25 page paper about Family Based Crime Prevention

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Family-Based Substance Abuse Prevention

CCJ 340 Prevention of Crime and Delinquency

Richard B. Groskin, Ph. D.

Submission Date: May , 2016

Author:

Family-Based Substance Abuse Prevention Page 2 of 37

8 Greenberg, R. (2000). Substance Abuse in Families: Educational Issues. Childhood Education, 76(2), 66-69. 9 Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child Adolesc Psychiatr Clin N Am, 19(3), 505-526. doi:10.1016/j.chc.2010.03.005 10 Hansen, W. B. (2002). Program Evaluation Strategies for Substance Abuse Prevention. Journal of Primary Prevention, 22(4), 409-436.

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

12 Important Elements of Substance Abuse Prevention Programs. (2003). NIDA, 2-5. 14 Kumpfer, K. L. (2014). Family-Based Interventions for the Prevention of Substance Abuse and Other Impulse Control Disorders in Girls. ISRN

Addiction, 2014, 1-23. 17 Kumpfer, K. L., & Johnson, J. L. (2007). Strengthening Family interventions for the Prevention of Substance Abuse in Children of Addicted Parents. Adicciones, 19(1), 13-25. 19 Lena, S., Hajela, R., & Panarella, C. (1991). Substance Use, Abuse, and Dependence Among Adolescents. Canadian Family Physician, 37,

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

Prevention, 23(1), 49-114. doi:10.1023/A:1016591216363 22 Morgan, T. B., & Crane, D. R. (2010). Cost-Effectiveness of Family-Based Substance Abuse Treatment. Journal of Marital and Family Therapy, 36(4), 486-498. doi:10.1111/j.1752-0606.2010.00195,x

Abstract

This study discusses the issue of substance abuse among children and adolescents and the

different strategies of family-based substance abuse prevention programs in universal, selective,

and indicative forms. In conclusion, it was found that the strategies of parent, child, and family

skills training put together would be the most effective strategy to use and there is an explanation

as to why. At the end, there is a proposal for the ideal family-based substance abuse prevention

program including the aspects of action strategy, program design, program plan, and evaluation

component/design.

Family-Based Substance Abuse Prevention Page 3 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

Family-Based Substance Abuse Prevention

Introduction and Statement of the Problem

Due to surveys taken during the 1990’s, substance use among adolescents and younger

adults became more apparent when a reversal was indicated from the declines in substance abuse

rates across the 1980’s. In accordance, surveys from 1995 discovered that there were increasing

trends of substance use among all illicit substances within the eighth, tenth, and twelfth

graders.20 From these, it was determined that the negative

attitudes and beliefs that were once held by youth had now

eroded, in which the percentage of adolescents who once

disapproved of drug use declined. Once another survey of

substance use was conducted in 1998, it was shown that there

was a decline from the 1995 levels, but the substance use

rates were still significantly higher than those seen in the early 1990’s.20 In regards to these

surveys, it was determined that there was also a steady increase of drug use from the age of

twelve to the age of eighteen, meaning the frequency and the number of substances used

increases over the period of adolescence.

From these surveys, it is shown that substance use and abuse among youth has become

and remained a serious issue within our society. Due to these alarming findings, many prevention

programs have been developed to address the issue, specifically family-based prevention

Family-Based Substance Abuse Prevention Page 4 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

programs because it is believed that adolescent substance use is a family-oriented problem.19

Also, these programs have proved to be especially effective in reducing drug use.14 This

particular domain of programs involves and engages the family, including parents, siblings, and

sometimes peers, in which the programs typically address many risk and protective factors

simultaneously. Some particularly focus on providing parents with the skills needed to keep their

children away from drugs while others focus on providing skills to the children. However, most

focus on teaching family skills with the parents and the children together. The most effective

approaches of these programs tend to be when the program focuses on skills of the both the

parent and the child, as well as family bonding.9

These programs generally are divided into three categories, which are universal,

selective, and indicative. Universal forms of family-based programs are comprehensive strategies

that are intended for all members of a general population, in which the program can be

replicated. Selective forms are intended for the high

risk population subgroups, where the focus is on

specific risk and protective factors that pertain to the

target population. Lastly, indicative forms are

intended for members of the population that have

been individually identified as being high risk, and who show early signs of being in the

trajectory towards a specified disorder, specifically substance abuse in this case.20

Family-Based Substance Abuse Prevention Page 5 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

This study will address the different strategies family-based programs use and which ones

are to be the most effective in substance abuse reduction. These strategies include parent

training; parent and family skills training; parent and child training; and parent, family, and child

training in the universal and selective forms. These strategies also include parent training; parent

and family skills training; parent and child skills training; and family skills training only in the

indicative forms. Further, family therapy and in home support strategies are discussed briefly.

