Family-involved alcoholism treatment. An update.

We reviewed 36 randomized studies of family-involved treatment and comparison conditions. A meta-analysis showed a medium effect size favoring family-involved treatments, over individual treatment or wait-list, for outcomes of alcohol use, treatment entry/attendance, and family adjustment. Studies of family-involved treatment when the alcoholic is unwilling to seek help show: (1) Al-Anon facilitation and referral help family members cope better; (2) the popular Johnson intervention apparently does not effectively promote treatment entry; and (3) Community Reinforcement and Family Training promotes treatment entry and should be disseminated if replicated. Studies of family-involved treatment to aid recovery when the alcoholic has sought help show: (1) evidence supporting behavioral couples therapy (BCT) has grown considerably; (2) the disulfiram contract procedure should be disseminated as part of a BCT treatment package; and (3) studies of family systems and of family disease approaches are beginning to appear in the literature. Future studies need to include more women and minority patients and focus on children.