An Effective Family Skills-based Intervention for the Prevention of Health Problems in Children of Alcohol and Drug-Abusing Parents

  • Karol l. Kumpfer University of Utah
  • Joaquín Fenollar Universidad de Kentucky
  • Ciara Jubani Blanchardstown Local Drugs Task Force
Keywords: Family interventions, substance abuse prevention, children substance abusers.

Abstract

Introduction. There is a need forwide-scale dissemination of effective family-focused skills trainingprograms for the prevention of multiple developmental problems and later substance misuse amonghigh-risk children. Independent reviews have found the author’s Strengthening Families Program (SFP) tobe the most effective substance abuse prevention intervention. Cultural adaptations have resulted in successful SFP outcomes in many countries, including in Spain as detailed in the Orte article. This article reviews 30 year history of implementation and outcomes of SFP in different cultures with cultural adaptations. Methods: The SEM-tested Social Ecology Model (Kumpfer, Alvarado, &Whiteside, 2003) is presented and reveals that family factors (bonding, supervision, and communication) are the most protective of later substanceuse.Hence, this causal theory served as the etiological theory behind the design of the 14-session SFP.Social cognitive behavior theory (Bandura, 1989) is the intervention theory. The Strengthening Families Program(SFP) was the first family skills training program developed and found effective in a randomized control trial (RCT) to improve outcomes for children of dug abusers.Many countries requested to replicate SFP; hence, staff training systems were developed and a cultural adaptation process. Results: Eight RCTs, four conducted by independent research teams, and hundreds of quasi-experimental studies in different countrieshave demonstrated SFP’s effectiveness in reducing substance use in adolescents with up to 10-yearfollow-ups. Comparative effectiveness reviews including ones using statistical meta-analysis by theOxford University Cochrane Collaboration Reviews, found SFP to be the most effective alcohol and drug prevention program (Foxcroft, et al., 2003). A cost-benefit analysis by Miller and Hendrie (2008) found SFP prevented the highest percentage of youth from using alcohol and drugs. Cultural adaptation is a mandated element of SFP fidelity and was found in five studies to improve recruitment and retention by 40 percent. Discussion: SFP is being disseminated worldwide by the UN Office of Drugs and Crime and also by 27 governments. This article describes the contents and the outcomes of the Strengthening Families Programmes number of countries including Spain plus future directions in computer delivery with a new Home Use SFP8-16 DVD.

References

Anda, R.F., Brown, D.W., Dube, S.R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34(5), 396-403.

http://dx.doi.org/10.1016/j.amepre.2008.02.002

PMid:18407006

Anderson, P., & Baumberg, B. (2006). Alcohol in Europe: a public health perspective. London: Institute of Alcohol Studies Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth. Washington State Policy Institute., Available at http://www.wsipp.wa.gov/rptfiles/04-07-3901.pdf

Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44, 1175–1184.

http://dx.doi.org/10.1037/0003-066X.44.9.1175

PMid:2782727

Barnard, M. & McKeganey, N. (2004). The impact of parental problem drug use on children: what is the problem and what can be done to help? Addiction, 99(5), 552-559.

http://dx.doi.org/10.1111/j.1360-0443.2003.00664.x

PMid:15078229

Brody, G. H., Beach, S. R. H., Philibert, R. A., Chen, Y.-f., & Murry, V. M. (2009a). Prevention effects moderate the association of 5-HTTLPR and youth risk behavior initiation: Gene × environment hypotheses tested via a randomized prevention design. Child Development, 80(3), 645-661.

http://dx.doi.org/10.1111/j.1467-8624.2009.01288.x

PMid:19489894

Brody, G. H., Beach, S. R. H., Philibert, R. A., Chen, Y.-f., Lei, M.-K., Murry, V. M., & Brown, A. C. (2009b). Parenting moderates a genetic vulnerability factor in longitudinal increases in youths' substance use. Journal of Consulting and Clinical Psychology, 77(1), 1-11.

