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Major approaches to initiate change
Institute intervention—Therapist helps family plan and
conduct surprise family confrontation meeting called an intervention.
relational intervention sequence for engagement (ARISE)—A
three-step model starting with low pressure methods and ending with
Johnson intervention if earlier steps are unsuccessful.
to change (PTC)—Teaches coping responses to empower family
member and provide incentives for alcohol abuser to change.
reinforcement and family training (CRAFT)—Teaches family
member to use positive reinforcement and negative consequences to discourage
substance use and encourage treatment.
Evidence for these approaches
is most effective, averaging 68% treatment engagement across
four randomized trials.
popular, the Johnson intervention has only 25%–30% engagement
rate because many families do not follow through with the confrontation.
reduces drinking for brief period but durability of changes are
is promising, but lacks controlled studies.
Major approaches to aid recovery
therapy (see Chapter
systems therapy (FST)—Joining with the family and restructuring
family alliances and interactions.
couples therapy (BCT)—Recovery contract with daily trust
discussion supports abstinence; positive activities and communication skills
has the strongest evidence base of over 15 randomized trials.
produces more abstinence, happier relationships, better compliance
with recovery-related medication, and greater reductions in partner
violence and emotional problems of the couple's children
than individual-based treatment.
supports FST for adolescent substance abusers and young adult heroin-dependent
that supports FST with adult alcoholism is not very extensive.