Author: John Carter

Couple and Family Therapy for Substance Use Disorders Family Therapy Magazine

Several randomized clinical trials have shown clinically significant effects of MDFT on reducing adolescents’ drug use and related behavioral problems in controlled and community-based settings (Rowe, 2012). Data also show that family functioning improves during MDFT, and families and adolescents maintain these gains at follow-up (Rowe, 2012). For some adolescents, MDFT may be an effective alternative to residential treatment (Liddle et al., 2018). Family-based SUD interventions focus on encouraging clients with SUDs to initiate and sustain recovery, improving their family communication and relationships to support and sustain their recovery, and helping family members engage in self-care and their own recovery. Cognitive behavioral therapy (CBT) is frequently used in the family programs of rehabilitation facilities. This method allows for emotional regulation by allowing someone to become aware of how their thoughts (cognition) lead to behaviors and other factors involved with the presenting problem.

Get input from family and recovery supports on the client’s early warning signs of returns to use. Have your client sign releases to have family members and recovery supports involved. Linking actively to family/CSO recovery supports and comprehensive case management services. BSFT is effective in long-term reductions in adolescent arrests, incarcerations, and externalizing behaviors like aggression and rule-breaking (Horigian, Feaster, Brincks, et al., 2015). Recent adaptation of MST for emerging adults who are aging out of the child welfare system follows the principles of MST but shifts the primary agent of change from parents to the emerging adult and the emerging adult’s social network, which may or may not include the parents. Pilot testing of this adapted approach shows promising outcomes (Sheidow, McCart, & Davis, 2016).

Most practitioners work within the context of a profoundly individual approach, granting supremacy to the notion of individualism, self-reliance, and the generally autonomous self (Rasheed, 2010). A paradigm shift toward relational interventions would invite movement toward systemic conceptualizations of SUD problems and solutions. It would also provide more fluid and flexible roles for target clients and CSOs while recasting “alone” to “together” in SUD treatment. A large-scale shift of SUD services would require re-alignment of billing/reimbursement, documentation, and services offered.

Stages of Recovery

Having harm reduction goals other than abstinence, which can bring positive physical and behavioral health benefits to the individual and entire family. These types of topics will naturally arise in family therapy, but gathering your thoughts about them ahead of time can give you a good starting point and help you communicate to the therapist what you’d like to focus on. A mental health counselor can mediate and help your family stay on track to getting the addicted person and your family unit the help to move forward. Other 12-Step recovery groups for family members are based on the Al-Anon model. Nar-Anon is for family members of people with SUDs other than AUD; Co-Anon, for family members of people with cocaine use disorder.

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. Acknowledging the value of relationships within the family and extrafamilial social networks as critical sources of support and positive reinforcement. When family members change their thinking about substance misuse and their behavioral responses to substance misuse, the entire family system changes. Family therapy includes relatives to provide insight to facilitate resolution.

Because of an incredible outpouring of support from community members and funders, the Afghan evacuee population is receiving about five times the amount of funding and resources than any other resettling refugee population. But many evacuees are upset because they expect to resettle into a middle-class American life, and the U.S. refugee program doesn’t provide resources to begin life in the U.S. at that economic level. Most families we have met are completely focused on their children, and they are here for their children.

Engage community-based supports to help family members sustain family system changes. Get professional help from an online addiction and mental health counselor from BetterHelp. That package that was begun in 2018 in Vienna is now called Treatnet Family (see below for an example of some of the concepts addressed in the package).

If you’ve never been in counseling before, you may feel apprehensive about family therapy for substance abuse. Many people have fears of being blamed or having to reveal more than they want. The truth is, family addiction counseling is as much for you as your addicted loved one. A family therapist can help you express how your loved one’s addiction has impacted your life. They’ll help you sort through any anger, guilt, sadness, or grief you’re feeling. Although the focus is on substance abuse, getting back to how it all started is crucial.

Promoting Personal and Family Wellness

Other methods of problem solving exist depending on the family therapist and can include more approaches to therapy. Substance use disorders (SUDs) occur when an individual continues to use alcohol or other drugs despite experiencing problems related to their use (American Psychiatric Association, 2013). Fortunately, there are couple- and family-based interventions for adults and adolescents with SUDs. We reviewed the past decade of research to provide an up-to-date picture of effective couple and family treatment for SUDs. In the 1980s and 1990s, Berg and Miller (1992) and de Shazer (1988) developed a family counseling approach to help family members find solutions to their problems instead of using the problemsolving approach of structural and strategic counseling. The main assumptions of solution-focused therapy are that pinpointing the cause of problematic family functioning is unnecessary and that counseling focused on solutions to specific problems is enough to help families change.

1. Have your client sign releases to have family members and recovery supports involved.
2. Couple and family-based therapies are shown to be superior to bona fide individual- and group-based therapies.
3. A major challenge in the implementation of the reviewed couple and family-based treatments is training of therapists in manualized protocols.
4. Each description includes an overview and goals of the approach, supporting research specific to SUD treatment, and relevant techniques and counseling strategies.

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. Having the client participate in individual sessions with the counselor as well as group sessions with the counselor and the network of family and friends. Offering affirmations and positive reinforcement for any positive change in substance use behaviors. Help parents develop/implement rules and consequences for substance use and risk behaviors. Teach advocacy skills to improve family interactions with extrafamilial community systems.

The Value Of Family Therapy

Family peer recovery support specialists understand the perspective of family members living with the effects of substance use behaviors and the challenges and successes of recovery. They provide education and emotional support to family members and actively link them to family-based resources in the addiction treatment, mental health, criminal justice, and child welfare service systems. Family peer recovery specialists also introduce and actively link family members to community-based recovery support services like Al-Anon. Moos (2011) noted that social factors protect people from developing SUDs and may also help them initiate and maintain recovery. These processes “are reflected in the active ingredients that underlie how community contexts, especially family members, friends, and self-help groups, promote recovery” (Moos, 2011, p. 45).

Relapse prevention interventions occur during the final phase of BCT (Klostermann & O’Farrell, 2013). The multidimensional approach suggests that behavior change occurs via multiple pathways, in different contexts, and through diverse mechanisms. MDFT “retracks” the adolescent’s development via treatment in the four domains. Knowledge of adolescent development and family dynamics guides overall counseling strategies and interventions. At IINE, we’ve been doing this a long time—we try to assess each family’s needs and we give as much individualized support as we can.

Ask recovery supports to share positive, non-substance-using experiences with the client. Discuss issues around safety and cultural appropriateness of inclusion of family members and recovery supports, including boundaries around confidentiality. Helping clients achieve long-term stability using a variety of SUD treatment tools. For example, avoiding relationships with others who are actively misusing substances, initiating medication-based treatment, attending mutual-aid support programs, and developing contingency contracts are all potential options. Solution-focused brief therapy replaces the traditional expert-directed approach aimed at correcting pathology with a collaborative, solution-seeking relationship between the counselor and the family.

Cognitive-Behavioral Approaches (CBT)

BCT not only positively affects the couple, but also has a secondary effect on children in the family (e.g., enhancing children’s psychosocial adjustment) even when the children do not participate in treatment (Fletcher, 2013). Adding specific content to BCT on parenting skills enhances the positive effects of this approach, not only on the couple but on the entire family. Much research on family-based SUD treatment interventions is on adolescents.