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Drug use, as a global public health concern, poses prolonged physical and psychosocial threats for not only those using drugs but also their families. Existing literature suggests that family members play a crucial role in maintaining abstinence from drugs and their involvement in intervention enhances overall family functioning. Yet, the mechanism through which such changes occur remains unclear. To address this issue, this study draws upon the Family System Theory and McMaster Family Functioning Model to examine the efficacy of family-based intervention for drug-using adults in Hong Kong using a quasi-experimental trial. The theory of change for the family-based intervention is defined as having four components, i.e., engagement, family roles, competency, and affection, thereby improving the family functioning of drug users, leading to strong motivation to remain abstinence.
Methods
Collaborated with a local social service provider, the authors recruited 82 drug users aged 18-55 years and allocated them to either an intervention group (N=41) that received both family-based intervention and routine care or a comparison group (N=41) that received routine care only. Both groups were assessed at three time points, i.e., pre-intervention (T0), post-intervention (T1), and one-month follow-up (T2) after post-intervention. The primary outcomes were the frequency of drug use and cravings for drugs, while the secondary outcomes included mental health, marital affection, marital satisfaction, family communication, family functioning, parenting competence, and co-dependency. The trial was registered with ClinicalTrials.gov (NCT04725266) and the steps strictly followed the CONSORT flow to prevent the study design from confounding treatment effects with extraneous differences.
Results
After applying intent-to-treat analysis and EM imputation to manage missing values, propensity score matching was performed, resulting in a final dataset consisting of 31 drug users in each group evaluated at three time points. Second, T-test and Chi-square tests were applied to ensure that there was no significant difference in descriptive statistics of demographic and baseline characteristics between the intervention and comparison groups. Third, a repeated measured ANOVA with a Greenhouse-Geisser correction (including over-time × group interactions) determined that compared to the comparison group, drug users in the intervention group had a significant decrease in the frequency of drug use (Cohen’s d = 0.448, p < 0.05) and a significant improvement in mental health (Cohen’s d = 0.707, p < 0.001) across the three time points. Finally, a mediation analysis was conducted, indicating that the change in parenting sense of competency at T1 completely mediated the effects of the intervention on the change in cravings for drugs at T2 (std. β = -0.20; p < 0.05).
Conclusions and Implications
The empirical evidence presented in this study provides substantial support that drug use could be significantly improved by being more competent in role-taking as parents. This is one of the core components of the theory of change underlying family-based interventions for drug abstinence. These findings have significant implications for enhancing the design of future family-based interventions offered by social work service providers.