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Family-Based Intervention Program for Parents of Substance-Abusing Youth and Adolescents

Family-Based Intervention Program for Parents of Substance-Abusing Youth and Adolescents
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  Research Article Family-Based Intervention Program for Parents of Substance-Abusing Youth and Adolescents David Bisetto Pons, 1,2 Remedios González Barrón, 1 and Álvaro Botella Guijarro 2 󰀱 Faculty of Psychology, University of Valencia, Valencia, Spain 󰀲  AEPA Foundation, Alicante, Spain Correspondence should be addressed to ´Alvaro Botella Guijarro; alvarbot@undacion-aepa.orgReceived 󰀲󰀷 April 󰀲󰀰󰀱󰀶; Revised 󰀱󰀴 August 󰀲󰀰󰀱󰀶; Accepted 󰀱󰀴 September 󰀲󰀰󰀱󰀶Academic Editor: Richard MidordCopyright © 󰀲󰀰󰀱󰀶 David Bisetto Pons et al. Tis is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the srcinal work is properly cited.Teuseodrugsamongadolescents/youthofenresultsinahighdegreeodistressortheamilymemberswholivewiththem.Tisin turn can lead to a deterioration o mental (psychological) health, hindering any attempt to successully cope with the situation.Te goal o our research was to study the effect o the Community Reinorcement and Family raining (CRAF) program onparentsoadolescents/youngadultdrugusers.Studyvolunteers(  = 50 )wereparentsromValencia(Spain)thatweredividedintotwo groups. Te experimental group (  = 25 ) was made up o parents whose sons and daughters exhibited problems with druguse and the constructed noncausal baseline group (  = 25 ) was made up o parents whose sons and daughters did not show any substance abuse problems. For both groups, sel-esteem (Rosenberg Sel-Esteem Scale), depression (BDI-II), anxiety (SAI), andanger (SAXI-II) were evaluated beore and afer the application o the CRAF program. Results show a significant improvementin the experimental group’s sel-esteem, depression, and anger state and a decrease in negative moods. Tese changes in parentsproduce a positive effect on their substance-using sons and daughters: o the 󰀲󰀵 participants, 󰀱󰀵 contacted specialized addictiontreatment resources or the first time. 1. Introduction Tere are a considerable number o studies which suggestthat parents and other relatives o adolescent/young adultsubstance users experience a high degree o distress andamily conflict that could result in a deterioration o mentalhealth [󰀱, 󰀲]. Te negative impact on the amily o adoles-cents/youth with substance use problems is comparable tothe impact on people living with an adult with the sameproblem [󰀲]. It is estimated that approximately five peopleclose to the adult substance abuser will be directly affectedby their addiction. Tis figure also holds true or amilieso adolescent/young adult substance user [󰀳]. Te adverseeffects experienced by the parents o substance users take theorm o physical, mental, and social stress which can lead todepression, somatic ailments, low sel-esteem, a high degreeoanxietyandanger,earthattheirson/daughterisindanger,despair,guilt,andpainarisingromtheeelingthattheyhaveailed as parents [󰀲, 󰀴–󰀶]. In the words o Orord et al. [󰀴],affected amily members are “ ordinary people trying to copewith highly