Treating Substance Abusers in Correctional Contexts: New Understandings, New Modalities

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Marriage and family therapy MFT had its origins in the s, adding a systemic focus to previous understandings of the family.

Systems theory recognizes that. They sought to shift family boundaries so the boundary between parents and children was clearer. Intervention is aimed at having the parents work more cooperatively together and at reducing the extent to which children assume parental responsibilities within the family. One major model that emerged during this developmental phase was cognitive—behavioral family and couples therapy. It grew out of the early work in behavioral marital therapy and parenting training, and incorporated concepts developed by Aaron Beck.

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Beck reasoned that people react according to the ways they think and feel, so changing maladaptive thoughts, attitudes, and beliefs would eliminate dysfunctional patterns and the triggers that set them in motion Beck This union of cognitive and behavioral therapies in a family setting was new and useful. Cognitive—behavioral family therapy and behavioral couples therapy are two models that have strong empirical support.

Through the s and s, newer models of MFT were articulated.

They asserted that pinpointing the cause of poor functioning is unnecessary and that therapy focused on solutions is sufficient to help families change. This family therapy development has focused on the way people construct meaning and how the construction of meaning affects psychological functioning.

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In the early part of the 21st century, MFT seems poised to undergo another change, focused on empirically demonstrating the effectiveness of different approaches to therapy. The few models that have been tested empirically have shown promising results. Among the couples therapy models known to have reduced marital distress and psychological problems are emotionally focused couples therapy , cognitive—behavioral couples therapy , behavioral couples therapy , integrative couples therapy , and systemic couples therapy.

See chapter 3 for further information.

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There are numerous variations on the family therapy theme. Some approaches to family therapy reach out to multiple generations or family groups. Some treat just one person, who may or may not be the IP. Usually, though, family therapy involves a therapist meeting with several family members. Most family therapy meetings take place in clinics or private practice settings. Meeting the family where it lives also provides valuable information about how the family really functions.

Four predominant family therapy models are used as the bases for treatment and specific interventions for substance abuse: The family disease model looks at substance abuse as a disease that affects the entire family. Limited controlled research evidence is available to support the disease model, but it nonetheless is influential in the treatment community as well as in the general public McCrady and Epstein The family systems model is based on the idea that families become organized by their interactions around substance abuse.

In adapting to the substance abuse, it is possible for the family to maintain balance, or homeostasis. For example, a man with a substance use disorder may be antagonistic or unable to express feelings unless he is intoxicated. Using the systems approach, a therapist would look for and attempt to change the maladaptive patterns of communication or family role structures that require substance abuse for stability Steinglass et al.

C ognitive—behavioral approaches are based on the idea that maladaptive behaviors, including substance use and abuse, are reinforced through family interactions.

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Most recently, multidimensional family therapy MDFT has integrated several different techniques with emphasis on the relationships among cognition, affect emotionality , behavior, and environmental input Liddle et al. MDFT is not the only family therapy model to adopt such an approach. Functional family therapy Alexander and Parsons , multisystemic therapy Henggeler et al.

The integration of family therapy in substance abuse treatment is still relatively rare. Family therapy in substance abuse treatment helps families become aware of their own needs and provides genuine, enduring healing for people. Family therapy works to shift power to the parental figures in a family and to improve communication. Other goals will vary according to which member of the family is abusing substances.

Family therapy can answer questions such as. Whether a child or adult is the family member who uses substances, the entire family system needs to change, not just the IP. Family therapy, therefore, helps the family make interpersonal, intrapersonal, and environmental changes affecting the person using alcohol or drugs.

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It helps the nonusing members to work together more effectively and to define personal goals for therapy beyond a vague notion of improved family functioning. As change takes place, family therapy helps all family members understand what is occurring. A major goal of family therapy in substance abuse treatment is prevention——especially keeping substance abuse from moving from one generation to another.

Study after study shows that if one person in a family abuses alcohol or drugs, the remaining family members are at increased risk of developing substance abuse problems. Further, if the person abusing substances is an adolescent, successful treatment diminishes the likelihood that siblings will abuse substances or commit related offenses Alexander et al.

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Treating adolescent drug abuse also can decrease the likelihood of harmful consequences in adulthood, such as chronic unemployment, continued drug abuse, and criminal behavior. Because of the variety of family therapy models, the diverse schools of thought in the field, and the different degrees to which family therapy is implemented, multiple therapeutic factors probably account for the effectiveness of family therapy.

Still another reason that family therapy is effective in substance abuse treatment is that it provides a neutral forum in which family members meet to solve problems. Such a rational venue for expression and negotiation often is missing from the family lives of people with a substance problem.

Though their lives are unpredictable and chaotic the substance abuse—the cause of the upheaval and a focal organizing element of family life—is not discussed. If the subject comes up, the tone of the exchange is likely to be accusatory and negative. In the supportive environment of family therapy, this uneasy silence can be broken in ways that feel emotionally safe. As the therapist brokers, mediates, and restructures conflicts among family members, emotionally charged topics are allowed to come into the open. The therapist helps ensure that every family member is accorded a voice. Often family members are surprised to learn that others share their feelings, and new lines of communication open up.

Family members gain a broader and more accurate perspective of what they are experiencing, which can be empowering and may provide enough energy to create positive change. It is clearly a step forward for the family of a person abusing substances to become a stable, functional environment within which abstinence can be sustained.

To achieve this goal, family therapy facilitates changes in maladaptive interactions within the family system. In contrast to the peripheral role that families usually play in other therapeutic approaches, families are deeply involved in whatever changes are effected. In fact, the majority of changes will take place within the family system, subsequently producing change in the individual abusing substances.

Family therapy is highly applicable across many cultures and religions, and is compatible with their bases of connection and identification, belonging and acceptance. Most cultures value families and view them as important.

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This preeminence suggests how important it is to include families in treatment. In cultures that revere families, people may conceal substance abuse within the family because disclosure would lead to stigma and shame. Cultures differ in their views of what people need in order to heal. The identities of individuals who have the moral authority to help for example, an elder or a minister can differ from culture to culture.

Therapists need to engage aspects of the culture or religion that promote healing and to consider the role that drugs and alcohol play in the culture. Issues of culture and ethnicity are discussed in detail in chapter 5. While there are limited studies of the effectiveness of family therapy in the treatment of substance abuse, important trends suggest that family therapy approaches should be considered more frequently in substance abuse treatment.

One reason is that research with families is difficult and costly. Ambiguities in definitions of family and family therapy also have made research in these areas difficult. As a result, family therapy has not been the focus of much substance abuse research. However, evidence from the research that has been conducted, including that described below, indicates that substance abuse treatment that includes family therapy works better than substance abuse treatments that do not Stanton et al.

Bukstein emphasizes that family therapy interventions can focus on the environmental factors that promote both disorders. The studies all demonstrated the superiority of brief family treatment over individual and group treatments for reducing drug use.