http://dx.doi.org/10.1037/a0012996

PMid:19170449 PMCid:PMC2868377

Brody, G. H., Chen, Y.-f., Kogan, S. M., Murry, V. M., & Brown, A. C. (2010). Long-term effects of the Strong African American Families program on youths' alcohol use. Journal of Consulting and Clinical Psychology, 78(2), 281-285.

http://dx.doi.org/10.1037/a0018552

PMid:20350039 PMCid:PMC2904520

Brody, G. H., Chen, Y.-f., Kogan, S. M., Yu, T., Molgaard, V. K., DiClemente, R. J., & Wingood, G. M. (2012). Family-centered program to prevent substance use, conduct problems, and depressive symptoms in Black adolescents. Pediatrics, 129(1), 108-115.

http://dx.doi.org/10.1542/peds.2011-0623

PMid:22157131 PMCid:PMC3255466

Brook, J., McDonald, T. P., & Yan, Y. (2012). An analysis of the impact of the Strengthening Families Program on family reunification in child welfare. Children and Youth Services Review, 34, 691-695.

http://dx.doi.org/10.1016/j.childyouth.2011.12.018

Champagne, F. (2010). Epigenetic influences of social interaction across the lifespan. Developmental Psychobiology. Wiley Interscience, online publication (www.interscience,wiley.com).

http://dx.doi.org/10.1002/dev.20436

Champagne, F. A., & Meaney, M. J. (2007). Transgenerational effects of social environment on variations in maternal care and behavioral response to novelty. Behavioral Neuroscience, 111 (6), 1353-1363.

http://dx.doi.org/10.1037/0735-7044.121.6.1353

PMid:18085888

Chassin, L., Carle, A., Nissim-Sabat, D., & Kumpfer, K. L., (2004). Fostering resilience in children of alcoholic parents. Maton, K.I. (Ed), In Investing in Children, Youth, Families, and Communities: Strengths-based Research and Policy. Washington, D.C.: APA Books. [PMID: 15645706]

Coombes, L., Allen, D. M. & Foxcroft, D.H. (2012). An exploratory pilot study of the Strengthening Families Programme 10–14 (UK). Drugs: Education, Prevention, and Policy, 19 (5), 387-396.

http://dx.doi.org/10.3109/09687637.2012.658889

Forehand, R.L., & McMahon, R.J. (1981). Helping the noncompliant child. A clinician's guide to parent training. New York: Guilford Press.

Foxcroft, D., Allen, D. & Coombes, L. (2005). Adaptation and Implementation of SFP 10-14 Years for U.K. Abstract submitted to Society for Prevention Research, San Antonio, May 2005. School of Health and Social Care, Oxford Brookes University, Oxford, UK.

PMCid:PMC1479788

Foxcroft, D.R., Ireland, D., Lister-Sharp, D.J., Lowe, G., & Breen, R. (2003). Longer-term Primary prevention for alcohol misuse in young people: A systematic review. Addiction, 98(4): 397-411.

http://dx.doi.org/10.1046/j.1360-0443.2003.00355.x

PMid:12653810

Foxcroft, D.R., & Tsertsvadze, A. (2012). Universal alcohol misuse prevention programmes for children and adolescents: Cochrane systematic reviews. Perspectives in Public Health. 132: 128-134.

http://dx.doi.org/10.1177/1757913912443487

PMid:22700577

Gómez-Fraguela, J., Fernández, N., Romero, E., Luengo, Á. (2008). El botellón y el consumo de alcohol y otras drogas en la juventud. Psicothema, 211-217.

PMid:18413080

Gottfredson, D., Kumpfer, K.L., Polizzi-Fox, D., Wilson, D., Puryear, V, Beatty, P., & Vilmenay, M. (2006). Strengthening Washington, D.C. Families Project: A randomized effectiveness trial of family-based prevention, Prevention Science, 7(1), 57-74.

http://dx.doi.org/10.1007/s11121-005-0017-y

PMid:16555144

Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness, Journal of Abnormal Psychology, 36: 567-589.

http://dx.doi.org/10.1007/s10802-007-9201-9

PMid:18205039

Kelly, M. L., & Fals-Stewart, W. (2002). Couple-versus individual-based therapy for alcohol and drug abuse: Effects on children's psychosocial functioning. Journal of Consulting and Clinical Psychology. 70, 417-427.