stressful experiences .” All o these maniestationsare similar to those experienced during prolonged periodso stress or adversity, such as war, long-term unemployment,one’s own chronic illness, or the illness o a amily memberliving in the same household [󰀵].Furthermore, the importance o amily support duringtherecoveryprocessoapersonwithasubstanceabusedisor-der has been widely shown. For instance, Casas and Gossop[󰀷] suggest that amily pressure has an influence on the user’sdecision to stop using alcohol or other drugs (hereinaferAOD). Levy [󰀸], in his five-year ollow-up study o narcoticaddicts, ound that subjects who overcame addiction usually did so because amily support was part o the process.Booth et al. [󰀹] ound that amily support received by substance users during addiction treatment led to increasedsel-esteem and personal efficacy and led them to remainin treatment as a result. L´opez-orrecilla et al. [󰀱󰀰] indi-cate a greater degree o personal efficacy among substance Hindawi Publishing CorporationJournal of AddictionVolume 2016, Article ID 4320720, 8 pages  󰀲 Journal o Addictionusers whose relatives were involved in their addictiontreatment.Similarly, or adolescent/young adult substance users, anumber o authors have observed that amily support avorsthe processes o detection, prevention o problematic druguse, and probability o initiating and remaining in treatment[󰀱󰀱–󰀱󰀴]. Improvement has also been observed in individualtreatment programs, leading to ewer relapses, improvedamily relations, and a higher probability o reducing the useo AOD among substance users [󰀱󰀵]; these substance usersare also more likely to distance themselves rom settings andrelationships associated with AOD abuse behaviors [󰀱󰀶, 󰀱󰀷],helping them put an end to drug abuse [󰀱󰀸].Te ollowing data is a summary o the situation inSpain regarding the use o AOD among adolescents/youth:adolescents start using drugs between the ages o 󰀱󰀳 and󰀱󰀶 or most substances. Alcohol, tobacco, and cannabiscontinuetobethemostrequentlyuseddrugsamongSpanishadolescents/youth. It was estimated that 󰀵󰀲.󰀲% o youth agedbetween 󰀱󰀵 and 󰀲󰀴 years smoke cannabis [󰀱󰀹]. In addition,cannabisuseisthereasonor󰀹󰀳%oallrequestsortreatmentamong adolescents between 󰀱󰀴 and 󰀱󰀸 years o age; thisindicates a growing trend in the problematic or high-risk use o cannabis, which is associated with lower academicperormance [󰀱󰀹, 󰀲󰀰].As a developmental stage, adolescence/youth is markedbysignificantpsychological,physiological,andsocialchanges[󰀲󰀱]. For this reason, it is considered a stage where the youngadult is most at risk, avoring the appearance o mentaldisorders such as anxiety, impulsive and aggressive behavior,stress, and depression [󰀲󰀲–󰀲󰀴], which are associated with agreater degree o amily conflict [󰀲󰀵]. Tis is coupled with anobserved desire to experiment with substances while playingdown the danger they pose, overconfidence, and a alse senseo being in control. All o these actors increase the risk o suffering rom problems associated with the use/abuseo AOD [󰀲󰀶] and increase the chance o developing drugdependency problems in the uture [󰀲󰀷–󰀲󰀹] which may notbe seen by the substance abuser as being problematic [󰀳󰀰].In