Family-based interventions for substance misuse : a systematic review of systematic reviews—protocol

BACKGROUND: Worldwide, there are an estimated 15 million individuals with drug use disorders and over five times as many with alcohol use disorders (WHO 1:2, 2005). Most individuals with substance misuse have families who are affected. Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse. Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse. METHODS: Extensive electronic and manual searches will be undertaken. Screening, data extraction and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion. The inclusion criteria will be that the study is a systematically undertaken review, the population is individuals with substance misuse problems and the interventions include a family-focused component. Reviews that focus on prevention rather than treatment will be excluded. The reviews will be assessed for quality and relevance. The evidence from included systematic reviews will be mapped by focus of intervention (promoting engagement of user into treatment/joint involvement in treatment of user/treating family member in own right) for both adults and adolescents for drug and/or alcohol misusers to allow assessment of the density of available evidence. The higher-quality, up-to-date evidence for each domain will be identified and described, and conclusions will be drawn with limitations of the evidence highlighted. DISCUSSION: This systematic review of systematic reviews will be an efficient and robust way of looking at the current state of the evidence in the field of family-based interventions for substance misuse. It will evaluate all the available systematic-review-level literature to report on the effectiveness of family-based psychological interventions in improving substance-related outcomes and improving health and wellbeing of substance misusers and/or their families. This will inform future treatment policies and commissioning decisions. In addition, it will identify areas of poor quality, inconsistency and gaps in the evidence base for family-based psychological interventions in substance misuse with respect to secondary evidence in order to inform future research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD4201400683

Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction

Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with "health" as evaluative space and "health maximization" as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability. Capability well-being is an evaluative space grounded on Amartya Sen's capability approach and assesses well-being based on individuals' ability to do and be the things they value in life. Sufficient capability is an egalitarian approach to decision making that aims to ensure everyone in society achieves a normatively sufficient level of capability well-being. The case study is treatment for drug addiction, and the cost-effectiveness of 2 psychological interventions relative to usual care is assessed using data from a pilot trial. Analyses are undertaken from a health care and a government perspective. For the purpose of the study, quality-adjusted life years (measured using the EQ-5D-5L) and years of full capability equivalent and years of sufficient capability equivalent (both measured using the ICECAP-A [ICEpop CAPability measure for Adults]) are estimated. The study concludes that different evaluative spaces and decision-making rules have the potential to offer opposing treatment recommendations. The implications for policy makers are discussed

La cohesión y el conflicto en familias que enfrentan el consumo de alcohol y otras drogas una comparación transcultural México-Gran Bretaña

This paper presents a comparison of the results obtaines through the Interpersonal Relations subscale of the Family Environment Scale (Moos & Moos, 1981) in Mexico and England. The main objective is to demonstrate that there are differences between both countries regarding how families perceive cohesion and conflict in the light of the colectivism-individualism construct. The sample studied was integrated by 107 individuals from separate families from Mexico City and 100 individuals from South West England; all of them had lived with an alcohol or drug user. Through exploratory factor analysis two factors were found, one of them related to positive aspects of the family environment (cohesion) and a second factor which denotes conflict. The confirmatory factor analysis demonstrated that both factors are inversely related. Other correlations indicate higher risk for alcohol consumption in families with high cohesion and high risk for drug use in families with a large number of members. Later, variance analysis corroborates that relatives of alcohol users perceive higher cohesion than relatives of drug users. Furthermore, it was observed that English relatives report higher scores in some items of the cohesion subscale while Mexican relatives scored higher on 2 items of the conflict subscale. These results might reflect different situations occurring within the family depending on the number or members and the extent of their agreements to cope with substance use.En este artículo se comparan los resultados obtenidos en México e Inglaterra empleando la subescala de Relaciones Interpersonales de la Escala de Ambiente Familiar (Family Environment Scale [FES], Moos & Moos, 1981). El objetivo principal es demostrar que existen diferencias entre ambos países en cuanto a la forma en que las familias perciben la cohesión y el conflicto a la luz del constructo colectivismo-individualismo. La muestra estuvo integrada por ciento siete familiares en la Ciudad de México y cien en el Sur de Inglaterra, todos ellos habían vivido con un familiar consumidor de alcohol o drogas. A través de un análisis factorial exploratorio se encontraron dos factores, uno de ellos relacionado con aspectos positivos del ambiente familiar (cohesión) y el segundo factor que denota aspectos de conflicto. El análisis factorial confirmatorio demostró que ambos factores están inversamente relacionados. Otras correlaciones indican niveles de asociación entre las familias con alta cohesión y consumo de alcohol, así como asociaciones entre familias con un número de integrantes mayor y consumo de drogas. (Posteriormente se realizó un análisis de varianza en el que se corroboró que los familiares de usuarios de alcohol perciben mayor cohesión que los familiares de usuarios de drogas). Por otra parte, se observó que los familiares ingleses reportan mayores puntajes en algunos reactivos de la sub-escala de cohesión en tanto que los mexicanos tuvieron mayor puntaje en 2 reactivos de la subescala de conflicto. Estos resultados pueden estar reflejando diferentes situaciones que ocurren en el interior de las familias dependiendo del número de integrantes y el grado de acuerdo entre ellos para hacer frente al problema de consumo

