"When my children see their father is sober, they are happy": A qualitative exploration of family system impacts following men's engagement in an alcohol misuse intervention in peri-urban Kenya

SSM Ment Health. 2021 Dec:1:100019. doi: 10.1016/j.ssmmh.2021.100019. Epub 2021 Sep 16.


Background: Men's alcohol misuse does not occur in a vacuum but has a cascade of consequences for families and children, with ties to violence, poor parenting, and poor partner and child mental health. Despite the intersection of individual and interpersonal problems associated with men's alcohol use, studies exploring the impact of men's completion of alcohol misuse treatment on family and family member outcomes are scarce. Here we begin to explore this question.

Methods: We conducted qualitative interviews (N = 13) with female partners and children (8-17 years) of men with problem drinking who completed individual treatment targeting alcohol misuse, depressed mood, and family-focused efforts in Eldoret, Kenya. Interviews and thematic content analysis were guided by ecological-transactional systems theory.

Results: Findings highlighted positive perceived changes for men, families, women and children that interacted together in a bi-directional pathway. Partners and children described men's reduced drinking, reduced spending, increased family-focused effort (e.g., coming home early), as well as increased emotion regulation, and openness to and communication with family. These changes were tied to perceived improvements in the couple and father-child relationship, including improved trust and time together, which were tied to improvements in women and children's emotional well-being (e.g., hope). Concurrently, reports noted men's increased effort to share money earned with the family which alleviated financial stress and helped ensure basic needs were met. Results aligned with the ecological transactional systems frame, with individuals in the family, family relationships, and economic climate each dynamically shaping each other.

Conclusions: Although larger studies are needed, results provide promising signals regarding the potential downstream effects of individual treatment on family systems and members, which may in turn help maintain men's changes in drinking.

Keywords: Alcohol intervention; Family outcomes; Fathers; Global mental health; Kenya; Therapeutic change.