Addiction Treatment Should Include Family Therapy

Treatment programs aimed at those who havealcoholanddrug addictionproblems can have better outcomes if the abuser's family or close associates are also involved in the process.

In fact, if the family does not become involved in learning about substance abuse and the role it can play in the dynamics of the family, it might actually hinder the alcoholic or addict's recovery if family members continue theirdysfunctional or enabling behaviors.

To this end, the Substance Abuse and Mental Health Services Administration has published a manual, "Substance Abuse Treatment and Family Therapy," which is a guide for substance abuse counselors as well as for family therapists.

The guide provides the family therapist with basic information about substance abuse treatment models and the role of12-step, self-help programsin the treatment of substance abusers and their families.

The guide includes discussion of treatment models that integrate substance abuse treatment and family therapy. These models can serve as a guide for joint treatment of the addicted person and his or her family and others with close emotional connections.

Family Therapy Can Help

"Family therapy in substance abuse treatment can help by using the family's strengths and resources to find ways for the person who abuses alcohol or drugs to live without substances of abuse and to ameliorate the impact of chemical dependency on both the patient and the family, according to SAMHSA. "Family therapy can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another."

The SAMSHA guide warns substance abuse counselors that they must always be aware that family counseling techniques should not be used wherea batterer is endangering a clientor a child. The first priority is safeguarding all parties.

The guide also warns that family therapy for women with substance use disorders is not appropriate for cases ofongoing partner abuse. Also, women who have lost custody of their children may be strongly motivated to overcome their substance abuse since often they are working to get their children back.

Substance Abuse Impacts Families

SAMHSA's Treatment Improvement Protocol (TIP) #39 identifies the following family structures and how substance abuse may impact these families:

• A client who lives alone or with a partner– In this situation both partners need help. If one is chemically dependent and the other is not, issues of codependence arise.
• Clients who live with a spouse or partner and minor children– Most available data indicate that a parent's drinking problem often has a detrimental effect on children. The spouse of the person abusing substances is likely to protect the children and assume the parenting duties of the parent abusing substances. The effect on children is worse if both parents abuse alcohol or drugs.
• A client who is part of a blended family– Stepfamilies present special challenges and substance abuse can become an impediment to a step family's integration and stability.
• An older client with grown children– Additional family resources may be needed to treat the older adult's substance use disorder. There may be issues of elder maltreatment that must be reported to local authorities.
• An adolescent substance abuser living with his or her family of origin– Siblings in the family may find their needs and concerns ignored while their parents react to the continuous crises involving the adolescent who abuses alcohol or drugs. If there isa parent who also abuses substances, this can set in motion a combination of physical and emotional problems that can be very dangerous.

Sometimes Substance Abuse Is Overlooked

The SAMHSA guide also points out that often family therapists do not screen for substance abuse because therapists are not familiar with the questions to ask or the cues provided by their clients.

It also emphasizes that substance abuse counselors should not practice family therapy without proper training and licensing, but they should learn enough to determine when a referral is indicated.