinking (n = 234) completed a baseline survey and a follow-up assessment five months later. Structural equation modeling was used to prospectively examine the association between concern about partner drinking and relationship functioning (i.e., relationship quality, conflict, communication patterns), and the mediated effect of regulation strategies. Results suggested that changes in participant concern were related to changes in relationship functioning, and these changes were mediated by changes in punishment and rewarding sobriety regulation strategies. This research suggests that concern about partner drinking is linked with poorer relationship functioning partly because of the increased use of punishment and the decreased use of rewarding sobriety.
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Trail TE, Osilla KC, Rodriguez LM, Pedersen ER, Gore KL. Exploring the association between changes in partner behaviors, perceived service member drinking, and relationship quality: Secondary analysis of a web-based intervention for military partners. J Subst Abuse Treat 2019; 98:66-72. [PMID: 30665606 DOI: 10.1016/j.jsat.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 12/26/2022]
Abstract
Problematic drinking is a serious and persistent problem among U.S. military service members and veterans, who face barriers to seeking help and are less likely to seek help than the civilian population. One way to reach this population is through spouses or partners who are concerned about the service members' drinking (concerned partners [CPs]). CPs of military service members were recruited for a web-based intervention, Partners Connect, that aimed to improve patterns of communication about the service members' drinking. Participants were 234 CPs (95% female; 71% White; 89% married; average age 32 years) who completed a baseline survey, were randomized to a four-session web-based intervention or a waitlist control group, and completed a follow-up assessment 5 months later. Three measures reported by CPs assessed perceived partner drinking (drinks per week, highest number of drinks across a typical week, and frequency of drinking in the past month) and CP behaviors were assessed using the Significant-other Behavior Questionnaire (SBQ) and the State-Trait Anger Expression Inventory (STAXI-2). Results demonstrated that the intervention did not have a main effect on CP behaviors relative to control. However, changes in CP punishment of partner drinking and behaviors supporting sobriety were significantly associated with decreased perceived partner drinking and improved relationship quality over time. Furthermore, compared to the control group, to the extent that CPs in the treatment group reduced their negative behaviors, perceived partner drinking declined and relationship quality improved. The results reinforce the importance of considering CP behaviors when designing interventions to reduce drinking.
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