Following this, certain barriers to the family-based domain for substance abuse prevention are

covered, such as recruitment, funding and cost-effectiveness, and cultural sensitivity or culture

appropriateness. The study will then conclude with why the strategies are the most effective in

family-based substance abuse prevention. It is then presented of what would make an ideal

action strategy, program design, program plan, and evaluation component/design.

Presentation of Principle Findings

Universal/Selective Forms

Parent Training

The first approach to substance abuse prevention through family-based programs is the

strategy of parent training in universal and selective type programs. In these approaches, the

main focus is on the parent, in which the parents are taught basic skills such as discipline,

supervision, and problem solving skills as well as enhancing parent-child bonding and fostering

Family-Based Substance Abuse Prevention Page 6 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

parents’ involvement in the child’s school.20 These interventions are usually moderately effective

due to the absence of other family members. This causes the skills learned to fade in a short

period of time.

Through a group of studies examined by Lochman and Steenhoven, there were only nine

studies that only used parent training as a component.20 It was shown that all of the studies led to

improvements in parenting or decreases in

children’s problem behaviors, but only seven

reported maintenance of effects at the follow-up

stage.20 Parent training programs by themselves

are useful in creating important changes in

children’s behavior; however, if more components are involved, then there is an impact on more

risk factors that are being targeted to address. Therefore, there are clear outcomes that prove

parent training is effective, but the results also showed that if other components are added, such

as family skills training or child training, then the effectiveness of the outcomes is positively

influenced.20

Overall, it was suggested that parent training programs should include other components

and focus on both helping parents to interact in more positive and attentive ways with children,

increasing parents rates of social enforcement, and in developing more constructive, and less

harsh methods for discipline of negative behaviors. There are also positive outcomes with the

Family-Based Substance Abuse Prevention Page 7 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

children and the rest of the family due to parent training, but generally these outcomes are

limited.

Parent and Family Skills Training

Parent and family skills training is another strategy used in universal and selective based

family-based substance abuse prevention programs. These programs usually focus on trying to

change and improve general family functioning by teaching family members how to strengthen

their prosocial behaviors and skills, such as improving family cohesion, organization, and

relationships and conflict resolution.20 By

doing so, it prevents the development of

risk factors for substance abuse and it

strengthens the factors that protect against

substance abuse. Most of these programs

are delivered to parents and children in

separate group meetings, and to parents and children together in sessions for at least part of the

time.20 The activities usually include sessions where skill training and practice, role playing,

modeling, and video-based training are done with both the parent and the child, in which the

parent and the child get to practice these skills together.

From the research done by Lochman and Steenhoven, eleven studies were examined that

included both parent and family skills training. Three of the eleven studies used randomly

Family-Based Substance Abuse Prevention Page 8 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

assigned comparison and control groups.20 It was shown in the results that universal and

selective type interventions has had positive effects on measures related to children, parents, and

family functioning, and on the onset of substance abuse.20 Specifically, there is improvement in

parenting behavior, indicated by improved child management, improved problem solving skills,

and improvements in attitudes or acceptance of the children.20 There is also evidence of

improvements in parent-child family relations, decreased family conflict, increased family

cohesion, and decreased family problem behaviors and substance abuse.20

Comprehensively, parent and family skills training had a positive impact or effect. When

family skills training is an added component to parent training, there is evidence of children’s

prosocial behaviors, in which the children are doing things to help others and they work to

complete tasks at home, as being of increased capacity.20 Therefore, it is shown that by adding

extra components, effectiveness is improved, due to addressing a more broad range of risk

factors. Moreover, by including more interactive tasks for the parents and children, there is

improvement within the family, showing that these methods play an important role in success of

these programs.

Parent and Child Training

Along with the strategy of parent and family skills training, parent and child training in

universal and selective forms focuses on how the parent and child interact, in which they try to

change and improve family functioning as well as enhancing parent-child bonding. For the child

Family-Based Substance Abuse Prevention Page 9 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

component, the programs are focused on improving behavior by enhancing peer pressure

resistance skills, social problem solving skills, conflict management skills, and academic skill

training.20 Again, the sessions focus on the parent and child separately as well as together, giving

them the opportunity to exercise the newly learned skills together in interactive teaching

methods.

