Prevention is better than cure, right? When it comes to preventing drug- and alcohol-misuse, children of substance-abusing parents are a really important group to work with, as they are at higher risk of developing their own subtance-related problems, or other mental health problems, than their peers from non-substance-using families.
A new systematic review from Germany has brought together evidence on interventions aimed at this group. The authors searched for studies published between 1994 and 2009 and found 13 suitable for inclusion, including seven randomised controlled trials, evaluating nine programmes. One programme was community-based, four took place in schools and four with families. Most lasted between 8 and 14 weeks with weekly sessions of approximately 90 minutes. Content varied but common themes were coping with emotions, problem solving, education on drugs and addiction and family relations. There was one study each from Canada and Spain, while the rest were from the US. Here’s what they found:
- Effects of school programmes were mixed. One family-based programme (3 studies) showed good results
- All studies measuring changes in knowledge found that knowledge improved with the programmes
- Programmes were not successful in improving self-worth, except with participants who received additional mentor training in one long-term programme
- Coping strategies frequently improved
- There were no statistically significant reductions in substance use. The authors note that this may be because many studies involved children aged under 12, of whom the majority were probably not substance-users
- Some studies reported unexpected negative effects, such as increased positive expectations of alcohol, an increase in health complaints and decreased social integration for boys, while some studies did not mention negative effects so we don’t know if any occurred
- Study quality was mixed but all but the one community-based programme were evaluated in at least one very good or good quality study
The authors concluded:
“The few available studies provide some preliminary evidence to suggest that programmes may be effective, especially when they lasted longer than ten weeks and when they involved children’s, parenting, and family skills training components,”
“Even though some study results seem promising, evidence is still too mixed for definite conclusions on “what worked best”. This is especially true for school-based programs.”
They call for more, high quality evaluations, with a focus on the impact of different programme components and delivery methods and exploring long-term effects on children’s substance use, delinquency, mental health, physical health and school performance.
Broening S, Kumpfer K,Kruse K Sack P-M, Schaunig-Busch I, Ruths S, Moesgen D, E Pflug, Klein M, Thomasius R. Selective prevention programs for children from substance-affected families: a comprehensive systematic review (PDF). Substance Abuse Treatment, Prevention, and Policy 2012, 7:23.