A Systematic Review of Family-Based Interventions Targeting Alcohol Misuse and Their Potential to Reduce Alcohol-Related Harm in Indigenous Communities

Abstract

Alcohol misuse is a major risk factor for harm in indigenous communities. The indigenous family unit is often the setting for, and is most adversely affected by, alcohol-related harm. Therefore, family-based alcohol interventions offer great potential to reduce alcohol-related harm in indigenous communities. This systematic review aims to identify peer-reviewed published evaluations of familybased alcohol interventions, critique the methodological quality of those studies, describe their intervention characteristics, and identify which interventions appear most promising to reduce alcohol-related harm in indigenous communities. Method: Eleven electronic databases were searched. The reference lists of reviews of family-based approaches focused on alcohol interventions were hand-searched for additional relevant studies not identifi ed by the electronic database search. Results: Initially, 1,369 studies were identifi ed, of which 21% (n = 142) were classifi ed as intervention studies. Nineteen intervention studies were family-based alcohol interventions. Eleven of these studies included family members in the treatment of problem drinkers, and eight studies specifi cally targeted family members of problem drinkers. Methodological quality of studies varied, particularly in relation to study design, including confounding variables in the analyses, and follow-up rates. Conclusions: The evidence for the effectiveness of family-based alcohol interventions is less than optimal, although the reviewed studies did show improved outcomes. Given the important role of family in indigenous communities, there is merit in exploring family-based approaches to reduce alcohol-related harms. Tailored family-based approaches should be developed that include direct consultation with targeted indigenous communities.

Does Indigenous health research have impact? A systematic review of reviews

“…In some reviews, grey literature was not included but listed as a limitation [18, 19] or was excluded but not justified [20]. In only three reviews, it could not be ascertained whether authors included any grey literature at all [14, 21, 22]. Most studies (70%) appraised the scientific quality and successfully incorporated the results of the analysis in the conclusions to the review.…”

“…Most reviews (40%) failed to explain the method utilised to combine the findings of primary studies. In some cases, reviews did not provide the method, but acknowledged as a limitation that, for example, meta-analysis as a form of synthesis, was improper to apply due to the heterogeneity [18, 21, 26, 27]. The majority of reviews did not address the domain “Publication bias” or addressed it partially.…”

A Decision Model for Targeting Social Welfare Services: A Case Study of Intensive Customer Support

“…Krishna (2007) suggests that efforts should target the mechanisms via which people slide into, or escape from, poverty. For example, targeting dangerous consumption of alcohol can be an effective means of preventing people from falling into, or staying within, a poverty trap (Smith, 1982;Calabria et al, 2012). This is something that can be achieved for an entire nation without any geographic focus via mechanisms such as tax disincentives.…”

Tailoring a family-based alcohol intervention for Aboriginal Australians, and the experiences and perceptions of health care providers trained in its delivery

“…Approaches that simultaneously target individuals and families at-risk of alcohol-related harm are likely to be acceptable to, and feasible for, delivery to Aboriginal Australians [3], given that positive interaction with family members influences behavioural change in Aboriginal Australians [4], and family relationships are fundamental to the cohesion and wellbeing of Indigenous communities [4,5]. …”

“…CRA aims to reduce alcohol consumption by using social, recreational, family and vocational reinforcers to motivate people towards making their non-drinking lifestyle more rewarding than drinking alcohol. Community Reinforcement and Family Training (CRAFT) [8] is a family-based intervention modelled on CRA and has been identified as an effective cognitive-behavioural intervention with potential to be tailored, in collaboration with locally targeted Aboriginal communities, for delivery in Aboriginal-specific health care settings [3]. CRAFT provides structured, personalised training and support to a family member of a problem drinker.…”