From Lochman and Steenhoven’s examination of studies, it was found that four studies

used both components of parent and child training in their interventions. From these four, two

studies provided improvements in parenting behavior, reductions in child oppositional behavior,

and less prevalence in alcohol use.20 However, the other two studies only showed mixed or

negative results. Positive outcomes for

children included increases in prosocial

behaviors and decreases in problem

behaviors. In addition, there was a display

of increased school attachment, greater peer

acceptance, and increased positive affect in

interactions with their parents.20 Therefore, when child training is combined with parent training,

effectiveness is improved, just as it is when family skills training is combined with parent

training. When child training is added, the effects are generalized more broadly out of the home,

Family-Based Substance Abuse Prevention Page 10 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

in which the children receiving the training are more likely to have improved positive social

interactions with peers and have improved behavior in the school setting.20

Taken altogether, parent and child training is effective in preventing substance abuse

because there is improvements in how the parent and the child interact and solve disagreements.

It has more effect on the child, including outside of the home while at school and with

interactions with their peers. It is, as mentioned before, just as important in these programs to

include interactive teaching methods because it allows the parent and the child to practice what

they learned together and more effectively, where there is a mediator if one or the other still

needs more practice. Furthermore, it is shown that even though these two strategies are

moderately effective when implemented by themselves, they are even more effective, to where

they address more risk factors, when the two strategies or components are implemented together

in one program.

Parent, Family, and Child Training

When combining all three of these strategies in universal and selective forms of family-

based substance abuse prevention programs, all of the positive outcomes are combined, in which

the ultimate effectiveness is achieved. When addressing all the risk factors dealing with the

parent, the child, and the family altogether, effects are more widespread, in which the

comparison group is being exposed to all of the trainings, and the skills they are learning are

overlapping. When these skills are overlapped, the skills they learned become more internalized,

Family-Based Substance Abuse Prevention Page 11 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

which contributes to the long-term effectiveness of the strategies and the program that’s

implementing them. Furthermore, when interactive teaching methods are used, these skills are

better learned due to the opportunity the parent and the child are given in which they practice on

the skills together.

Parent training by itself has positive effects on the parents’ parenting strategies and in

reducing the child’s negative behaviors. When it is combined with family skills training, the

child’s prosocial behaviors are even more increased than before, and interactions between the

child and the parent are improved. In addition, when child training is added along with family

skills training, it is shown that the intervention effects spread even more to the point where the

prosocial behaviors are expressed outside of the home, and the child has better positive social

interactions with his/her peers along with improved behavior when in school.

In regards to the full impact, when having all three strategies implemented in the

program, effectiveness is significantly improved. This is due to the more internalization the

parent and the child experience when they are able to interact and practice the skills together as

well as when they are learning some of the same skills in each component. From this, it can be

shown that the most effectiveness can be accomplished when all three strategies are used. The

more multi-modal or the more components involved in the intervention, the successful the

program will be in preventing the unwanted behavior, such as substance abuse.

Family-Based Substance Abuse Prevention Page 12 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

Therefore, the most effective programs are those that include many components that

work together to enforce some of the same skills as well as other skills that are influential in all

three strategies. In the universal and selective forms, the risk and protective factors are the main

focus, in which each component focuses on a certain range. However, when other components

are added to improve effectiveness, more risk factors can be addressed, leading to intervention

effects being generalized more broadly. In addition, even though it was not specifically

examined, it is generally known that the programs who are theory based tend to have more

effectiveness, especially when one or more theories are used to explain behaviors or risk factors.

Moreover, although it wasn’t particularly reviewed, if the families received extensive multiple

method, multiple setting, and multiple agent assessments, the effectiveness significantly

increases as well.

Indicative Forms

Parent Training

Family-Based Substance Abuse Prevention Page 13 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

The first indicative form approach in family-based substance abuse prevention is parent

training. These types of strategies only focus on the parent and very specific risk factors, in

which the parents receive knowledge about the specific risk factor being addressed; the programs

work to change parents’ attitudes towards their children; acquiring and improving parenting

skills; obtaining child management abilities,

problem solving skills, communication skills,

and crisis management skills.20 These are similar

to the universal and selective forms of parent

training, but indicative focuses on multiple risk

factors that cause a parent to be at high risk or

only focuses on one risk factor, in which there is a high level of exposure. With this, indicative

forms tend to focus more on specific behaviors to be changed rather than a range of risk factors

that could be responsible for the behaviors.

