Consult your clinical supervisor to determine the appropriate course of action if you believe that any family member is in danger of domestic violence. It is unsound practice if sessions focus on improving communication instead of the abusive behavior. Counselors can tailor SUD treatment to meet family needs through developmental tasks. Following is an example of a couple who could benefit from treatment that aligns with their family development stage.
Five Counseling Theories and Approaches
- An initial intake interview to identify family strengths and challenges, engage the family, and videotape a structured assessment protocol of parent-adolescent interactions.
- Support staff in exploring the role of SUDs in family counseling and in developing collaborative relationships to meet the diverse needs of families.
- Family members may direct these feelings toward the substance rather than the person.
- Behavioral family counseling emphasizes daily support for abstinence as in BCT, but focuses less on sharing rewarding activities and practicing communication skills at home.
Families have shared histories and often develop defining narratives around past familial events. Individual family members can adopt these narratives even when they were not personally present for key events within that narrative, such as by hearing stories of past events about ancestors. Events in each family member’s life can be incorporated into the defining family narrative over time as well. This section summarizes some of the core objectives of family-based interventions for SUDs. How to make changes as an individual and as a family to address the impact of the SUD. How he or she adjusts or changes certain behaviors in response to the individual’s progressing SUD.
Addiction treatment services
BCT aims to lessen relationship distress, improve partners’ patterns of interaction, and build more cohesive relationships to reduce risk of returns to use for the partner with an SUD (Klostermann & O’Farrell, 2013). The goals of BCT are to support abstinence from substances and improve relationship functioning (O’Farrell & Schein, 2011). For example, in SUD treatment, family counseling focuses on how the family influences one member’s substance use behaviors and how the family can learn to respond differently to that person’s substance misuse. The genogram in Exhibit 4.3 shows five generations in American playwright Eugene O’Neill’s family, depicted by Monica McGoldrick (1995). The key to symbols depicts a slightly different version of how to identify family members with SUDs, mental disorders, physical illnesses, emotional closeness, conflict, and cutoffs than shown in the key in Exhibit 4.2. It is a good example of how a genogram can uncover a family history of substance misuse.
How Does Family Therapy in Addiction Treatment Work?
Drug and alcohol counselors were often in recovery themselves, yet had no experience addressing their own family histories. In earlier attempts to involve families in SUD treatment, spouses were invited to sessions of groups that the family member with the SUD attended regularly with other individuals in residential treatment. This did not often foster a welcoming environment for spouses, who were generally ill-prepared and had no alliances to create a sense of safety in the group. The objective of including spouses and other family members in this way was substance abuse counseling to gain collateral information from them about patterns of substance misuse in the individual with the SUD—and to highlight spouse or family behaviors that contributed to past use or could trigger a relapse. The focus was on the individual’s, rather than the whole family’s, recovery from addiction and its effects. CM interventions have also been adapted to provide patients with rewards for engaging in vocational training and to make participation in training and its attendant monetary rewards contingent on abstinence.
For example, social skills training teaches patients communication and assertion skills, including how to initiate social interactions, express thoughts and feelings, respond appropriately to criticism, and refuse drugs and alcohol. When treatment is delivered in a group format, patients can practice new skills, receive feedback, and model each other’s behavior. Twelve-step facilitation (TSF) treatment is based primarily on principles of Alcoholics Anonymous (AA) and a disease model of addiction. In addition, TSF focuses on the value of strong bonds with family, friends, work, and religion as a way of motivating clients to engage in responsible behavior.
Dialectical Behavioral Therapy (DBT)
- You may choose to explore other theories, there are links to multiple theories of substance use disorders in additional resources.
- Genograms are useful to discuss in psychoeducational sessions, family interviews, and assessments (Platt & Skowron, 2013).
- Inform all family members about agency policies, their rights and responsibilities as clients, and your legal/ethical responsibilities as a counselor.
- The structure of rules creates a sense of safety—as long as those rules are not too rigid.
When substance misuse occurs in the family, members will try to manage the behavior of the person who is using drugs or alcohol and the consequences of that use for the family. Some may view these responses as unhealthy, enabling, compensatory, or counterproductive, but they serve a purpose— to keep the system operating. This operating system directly influences treatment engagement, treatment outcomes, use of support systems, and sustained recovery for each family member.
Evaluating practices using hierarchy of evidence models
For instance, counselors should emphasize the importance of all network members regularly attending sessions and engaging in supportive activities designed to help the client abstain from substances. Network Therapy is also not intended to be an “intervention” in the sense that there is no confrontation of the client or threats to withdraw support if the client does not seek abstinence. The goal is simply for the network to remain supportive and engage in behaviors that help the client become and remain abstinent. Relationship-focused interventions to enhance caring behaviors, shared activities, and communication. Assess risk and protective factors of the individual, parents, family, and extrafamilial systems.
NAATP Research Foundation Releases Report Revealing Addiction Treatment Outcomes
Motivational interviewing (MI) strategies can help you build a therapeutic alliance and help the client and family members resolve their ambivalence about participating in family counseling (Lloyd-Hazlett, Honderich, & Heyward, 2016). Marked by transitions, aging, births, and deaths, extended families undergo developmental stages that predicate the normative stresses, tasks, and conflicts they may face. Understanding these normative stages will help counselors better perceive a family’s presenting problems, including SUDs.
In this vein, MET may be especially effective for individuals who are not yet committed to change because they are especially likely to benefit from a supportive, goal-directed and structured relationship with a counselor (Rohsenow et al., 2004). Systematic reviews of randomized trials have concluded that MI is an effective intervention, particularly for strengthening engagement in more intensive substance use disorder treatment. In studies of clients with alcohol and/or drug use disorders, MI appears to be equivalent to other active treatments and superior to no treatment and placebo comparison conditions (Burke et al., 2003; Dunn et al., 2001). In addition to these positive evaluations of MI, recent studies have shown MET to be as effective as other common treatments, such as TSF, CBT, and social behavior and network therapy (Babor and Del Boca, 2003; Stephens et al., 2000; UKATT Research Team, 2005). According to social learning theory, substance use originates in the substance-specific attitudes and behaviors of the adults and peers who serve as an individual’s role models.
