thebraultlab@gmail.com - Data & Sources

thebraultlab@gmail.com

Interesting Data

Consider - Question - Analyze

-Close to 50% of adults in the U.S. have a family member with an addiction

-Family influence is critical to recovery, yet most U.S. treatment programs ignore it: fewer than 25% conduct formal family assessments, and only 9% provide evidence-based family interventions

-Multiple studies show and support that enabling and codependent behavior often fuels drug addiction (giving money, concealing harm, housing, etc.)

-Well over 80% of people with a substance addiction relapse within one year and close to 70% are readmitted to same program with same protocol

-Multiple studies address and conclude that family system stress predicts relapse better than clinical factors...and family conflict can increase relapse by at least 70%

-Codependency is measurable, harmful, and clinically relevant - but rarely addressed...though, multiple studies addressing codependency note that overinvolvement and the emotional fusion between addict and family/friend correlates to early drop out of treatment among addicts

-Addiction intergenerational harm is massive and understudied. Children of parents with an addiction are:

• 4× more likely to develop addiction

• 2–3× more likely to attempt suicide

• 3× more likely to develop depression/anxiety

-Addiction is not just neurobiology - it can stem from and involve environmental, family, and system-level pressure...the majority of addiction risk is environmental.

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Information listed above, other supporting studies, and literature to reference are located below

Sources - Support - References

Treatment Failure, Relapse, & Readmission

Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28(Suppl. 1), S51–S62. https://doi.org/10.1016/j.jsat.2004.10.013

Hser, Y.-I., Mooney, L. J., Saxon, A. J., Miotto, K., Bell, D. S., & Zhu, Y. (2017). High mortality among patients with opioid use disorder in a large healthcare system. Journal of Addiction Medicine, 11(4), 315–319. https://doi.org/10.1097/ADM.0000000000000312

McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695. https://doi.org/10.1001/jama.284.13.1689

Moos, R. H. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222. https://doi.org/10.1111/j.1360-0443.2006.01310.x

Strang, J., Volkow, N. D., Degenhardt, L., Hickman, M., Johnson, K., Koob, G. F., Marshall, B. D. L., Tyndall, M., & Walsh, S. L. (2020). Opioid use disorder. Nature Reviews Disease Primers, 6, Article 3. https://doi.org/10.1038/s41572-019-0137-5

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224–235. https://doi.org/10.1037/0003-066X.59.4.224

Family Burden & System Impact

Bloomfield, K., Jensen, H. A. R., & Ekholm, O. (2019). Alcohol’s harms to others: The self-rated health of those with a heavy drinker in their lives. European Journal of Public Health, 29(6), 1130–1135. https://doi.org/10.1093/eurpub/ckz092

Copello, A., Templeton, L., & Powell, J. (2010). The impact of addiction on the family: Estimates of prevalence and costs. Drugs: Education, Prevention and Policy, 17(Suppl. 1), 63–74. https://doi.org/10.3109/09687637.2010.514798

Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010). Family members affected by a close relative’s addiction: The stress-strain-coping-support model. Drugs: Education, Prevention and Policy, 17(Suppl. 1), 36–43. https://doi.org/10.3109/09687637.2010.514801

Templeton, L., Ford, A., McKell, J., Valentine, C., Walter, T., Velleman, R., Bauld, L., Hay, G., & Hollywood, J. (2016). Bereavement through substance use: Findings from an interview study with adults in England and Scotland. Addiction Research & Theory, 24(5), 341–354. https://doi.org/10.3109/16066359.2016.1153632

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol Series No. 39). U.S. Department of Health and Human Services.

Enabling, Codependency, & Harmful Helping

Dear, G. E., Roberts, C. M., & Lange, L. (2004). Defining codependency: A thematic analysis of published definitions. In S. P. Shohov (Ed.), Advances in psychology research (Vol. 34, pp. 189–205). Nova Science Publishers.