From the research done by Lochman and Steenhoven, there were nine studies to be

identified to have examined the effects of parent training with problem behavior children.20 All

the studies examined showed significant improvements in either the parents’ parenting behavior

or the children’s behavior. Out of the nine, only six of the studies examined had sustained effects

at the follow-up stage. The main parenting practices that were targeted by the interventions were

appropriate discipline, positive involvement, monitoring, problem solving, and skill

Family-Based Substance Abuse Prevention Page 14 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

encouragement.20 From these programs, the results provided that there was improved parenting

practices as well as improvements in teacher-reported school adjustment, child-reported

maladjustment, and mother-reported maladjustment.20 Specifically, there were reductions in

parental aversive behavior and spanking, increases in contingent parent attention, and increases

in parental positive affect directed towards children.20 In addition, parents reported greater

satisfaction with their parenting and more parental involvement in the child’s school.

Overall, parent training in the indicative form are very effective in addressing how the

parent disciplines the child, in which more positive interactions are promoted. The parents used

less physical punishment and more consistent use of reinforcement. Furthermore, it was found

that these parenting techniques can not only address or impact low risk parents in the general

population, but can also impact high risk parents and their children, which was a very significant

finding. However, as mentioned before, parent training components to programs are only

somewhat effective by themselves. When other components are added, the effectiveness is

increased.

Parent and Family Skills Training

The next approach of family-based substance abuse prevention programs in indicative

form is parent and family skills training. These strategies focus more on how the family develops

family skills to address dysfunctional and counterproductive family functioning and behavior.20

However, the family skills training also involves the child, in which the strategy tries to reduce

Family-Based Substance Abuse Prevention Page 15 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

or eliminate children’s problem behaviors. In other words, while focusing on the parent and on

how the family interacts with all members, the strategy stills tries to address children’s problem

behaviors, in which it hopes that when family skills training is included, it addresses the child

aspect as well.

From Lochman and Steenhoven’s examination of parenting and family skills training in

indicative forms, only four studies were detected that followed this criteria.20 However, only one

study was found to have a stronger design because of its usage of randomized comparison and

control groups. In addition, “synthesis teaching” was included in the intervention, meaning there

was the involvement of discussions about how the

parents’ experiences with child care and with other

stressful factors might influence their abilities to

parent effectively or adequately.20 It was found

that “synthesis teaching” had a positive impact, in

which those who received “synthesis teaching” and parent training versus those who only

received parent training were more consistent during mother-child interactions.20 Outcome

studies showed that broader improvements were evident in family functioning, including better

problem solving and communication, greater responsiveness between family members, clearer

family structure and organization, and reductions in observed family conflict.20

Family-Based Substance Abuse Prevention Page 16 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

Taken altogether, it can be shown that parent and family skills training strategies are

effective in addressing parental disciplinary techniques as well as family functioning issues, even

with discussions of how stressful events and factors could cause inconsistent mother-child

interactions. Also known as “synthesis teaching,” this aspect seemed to be especially successful

because it allows the parents to discover why they parent the way they do or to the extent of how

to parent their children. In addition, while focusing on certain aspects of the family, such as

family functioning and structure, it helps the families pinpoint what the problems are and when

and where these problems occur. Furthermore, as there are discussions about what stresses cause

inconsistent parenting, exercising interactive teaching methods, again, are a great tool to help

families practice what they have learned with each other, and internalized these learned

behaviors. Therefore, parent and family skills training strategy based programs are considered

more effective than parent training by itself.

Parent and Child Skills Training

Parent and child skills training approaches to family-based substance abuse programs in

indicative form address the parent and the child, in which it combines parent training with child

training. The parent training portion focuses on providing parents with general parenting skills

and interpersonal skills while the child training portion focuses on providing skills pertaining to

social problem solving skills and conflict management skills.20 Usually, as done in universal and

Family-Based Substance Abuse Prevention Page 17 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

selective forms, these strategies held separate parent and child sessions along with sessions with

both the parent and the child together afterwards.

