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Chapter 30. Family Therapy

Timothy J. O'Farrell, Ph.D.; William Fals-Stewart, Ph.D.
DOI: 10.1176/appi.books.9781585623440.348954

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Excerpt

Any review of the development and applications of the family treatment model for addictions over the last half-century reveals a rapid progression in the acceptance of family-involved therapy as an important component of treatment for alcoholism and drug abuse. For example, the treatment literature from the 1950s and early 1960s primarily conceptualized substance abuse as an individual problem that was best treated on an individual basis (e.g., Jellinek 1960). However, throughout the 1960s, this view was gradually supplanted by what would now be the prevailing clinical wisdom that family members can play a central role in the treatment for alcoholism and drug abuse (Stanton and Heath 1997). In the early 1970s, couples and family therapies were described by the National Institute on Alcohol Abuse and Alcoholism as "one of the most outstanding current advances in the area of psychotherapy of alcoholism" (Keller 1974, p. 161). By the late 1970s, family therapy for substance abuse was embraced by the majority of substance abuse treatment programs and community mental health settings (e.g., Coleman and Davis 1978; Kaufman and Kaufman 1992), and since the late 1980s, family-based assessment and intervention have become widely viewed as part of standard care for alcoholism and drug abuse. In fact, many have argued that the only reason not to include family members in the treatment of a substance-abusing patient is refusal by the patient or members of the family to be involved (e.g., O'Farrell 1993b).

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FIGURE 30–1. Recovery contract and calendar for Mary and Jack.Source. Reprinted from O'Farrell TJ, Fals-Stewart W: Behavioral Couples Therapy for Alcoholism and Drug Abuse. New York, Guilford, 2006, p. 48. Used with permission.

FIGURE 30–2. Contract and calendar for Sue and Gene, a dual problem couple.Source. Reprinted from O'Farrell TJ, Fals-Stewart W: Behavioral Couples Therapy for Alcoholism and Drug Abuse. New York, Guilford, 2006, p. 48. Used with permission.
Table Reference Number
TABLE 30–1. Family-based methods to help the family when the substance abuser refuses to get help
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TABLE 30–2. Family-based methods to initiate change when the substance abuser refuses to get help
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TABLE 30–3. Family-based methods to aid recovery when the substance abuser has sought help
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Family therapy interventions have been designed for three main purposes: 1) to help the family when the substance abuser refuses help, 2) to initiate change when the substance abuser resists treatment, and 3) to aid recovery once treatment has begun.

Major approaches to help the family when the substance abuser refuses help are 1) Al-Anon facilitation and referral and 2) coping skills therapy (CST).

Studies show that both Al-Anon and CST reduce emotional distress and improve coping by the family member. However, CST leads to less drinking and less violence by the substance abuser than does Al-Anon.

Major approaches to initiate change when the substance abuser resists treatment are 1) the Johnson Institute intervention, 2) a relational intervention sequence for engagement (ARISE), 3) pressure to change (PTC), and 4) community reinforcement and family training (CRAFT).

Studies show that CRAFT is most effective in initiating change, averaging a 68% treatment engagement rate across four randomized trials. Although popular, the Johnson intervention has only a 25%–30% engagement rate because many families do not follow through with the confrontation meeting that is the hallmark of this approach.

Major approaches to aid recovery once treatment has begun are 1) network therapy, 2) family systems therapy (FST), and 3) behavioral couples therapy (BCT).

Studies show that BCT is effective with alcoholism and drug abuse. BCT produces more abstinence, happier relationships, better compliance with recovery-related medication, and greater reductions in partner violence and in emotional problems of the couple's children than does individual-based treatment.

Studies support FST for adolescent and young adult drug abusers, but evidence supporting FST with adult alcoholism is not very extensive.

References

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Sample questions:
1.
A major advantage of coping skills therapy (CST) over Al-Anon facilitation therapy (AFT) is CST's ability to produce greater:
2.
Which of the following family-based methods to initiate change when the substance abuser refuses to get help teaches family members to use positive reinforcement and negative consequences to discourage substance use and encourage treatment?
3.
Which of the following therapies has been shown to be most effective?
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Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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