Alcoholism has been a persistent problem affecting the American family, with approximations of up to 18 million Americans going through alcohol related problems (O’Farrell, et al, 2003). There are many cost effects accompanying the alcoholism problem, both physical, emotional and economic. The vastness of the costs of alcoholism cannot be over emphasized, as they affect not only the alcoholic but close family members, friends, colleagues and even the state. Statistics indicate that about 1 million adult Americans seek treatment for alcohol-related problems each year (O’Farrell, & Rotunda, 1997),
The most popular and widely used treatment method for alcohol and other substance abuse problems is group therapy as a psychotherapeutic method. The psycho-educational model of the psychotherapeutic methods is commonly employed in the treatment of alcohol dependency disorders shortly after detoxification, and is designed to run for about 8 weeks. The topics covered in the sessions include medical complications, relapse, cravings, job and social problems, and other related issues.
Other aspects that are considered important for a successful recovery process are also covered, with the intention of achieving total abstinence by the patient. Patients are also equipped with information on how to improve the quality of the life they are leading, and the relationships they have with close family members and associates. Members of a therapy group are all recovering alcoholics who have undergone detoxification.
Another popular method of treating alcohol-related disorders is by involvement of the patient’s family members or spouses through marriage and family therapy. This is with the recognition that most alcohol dependency problems are a direct result of family settings or predisposition. Research has also shown that by having close family members involved in the recovery process of a recovering dependant is an important step in the overall recovery process. Family support has been shown to contribute positively in the process of seeking treatment for alcoholism, and the achievement of abstinence for the patient (O’Farrell, & Rotunda, 1997).
The application of the two methods of treatment has produced different results, and the proposed research is intended to test the effectiveness of these methods in the treatment of alcoholism. Through the use of an experimental and control group, the researcher intends to subject the experimental group to both types of treatments, and the control group will be exposed to family and marriage therapy. The results will then be analyzed to come to a conclusion on the effectiveness of family-involved therapy in the treatment of alcoholism.
Background and significance
A large proportion of the adult American population experiences, or is coping with alcohol-related disorders. The alcoholic individual is often seen as the sole problem in this scenario, but this has been proved to be far from the truth. He/she is usually just part of a larger social problem. Alcoholism starts as a harmless social habit, often in the company of close friends and relatives. With time, it becomes uncontrolled and if one does not get sufficient social and familial support, it spirals on into a bigger problem requiring medical and psychological assistance.
Edwards & Steinglass (1995) present evidence that alcoholism development is greatly influenced by the family environment, in addition to other social factors. They argue that familial disposition is to blame for the development of alcoholism. Scientific evidence is called in to support this proposition, and they try to show a link in the genetic makeup of family members and their predisposition to developing alcohol related disorders. They claim that there is scientific proof that members of certain families are at a higher risk of developing alcoholism as a condition than other families due to a genetic condition.
Donation of the genetic makeup of an individual is not the only role played by the family in the development of alcoholism, as other factors such as the family environment and family systems have also been found to play a significant role (O’Farrell, et al, 2005). The family unit has also been shown to wield a lot of influence on the recovery process, and it is a huge contributor to the failure or success of the treatment of the alcoholic.
Rotunda & O’Farrell (1997) argue that “alcoholic” families exhibit many dysfunctional characteristics, with increased cases of divorce, separation psychological problems among them. They use this argument to advance the assertion that the family unit should be an essential part of the treatment method used to treat an alcoholic. O’Farrell, & Rotunda, (1997), O’Farrell, et al, (2005) in their writings advance the cause for family-involved therapy methods in the treatment of alcoholics.
They support their arguments with evidence from their research indicating that when a spouse or other family members are involved, there are higher probabilities that the alcoholic will accept to begin treatment, and the success rates are also higher. The conclusions they come up with are that marital and family therapy (MFT) is effective in assisting the alcoholic to seek help when he/she is unwilling, and Al-Anon facilitation is particularly pointed out as effective for this purpose. MFT also assists family members to cope better and strengthens the family bond.
MFT has been proved through research to be more effective in the treatment of alcoholism than individual therapy due to the support system that it creates. O’Farrell, et al, (2005) strongly recommend the use of Behavioral Couples Therapy (BCT) and claim that it improves relationship functioning and helps to record higher abstinence rates in treatment. Those who go through the therapy are reported to have fewer emotional and coping problems, domestic violence is markedly reduced, and their children are more emotionally stable.
Family-involved treatment methods concentrate not only on the alcoholic’s need to recover but also the family members’ coping abilities. There is a variety of models of family-involved treatment methods whose focus is mainly on the emotional wellbeing of other family members, especially a spouse with an alcoholic partner. There are two approaches where participants are taught how to deal with and react to alcohol related situations, and also how to apply the resources and concepts of Al-Anon (O’Farrell, et al, 2005).
Research conducted by Zetterlind, Rychtarik and McGillicuddy in 1998 shows that spouses who went through the coping skills therapy registered less violence in their relationships and had decreased levels of emotional instability than those who did not. However, the coping skills therapy was found to be more effective in helping families cope with the problems associated with alcoholism in the family than the Al-Anon facilitation. When Al-Anon is applied. treatment entry and change in drinking habits of the alcoholic is not achieved either.
There are many models of family-involved methods of treating an alcoholic through various forms of therapy. The popularity of these models stem from the fact that most research information shows that they are cost effective, are highly effective in the treatment of alcoholism and promote better family relations. However, most of the available information does not show exactly to what extent these methods are effective in the treatment of alcoholism, or how cost effective they are. In fact, there exists arguments that they may actually not be very cost effective.
There therefore, exists the need to find out the answers as to just how effective these methods are, and to what extent they are cost effective if in fact they are. It is also important to find out what outcome they would elicit if combined with another method of treatment, in this case the method being Psycho-educational therapy. Even with the existence of a variety of treatment methods for alcoholism the problem still persists and there is therefore, need to keep advancing through research in order to find the most effective way of treating patients with alcohol-related disorders.
If the proposed study is carried out successfully and the desired results obtained, it will help mental health practitioners to have a better and more informed understanding of how effective family-involved therapy is. By finding out the effect of combining the two methods of treatments on the effectiveness of family-involved therapy, doctors and patients will have more information that they need in deciding on the appropriate treatment method to choose.
Most researchers embark on their projects with the intention unearthing new dimensions of what is already known, coming up with a completely new invention or filling gaps in the existing information among others. As stated, it is not in contention whether or not family and marital therapy or other family-involved forms of therapies are effective, what doesnt seem to be agreed upon is the percentage or extent to which they are effective. The researcher will embark on finding this out, by the use of an experimental and control group, who will be separately exposed to the two methods of treatment that interest the him.
Research design and methods
The researcher intends to come up with generalized findings and this, therefore, calls for a representative group that is as heterogeneous as possible. This applies to all aspects of the participants’ differentiation. The sample will consist of persons from various races, social and economic background, there will be gender balance, and different age groups will also be represented. In addition to this, the participants must meet a certain criteria. They must be married, cohabiting or will make up and live together for the purpose of the study. One of the partners must have been diagnosed with an alcohol dependency problem, and if both of them have had problems with alcohol dependency, then one of them must have abstained for the past 90 days.
The selected participants will also be required to satisfy the researcher that they do not suffer from any psychotic disorder, because research shows that there is a high drug and alcohol abuse prevalence among persons with mental disorders. The requirement of gender, ethinicity and race balance is to ensure that the research findings are as generalized as possible. The sample group will be a small one, with about 30 couples participating in the study. All participants must give a warrant that they will be committed to the study to conclusion.
After identifying the participants, they will be classified into the experimental and control groups. These two groups will go through different types of therapies. The experimental group will go through both psycho-educational and marital and family therapy while the control group will only be exposed to psycho-educational therapy. They will be required to make reports on their progress by filling out forms daily and answering questions on their cravings, abstinence, social relationships, change in the family environment, among others reflecting on their everyday life. These reports will be made by both the alcoholic and spouse.
The outcome of the study will be measured according to a number of categories. These will include; satisfaction in the marriage, interaction between the spouses, drinking patterns, emotional stability and expenditure patterns. The researcher will be on the lookout for changes in the alcohol consumption patterns of the alcoholic such as the amount of alcohol consumed and number of days he/she is abstinent, Spouses feelings and emotional reactions to alcohol related situations will also be measured, to give an indication of the effectiveness of the treatment on them. There will also by physical measures such as taking urine or blood samples to give an indication of the alcohol level in the alcoholic’s body in any given time.
The researcher’s first priority will be to identify the sample group, which will be done after rigorous screening to ensure that only the desired participants make it to the final group of participants. The next step will be to prepare the group for the study, and the eventual carrying out of the study. The participants will be given the stated therapies for about 8 weeks and data collected for analysis. Follow up studies will be conducted and results analyzed so as to come up with the final conclusions.
