As in many other Western countries, alcohol use is common in Denmark. More than 85% of adults in Denmark consume alcohol (1); it is estimated that 585,000 Danes have a harmful use and 148,000 Danes (equaling 3% of the population) is dependent of alcohol (2). Alcohol use disorders (AUD) can have serious consequences for the both the drinkers (or so-called identified patients, IPs) (3, 4) and their concerned significant other (CSO). The impact on the CSO varies, depending on type of relation to the IP; partners who live together with the IP experience other problems than do e.g., siblings, adult children, and friends (5).
Partners to IPs live in a daily stressful situation and are often exposed to aggressions, psychological and sometimes physical abuse from the IPs which leads to frequent conflicts (6). Thus, partners to IPs report lower quality of life than the general population (7), even if they do not live together (7). Moreover, relationsship distress and AUD are strongly related and it has been shown that one partner’s AUD influence the other partners use of alcohol in a negatively way (8). Futhermore, parents of IPs often feel inadequate in their partenting (9) which can lead to physiological and/or physiological symptoms (10). Children of IPs frequently experience verbal abuse, neglect, being left alone unsupervised, and having to adopt responsibilities or parenting roles at an early age (11, 12). This can affect the child during all stages of development and make them at risk for developing, for example, behavioral problems, emotional difficulties, behavioral disturbance and social isolation and these problems might follow them as adolescents and into adulthood (12). Unlike family, friends can be chosen and abandoned, making these relationships more dynamic. The interaction between friends is often less regular, less continuous and usually less intensive, seen over a lifespan, which make the commitment towards friend less demanding in relation to time, emotions, finance and responsibilities (13).
Despite of the negative effects alcohol causes, CSOs are highly concerned and worried for the IP’s health and wellbeing (10, 14). Therefore, CSOs are often highly motivated to help the IP to become sober or to a reduction in drinking (15). The CSOs hold important knowledge about the IP since some of the CSO spend considerable time with the IP, and this gives the CSOs a possibility to influence the IP in a higher degree than a treatment provider who might see the IP one hour per week (16). The CSO can also play an important role in recovery of the person with AUD by supporting and participating in the alcohol treatment. There is evidence which shows that when the CSOs participate in the IP’s treatment, the treatment outcome is better (8).
Often a CSO has tried to help the IP in several ways and during a long time, but it can be a struggle if the IP has not acknowledged the alcohol problem or motivated for treatment (15). The program Community Reinforcement and Family training (CRAFT) aims at helping CSOs of treatment-refusing IPs into treatment through a positive reinforcement process but also to increase the CSOs’ quality of life and the relation between to the IP (15). So far, a CRAFT intervention offered to the CSO is the method that has been most evident in increasing the likelihood that the IP will enter treatment (17).
Earlier studies on CRAFT indicate that the most common CSOs seeking the program were partners/spouses, followed by adult children. In some studies, also siblings and parents participated to a minor degree (17). Only one study on CRAFT has identified an association between ‘type of relation’ between the CSO and the IP, and IP treatment entry; Meyers, Miller (15) found that parents were more able to engage the IP adult child in treatment than non-parents (15, 17). The IPs in this study were, however, drug users.
Most studies on CRAFT have had rather rigorous inclusion criteria according to how much contact the CSO and IP should have. For example, in some studies it was an inclusion criteria that the CSO and IP should spend 40% of their time together (18–20), or they should be spending at least 20 hours together per week or being living together (21), or see each other a least 12 days per month (22). Furthermore, several studies on CRAFT have excluded CSOs who themselves had indications on alcohol use disorder or other substance use disorder (18, 21–24).
Hence, there is limited knowledge about what characterize the CSOs who succeed in motivating their IPs to treatment. In a recent Danish study on CRAFT, there were, however, no requirement according to amount of time that the CSOs spend with the IPs. Instead information on ‘time spend together’ were collected (25). Thus, the Danish study allows for investigating if there is a correlation between time spend with the IP and IP treatment entry, which is the aim of the present study. By means of descriptive explorative analysis we wish to investigate if four factors have an influence on IP treatment engagement three or six months after the CSOs enrolled in the CRAFT study : 1) Type of relation between CSO and the IP 2) The amount of time the CSO spend with the IP 3) Does the IP know that the CSOs has entered the CRAFT intervention, and 4) The CSO’s own alcohol use, measured by means of Alcohol Use Disorder Identification test (AUDIT).