http://dx.doi.org/10.1037/0022-006X.70.2.417

Kimber, B. (2005). Cultural Adaptation and Preliminary Results of the Strengthening Families Program 6-11 in Sweden. Paper presented at Society for Prevention Research, San Antonio, TX, full report at Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

Kumpfer, K.L., & Alvarado, R. (2003). Family strengthening approaches for the prevention of youth problem behaviors, American Psychologist, 58,(6/7), 457-465.

http://dx.doi.org/10.1037/0003-066X.58.6-7.457

PMid:12971192

Kumpfer, K. L., & Brown, J. (2011). New Way to Reach Parents: A SFP DVD. Western States Substance Abuse Annual ATOD conference, Boise, ID. Sept. 22, 2011.

Kumpfer, K.L., & Fowler, M. (2008). Parenting skills and family support programs for drug abusing mothers. Seminars in Fetal and Neonatal Medicine. 163, 1 –9.

Kumpfer, K. L. & Johnson, J. (2007). Strengthening family interventions for the prevention of substance abuse in children of addicted parents, Adicciones, 11 (1), 1 – 13.

Kumpfer, K. L., & Johnson, J. L. (2010). Enhancing positive outcomes for children of substance-abusing parents. Chapter 65, In B. Johnson, (Ed.) Addiction Medicine: Science and Practice, Springer Verlage Publisher.

http://dx.doi.org/10.1007/978-1-4419-0338-9_65

Kumpfer, K. L. & Hansen, W. (in press). Family-based prevention programs. Ch. 8 in L. Scheier & Hansen, W. Parenting and Teen Drug Use, Oxford Press.

Kumpfer, K. L. & Whiteside, H. O. (2004). Strengthening Families Program 6 – 11 Years: Parent, Child, and Family Skills Training Group Leaders Manuals. LutraGroup: Salt Lake City, Utah.

Kumpfer, K.L. Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for the substance abuse prevention. Substance Use and Misuse, 38 (11-13): 1759-1789.

http://dx.doi.org/10.1081/JA-120024240

PMid:14582577

Kumpfer, K. L., Fenollar, J. & Xie, J. (2011). Ch. 16: Resilience Framework: Resilience and Resourcefulness in the Face of Chronic Family Adversity. In K. M. Gow & M. J. Celinski, (Eds). Continuity versus Creative Response to Challenge: The Primacy of Resilience and Resourcefulness in Life and Therapy, (pp.259 -272)

Kumpfer, K.L., Smith, P. & Franklin Summerhays, J. (2008). A wake -up call to the prevention field: Are prevention programs for substance use effective for girls? Substance Use and Misuse, 43, 1-24.

http://dx.doi.org/10.1080/10826080801914261

PMid:18649225

Kumpfer, K. L., Xie, J. & Hu, Q. (2011). Engendering resilience in famlies facing chronic adversity through family strengthening programs. In K. Gow & M. Celinski (Eds) Wayfinding Through Life's Challenges: Coping And Survival (pp. 461-483). New York: Nova Science Publishers Inc.

Kumpfer, K.L., Xie, J. & Magalhães, C. (2012). Cultural adaptations of evidence-based family interventions to strengthen families and improve children's outcomes. European Journal of Developmental Psychology. 9 (1), 104-116.

http://dx.doi.org/10.1080/17405629.2011.639225

Kumpfer, K.L., Xie, J., & O'Driscoll, R. (2012). Effectiveness of a culturally adapted Strengthening Families Program 12-16 Years for high risk Irish families. Child and Youth Care Forum, 41, 173-195.

http://dx.doi.org/10.1007/s10566-011-9168-0

Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002a). Cultural sensitivity in universal family-based prevention interventions. Prevention Science, 3 (3), 241-244.

http://dx.doi.org/10.1023/A:1019902902119

PMid:12387558

Kumpfer, K. L, Alvarado, R, Tait, C., & Turner, C. (2002b). Effectiveness of school-based family and children's skills training for substance abuse prevention among 6-8 year old rural children. Psychology of Addictive Behaviors, 16 (4), 65-71.