Meta-analysis will be employed in analyzing the information collected from the study, which will be combined and compared with information from other studies. Statistical analysis will be conducted on the result findings collected from the experimental and control groups to come to a conclusion. The effects of other studies will however not be calculated, and the focus of the calculations will be on the percentage of effectiveness of treatment or abstinence achieved. To determine whether the methods studied are cost effective, the information collected from the participants on their spending patterns will be analyzed in relation to other family members and the society at large, something that has not been done in other studies, or has happened to a limited extent. This is to assist in calculating to what extent the models are cost effective
The proposed method of study may be prone to a number of problems or limitations. The first difficulty may be encountered when selecting the participants and collecting data from them. Most research projects face the problem of incorrect or biased information given and this may also affect this project. The participants may be interested in giving information biased towards a certain view and this applies to all information not capable of being scientifically verified by methods such as blood or urine samples analysis. This method may also face the limitation of lack of replication studies. The sample group may also not be considered large enough for completely representative and generalized research findings. The results obtained may not be reflective of the majority of cases involving alcoholism.
Protection of human subjects
All researchers must adhere to the stipulated research ethical standards. Research that is ethically carried out ensures that informed consent is obtained from the participants, and that the study is done in accordance with the research method proposed (CDC, 1997). This helps to assure participants of their safety and reduces the amount of risk to which they may be exposed to. care must be taken when dealing with members of the society considered to be special, such as pregnant women and children. They are considered to be vulnerable to various risks than other individuals.
The proposed study involves members of the alcoholic’s family, particularly the spouse. The suggested sample of participants does not exclude pregnant spouses, and these belong to the class of participants considered special. The accompanying emotional and physical involvement in the study may negatively affect the health of such a spouse. This risk is however, minimized and even countered by the fact that studies have shown that similar experiments have led to a more balanced emotional status and balance for the participants.
The participants are exposed to the risk of having their privacy violated through collection of information about their personal family lives. This may also happen through the unethical use of results obtained from samples of blood or urine collected from them for research purposes. Conducting the research ethically and using the information collected for the purposes stated and revealed to the participants will occasion them no such infringement on their rights. In other medical aspects though, the proposed therapy is not known to pose any health or physical risks to the participants.
The results of the study will be of importance to both the participants and the mental health fraternity at large. It will show just how effective the stated methods are effective in the treatment of alcoholism, to what extent they are cost effective, and also reveal the factors that affect their effectiveness. If positive results are recorded much benefit will go to the participants who will have undergone successful treatment for their alcoholism problems. Family-involved methods of treating alcoholism have in the past recorded positive results and this is expected to be the case in the current study.
The participants are expected to benefit from better coping strategies learnt from the therapy, increased emotional stability and improved reactions to alcohol related situations. The alcoholic participants are also expected to recover from their alcoholism if the therapy is successful, and also have better interactions with their spouses and other members of the society. Research findings show that participants who have undergone this kind of therapy have reported improved family relations which have also been beneficial to their children as a couple.
A critical look at the proposed study reveals very few risks involved, or to which the participants are exposed. The benefits of the study to the participants greatly outweigh the risks. The findings will also be beneficial to other mental health practitioners in terms of increased knowledge on the treatment of alcoholism through family-involved therapeutic methods. It will also advance the use of combinations of methods in treatment.
There is already in existence a lot of information on the treatment of alcoholism using these methods, and they are commonly used when administering group therapy to patients (Ruff S, et al, 2010). However, as pointed out earlier in the essay, the extent to which these methods are effective in treating alcoholism or the extent to which they are cost effective is not exactly clear from the existing research findings. This is the gap that the proposed research intends to fill.
Center for Disease Control and Prevention (CDC). (1997). CDC Procedures for Protection of
Human Research Participants. US Department of Human and Health Services. Retrieved from http://www.cdc.gov/od/foia/manuals/procphrp.pdf on 28th November 2011.
Edwards, M.E. & Steinglass P. (1995 ). Family Therapy Treatment 0utcomes for Alcoholism.
Journal of Marital and Family Therapy.1995, Vol. 21 issue 4.
O’Farrell, T.J. et al. (2005). Behavioral Couples Therapy for Alcoholism and Drug Abuse:
Where We’ve Been, Where We Are, and Where We’re Going. Journal of Cognitive Psychotherapy: An International Quarterly. 2005, Vol. 19 number 3.
O’Farrell, T.J. & Rotunda, J.R. (1997). Marital and Family Therapy of Alcohol Use Disorders:
Bridging the Gap Between Research and Practice. Professional Psychology: Research and Practice.1997, Vol. 28, Number. 3.
O’Farrell, et al, (2003). Alcohol Abuse. Journal of Marital and Family Therapy. 2003, Vol. 29,
Ruff, S. et al. (2010). Behavioral Couples Therapy for the Treatment of Substance Abuse: A
Substantive and Methodological Review of O’Farrell, Fals-Stewart, and Colleagues’ Program of Research. Family Process,2010. Vol.49, Number. 4.