summary, studies indicate the existence o an adoles-cent/young adult population with substance use problems.Tis risky use o AOD and the circumstances that ofensurround this behavior have been shown to affect the mentalhealth o their amilies, among other reasons, because thissituation exposes amily members to a high degree o stress.Whentheyappear,theseeffectsonthementalhealthoothermembers o the amily make it more difficult or the sameamilymemberstoactappropriatelywhenitcomestodetect-ingandpreventingsubstanceuseandalsopreventthemrominitiating and remaining in an addiction treatment program.In light o these considerations, effective addiction treatmentshould include support or amily members, empoweringthem to take control o the situation wherever they can.Tere are a number o empirically validated interventionprograms which work towards improving mental distressexperienced by close relatives o adolescents/youth who aresubstance abusers [󰀱]; these include the 󰀵-Step Method [󰀳󰀱],the Adolescent ransition Program (AP) [󰀳󰀲],  BES  , and BES-Plus  [󰀳󰀳, 󰀳󰀴].Te Community Reinorcement and Family raining(CRAF) program developed by Smith and Meyers [󰀳󰀵] hasbeen ound to be effective in both adults resistant to startingtreatment[󰀳󰀶]andadolescent/youngadultsubstanceabusers[󰀳󰀷]. Tis treatment program has been ound to improve themental health o non-substance-abusing amily members by encouraging the adolescent to cease using said substances[󰀳󰀸, 󰀳󰀹]. Te CRAF program is recommended when work-ing with non-substance-abusing amily members because itincreases their sel-esteem, improves symptoms associatedwith depression and anxiety, and reduces distress and anger[󰀳󰀶, 󰀴󰀰].Te CRAF program [󰀳󰀵] is divided into two large sec-tions. Te first provides training in behavior modificationtechniques. Tis section consists o the ollowing com-ponents: strategies that encourage participants to actively engage in treatment, identification o high-risk situationsthrough a unctional analysis o the amily member’s drug-using behavior, prevention o domestic violence, trainingin positive communication skills, identification o activitieswhich reinorce positive behavior and compete with druguse, training on how to remove reinorcement o substance-abusing behavior, assistance to amily members in planningliestyle changes in those areas o their lives which they eel are unsatisactory, problem solving, and training thathelps them encourage adolescents with drug problems toenter addiction treatment program or seek out specializedassistance.Te second portion o the program ocuses on theadolescent/young adult once they have entered addictiontreatment program with the support o their amily.In this study, the program was adapted or use on aSpanish group o participants. It was implemented using thegrouptherapyapproachdevelopedbyFooteandManuel[󰀴󰀱].Te objective o this pilot study was to analyse, in theSpanishpopulation,howthefirstpartotheCRAFprogramhelps parents o adolescent/young adult substance usersacquire or use skills that allow them to improve their mentalwell-being and thereore assist their children in initiating anaddiction treatment program [󰀴󰀲].o this end, the ollowing working hypotheses have beenestablished.