ABSTRACT

Alcoholism is a family illness that requires treatment of the whole family, because recovery after rehabilitation seems mostly achievable when both the individual and their family are involved in relapse prevention. While studies  have demonstrated that family plays an important role from diagnosis to treatment of alcoholism, few studies have focused on the interpersonal dynamics of family members  which  would maintain the alcoholic behaviours and lead to relapse. Such interpersonal dynamics would include the family emotional expression (EE) and how it may  relate to relapse. In this study, the relationship between family EE (characterized by hostility, criticism and emotional over-involvement) and the occurrence of relapse  in alcoholism was examined. The Family Systems Theory informed the current  study in helping understand the complex dynamics of interactions of family members and how such interactions maintained maladaptive behaviours such as alcoholism. Samples were derived from populations of  inpatient  alcoholics (N=186) and their family members (N=135) in Nairobi County, Kenya. The instruments used in the study were the Alcohol Use Disorders Identification Test (AUDIT) to assess for alcoholism. The  Family Member Attitude Scale  (FMAS)  and the Individual Attitude Perception Scale (IAPS) were used for assessing family EE. In addition, individual interview schedules were developed to assess how both the alcoholic and family members perceived family EE and how this may have contributed to relapse. Pearson correlations were used to test the relationship between the dependent variable (relapse) and the independent variables (hostility, criticism, and emotional over-involvement). Regression analyses were used to  clarify the nature of the relationship of the variables, and to assess the statistical significance using the Statistical Package for the Social Sciences (SPSS). The study found out that EE was statistically significant at p=0.000<0.05 and had a predictive power of 34%. While hostility was found to have an inverse relationship  with relapse (β=-.133), criticism was found to predict relapse at 28.2% and over- involvement at 47.1%. This could mean that EOI was the major EE predictor variable for relapse among recovering alcoholics. The EE/relapse association was also evidenced by interviews by the participants. It was concluded that high levels  of family EE were a contributing factor to returning to heavy drinking after  treatment of an alcoholic.

CHAPTER ONE INTRODUCTION

• Background to the Study

The development of relapse in alcohol addiction is dependent upon many factors, some found within the individual and others found within the  social  milieu  in which the individual lives. Treatment of addictive disorders in the recent years has focused on relapse prevention as an important component in recovery from such addictions (Marlatt, Parks & Witkiewitz, 2002). Although some studies on relapse prevention focus on the individual factors (Witkiewitz & Marlatt, 2004), most studies have recognized that the social context in which the alcoholic lives is very significant to whether they remain abstinent from alcohol drinking or relapse after treatment (e.g. Copello, Velleman & Templeton, 2005; Saatcioglu, Erim  &  Cakmak, 2006). Proponents of the role of the social environment on relapse have revealed that the family context in which an alcoholic lives might be the main contributing factor to relapse (Saatcioglu et al., 2006). A supportive family is considered the strongest source of identity and social support among all contextual relationships (Beattie, 2001) and hence associated with better prognosis and successful reduction of drug use during treatment. Social support in alcoholic families is the encouragement provided by close members of the family to help in dealing with a problem such as alcoholism. Arguments for the role of family on alcohol abstinence maintenance or relapse have contributed to a high impetus in

expansion of the scope of effectiveness in alcohol treatment to include the alcohol- using individual’s family (Copello et al., 2005).

Substance abuse and alcoholism are seen as symptoms of a dysfunctional family system, and hence the family is considered as part of the solution to the relapse problem without which the individual would relapse (Pierce, Frone,  Russell, Cooper, & Mudar, 2000). There is strong evidence to support the effectiveness of family interventions in treatment of alcoholism, which demonstrates that family therapy for alcoholics is effective in improving overall family relationships and functioning, and which in turn improves overall substance use outcomes, engagement, and retention in therapy (Saatcioglu, et al., 2006). Family treatment also brings about marital satisfaction for alcoholics, improve communication, and improve positive couple functioning which in turn improve prognosis (Antoine, Christophe, & Nandrino, 2009). Family members’ involvement in therapy has a great influence on the individual alcoholic’s motivation to change and maintain abstinence (Templeton, Velleman, & Russell, 2010). While involved in a treatment program, family members are a rich source of information about the real life interactions and experiences of the addict that may have a contribution to effective treatment planning and relapse prevention (Saatcioglu, et al., 2006).

Although better outcomes and compliance for alcoholism treatment are seen  as more effective when approached from the family intervention approach rather than treatment of the individual alcoholic, there is need to look more deeply at

interpersonal dynamics within the family that may enhance relapse. This is especially because despite the effectiveness of family therapy for alcoholic patients, the impression given in many parts of the world is that relapse rates in addiction are still very high and addictions have continued to plague many drug users. For instance the National Survey on Drug Use and Health (NSDUH, 2006)  gives  relapse rates at 50%-90% in America. And although reports on alcoholism in England and Africa in general are committed to giving a broad picture on health issues relating to alcohol, there is an underlying impression that relapse rates are still high in these areas.  In Kenya the National Campaign Against Drug Abuse Authority (NACADA) has given the impression that relapse rates are very high, however it is more committed at providing statistics of areas dominated by drug use and the drug of choice (DOC) in such areas (NACADA 2011). Some available data for four outpatient rehabilitation programs in Kenya from 2007 to the first quarter of 2010 estimated  the overall abstinence rates for three drugs: cannabis, alcohol, and heroine as 42%, while that for alcohol and cannabis alone was 46% of users (Deveau,  Tengia, Mutua, Njoroge, Dajoh, & Singer, 2010). However, there are no reports on alcohol relapse on its own both regionally or in Kenya.