Presentation on theme: "Family Alcohol Misuse Dr Paul Toner Department of Health Sciences University of York."— Presentation transcript:
Family Alcohol Misuse Dr Paul Toner Department of Health Sciences University of York
Parental alcohol misuse is a major societal issue (Harwin, 2011). No accurate prevalence figures in the UK. Estimates put this figure at 3.3 to 3.5 million children living with parents whose alcohol consumption ranges from increasing risk to dependency (Manning et al., 2009). Parental Alcohol Misuse
Parents who misuse alcohol can experience problems across other areas of their family lives. Including: external stressors such as housing and financial strain, mental health problems, unemployment and lack of social engagement (Kroll, 2004). Parental alcohol misuse can also adversely affect children growing up in this environment, impacting on attachment (Flores, 2001), family dynamics, relationships and functioning (Velleman & Templeton, 2007).
In the UK newborns and children under three are known to be at particular risk of neglect and physical harm (Forrester & Harwin, 2011). An additional factor in these children’s vulnerability lies in the high proportion of women with alcohol misuse problems who are parenting alone or with serial partners who also have a substance misuse problem (Chance & Scannapieco, 2002). Parental problem substance use is also one of the most prominent reasons for children being received into the care system (Porowski et al., 2004).
There is also evidence that children with a family history of problem alcohol use are at increased risk of developing substance misuse problems themselves (Osterling & Austin, 2008). Given the complexities inherent in families where there is parental alcohol misuse, it is perhaps unsurprising that interventions have not been readily developed and evaluated to address the needs of this population.
Addiction services and child protection systems have developed separately, as policy and practice environments, holding different professional values and focusing on different issues (Kroll and Taylor, 2003). Nonetheless, there is general agreement in the field that multi-agency, holistic approaches are needed in terms of meeting the complex and multiple needs of families with alcohol misusing parents (Barnard, 2007). A way forward
There are a number of holistic services which have been established in recent years, including the Family Alcohol Service, Option 2, Families First and the Family Drug and Alcohol Court. The rationale is to provide intensive interventions to help bridge the gaps between child and adult services by protecting vulnerable children, while concurrently improving parenting capacity (Forrester & Harwin, 2011). Evidence of effectiveness is still emerging.
Research has highlighted the pivotal role that families play not only as a risk for, but also a protection against, substance-related problems (Velleman et al., 2005). More evidence is currently available which indicates that family focused interventions primarily aimed at the needs of children and adolescents as the focal clients are promising. Including preventative approaches such as The Strengthening Families Programme (Kumpfer & Alvarado, 2003). And treatment approaches, for example, multidimensional family therapy (Liddle et al., 2001).
Early onset of alcohol use in children and young people has been associated with later problematic use (Hingson et al., 2006). Also early onset and early hazardous use has been associated with a range of other problems including risky sexual behaviour, injury, antisocial behaviour, violence and changes in brain development (Jones et al., 2007; Brown et al., 2008). A focus on young people
Furthermore, when investigating the impact of substance use on the family, research has shown that alcohol use among young people can adversely affect relationships with parents and other family members (Copello et al., 2005). In addition, family involvement in interventions has been shown to influence the course of the problem in a positive way (Velleman et al., 2005).
Among school-age children, while proportions of those drinking at all have dropped slightly since 1988, the average units consumed increased markedly between 1990 and 2006 and this has since stabilised at this higher level (Smith & Foxcroft, 2009). Contrary to popular perceptions, average alcohol consumption among young adults (aged 16 to 24) has fallen since a peak in Nonetheless, 15 to 16 year olds in the UK have one of the highest rates of underage drinking and drunkenness in Western Europe (Hibell et al., 2007).
Reviews of evaluation studies have shown family- based approaches to be effective in reducing drinking among young people (Tripodi et al., 2010). However, problems remain with regards to engagement of family, treatment decay and translating research into practice. A key factor appears to be the resource-intensive nature of many family interventions, making them difficult to implement and deliver in many service settings, especially in the context of substantial cuts to drug and alcohol services for young people. Rationale for a new approach
SBNT Originally developed as part of the United Kingdom Alcohol Treatment Trial (UKATT). Utilising cognitive and behavioural strategies Social Behaviour and Network Therapy helps clients build family and social networks supportive of change. A key strength of the approach is the primary focus on addressing alcohol problems by engaging with a network of positive support for lifestyle change (Copello et al., 2009).
Y-SBNT SBNT has additional advantages to help sustain engagement with vulnerable young people who may be disconnected from their families by broadening the reach of the intervention beyond the traditional family to include supportive peers. Core strategies include motivational techniques, improving communication and coping mechanisms and crucially given the nature of alcohol misuse developing a network-based relapse management plan. The therapeutic approach also has scope to address client focussed elective areas, for example, educational requirements (Copello et al., 2009).
Y-SBNT Study A pilot feasibility study: 2 sites Birmingham and Newcastle. Random allocation of 30 cases in each site. 15 cases receive Y-SBNT. 15 cases receive TAU. End of treatment and 12 month follow-up. Quantitative and qualitative measures.
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