(a) Tere are statistically significant differences in sel-esteem, depression, state anxiety and trait anxiety,state anger, trait anger, and anger expression index(AX Index) scores between the group comprisingamily members o adolescent/young adult substanceusers beore treatment and the group o amily mem-berswhostatethattheydonothaveanyproblems(thenoncausal baseline group).(b) Te amily members targeted by the intervention willshow improved scores in the variables mentionedabove, obtained afer treatment, when compared toscores obtained prior to treatment.(c) Scores obtained afer treatment or study variableswillnotdiffersignificantlyromthoseobtainedintheconstructed noncausal baseline group.  Journal o Addiction 󰀳(d) At least 󰀵󰀰% o the members o the experimentalgroup will help their substance-abusing relative toseekouthelpromaspecializedresourceorthetreat-ment and indicate prevention o substance abuse(Addictive Behavior Unit and Community Preven-tion Unit) beore treatment program completion (tenweeks). 2. Materials and Methods 󰀲.󰀱. Research Classification.  Te study is a quantitative, pre-treatment, and posttreatment study with a constructed non-causalbaseline(hereaferCNCB)[󰀴󰀳,󰀴󰀴].Te“baseline”herereers to the scores obtained in the study variables by theparents who did not have adolescent/youth with AOD useproblems. 󰀲.󰀲. Participants.  o carry out the study, the authors per-ormed convenience sampling. Te parents o adolescent/young adult substance users were reerred rom the Addic-tive Behavior Unit (Spanish acronym: UCA), Community Prevention Unit (Spanish acronym: UPCCA), and the SocialServicesDepartment.Teseresourceswerecontactedtoofferthe intervention program or parents with adolescent/youngadult substance users. None o the participants had a amily history o addiction.All participants stated that none o the siblings o sub-stance users had experienced problems associated with druguse.All o the parents in the first group claim to have or havehad mental, social, and even somatic problems and a amily atmosphere they classiy as being either “ quite bad  ” or “ very bad  .”At the same time, convenience sampling was perormedtoselectparticipantsortheCNCBgroup.Tesewereparentswhose sons or daughters did not have any substance useproblems and were not suffering rom any other stressul liesituationsthatcouldgiverisetosimilarsymptomsodistress.Tis inormation was provided by the parents themselves. 󰀲.󰀳.Instruments.  Sociodemographiccharacteristicswerecol-lected by way o a semistructured interview conducted witheach o the participants, adapted rom Cort´es-om´as andPascual-Pastor [󰀴󰀵].Sel-esteem was evaluated through  Rosenberg’s Self-Es-teem Scale  [󰀴󰀶], adapted by Echebur´ua [󰀴󰀷], and consistingo ten items answered on a our-point scale (󰀱: strongly agree,󰀲: agree, 󰀳: disagree, and 󰀴: strongly disagree). Te reliability and validity o this instrument are 󰀰.󰀸󰀷 and 󰀰.󰀷󰀲, respectively [󰀴󰀸].o evaluate depression, the  Beck Depression Inventory  (BDI-II) was used [󰀴󰀹]. Tis inventory is composed o 󰀲󰀱items, each with our possible responses that are assigned ascore indicating the severity o the symptom (arranged inorder rom mild to severe). It has a high internal consistency,in both clinical and nonclinical samples, with an alpha scoreo 󰀰.