Marks, A. D. G., Blore, R. L., Hine, D. W., & Dear, G. E. (2012). Development and validation of a revised measure of codependency. Australian Journal of Psychology, 64(3), 119–127. https://doi.org/10.1111/j.1742-9536.2011.00034.x

Meyers, R. J., Miller, W. R., Hill, D. E., & Tonigan, J. S. (1998). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10(3), 291–308. https://doi.org/10.1016/S0899-3289(99)00003-6

Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010). Family members affected by a close relative’s addiction: The stress-strain-coping-support model. Drugs: Education, Prevention and Policy, 17(Suppl. 1), 36–43. https://doi.org/10.3109/09687637.2010.514801

Sarkar, S., Mattoo, S. K., Basu, D., & Gupta, J. (2015). Codependence in spouses of alcohol and opioid dependent men. International Journal of Culture and Mental Health, 8(1), 13–21. https://doi.org/10.1080/17542863.2013.868502

Family Conflict & Relapse

Copello, A. G., Velleman, R. D. B., & Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 24(4), 369–385. https://doi.org/10.1080/09595230500302356

Fals-Stewart, W., O’Farrell, T. J., & Birchler, G. R. (2004). Behavioral couples therapy for substance abuse: Rationale, methods, and findings. Science & Practice Perspectives, 2(2), 30–41. https://doi.org/10.1151/spp042230

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012

Moos, R. H. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222. https://doi.org/10.1111/j.1360-0443.2006.01310.x

O’Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment, 18(1), 51–54. https://doi.org/10.1016/S0740-5472(99)00026-4

Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59–81. https://doi.org/10.1111/j.1752-0606.2011.00280.x

Codependency & Treatment Outcomes

Bortolon, C. B., Moreira, T. C., Signor, L., Guahyba, B. L., Figueiró, L. R., Ferigolo, M., & Barros, H. M. T. (2017). Six-month outcomes of a randomized, motivational tele-intervention for change in the codependent behavior of family members of drug users. Substance Use & Misuse, 52(2), 164–174. https://doi.org/10.1080/10826084.2016.1223134

Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., Moore, L., MacLeod, J., & Godfrey, C. (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: A randomized trial. Addiction, 104(1), 49–58. https://doi.org/10.1111/j.1360-0443.2008.02417.x

Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-Step Method: Evidence of gains for affected family members. Drugs: Education, Prevention and Policy, 17(Suppl. 1), 100–112. https://doi.org/10.3109/09687637.2010.514234

Marks, A. D. G., Blore, R. L., Hine, D. W., & Dear, G. E. (2012). Development and validation of a revised measure of codependency. Australian Journal of Psychology, 64(3), 119–127. https://doi.org/10.1111/j.1742-9536.2011.00034.x

Sarkar, S., Mattoo, S. K., Basu, D., & Gupta, J. (2015). Codependence in spouses of alcohol and opioid dependent men. International Journal of Culture and Mental Health, 8(1), 13–21. https://doi.org/10.1080/17542863.2013.868502

Systemic Gaps in Treatment

Copello, A. G., Velleman, R. D. B., & Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 24(4), 369–385. https://doi.org/10.1080/09595230500302356

Orford, J., Templeton, L., Copello, A., Velleman, R., Ibanga, A., & Binnie, C. (2009). Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agencies. Drugs: Education, Prevention and Policy, 16(5), 379–408. https://doi.org/10.1080/09687630802258553

Orford, J., Templeton, L., Copello, A., Velleman, R., & Ibanga, A. (2010). Working with teams and organizations to help them involve family members. Drugs: Education, Prevention and Policy, 17(Suppl. 1), 154–164. https://doi.org/10.3109/09687637.2010.514807

Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59–81. https://doi.org/10.1111/j.1752-0606.2011.00280.x

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol Series No. 39). U.S. Department of Health and Human Services.

Children of Addicted Parents

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4

Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64–105. https://doi.org/10.1037/0033-2909.112.1.64

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol Series No. 39). U.S. Department of Health and Human Services.

Environmental & Systemic Predictors of Addiction

Galea, S., Nandi, A., & Vlahov, D. (2004). The social epidemiology of substance use. Epidemiologic Reviews, 26(1), 36–52. https://doi.org/10.1093/epirev/mxh007

Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64–105. https://doi.org/10.1037/0033-2909.112.1.64

Kendler, K. S., Gardner, C. O., & Prescott, C. A. (2011). Toward a comprehensive developmental model for alcohol use disorders in men. Twin Research and Human Genetics, 14(1), 1–15. https://doi.org/10.1375/twin.14.1.1

McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695. https://doi.org/10.1001/jama.284.13.1689

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480

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