Abstract
Background
Intergenerational transmission of substance use disorders (SUDs) is shaped by complex processes embedded in family dynamics and adversity. Few interventions explicitly target these systemic mechanisms. This study reconstructs and tests the program theory of A Family Affair! (AFA), a practitioner developed group-based systemic intervention addressing family functioning to prevent SUD related suffering.
Methods
A two-phase theory-based evaluation was conducted in France. Phase one included program documents (n = 57), interviews (n = 28) and four focus groups. Phase two comprised interviews (n = 9), facilitator data and logbooks, a pilot three-wave quantitative study (n = 17) assessing family relationships and psychological well-being. Thematic analysis and statistics were combined to test the program theory.
Findings
AFA targets rigid family patterns and low differentiation of self through experiential group activities. It operates via cognitive shifts, including family systems awareness and reframing of family history, leading to changes such as emotional distance and agency, and improved family communication and parenting. SUDs are addressed indirectly as a manifestation of relational dysfunction. Reported changes were consistent across participants, with indications of wider family effects. Recruitment was diverse but socioeconomic status was above the general population. Implementation analysis highlights key conditions including group size, attendance, adaptations, attrition, and engagement in home tasks. Quantitative results show a significant increase in family cohesion and communication, with no change in overall psychological well-being. Our qualitative interviews point to a latency of effect on well-being.
Conclusions
AFA is an innovative systemic approach shifting SUD prevention from individual behaviors to family processes. Our study contributes to theory-driven family interventions and provides insights into implementation and early effects.
Key messages
• Targeting family dynamics is key for effective prevention of substance use disorders, as relational processes shape intergenerational risk.
• AFA targets dysfunctional family dynamics through cognitive shifts, improving communication and cohesion, with indirect effects on substance use disorders.