Brief Family Treatment in Primary Care Might Lessen the Burden of Having an Addicted Relative

Addiction adversely affects family members, but it is unknown whether primary care interven-tions can ameliorate this burden. Investigators in England recruited primary healthcare profes-sionals (PHCPs) from 136 primary care practices cluster-randomized to provide either brief intervention (a self-help manual with an introduction session) or full intervention (a self-help manual and up to 5 face-to-face manual-guided counseling sessions delivered by a PHCP) to 143 family members affected by a relative’s alcohol or drug problem. The self-help manual, de-veloped from the counseling manual, helped family members identify sources of stress, enhance coping skills, and increase social support. Participants had perceived their relative to have a substance-use problem for an average of 8.8 years. Eighty-six percent were women (mean age, 45), and few had sought help. The substance-using relative was a husband or male partner for 42% of participants and a child for 36%, with alcohol as the main substance of abuse for 59% and drugs for 36%.

• At 12-week follow-up, family members in both study arms showed significant reductions in stress and improvements in coping skills, with no differences detected between the groups.

Comments:

Addiction is a family disorder, and the impact on the well-being of family members should be a concern for primary care clinicians. This study suggests that, when delivered by primary care staff, a brief self-help intervention may help family members as well as a more intensive one. Clearly brief family treatment in primary care settings merits further study to determine whether delivery from a primary care provider could supplement or replace therapy by a well-trained family or marital therapist.

Peter D. Friedmann, MD, MPH

Reference:

Copello A, Templeton L, Orford J, et al. The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: a randomized trial. Addiction. 2009;104(1):49–58.