Family Factors

Patients should be encouraged to explore relevant family issues during assessment. Such issues may include relationships with their spouse or partner, their parents, their children, and other significant people in their lives, and attributions about the effects of the patient’s drinking. 

Domestic violence and sexual abuse, either as perpetrator or victim, are common and serious problems associated with alcohol and other substance use. Because of the sensitivity of these issues, it may not be appropriate to raise them in the first contact session unless the clinician believes there may be a current safety risk. It is important to determine whether the patient wishes to discuss these issues. Specialist assessment and intervention is typically needed. 

Enquire into the family’s role in convincing the patient to seek help. A patient who is self- referred may be responding to family pressure and this is important information when assessing the patient’s motivations and ambivalence. When it is possible the clinician should interview the spouse and/or family members. The interview should provide family members with the opportunity to discuss: 

• • • Their observations about the behaviour of the person who drinks. 

    • The problems they have had in coping with the drinking behaviour. The clinician will need to evaluate the levels of distress within the family, feelings of isolation and confusion, specific crises preceding help seeking, and who feels responsible for solving the family problems. 

    • Expectations family members have about treatment. If the spouse or partner is going to be involved in the alcohol treatment, the clinician needs to assess whether the couple has adequate communication to enable mutual problem solving (see Chapter 9 Psychosocial interventions for alcohol use disorder). 

    • What happens before and after drinking episodes, so particular dynamics relevant to the drinking can be identified. If the spouse’s role in therapy is aimed at selectively reinforcing certain behaviours in their partner, the clinician should be sure that does not threaten the spouse’s wellbeing by reinforcing the notion that she or he is responsible for the partner’s drinking. 

The family interview is an opportunity for family members to ask questions and to voice their concerns. It is also a good time to help the family put the drinking problem into perspective. For instance, family members should be advised that achieving abstinence or moderation does not necessarily resolve family problems, and that their personal health and wellbeing does not necessarily depend upon resolution of their family members problem with drinking. The attitude of the clinician should permit the partner to help themselves rather than feeling obligated to help the family member. 

While this kind of complex information is best obtained by clinical interview, the Alcohol Problems Questionnaire has a subscale assessing family problems and one assessing marital/ relationship problems.