The determinants of family-based intervention for drug-abusing adults and their potential impacts on families : a mixed methods study

Abstract

Background Drug abuse poses prolonged physical and psychosocial threats for not only those taking drugs but also their families. The extant literature demonstrates that the family plays a vital role in maintaining abstinence in drug users, and family involvement in interventions addresses drug abuse problems and improves family outcomes. However, the mechanisms underlying such changes remain unclear. The determinants that lead to drug abstinence and improved family outcomes are also ill-defined. Here, the author aims to conceptualize and evaluate a family-based intervention for drug abusers and families. Methods & Results Study 1 was a qualitative study including semi-structured interviews with four drug-abusing adults and their families. The findings of interviews identified the long-term drug-abusing experiences, impacts of drug abuse on family, the service needs for improving family functions, and family factors motivating drug abusers to maintain drug abstinence. The integration of qualitative interviews and a comprehensive literature review informed the conceptualisation of family-based intervention and the development of logic model and facilitated social service providers to design meaningful intervention activities. Study 2 aimed to test the effects of the family-based intervention with a two-arm quasi-experimental trial. After imputation and propensity score matching, the analysis compared the data from 31 drug abusers and their families (spouses and/or children) in the intervention group—who received both family-based intervention and routine care in one month—and 31 drug abusers and their families in the comparison group, who received routine care only in one month. Both groups were assessed at three time points: pre-intervention (T0), post-intervention (T1), and one month after post-intervention (T2). The trial was registered with ClinicalTrials.gov (NCT04725266), and the steps strictly followed the Consort flow (Ethics approval: EA200018). Data analysis included independent t-tests, Chi-square tests, analysis of covariance (ANCOVA), and mediation regressions. The findings revealed that drug abusers in the intervention group exhibited a significant reduction in the frequency of drug use, and a significant improvement in mental health across three time points, compared to the comparison group. The findings also indicated that parenting competence significantly mediated the relationship between family-based intervention and drug craving, suggesting that parenting competence was a key determinant for the family-based intervention. Study 3 adopted a sub-group analysis to examine the possible ripple effects of the family-based intervention on 19 spouses of drug abusers. The Actor–Partner Interdependence Modeling (APIM) analysis results indicated significant associations between improvements in family roles and the affection of spouses with changes in drug craving among drug abusers. Furthermore, the findings also suggested significant partner effects of changes in parenting competence and co-dependency of spouses on changes in the family functioning of drug abusers. Conclusion The theory of change for the family-based intervention in drug abstinence was supported by empirical evidence. It showed effects not only on drug abstinence but also on several family-related outcomes. Competence was a critical factor in family-based intervention, which generated desirable effects on drug craving for drug abusers. These findings raise significant implications for refining the design of future family-based interventions by social service providers.