󰀹󰀲. Te Spanish version o this test also shows highinternalconsistency both in samples with university students(󰀰.󰀸󰀰) and in general or clinical population [󰀵󰀰].Anxiety was evaluated using the  State-rait Anxiety Inventory   (SAI) [󰀵󰀱], composed o two Likert-type scaleswith a total o 󰀴󰀰 items that measure state anxiety (A-State)and trait anxiety (A-rait). As ar as reliability and validity are concerned, this inventory has been tested on the Spanishpopulationandshowsaninternalconsistencyobetween󰀰.󰀹󰀰and 󰀰.󰀹󰀳 or state anxiety and between 󰀰.󰀸󰀴 and 󰀰.󰀸󰀷 or traitanxiety.Anger was evaluated through the State-rait Anger Ex-pression Inventory (SAXI-󰀲) [󰀵󰀲]. Te items that it containsmeasure state, trait, and expression o anger [󰀵󰀳]. Te inven-tory shows good psychometric properties that are internally consistentwithanalphascoreo󰀰.󰀸󰀹ortheStateAngerScaleand 󰀰.󰀸󰀲 or the rait Anger Scale. 󰀲.󰀴. Procedure.  Once the participants o the experimentalgroup were reerred by the various collaborating bodies,they were evaluated by a psychologist using the instrumentsdescribed above.TeexperimentalgroupsettoreceivetheadaptedCRAFprogram was divided into our smaller intervention groups[󰀳󰀵], consistingosixparticipantseach, except oronegroup,which had seven participants. Each intervention consisted o ten weekly sessions lasting one hour and thirty minutes each.Te sessions were given by the same therapists. 󰀲.󰀵. Data Analysis.  Te percentage o amilies with problemsassociated with AOD use that sought out some kind o addiction treatment or intervention at some time during thestudy was calculated based on the inormation provided by the parents attending the group sessions.An exploratory analysis was conducted to identiy possi-bleoutliersandmissingdataanddeterminedatadistribution,symmetry, kurtosis, homoscedasticity, and other aspects.Tese analyses revealed that, given the study samples, itcould not be stated that the data are rom a normally distributedpopulationorthevariablesunderstudy(Shapiro-Wilk test). Furthermore, outlying scores were ound or all variables, and the variances o the groups to be comparedwereoundtobeequal(Levene’stesttoassesshomogeneityo  variance).In light o the above findings, the authors decided to usenonparametrictestsorinerentialanalyses.Whilethesetestsoffer statistical robustness, they have less power; that is, their 󽠵  valuestendtobehigherandthereisagreaterchanceotypeII errors.Scores obtained beore treatment were compared toscores taken afer treatment in the experimental group, usingthe Wilcoxon signed-rank test, the nonparametric version o the  􍠵 -test or dependent samples.Scores at pretreatment or each variable were com-pared to scores rom the constructed noncausal baselinegroup to see i there were differences in the study vari-ables between amilies o adolescent/young adult substanceabusers beore intervention and amilies that stated thatthey did not have any drug-related problems. o make thiscomparison, the Mann–Whitney   󝠵  test was used, which isthe nonparametric equivalent to the  􍠵 -test or independentsamples.  