Involving young people in drug and alcohol research

Purpose: Young people’s involvement should lead to research, and ultimately services, that better reflect young people’s priorities and concerns. Young people with a history of treatment for substance misuse were actively involved in the Youth Social Behaviour and Network Therapy (Y-SBNT) study. This paper explores the impact of that involvement on the study and our understanding of involving young people in drug and alcohol research. Methods: The initial plan was to form a young people’s advisory group, but when this proved problematic the study explored alternative approaches in c collaboration with researchers and young people. Findings: Input from young people informed key elements of the intervention and research process. Furthermore their involvement needed to be dynamic and flexible, with sensitive handling of difficult personal experiences. Engagement with services was crucial both in recruiting young people and supporting their ongoing engagement. Implications: The dominant discourses and cultures of health services and research (including interpretations of participation in public involvement) often do not sit easily with co-production and young people-centred involvement. There is a need to consider and document how approaches may facilitate exclusion or inclusion of young people in substance use research and more widely. Young people should be involved in influencing how they participate in drug and alcohol research, as well as having the right to choose whether or not they are involved. Originality/value: The outcomes of this work contributed to innovative thinking and practice and the development of a more flexible and young people centred model for involvement

Substance misuse brief interventions during psychiatric hospital admissions

Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission

Pilot study of a social network intervention for heroin users in opiate substitution treatment: study protocol for a randomized controlled trial

Background: Research indicates that 3% of people receiving opiate substitution treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing treatment, and there is concern that treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users' psychological treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST.Methods and design: In this two-site, early phase, randomized controlled trial, a total of 120 patients receiving OST will be recruited and randomized to receive one of three treatments: 1) Brief Social Behavior and Network Therapy (B-SBNT), 2) Personal Goal Setting (PGS) or 3) treatment as usual. Randomization will take place following baseline assessment. Participants allocated to receive B-SBNT or PGS will continue to receive the same treatment that is routinely provided by drug treatment services, plus four additional sessions of either intervention. Outcomes will be assessed at baseline, 3 and 12 months. The primary outcome will be assessment of illicit heroin use, measured by both urinary analysis and self-report. Secondary outcomes involve assessment of dependence, psychological symptoms, social satisfaction, motivation to change, quality of life and therapeutic engagement. Family members (n = 120) of patients involved in the trial will also be assessed to measure the level of symptoms, coping and the impact of the addiction problem on the family member at baseline, 3 and 12 months.Discussion: This study will provide experimental data regarding the feasibility and efficacy of implementing a social network intervention within routine drug treatment services in the UK National Health Service. The study will explore the impact of the intervention on both patients receiving drug treatment and their family members.Trial registration: Trial Registration Number: ISRCTN22608399. ISRCTN22608399 registration: 27/04/2012. Date of first randomisation: 14/08/2012. © 2013 Day et al.; licensee BioMed Central Ltd