Through a group of studies examined by Lochman and Steenhoven, seven programs were

identified as using multicomponent interventions, specifically parent and child training. There

were six of the seven programs that used randomized

comparison and control groups. There were significant

outcomes in regards to child behavior, including lower rates

of aggressive problem behavior at home and at school, lower

rates of antisocial and delinquent behavior, fewer days

confined in juvenile correctional institutions, more positive

effects in improving children’s school behavior, more age appropriate grade placement, and

better peer acceptance.20 It was determined that parent training is effective by itself, but when in

combination with child training, there is an increase in effectiveness, especially in terms of

increasing a child’s social problem solving skills. Moreover, the combination of parent and child

training is superior over only having the child training component as well in terms of

improvement in parenting behaviors and child behavior problems.20

Overall, parent and child skills training is found to be effective in improving parenting

behaviors as well as heavy improvement in child training. Children were seen to have reductions

in their aggressive behaviors at home and in school, and in their antisocial and delinquent

Family-Based Substance Abuse Prevention Page 18 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

behaviors. It was also found that when combining more than one strategy, the positive results

seen are sufficiently maintained in a stronger fashion at the follow-up stages. When child

training is added to parent training, more generalized effects are obtained, meaning more

improvements in the child’s behavior at home and in school. As mentioned before, when

including role play or modeling techniques, it helps to maintain and internalize the skills that are

learned in these programs.

Family Skills Training Only

In indicative form, the approach of family skills training being the only component in a

family-based substance abuse prevention can be effective. These types of approaches are

directed at the child and the parent together. These sessions together are usually designed to

allow the parents and the children to be able to express their feelings and thoughts, and to help

parents empathize with and enjoy their children.20 The main goal of this type of family session is

to increase the cooperation of all family members, maybe even including those that are not a part

of the immediate family.20

In the Lochman and Steenhoven studies, this type of approach was not given as much

attention as the other sections.20 The only information available is that there was ten studies that

demonstrated at least some positive effects. However, the results do show the outcomes that were

found from these ten studies. There was strong family functioning outcomes, including better

problem solving and communication between family members, greater responsiveness between

Family-Based Substance Abuse Prevention Page 19 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

family members, clearer family structure and organization, and reductions in observed family

conflict, as seen when combining parent training with family skills training.20 In addition, the

changes found in how parents relate to their children and to each other in a variety of everyday

situations in family life were positive.20

In regards to the full impact, these strategies are effective when implemented

individually. However, it has constantly been proven that the effects are much stronger and lasts

much longer when implemented with other components, such as parent training or child

training.20 Emphasis is continuously being put on interactive teaching methods as well because it

allows the parent and child to learn together and to practice together, ultimately increasing the

length in which these techniques are maintained and increasing the depth in which the techniques

are internalized. Overall, when referring to family-based substance abuse prevention programs,

the best approach is to include as all three components of parent training, child training, and

family skills training whether the intervention is in universal, selective, or indicative form.

Therefore, it is seen again that the most effective programs include all three components,

if not more in order to achieve maximum effectiveness. As long as these components work well

together, the most effective outcomes can be obtained. Indicative forms of interventions seem to

be more effective in addressing very specific risk factors and problems or behaviors. This helps

to address the most high risk populations as long as there is no indication of labeling these

Family-Based Substance Abuse Prevention Page 20 of 37

doi:10.1023/A:1015231724053 11 Hogue, A., Leckrone, J. J., & Liddle, H. A. (1999). Recruiting High-Risk Families into Family-Based Prevention and Prevention Research.

Journal of Mental Health Counseling, 21(4), 337-351.

1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

groups as high risk. The most effective programs are also theory based and have extensive

multiple method, multiple setting, and multiple agent assessments.

Family Therapy and In Home Support

These approaches differ from the other approaches in family-based substance abuse

prevention due to the fact that they rely and use more traditional family therapy models, address

basic family processes, and are often much more

intensive.20 In addition, this is especially true for the in-

home family interventions because they require frequent,

daily service provisions for a prescribed period of time.20

Granted these in-home services are very effective in

family-based substance abuse prevention programs, they require more funding; and therefore are

not usually implemented unless the program is extensively proven to be effective.

