Authors' objectives:

This systematic review evaluated the clinical and cost-effectiveness of psychological therapies such as psychotherapy and counselling where one or more family members or concerned significant others are involved in the therapy compared to any other therapy or treatment in alcohol misuse or dependence to reduce alcohol-related outcomes.

Authors' results and conclusions: There were 34 randomised controlled clinical-effectiveness trials of variable quality included, with sample sizes ranging from 12 to 742 and follow up durations of four weeks to four years. Compared to individual or group counselling or psychotherapy, therapy involving family or friends generally demonstrated better outcomes. Compared to other care they demonstrated an increase in abstinence, better relationship functioning and an increase in drinker treatment entry rates. The metaanalysis results for abstinence rates were OR 2.01, 95%CI 0.89 to 4.55, for mean abstinent or mean percentage days abstinent were SMD 0.40, 95%CI 0.24 to 0.55 and for drinker treatment entry rates were OR 5.65, 95%CI 2.79 to 11.44 in favour of therapy involving family or friends. Of the two UK cost effectiveness studies, one based on an RCT suggested littledifference in clinical effectiveness and costs between social behaviour and network therapy and individual motivational enhancement therapy. The other, based on a decision analytic model, found that family therapy was cost saving to the NHS over 20 years when compared to undefined standard care, i.e. the discounted incremental saving per additional abstinent patient was GBP2,696. In sensitivity analysis, the range varied between a saving of GBP3,886 and a cost of GBP2,091.

Authors' recommendations: The evidence suggests that therapy involving family and friends can reduce alcoholrelated outcomes and may be cost-saving to the NHS. It would be useful to know whether different forms of therapy involving family and friends are equally effective, particularly those from the different theoretical models of the family and using different psychotherapeutic approaches. More research is needed on the long-term effectiveness of different treatment strategies and their cost implications. There may need to be more specialist alcohol treatment service provision and more targeted health promotion to encourage problem drinkers to seek help.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2007/FamilyTherapy.pdf

Year Published: 2007

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham