Interventions for children of substance abusing parents (COSAPs) that are family-focused can be effective in repairing the child-parent relationship and help overcome the stigma associated with addiction. The study, published in the open access journal Systematic Reviews, gives further understanding into why these types of programs work.
It is estimated that 7% of adults in the US and 11% of adults in the UK have an alcohol disorder. The prevalence of substance abuse, which includes drugs and alcohol, is estimated to be 11%, in Canada. It is also thought that one in four children in the US are exposed to alcohol abuse in their family. It has been found that COSAPs are at increased risk of depression, anxiety, behavioral problems and lower academic achievement.
Family-based COSAP programs have been developed with the aim of strengthening family functioning and reducing negative childhood outcomes by involving multiple family members. It has been found that these family-based interventions can be more effective than working with the children or parents alone.
Researchers from Ryerson University, Canada, conducted a realist systematic review to understand how and why these outcomes are achieved in two types of family-based approaches. A realist review looks at the evidence to examine how and why a social intervention is effective and asks in what context is the intervention effective.
Lead researcher, Amelia Usher, said: "Interventions for COSAPs are typically developed from two different perspectives: the public health prevention field and the more grassroots family addiction field. There were a limited number of published studies on this topic; we had to look to community reports and other grey literature to supplement our research. Given that most COSAP programs are delivered in the community, this speaks to limited capacity for community organizations in evaluating their programs."
The systematic review identified 32 documents from seven COSAP programs that took place in the US, UK, Spain and Canada. Four themes were found to prevail in the programs that were evaluated as being successful: opportunities for positive parent-child interactions; supportive peer relationships among child participants and among parents; knowledge and education about the impact of addiction and substance abuse; and engaging hard to reach families using strategies that are responsive to socioeconomic status.
Amelia Usher said: "Tackling the shame and stigma associated with addiction is fundamental, particularly for children. Findings suggest that providing children with an age-appropriate support system of peers who share their experience of living with addiction can be immensely helpful. Similarly, this is also true for parents who struggle with raising children while in recovery.
"Our findings suggest that there is not a one-size-fits-all approach to effective intervention. Context matters greatly and services should be tailored to the needs and preferences of the community, for example, paying attention to social determinants of health and meeting basic needs. If organizations provide families with a meal, transportation, or other instrumental supports, this may have a significant impact on program engagement."