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Spring 2008 | Vol 11 No 3

Review

Joanne Shenfeld

Family responses to alcohol problems

Familial Responses to Alcohol Problems presents a collection of articles that review knowledge and approaches to addiction treatment and prevention across the lifespan and address other issues related to family coping and functioning. The first set of articles focuses on children, youth and older adults; the second set looks at family systems, with a focus on couples and family response and the last two articles examine co-morbidity and spirituality within a family context. The book includes perspectives from several different treatment and prevention approaches.

The first article reviews the findings of the first 12 years of the Michigan Longitudinal Study, which provides interesting insights into risk factors for the development of alcohol problems in children. The breadth of data is impressive and allows the authors to generate some ideas about identifying children at risk and developing prevention measures. “Family Response to Adolescence, Youth and Alcohol” looks at the efficacy of family intervention for youth substance abuse and reviews three models of family treatment. Multi-systemic therapy and brief strategic family therapy are older models, while multi-dimensional family therapy is somewhat newer. All three models are described as effective but the article does not really address differences or drawbacks. The article about older adults provides a good summary of the difficulties in identifying and treating alcohol abuse in this population and discusses a family approach to this challenging problem.

The second section of the book focuses on family responses to addiction. The first article looks at the ARISE (A Relational Intervention Sequence for Engagement) model for helping family members get a loved one into substance use treatment. The model is linked to motivational approaches and is embedded in the stages of change concept. The subsequent articles are more associated with traditional 12-step treatment models. “Family Response to Adults and Alcohol” looks at augmenting individual treatment with the couples reciprocal development approach to improve outcomes and family functioning. Another article presents concrete tools and exercises to help family members cope with the different stages of recovery and may be useful to abstinence-based therapists.

The last two articles focus on different issues. “Treatment of Comorbidity in Families” describes common concurrent mental health and addiction problems and ideas around treatment approaches. The author notes that attention to family, children in particular, can help to promote better treatment outcomes in co-morbid situations and may have a preventative effect for the children. The final article examines ways to incorporate spirituality into the family context as part of recovery. The article is broad and inclusive in defining spirituality, embracing family ritual, meditation and community service, as well as prayer and religious affiliation. It is refreshing to see a topic that is often examined only in individual terms addressed at a family level, and that is seen as a potentially beneficial force for all family members, including the substance user.

The editors fall short of their goal to provide “state of the art endeavors” in this book; most of the articles focus on fairly established approaches, and the references are mainly from the 1990s and earlier. However, although there may be more recent developments in the area of family approaches to addiction, this book provides a thoughtfully chosen overview and a good introduction to the idea of family intervention.

Familial Responses to Alcohol Problems. Judith L. Fischer, Miriam Mulsow and Alan W. Korinek, eds. Haworth Press, New York, 2007, 179 pp., $25US.

Joanne Shenfeld is the service manager of Family and Youth Addiction Services at the Centre for Addiction and Mental Health in Toronto.