According to the group studies done by Lochman and Steenhoven, there were six to be

identified as family in-home support services and nine were identified as variations of family

therapy.20 Results concluded that these types of approaches are highly supported with high risk

children and adolescents, in which they have dealt with families with adolescents with relatively

serious behavioral and delinquency problems. It was proven that family therapy approaches, such

as Multisystemic Therapy, are clearly effective in improving family communication, improving

parenting skills, decreasing inappropriate parental control over adolescents, improving

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

perceptions and attitudes of parents and adolescents about each other, and in reducing recidivism

of juvenile offenders.20 These approaches have also been used in nuclear families, in which it

addresses other members of the family besides immediate members. However, when it comes to

in-home support services, there are a lack of well-designed studies with randomized comparison

and control groups although there are clear indications that these services are effective.20

Overall, these types of approaches have not been through the extensive research needed

to completely agree with their shown effectiveness. However, there is some evidence of positive

outcomes from these types of programs. A part of this issue comes from funding issues, which

will be addressed in the next section along with other reoccurring problems in implementing

family-based substance abuse prevention programs.

Common Barriers

The most common barriers associated with implementing family-based substance abuse

prevention programs are recruitment, funding and cost-effectiveness, and cultural sensitivity or

cultural appropriateness. With these common challenges in the family-based domain, it can be

difficult to truly provide evidence of effectiveness when it comes to substance abuse prevention.

Without addressing these, family-based prevention can be undermined and therefore, not receive

the support it deserves in its efforts of substance abuse prevention.

The first challenge most family-based substance abuse prevention programs experience

are problems with recruitment. To start off, there is a lack of attention devoted to client

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

recruitment issues. Not many realize that family-based substance abuse prevention programs

especially struggle with recruitment because they have to rely on outreach and recruitment

heavily in order to obtain intervention populations.11 In order to recruit people, the program

personnel have to mail out information and call the parents at home, introduce an unfamiliar

package of services, and attempt to emphasize the importance of participating without alarming

the parents or undermining their sense of competence in managing their children.11 As a result,

there are poor participation rates and selection bias, which severely compromise the

generalizability of the outcomes.

The next challenge that will be discussed is funding and cost-effectiveness. Funding is

very scarce when it comes to implementing prevention programs in general. For example, when

it comes to in-home support services, these strategies are effective, but they cost extra money.

Since there have many researchers to implement

ineffective programs, the federal funding has been cut

for all programs. Therefore, researchers now have to

have a full layout of the effectiveness in order to

receive the money they need to implement these

practices or strategies. In addition, cost-effectiveness is an important part of implementing a

prevention program. In order for the federal government to want to give researchers the money

for prevention programs, there has to be a legitimate effort made to reduce the costs of the

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

program. Furthermore, cost-effective research can demonstrate to healthcare insurers and policy

makers which treatments are viable options for transfer implementation.22

The last main barrier that pertains to family-based substance abuse prevention programs

is cultural sensitivity or cultural appropriateness. It is very important that if a program is going to

be including many races and ethnic backgrounds in its target group that the program itself needs

to be sensitive to the different cultures that will be involved. Good examples of a culturally

sensitive or culturally appropriate program are the Strengthening Families Program or the Safe

Haven Program. Both of these programs are modified in order to make the program more

relatable to the cultures of the participants. The simple fact that a program is culturally

appropriate has the potential of increasing the effectiveness of the intervention because it

integrates the clients’ unique cultural assets.17 This is can help with recruitment issues as well

because if the participants feel more comfortable with the intervention, they are more willing to

participate and stay in the intervention.

Conclusions and Recommendations

Conclusion

In conclusion, the most effective programs in family-based substance abuse prevention

programs are the ones that include the most components as long as the components work well

together and they are well implemented together. From the presentation of principle findings, it

was found that the most effective programs are the ones that include parent training, child

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

training, and family skills training. The parent training component addresses the risk factors and

issues that deal with the parent while the child training component deals with the risk factors and

problems that pertain to the child. The family skills training component brings it all together by

concentrating on the whole family as a unit. It also reiterates the skills taught in the parent and

child training components in a sense that all the skills are overlapped and reiterated, which can

help the practicing of these skills. With the inclusion of interactive teaching methods, these skills

are further practiced and internalized, raising the effectiveness of the program.

Moreover, universal and selective forms of programs are the most effective in situations

where the program is trying to cover the most or the most common risk factors and therefore

covering all possibilities as to why there are problems within the family unit. However,

indicative forms of programs can be just as effective in other situations where the program is

trying to target a specific problem and the risk factors associated with that problem. Also, in

reference to cultural sensitivity, indicative is the more effective form of prevention programs

because it is targeting very specific risk factors or problems. When trying to address specific risk

factors or problems with certain ethnicities or cultures, it gets very straight to the point and could

really be helpful in the staff-participant relationship due to the staff’s knowledge of the problems

associated with these types of programs.