󰀴 Journal o Addiction 󰁡󰁢󰁬 󰀱: Sociodemographic variables (in %, except age, in years).Experimental group CNCB group Children o EG members with AOD use problem Sex  Male 󰀲󰀴 󰀳󰀲 󰀹󰀸Female 󰀷󰀶 󰀶󰀸 󰀲  Age Mean 󰀵󰀱.󰀶 󰀴󰀸.󰀲 󰀲󰀱.󰀴Standard deviation 󰀶.󰀸 󰀸.󰀳 󰀴.󰀸  Marital status Married or domestic partnership 󰀸󰀸 󰀸󰀴Separated or divorced 󰀱󰀲 󰀱󰀲Widow/er — 󰀴 Number of children 󰀱 󰀸 󰀴󰀲 󰀹󰀲 󰀸󰀸󰀳 — 󰀸 Educational level  Primary education 󰀸󰀴 󰀶󰀴 󰀹󰀶Secondary education 󰀸 󰀲󰀴 󰀴Higher education 󰀸 󰀱󰀲 — Principal drug  Cannabis 󰀵󰀶Cocaine 󰀲󰀸Alcohol 󰀱󰀲Heroin 󰀴 Lastly,thescorestakenromtheexperimentalgroupafertreatment were compared to those o the noncausal baselinegroup to determine whether any differences observed beoretreatment between the substance-user amily member groupandtheCNCBgrouphaddiminished.TeMann–Whitney  󝠵 test was also employed or this analysis.Effect sizes were calculated or each comparison, usingthe ormula   = /√  , where    is the effect size,    is the 󝠵  or    score, depending on the test employed, convertedto a    score, and    is the total size o the sample, that is,the sum o both sample sizes o each group (󰀵󰀰 in this case).Te coefficient o determination (  2 ) was calculated to allow or a better interpretation o the effect size according to theproportion o explained variance.o conduct this statistical analysis, the R computingsofware environment was used, version 󰀳.󰀲.󰀳 WoodenChristmas-ree, released 󰀱󰀰-󰀱󰀲-󰀲󰀰󰀱󰀵, using the coin package[󰀵󰀴], with the  RStudio  integrated development environment, version 󰀰.󰀹󰀹.󰀴󰀹󰀱. 3. Results A summary o sociodemographic variables is provided inable 󰀱. No statistically significant differences were observedbetween the experimental and constructed noncausal base-linegroupsintermsoparentalage( t  (󰀴󰀸)= − 󰀱.󰀸󰀰; 󽠵 = 0.078 ,two-tailed) or gender (  2 (󰀱,   = 50 ) = 󰀰.󰀳󰀹󰀷;  󽠵 = 0.754 ,two-tailed). Hypothesis a . Te results obtained beore treatment by theexperimental group, when compared to those obtained romthe CNCB group, show statistically significant differences( 󽠵 < 0.01 ) or all variables except state anxiety and angerexpression index (AX Index) (able 󰀲).In particular significant differences were ound in sel-esteem ( 󽠵 < 0.01 ), where the means were ound to be higheror the constructed noncausal baseline group. Te experi-mental group showed higher means or depression ( 󽠵 <0.01 ), trait anxiety ( 󽠵 < 0.01 ), and state anger and trait anger( 󽠵 < 0.01 ). Te effect sizes (  ) indicate a correlation betweenthe particular group each member belongs to and each o the variables, in terms o absolute values. For instance, or thesel-esteem variable, a correlation o 󰀰.󰀶󰀵 was ound betweenmembership to one o the groups and sel-esteem scores.Te determination coefficient (  2 ) indicates the percentageo variance which predicts membership to one or the othergroup. For the sel-esteem variable, this was ound to be󰀴󰀲.󰀲%. Hypothesis b . Pretreatment and posttreatment results werecompared or the experimental group (able 󰀳). All o the variables under study improved, with statistically significantdifferences obtained or sel-esteem ( 󽠵 < 0.01 ), depression( 󽠵 < 0.01 ), and state anger ( 󽠵 < 0.01 ). Participants whocompleted the program experienced greater sel-esteem andshowedreducedscoresintermsodepressionandstateanger.Te treatment explained 󰀳󰀵%, 󰀲󰀴%, and 󰀱󰀵% o the varianceo these scores, respectively.  