CHAPTER 9 Family Treatment Substance Abuse Counseling Theory

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

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 Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -2

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 Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -3

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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -4

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. § § § Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -5

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 Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -6

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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -7

The Family and Substance Abuse Kaufman’s Structures of Alcoholic Families Steinglass’ Developmental Phases Families with ATOD problems use: Functional Early Anger Neurotic Enmeshed Disintegrated: Temporary Separation Disintegrated: Absent Blame Middle Guilt Late Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved Judgment 9 -8

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 § Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -9

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 Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -10

Children in the Addicted Family Children can avoid the worst of the impact if they are able to find a parental surrogate. Resiliency The Silver Lining ● This is our main role as counselors! Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -11

Children in the Addicted Family Other factors that impact a child’s resiliency Environmental Factors Support from the larger social systems Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -12

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 Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -13

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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -14

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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -15

Programs Utilizing Family Therapy ● Multidimensional Family Therapy (MDFT): Focuses on adolescent substance abuse ● Alcohol Behavioral Couple Therapy (ABCT) Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5 e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9 -16