Accolade for SFP 10-14 from Cochrane review

The Strengthening Families Programme (SFP 10-14) received a boost when Professor David Foxcroft and colleagues singled it out as the most promising "effective intervention over the longer-term for the primary prevention of alcohol misuse."* It was a considerable accolade because the comment came in a Cochrane review, the scrupulously scientific series created by the international Cochrane collaboration The same work was later published in the journal, Addiction.**

Conclusions of Cochrane Review


Problems in Reviewed Studies

Poor Quality
  • Lack of suitable control groups
  • Non random allocation or non-equivalent groups
  • Lack of pretest information
  • High levels of attrition
  • Inappropriate analysis
  • Poor quality presentation
  • Intention to treat issues
Little Evidence of Intervention Effectiveness
  • Small effect sizes
  • Partial effectiveness not repeated over the long term
  • Evidence base does not support continued use

To get to this point Foxcroft's team examined over 6,000 reports of studies of psychosocial or educational interventions intended to prevent alcohol use or misuse by young people. Just 56 were acceptably rigorous and relevant to be included in the review and just three reported alcohol use or misuse reductions which persistent over a follow-up period of at least three years.

That left the Strengthening Families Programme (SFP 10-14), the latest study*** of which featured a "strong design, and ... a consistent pattern of effectiveness across the three drinking behaviour variables they reported." Unusually, its effectiveness "seemed to increase over time, reflecting the developmentally orientated ... model on which the intervention is based." What David Foxcroft added was a reanalysis accounting for children who could not be re-interviewed at the tenth-grade (age 15-16) follow-up by assuming that they had behaved similarly to children whose families had not been offered any intervention at all.

The resulting estimate was that for every nine children whose families had been offered the Strengthening Families Programme (SFP 10-14), one was prevented from beginning to drink, to drink without permission or for the first time getting drunk, the last two being statistically significant. This may not seem spectacular but it was around twice as good as the estimate for the other two programmes and more consistent across all the drinking measures. It was enough to persuade Professor Foxcroft to call for "a project to translate, develop and pilot the Strengthening Families Programme (SFP 10-14) in the United Kingdom."****

Disappointing results from school-based programmes have encouraged interest in family interventions. The one with the best track record is the US Strengthening Families Programme (SFP 10-14), approach now being tried in Britain.
~David Foxcroft, Oxford Brookes University

*Foxcroft, D.R. et al. "primary prevention for alcohol misuse in young people (Cochrane Review)." In: The Cochrane Library: 2002, 4. Oxford: Update Software.
**Foxcroft D.R. "Longer-term primary prevention for alcohol misuse in young people: a systematic review." Addiction: 2003, 98, p. 397-411. 2918 10.9
***Spoth, R.L. et al. "Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline." Journal of Consulting and Clinical Psychology, 2001, 69(4), 627-642. 1744a 10.2 in 10.2 419.
****Foxcroft, D.R. Alcohol misuse prevention for young people: psychosocial and educational interventions. Alcohol Concern, 2003.

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