Recommendations

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

In regards to recommendations, it is generally suggested evaluations be done in order to

determine cost-effectiveness, which could help prove that these programs should be

implemented. There has to be a full layout of the effectiveness of these programs as well because

of funding issues for these programs due to researchers continuing to implement programs that

are ineffective. Also, the staff should be competent and have the professional experience needed

in order to interact with participants and their families. This is especially true in the recruitment

process as well as when implementing culturally appropriate programs. If the staff are not

competent, it can have a negative effect and cause participants to not want to participate because

they may feel as if the staff truly don’t care about their problems and are only out to complete

another study.

In the recruitment process, there are many strategies that have been recommended in

order to recruit families effectively. First, the program needs to have and maintain a close

working relationship with a well-known local community leaders and organizations. This gives

the program a higher degree of community visibility and acceptability. Next, acceptability can be

enhanced when there are featured components that are culturally sensitive or appropriate,

especially when the staff has ties with the community, such as former participants or other

parents to advocate for the program. Again, the prevention program staff needs to be properly

and efficiently trained, especially in the task of recruiting participants. Lastly, those who

participate could be given incentives to increase participation rates as well as help those who

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

really need that extra help, particularly when these programs are asking the participants for their

precious time.

In regards to cultural sensitivity or cultural appropriateness, having the staff educated on

the issues currently occurring in the community as well as those that have been constant is a

good way to create a positive, trusting relationship between the staff and the participants. The

staff should be educated on the participants’ cultures as well, in a sense that they will be sensitive

to what these people go through, be knowledgeable about each cultures’ ways of thinking, and

each cultures’ way of interacting with their families. The training needs to be extensive and the

staff should have to prove their competence in this area, maybe by taking a test or assessment

before being able to move forward.

Action Strategy

From the research in this study, it has been found that the more components included in a

program, the more effective the program will be as long as they are implemented well together.

Therefore, when it comes to family-based substance abuse prevention programs, the best strategy

to use is the grouping of parent training, child training, and family skills training. These need to

reinforce each other’s teachings and need to have interactive teaching methods. By doing this, it

causes the teachings to be more internalized and the parent, child, and possibly other family

members can practice these skills together. Also, there needs to be theories in which these skill

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

trainings are based on, because it has been proven that substance abuse prevention programs in

the family-based domain are more effective when theories are used as a foundation.

Program Design

The main goal of the program should be to reduce or prevent any and all forms of

substance abuse among children or adolescents. Other goals include increasing positive family

functioning; increasing positive parent and child interactions; increasing positive behavior of the

child at home and at school; to strengthen the bonds between the family, the community, the

school; to facilitate participant development of skills; and increasing the knowledge about

substance abuse and its effects on the individual as well as the whole family as a unit.14 These all

come from parent training, child training, and family skills training strategies and will hopefully

enforce or increase the effectiveness of these protective factors. There should be a number of

theories as the foundation of these objectives and to serve as a basis of how to approach the

different risk factors associated with the targeted problem.

There should be sufficient dosage of the program, specifically between eleven to twenty

sessions due to the program specifically covering certain risk factors of substance abuse.14 In

addition, the structure of the program needs to be organized and constructed professionally. The

specific tasks or skills to be taught should match the specific needs of the families, in which only

certain skills will be taught to those dealing with those types of problems. When providing these

skills trainings, there needs to an incorporation of information on school support and

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

participation.8 In addition, information about substance abuse as far as an educational stance

should be used so the participants are knowledgeable about the dangers and consequences of

substance abuse. There should be sufficient training for the implementers as well. For example,

the staff should be taught how to reward appropriate behavior because it helps to foster the

participants’ positive behavior.

