CHAPTER 9: Family Treatment

1. CHAPTER 9:Family Treatment Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • Introduction • Defining Family • General Systems Concepts • Systems and Addictive Families • The Family and Substance Abuse • Children in the Addicted Family • Treatment with Addictive Families • The Process of Treatment • Programs Utilizing Family Therapy

3. Introduction • Cause/Result debate • Historical tracks of research in family therapy and substance abuse: • Working with the alcoholic family • Working with the substance abuse family • Nature (Genetic/Biological)/Nurture (Environment/Sociological)/Psychological debate

4. Defining Family • The definition of family varies from culture to culture and from individual to individual within that same culture. • Definition of family for this text/discussion: any combination of nuclear extended, single parent, reconstituted, gay and lesbian couples and/or any other form of family life. • Nuclear family: the individuals with whom the person is currently living. • A family is composed of the people – regardless of their actual blood or legal relationship to the client – whom clients consider to be members of their family.

5. General Systems Concepts • Underlying concepts of systems theory framework: • All systems seek homeostasis. • All systems incorporate feedback loops to function. • Hierarchy is an integral part of systemic functioning, including all the roles, rules and subsystems necessary. • Boundaries are necessary to facilitate the existence of roles, rules, and subsystems. • The system cannot be understood by reductionism but must be examined as an entity, synthesizing the component part into a whole. • Change in one part of the system creates change in all part of the system. • Values are passed down from generation to another affecting the dynamics of the family system.

6. Systems and Addictive Families • Common characteristics of addictive families: • Secrecy (Disengagement) • Denial of a problem • “The key to surviving in an alcoholic home is adaptation” • Hypervigilance • Inability to express feelings • Shame

7. Systems and Addictive Families • The Marital Dyad and Substance Abuse • Marriage may be a protective factor for addiction but not for heavy drinking • Issues of control are central to the alcohol-abusing marriage. • Communication in these marriages is often angry, hostile, and critical. • Codependency: an adaptive function of a trouble family. • Enabling: anything done to protect the chemically dependent person from the consequences of his or her behavior. • These marriages use substances to triangulate their relationship. • Boundaries for these couples are not well-defined.

8. The Family and Substance Abuse

9. Children in the Addicted Family • Children in the addicted family are at high risk for the development of a variety of stress-related disorders including: • Conduct disorders • Poor academic performance • Inattentiveness • Children in substance-abusing families: • Are socially immature • Lack self-esteem and self-efficacy • Have deficits in social skills

10. Children in the Addicted Family • Because these children live in chronic chaos and trauma, they might develop: • Long-lasting emotional disturbances • Antisocial personality disorders • Chemical dependence in later life • Factors affecting the impact of parental chemical dependence on children: • The gender of the abusing parent • The gender of the child • The length of time the parent has been actively abusing • The age of the child during the period of active abuse • The extent of the abuse/dependence on the chemical

11. Children in the Addicted Family • This is our main role as counselors!

12. Children in the Addicted Family

13. Treatment with Addictive Families • Issues in Treatment with Addictive Families • Artificial compartmentalization • Many treatment facilities do not have clinicians trained in family systems theory • Underlying principle of systems theory: Systems (in this case, families) are self-regulating and self-maintaining. • Value in including family in assessment lies in the multiple perspectives that become available when family members are included. • Family Week

14. Treatment with Addictive Families • When an individual stops using substances, the family is destabilized. • This can create a crisis within the family, causing other problems to increase. • A systems approach recognizes the family’s attempt at returning to balance and addresses these issues from that perspective.

15. The Process of Treatment • General considerations • Systems theorists believe that a symptomology in the child or children helps balance a dysfunctional marital partnership. • A family member is always primarily loyal to the family, no matter how dysfunctional the family appears to outsiders. • Counselor must be cautious of criticizing the family in any way. • There is no ideal family structure. • Families operate in an emotional field of past, present, and future. • To be effective when working with chemically dependent families, the counselor must first develop a framework or theoretical orientation within systems theories.

16. Programs Utilizing Family Therapy • Multidimensional Family Therapy (MDFT): Focuses on adolescent substance abuse • Alcohol Behavioral Couple Therapy (ABCT)