Early family-based intervention in the path to alcohol problems: Rationaleand relationship between treatment process characteristics and child and parenting outcomes

Objective: Risk for subsequent development of alcohol problems is not unifo rm across the population of alcoholic families. but varies with parental co morbidity and family history. Recent studies have also identified disruptiv e child behavior problems in the preschool years as predictive of alcoholis m in adulthood. Given the quality of risk structure in highest risk familie s, prevention program ming is more appropriately Family based rather than i ndividual. Method: A family-based intervention program for the prevention o f conduct problems among preschool-age sons of alcoholic fathers was implem ented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month interven tion involving parent training and marital problem solving. The study exami ned the interplay between parent treatment investment and parent and therap ist expectations and satisfaction in predicting change in child behavior an d authoritative parenting style during the program and for 6 months afterwa rd among the 29 families whose sustained involvement allowed these effects to be evaluated. Results: parent expectations at pretreatment influenced th eir early investment in the program, which in turn predicted child and pare nting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program wou ld continue to promote changes in their child. Parent investment was a part icularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. Conclusions: Findings indicate that treatment pr ocess characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later ch ild outcomes.