The program must be implemented during a transition, such as when an adolescent is

going from elementary school to middle school, or when an adolescent is going from middle

school to high school. The program has to be age appropriate, in which if the program is

preventative, the age of the participants should be elementary school age, while if the program is

an intervention, the age of the participants should be middle to high school age.14 Furthermore,

when addressing school, the target should be to improve academic and social-emotional learning

for elementary school age children, in which the skills to be taught include self-control,

emotional awareness, communication, and social problem solving.12 For middle and high school

age adolescents, the target should be to increase academic and social competence, in which the

skills to be taught are good study habits, communication, peer relationships, self-efficacy and

assertiveness, drug resistance skills, reinforcement of anti-drug attitudes, and the strengthening

of personal commitments against drug abuse.12

Visual materials should be used, as well as interactive teaching methods. These include

video-based teachings, peer discussion groups, parent role playing, and modeling because these

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

allow for active involvement in learning about drug abuse and for the reinforcement of the

skills.12 These materials need to be appropriate for the different cultures that could be included in

the target population. Fidelity should also be addressed to avoid any skewed data and

assumptions about the results.

Program Plan

First, once the recruitment process has been done, the staff and the participants should get

together and do a number of family activities to gain the trust of the participants. By doing this,

they gain the trust needed as well as get to know the participants and come to understand what

they face on a day to day basis. This will also avoid any confusion when it comes to the subject

of confidentiality because not only do the participants trust the staff to keep their information a

secret, but there will also be a showing of how the process works when it comes to surveys and

evaluation methods of these surveys.

When the sessions start, the parents and the children should be separated for their own

skill trainings. When these sessions are done, the parents and the children will come back

together to practice these newly learned skills, to learn about how this can improve their

interactions with each other, and how this can help with the reduction or prevention of substance

abuse. At the end of each session, there is a full group discussion where the video-based method

would be used, and homework will be assigned to encourage engagement. The homework will

require the child and the parent to work together in order for it to be completed correctly. There

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

will also be sharing sessions where the parents and the children can give examples of how they

handled a situation based on what they learned. These sessions will continue until the tenth

session, and then take a week break in order to see if the families will continue to use these

skills. When the week break is over, the sessions will continue until the twentieth and last

session. During this last session, there will be a full review of what has been learned throughout

the program, and there will be a presentation of other support services within the community that

the families have access to after the program is completed.

Evaluation Component/Design

Evaluation methods have constantly been a problem in the domain of family-based

substance abuse prevention programs. Along with this, there has been a continuous effort to try

to enhance or improve evaluation methods in order to truly prove that the programs being

examined are effective in what they are trying to accomplish. It has been found that scientific

and planned designs have shown more control over the events, in which evaluation is easier

because there are not as many influential outside factors. Through current research, state of the

art program evaluations for substance abuse prevention efforts have been proven to be process

evaluations, outcome evaluations, and impact evaluations. In this ideal layout of a program, all

three will be used, as well a group of evaluators to complete the task.

A process evaluation is the focus on the quality and extent of the implementation and

degree to which risk and protective factors or targeted mediators are changed.10 An outcome

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

evaluation is the focus on the extent to which changes in substance abuse have been reduced.10

An impact evaluation is the focus on the extent to which consequences related to substance use

and abuse have been reduced.10 All three would be essential in proving the overall effectiveness

of a family-based substance abuse prevention program because when all three are put together,

they concentrate on all of the important elements to be tested. Goals of these evaluation methods

need to be organized in the manner of a logic model so the relationship between process

components can be diagramed in relation to outcomes and impacts.10

Each of these evaluations have certain goals. Process evaluation goals deal with program

delivery of how and when they are delivered, whether or not the program was adapted to local

circumstances, fidelity, which will be further discussed later on in this section, policy analysis,

and intervention improvement evaluations if needed.10 Outcome evaluation goals deal with the

program intervention itself, suppressing behavior, and keeping it from occurring.10 Impact

evaluation goals deal with documenting the impact that policies will have on a population due to

the restriction of laws and policies.10 These types of evaluations usually take advantage of

existing official data, which can actually be helpful.

In the process of implementing a program, when distinguishing comparison and control

groups, it should be highly randomized or it should use a quasi-experimental design. Afterwards,

when the program is collecting data, certain other standardized evaluation methods should be

used in order to collect the data and the impacts shown from each data set. These include

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

baseline data collection, pretest data collection, posttest data collection, follow-up data

collection, and sometimes booster sessions. In the event of a booster session or follow-up for this

program, it will increase the effectiveness of the outcomes and impacts. Every program should

have an evaluation done for each data set in order to measure impacts that happened in between

these survey like data collections. Therefore, this program will have evaluations done for each

level of data collection.

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1203-1209. 20 Lochman, J. E., & Steenhoven, A. V. (2002). Family-Based Approaches to Substance Abuse Prevention. The Journal of Primary

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