Brief strategic family therapy (BSFT) has been developed for Hispanic adolescents and their families. It has been shown to reduce drug use, enhance treatment compliance, and improve family relationships [49,50]. Although the intervention generally is conducted with families, some evidence supports its utility with a single person [51].
- There can also be differences in which parent makes which types of decisions for the family.
- Naltrexone directly blocks opiate receptor activity (receptor antagonist) and was approved in the 1990s for the treatment of opiate and later for alcohol use disorders.
- In addition,
the therapist might provide the client with self-help manuals that
outline the specific steps in the behavioral self-control process. - The husband’s abstinence has amplified the couple’s sense of being strangers in the same house, which initially became apparent when their children moved out.
In the beginning, they focus on helping you gain the knowledge and skills you need to prevent relapse. They talk to you about your life circumstances and immediately start problem-solving with you to get you out of toxic situations that threaten your recovery. If you don’t know of a local professional or program to call and ask, you can call a behavioral health crisis or information line for more help and guidance. These hotlines are free to use and are set up specifically to help you find the right level of behavioral healthcare. Keep in mind that individual counseling or therapy is not always a high enough level of care, especially in early recovery.
Brief strategic family therapy
Duration of therapy could be 6
to 10 sessions, depending on the purpose and goals of the intervention. Involving family members or concerned others in family therapy can have a number
of benefits. The dynamics of the family are already a factor in the client’s
substance-abusing behavior in a complex and unique relationship. In the same
manner, the family can participate in the positive experience of treatment and
recovery. The chronic disease model views SUDs as similar to other chronic medical conditions and acknowledges the role of genetics in SUDs (White, 2014).
Positive
emotional and situational factors were most important for those using
marijuana. Individuals dependent on sedatives and tranquilizers or
heroin/opiates reported that negative physical states and interpersonal
conflict were the most important risk factors. Again, it is the individual’s
appraisal of such situations, in terms of its threat to maintaining
abstinence relative to their available coping abilities, that determines the
situational risk for the individual (Myers et al., 1996).
Moral theory
Clients
involved in the abstinence-contingent program had fewer cocaine-positive
urine samples, fewer days of drinking, fewer days of homelessness, and more
days of employment during the followup period than those in the standard
treatment. CRA participants learn to encourage sobriety by reinforcing
abstinence while allowing the drinker to experience negative consequences from
intoxication. Significant others also learn to identify a time when the drinker
might be willing to enter treatment, in contrast to the confrontational methods
advocated by the Johnson Institute (Johnson,
1986) and Unilateral Family Therapy models (Thomas and Ager, 1993).
For
substance abuse disorders, these goals will, of course, involve a
reduction in or cessation of substance use. In addition to targeting
substance abuse as the primary focus, other goals will be developed to
assist the client in improving daily functioning (e.g., by reducing
stress, as described in Figure
4-5
). The focus of the therapy might be to
negotiate with the client to accomplish these other goals by reducing
use. The therapist will continue to engage the client in a collaborative
process in which they determine those problems to target, their relative
priority, and ways to resolve them. McCrady also included behavioral self-control training as another promising
but underutilized treatment approach (McCrady, 1991).
Substance Abuse Counseling vs. Therapy: How to Choose
Unlike some of the previous therapies, there is no underlying assumption in EBFT treatment that adolescent substance use stems directly from family dysfunction and conflict. As a result, the treatment occurs in both individual and family sessions allowing the therapist to help the youth make individual changes. This is accomplished through the use of cognitive behavioral techniques substance abuse counseling that teach the adolescent new skills for coping with intrapersonal and interpersonal problems. Ecological Based Family Therapy (EBFT) is a treatment that has been investigated in a few efficacy studies with runaway adolescents who use substances. It is based on Homebuilders Family Preservation model, which is an intervention created to keep youth in their own homes.
Some SUD treatment programs keep family involvement minimal until the individual with the SUD has obtained and maintained recovery. Other times, this approach may refect the outdated idea that sobriety or recovery must come first, regardless of an individual’s unique circumstances and family dynamics—despite family-based SUD treatment interventions typically enhancing outcomes for individuals and families. 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 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.
Most social workers are mandated reporters so this can present an ethical issue for those who work with individuals with SUDs, especially those with dependent children. Many patients know this and may withhold information about their substance use out of fear of being reported to Child Protective Services. Mandated reporters should disclose this role to their clients and be specific about what circumstances require reporting, while also emphasizing they will do everything they can to assist clients in obtaining the help they need. Only if clients feel a positive therapeutic rapport and trust the social worker will they disclose substance use. Parallel approaches deliver family counseling and SUD treatment independently, but at the same time. Some concurrent treatment approaches involve the person with SUD; others treat families separately from the family member with SUD.
Practitioners of this model approach SUDs as chronic illnesses that affect all members of a family and that cause negative changes in moods, behaviors, family relationships, and physical and emotional health. Their substance misuse was curtailed throughout the parenting years but escalated after the last child left the home. In recent months, the husband stopped drinking and began receiving treatment at an intensive outpatient counseling program. The husband’s abstinence has amplified the couple’s sense of being strangers in the same house, which initially became apparent when their children moved out. Triangulation happens when, instead of communicating directly with a family member who has an SUD, families who are under stress or lack coping skills instead talk around the person or with a third party in the family system. An example would be a mother who calls her daughter to talk about her son’s drinking rather than talking to the son himself about his problem with alcohol.
Five Counseling Theories and Approaches
Figure 4-3
provides an
overview of some of the advantages of behavioral theories of substance abuse and
dependence and their treatment. While therapy is a versatile tool, not all therapies work to treat all issues or conditions. And therapists who are inexperienced with substance use disorders can overlook warning signs of relapse and fail to provide essential interventions. It’s important to know that while all licensed substance abuse counselors are educated and trained to treat substance use disorders, not all therapists are.
- Their role may also encompass community outreach such as working with job placement services, support groups and schools, all to support their patients’ goals of living healthier lives.
- Structural therapists explore current family organization, especially hierarchy
and intimacy, while encouraging the family to loosen rules and expectations that
might be locking the substance abuser into a dysfunctional role (Minuchin and Fishman, 1981; Stanton, 1977). - In extreme cases, the separation may be due to the substance-related death of the parent from overdose, motor vehicle accident, or medical complications due to substance abuse.
- Clearly,
different clients will have different responses to these qualitatively different
approaches to modifying their thoughts and beliefs.
This can be individual, family, peer and community.(30) Substance use may be familial, a person may have watched a parent or caretaker use alcohol on special occasions or more frequently. Perhaps you had a parent who smoked tobacco, and this may have played a role in whether you smoke. These social connections that are critical for our development as babies, toddlers, youth and into adulthood play a role in what we do, how we act, and how we live. Every brain, and every person is different; we must look at biology as one potential factor in a substance use disorder. The field of Social Services is working to move beyond a moral model of substance use disorders.