Journal o Addiction 󰀵 󰁡󰁢󰁬 󰀲: Comparison between experimental group (beore treatment) and CNCB group.Variables Instrument Experimental group (beore treatment) CNCB group  󽠵  E(  )   2 Mean SD Mean SDEmotional variablesRosenberg Sel-esteem 󰀲󰀷.󰀸󰀸 󰀴.󰀸󰀱 󰀳󰀳.󰀵󰀶 󰀲.󰀶󰀵 󰀵.󰀱󰀸 󰀰.󰀰󰀰󰀰 ∗∗ 󰀰.󰀶󰀵 󰀰.󰀴󰀲BDI-II Depression 󰀱󰀳.󰀸󰀲 󰀱󰀰.󰀱󰀲 󰀲.󰀶󰀰 󰀲.󰀹󰀰  − 󰀵.󰀰󰀷 󰀰.󰀰󰀰󰀰 ∗∗ 󰀰.󰀶󰀰 󰀰.󰀳󰀶SAI S. anxiety 󰀲󰀷.󰀰󰀴 󰀱󰀱.󰀴󰀱 󰀲󰀴.󰀳󰀶 󰀶.󰀹󰀵  − 󰀱.󰀰󰀰 󰀰.󰀴󰀷󰀸 󰀰.󰀱󰀰 󰀰.󰀰󰀱. anxiety 󰀲󰀷.󰀴󰀶 󰀹.󰀷󰀸 󰀲󰀲.󰀲󰀴 󰀶.󰀹󰀳  − 󰀲.󰀰󰀹 󰀰.󰀰󰀰󰀶 ∗∗ 󰀰.󰀳󰀸 󰀰.󰀱󰀴SAXI-󰀲S. anger 󰀲󰀴.󰀳󰀶 󰀹.󰀹󰀷 󰀱󰀷.󰀷󰀲 󰀳.󰀳󰀴  − 󰀳.󰀱󰀶 󰀰.󰀰󰀰󰀱 ∗∗ 󰀰.󰀴󰀴 󰀰.󰀱󰀹. anger 󰀱󰀹.󰀶󰀸 󰀵.󰀰󰀷 󰀱󰀶.󰀰󰀴 󰀳.󰀳󰀶  − 󰀲.󰀹󰀹 󰀰.󰀰󰀰󰀹 ∗∗ 󰀰.󰀳󰀷 󰀰.󰀱󰀴AEI 1 󰀲󰀹.󰀸󰀰 󰀱󰀲.󰀲󰀶 󰀲󰀷.󰀳󰀶 󰀸.󰀱󰀳  − 󰀰.󰀸󰀳 󰀰.󰀴󰀴󰀳 󰀰.󰀱󰀱 󰀰.󰀰󰀱 1 Anger expression index. ∗∗ (  < 0.01 ). 󰁡󰁢󰁬 󰀳: Effect o treatment on study variables in experimental group.Variables InstrumentExperimental group  󽠵  E(  )   2 Pre PostMean SD Mean SDEmotional variablesRosenberg Sel-esteem 󰀲󰀷.󰀸󰀸 󰀴.󰀸󰀱 󰀳󰀲.󰀲󰀸 󰀴.󰀵󰀶  − 󰀴.󰀱󰀹󰀷 󰀰.󰀰󰀰󰀰 ∗∗ 󰀰.󰀵󰀹 󰀰.󰀳󰀵BDI-II Depression 󰀱󰀳.󰀸󰀲 󰀱󰀰.󰀱󰀲 󰀸.󰀸󰀰 󰀸.󰀵󰀲 󰀳.󰀴󰀸󰀰 󰀰.󰀰󰀰󰀰 ∗∗ 󰀰.󰀴󰀹 󰀰.󰀲󰀴SAI S. anxiety 󰀲󰀷.󰀰󰀴 󰀱󰀱.󰀴󰀱 󰀲󰀴.󰀲󰀰 󰀱󰀰.󰀴󰀳 󰀱.󰀳󰀳󰀳 󰀰.󰀱󰀸󰀸 󰀰.󰀱󰀹 󰀰.󰀰󰀴. anxiety 󰀲󰀷.󰀴󰀶 󰀹.󰀷󰀸 󰀲󰀵.󰀸󰀸 󰀱󰀱.󰀶󰀰 󰀰.󰀴󰀴󰀴 󰀰.󰀶󰀶󰀷 󰀰.󰀰󰀶 󰀰.󰀰󰀰SAXI-󰀲S. anger 󰀲󰀴.󰀳󰀶 󰀹.󰀹󰀷 󰀲󰀰.󰀲󰀰 󰀸.󰀶󰀷 󰀲.󰀷󰀶󰀴 󰀰.󰀰󰀰󰀴 ∗∗ 󰀰.󰀳󰀹 󰀰.󰀱󰀵. anger 󰀱󰀹.󰀶󰀸 󰀵.󰀰󰀷 󰀱󰀹.󰀰󰀴 󰀶.󰀳󰀴 󰀰.󰀲󰀰󰀳 󰀰.󰀸󰀴󰀷 󰀰.󰀰󰀳 󰀰.󰀰󰀰AEI 1 󰀲󰀹.󰀸󰀰 󰀱󰀲.󰀲󰀶 󰀲󰀵.󰀶󰀴 󰀱󰀱.󰀰󰀲 󰀱.󰀴󰀹󰀶 󰀰.󰀱󰀳󰀹 󰀰.󰀲󰀱 󰀰.󰀰󰀴 1 Anger expression index. ∗∗ (  < 0.01 ). 󰁡󰁢󰁬 󰀴: Comparison between experimental group (afer treatment) and CNCB group.Variables Instrument Experimental group (afer treatment) CNCB group  󽠵  E(  )   2 Mean SD Mean SDEmotional variablesRosenberg Sel-esteem 󰀳󰀲.󰀲󰀸 󰀴.󰀵󰀶 󰀳󰀳.󰀵󰀶 󰀲.󰀶󰀵 󰀱.󰀳󰀱 󰀰.󰀱󰀹󰀵 󰀰.󰀱󰀸 󰀰.󰀰󰀳BDI-II Depression 󰀸.󰀸󰀰 󰀸.󰀵󰀲 󰀲.󰀶󰀰 󰀲.󰀹󰀰  − 󰀲.󰀷󰀴 󰀰.󰀰󰀰󰀶 ∗∗ 󰀰.󰀳󰀹 󰀰.󰀱󰀵SAI S. anxiety 󰀲󰀴.󰀲󰀰 󰀱󰀰.󰀴󰀳 󰀲󰀴.󰀳󰀶 󰀶.󰀹󰀵 󰀰.󰀲󰀹 󰀰.󰀷󰀷󰀶 󰀰.󰀰󰀴 󰀰.󰀰󰀰. anxiety 󰀲󰀵.󰀸󰀸 󰀱󰀱.󰀶󰀰 󰀲󰀲.󰀲󰀴 󰀶.󰀹󰀳  − 󰀱.󰀴󰀳 󰀰.󰀱󰀵󰀶 󰀰.󰀲󰀰 󰀰.󰀰󰀴SAXI-󰀲S. anger 󰀲󰀰.󰀲󰀰 󰀸.󰀶󰀷 󰀱󰀷.󰀷󰀲 󰀳.󰀳󰀴  − 󰀰.󰀵󰀸 󰀰.󰀵󰀶󰀶 󰀰.󰀰󰀸 󰀰.󰀰󰀱. anger 󰀱󰀹.󰀰󰀴 󰀶.󰀳󰀴 󰀱󰀶.󰀰󰀴 󰀳.󰀳󰀶  − 󰀱.󰀹󰀹 󰀰.󰀰󰀴󰀵 ∗ 󰀰.󰀲󰀸 󰀰.󰀰󰀸AEI 1 󰀲󰀵.󰀶󰀴 󰀱󰀱.󰀰󰀲 󰀲󰀷.󰀳󰀶 󰀸.󰀱󰀳 󰀰.󰀱󰀵 󰀰.󰀸󰀸󰀱 󰀰.󰀰󰀲 󰀰.󰀰󰀰 1 Anger expression index. ∗ (  < 0.05 ). ∗∗ (  < 0.01 ). Hypothesis c . Posttreatment scores were compared withscores obtained rom constructed noncausal baseline group(able 󰀴). Differences decreased or all variables once theintervention program was completed; however, only thedepression and trait anger variables showed statistically sig-nificantdifferenceswithrespecttotheconstructednoncausalbaseline group, with a small effect size (󰀱󰀵%) or depressionand very small one (󰀸%) or trait anxiety. Hypothesis d  . Te percentage o amily members with sub-stance abuse problems who sought out some kind o treat-ment or intervention service or their problem was ound tobe 󰀶󰀰% (󰀱󰀵 out o 󰀲󰀵), according to the inormation gatheredduring the study period, that is, beore treatment programcompletion. 4. Discussion Although improvement was not observed in all the variablesunder study as was posited in Hypothesis b, the parents o substance-abusing adolescents/youth who took part in theprogramdidshowincreasedsel-esteemandimprovedmoodand anger expression, which is in keeping with previousstudies [󰀶, 󰀲󰀳, 󰀲󰀴]. Tis improvement in mental health gave
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