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
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Introduction
●
Defining Family
●
General Systems Concepts
●
Systems and Addictive Families
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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, 5e
© 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:


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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, 5e
© 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, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
9-4
General Systems Concepts
●
Underlying concepts of systems theory framework:
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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, 5e
© 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, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
9-6
Systems and Addictive Families
●
The Marital Dyad and Substance Abuse
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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, 5e
© 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, 5e
© 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:
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Conduct disorders
Poor academic performance
Inattentiveness
Children in substance-abusing families:
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Are socially immature
Lack self-esteem and self-efficacy
Have deficits in social skills
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
●
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, 5e
© 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, 5e
© 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, 5e
© 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, 5e
© 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, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
9-14
The Process of Treatment
●
General considerations
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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, 5e
© 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, 5e
© 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved
9-16