http://dx.doi.org/10.1037/0893-164X.16.4S.S65

Kumpfer, K.L., Greene J. A., Allen, K.C. & Miceli, F. (2010). Effectiveness outcomes of four age versions of the Strengthening Families Program in statewide field sites. Group Dynamics: Theory, Research, and Practice, 14 (3), 211-229.

http://dx.doi.org/10.1037/a0020602

Kumpfer, K. L., Pinyuchon, M., de Melo, A., & Whiteside, H. (2008). Cultural adaptation process for international dissemination of the Strengthening Families Program (SFP). Evaluation and Health Professions. 33 (2), 226-239.

http://dx.doi.org/10.1177/0163278708315926

PMid:18448857

Meaney, M. et al. (2007). Epigenetic mechanisms of perinatal programming of hypothalamic-pituitary-adrenal function and health. Trends in Molecular Medicine. 2007, 13, 269-277.

http://dx.doi.org/10.1016/j.molmed.2007.05.003

PMid:17544850

Miller, T. A., & Hendrie, D. (2008). Substance Abuse Prevention: Dollars and Cents: A Cost-Benefit Analysis; Center for Substance Abuse Prevention (CSAP), SAMHSA. DHHS Pub. No 07-4298, Rockville, MD.

Onrust, S., & Bool, M. (2006). Evaluatie van de Cursus Gezin aan Bod: Nederlandse versie van het Strengthening Families Program (SFP) [Evaluation of Cursus Gezin aan Bod: The Dutch adaptation of the Strengthening Families Program (SFP)]. Utrecht, the Netherlands: Trimbos Institute.

PMCid:PMC1698522

Orte, C., March, M., Ballester, L., & Touza, C. (2007, May). Results of a family competence program adapted for Spanish drug abusing parents (2005-2006). Poster presented at the 15th Annual Conference of the Society for Prevention Research, Washington, DC.

PMCid:PMC2095335

Orte, C., Touza, C., Ballester, L. (2007). Análisis del grado de fidelidad en la ejecución de un programa de competencia familiar. Pedagogía Social. Revista Interuniversitaria. Marzo-Sin mes, 95-103.

Pinyuchon, M. (2010). Effectiveness of implementing the Strengthening Families Program for Families of school children in Songkhla Province, Thailand, NIDA International Conference, Scottsdale, AZ.

SAMHSA (2012). National Survey on Drug Use and Health. Data Spotlight. Feb. 16, 2012 retrieved from http://www.samhsa.gov/data/spotlight/Spot061ChildrenOfAlcoholics2012.pdf

Schuckit, M. A. (2009). An overview of genetic influences in alcoholism. Journal of Substance Abuse Treatment. 36(1), 5-14.

Spoth, R., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63(2), 219-228.

PMid:12033699

Spoth, R., Randall, K., Shin, C., & Redmond, C. (2005). Randomized study of combined universal family and school preventive interventions: Patterns of long-term effects on initiatiion, regular use, and weekly drunkness. Psychol Addictive Behav, 19, 372-381.

http://dx.doi.org/10.1037/0893-164X.19.4.372

PMid:16366809 PMCid:PMC2409287

Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting & Clinical Psychology, 72, 535-542.

http://dx.doi.org/10.1037/0022-006X.72.3.535

PMid:15279537

Spoth, R., Shin, C., Guyll, M., Redmond, C., & Azevedo, K. (2006). Universality of effects: An examination of the comparability of long-term family intervention effects on substance use across risk-related subgroups. Prevention Science, 7, 209-224.

http://dx.doi.org/10.1007/s11121-006-0036-3

PMid:16791523

Spoth, R., Redmond, C., Mason, A., Kosterman, R., Haggerty, K., & Hawkins, D. (2005, May). Ten-year follow-up assessment of brief, family-focused intervention effects on lifetime conduct and antisocial personality disorders: Preliminary results. Poster presented at 13th annual Society for Prevention Research conference, Washington, D.C.

UNODC (2009). Guide to Implementing Family Skills Training Programmes for Drug Abuse Prevention, United Nations, New York.

Published
2013-01-01