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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-2 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-3 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-4 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-5 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-6 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-7 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-8 The Family and Substance Abuse Kaufman’s Structures of Alcoholic Families Functional Neurotic Enmeshed Disintegrated: Temporary Separation Disintegrated: Absent Steinglass’ Developmental Phases EarlyMiddleLate Families with ATOD problems use: AngerBlameGuiltJudgment

9. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-9 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-10 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-11 Children in the Addicted Family The Silver Lining Resiliency Children can avoid the worst of the impact if they are able to find a parental surrogate. ● This is our main role as counselors!

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

13. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-13 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-14 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-15 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 9-16 Programs Utilizing Family Therapy ● Multidimensional Family Therapy (MDFT): Focuses on adolescent substance abuse ● Alcohol Behavioral Couple Therapy (ABCT)