Treatment in Primary Care for Family Members Affected by Substance Abuse

Studies indicate that individuals who have a close family member with addiction suffer from multiple symptoms of physical and psychological stress. However, service interventions for family members are not routinely available. Researchers in England used a stress-strain-coping-support model of addiction to compare two family interventions in 136 primary care practices.

The full intervention consisted of five face-to-face, manual-guided counseling sessions focused on identifying stressors, providing information on alcohol and other drugs, and developing coping behaviors and sources of support. The brief intervention consisted of one face-to-face session and provision of a self-help manual based on the principles used in the full intervention. Eighty-six percent of the 143 participants were women. The substance-using relative was a male partner for 42% of participants and a child for 36%.

• Family members in both groups showed significant reductions in stress and improvement in coping skills at 12-week follow-up.
• There were no differences in outcomes between groups; the brief intervention was as effective as the full intervention.
• Despite the similarity in outcomes, both family members and primary care workers preferred the more frequent face-to-face contact provided with the full intervention.

Comments by Norma Finkelstein, PhD
Family members can play a critical role in the prevention and treatment of addiction and mental health problems. Unfortunately, understanding addiction as a family disease, while accepted theoretically, is not widespread in terms of service interventions. This study suggests that a brief family intervention by primary care staff can make a difference in a family member's well-being, although recruiting and engaging primary care workers presented a challenge for these researchers. In addition to incorporating family interventions in primary care, family support is critically needed in treatment programs to improve the emotional health of both patients and families.