TIP 39: Substance Abuse Treatment and Family Therapy

They often provide incentives formaintaining sobriety and are used in combination with behavioral therapies. During CBT, patients learn to recognize and modify risky behavior by using a variety of skills. They learn the underlyingcauses of problematic behavior so they can fix the problems at their source. They’re able to recognize cravings ortriggers and develop strategies for handling those situations.

• Not every person who uses a substance will develop a disorder; for some the pleasant feeling is just that, a pleasant feeling.
• Psychoeducation is more than just giving families information about the course of addiction and the recovery process.
• The following sections discuss adaptations of BCT that have been found to be effective in pilot studies.
• Maltreated children of parents with a SUD are more likely to have poorer physical, intellectual, social, and emotional outcomes and are at greater risk of developing substance abuse problems themselves (USDHHS, 2003).
• Marked by transitions, aging, births, and deaths, extended families undergo developmental stages that predicate the normative stresses, tasks, and conflicts they may face.

Cognitive-Behavioral Approaches to Alcoholism Treatment

Teach families how to generalize the skills they developed in Phase 2 to new situations and contexts other than the initial target behavior. Frame the counselor-family therapeutic relationship as a cooperative effort between experts. An initial intake interview to identify family strengths and challenges, engage the family, and videotape a structured assessment protocol of parent-adolescent interactions. Neither partner has a co-occurring mental disorder that would significantly affect participation. Suggesting reading, audio, or video material the client and family members can review at home.

Understand Your Role as an SUD Treatment Provider

Initially conceptualized by Murray Bowen (1978) as part of an intergenerational family model, a genogram is a comprehensive pictorial map of a family’s health, communication, relationship, vocational, and other psychosocial patterns within and across three or more generations of the family. It provides information about marriages, divorces, births, geographical locations, deaths, and illness over the generations. It also depicts family patterns, events, and relationships, including emotional closeness, enmeshment, conflict, and emotional cutoffs (Platt & Skowron, 2013). Genograms are useful to discuss in psychoeducational sessions, family interviews, and assessments (Platt & Skowron, 2013).

Online Therapy Can Help

Figure 1 provides Marlatt’s (1985) schematic of the relapse process, depicting two possible responses to a high-risk situation. As shown, when clients choose and execute an appropriate coping response, they feel a sense of mastery, but when no coping response is used, they feel helpless and anticipate that a drink would help in the situation. Such thoughts are likely to be followed by drinking, and the clients then contrast the previous perception of being in recovery with the current reality of renewed drinking. This incongruity leads to feelings of conflict, guilt, self-blame, and perceived loss of control, a syndrome that Marlatt has called the “abstinence violation effect.” Because of this despair, further drinking becomes likely and often leads to a full-blown relapse (Marlatt 1985). BSFT is founded on the concept that each family member’s behavior affects the entire family.

Some clients will have difficulty identifying their strengths or say that they don’t have any. As part of the family history, conduct a careful and thorough exploration of family members’ internal and external resources, how they have overcome adversity in the past, and how they have previously managed problems like SUDs, physical illness, or mental illness. Determining the need for further screenings and assessments of SUDs and mental disorders for individual family members. Engaging family members in treatment is the key to decreasing interpersonal conflict among family members and increasing family bonding and other elements of recovery support for the client. Create a written plan for family members, including specific self-care activities they can do, support people they can contact, and crisis numbers to call if the situation warrants. Learn or reengage effective coping skills to manage the stress of the individual’s return to misuse.

Parental Substance Abuse and Educational Functioning

Boundaries define internal and external limits of a system and are established to conserve energy by creating a protective barrier around a system. In a healthy family, boundaries surround the parental subsystem and the child subsystem by keeping them separate. In a family substance abuse counseling with a parent who has a SUD, boundaries around the parental and child subsystems are typically permeable as the parental subsystem does not function well as a cohesive unit. Boundaries around the family itself are rigid to maintain the family secret of substance abuse.

The emphasis is on the development of a solution in the future, rather than on understanding the development of the problem in the past or its maintenance in the present. As an SUD treatment provider incorporating family-based interventions into your practice, you should take care to work within the limits of your training, license, and scope of practice. Also take note of the specific licensure and other treatment-related professional requirements specific to your state. Understanding the complexity of SUDs and the importance of working with families to manage SUDs, as with any chronic illness that affects family functioning, physical and behavioral health, and well-being. Having harm reduction goals other than abstinence, which can bring positive physical and behavioral health benefits to the individual and entire family. Exhibit 1.7 explores integrated family SUD counseling for individuals who may not initially wish to include family members in their treatment process.