A randomized controlled trial of support programs for parents of treatment-refusing substance using young adults
Background: The use of alcohol and illicit substances is responsible for a large part of the burden of disease amongst young adults in the industrialized countries. Despite this, a majority of young adults never seek treatment for their hazardous substance use, resulting in adverse consequences in the short and long term. Bridging this treatment gap may be achievable through effective prevention interventions, encouraging more youths to seek treatment. Such interventions could specifically target parents of young adults struggling with substance use, a group of parents often experiencing compromised quality of life and mental health due to strains stemming from their young adult children’s substance use. This trial aimed to compare the efficacy of Community Reinforcement and Family Training (CRAFT) with manualized counseling for parents of young adults exhibiting problematic substance use but refusing treatment.
Methods: A randomized controlled trial compared the efficacy of CRAFT (8 individual manual-based sessions) for parents of young adults (18-24 years old) (N=58), to an active control group (N=57) receiving manual-based counselling (5 individual sessions). The study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video-conference due to COVID-19. Assessment of outcomes was conducted at baseline, 6, 12 and 24 weeks. Primary outcome was the young adult's initiation of treatment. Secondary outcomes included young adult substance use, parental mental health, relationship satisfaction, quality of life and parental self-efficacy.
Results: At the 24 weeks follow-up, 33% of CRAFT participants and 31% of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Significant reductions in young adult alcohol- and substance use were reported by parents in both conditions between baseline and 24-weeks follow-up. Parents in both conditions also reported increased relational happiness with the young adult and parental self-efficacy. No change in parental depression, anxiety or stress was found, but baseline levels were sub-clinical.
Conclusions: This trial could not establish evidence supporting CRAFT's superiority over manualized counseling in prompting treatment-seeking among young adults with hazardous substance use. The findings suggest that both CRAFT and manualized counseling contribute to increased treatment-seeking among young adults, reduced substance use, improved parent-young adult relationship and improved parental self-efficacy, but the lack of an untreated control group limits inferences regarding the interventions’ potential effectiveness. These results advocate for the implementation of supportive interventions for parents of treatment-refusing young adults.
Results from the trial have recently been published in Addiction: https://doi.org/10.1111/add.16429
