Taking the Bull by the Horns: A Family Therapy Case of an East Indian Adolescent Substance Abuser

The cultural clash between traditional East Indian cultural values and US values often leads to parent–child conflicts, which increases East Indian adolescents’ risk for substance abuse. This is demonstrated in theory and through a case presentation of an East Indian adolescent substance abuser who was treated through an approach that coincided with the core principles of multi-dimensional family therapy. Family therapy interventions that coincided with East Indian cultural values were generally effective and resulted in decreased parental substance abuse, decreased family conflict, and improved parenting skills. Family therapy interventions that conflicted with East Indian cultural values were not effective. Further study is needed to ascertain the extent of parental and adolescent substance abuse in East Indian immigrant families and the effectiveness of a multi-dimensional family therapeutic approach to treatment.     

Variables Associated with Therapy Attendance in Runaway Substance Abusing Youth: Preliminary Findings

Service providers and researchers note that youth with substance abuse problems are difficult to engage in treatment and, when engaged, often drop out early. Estimates of the alcohol and drug abuse rate of runaway youth range from 70% to 95%. This study evaluated predictors of therapy attendance in a sample of substance abusing youth recruited through two southwestern runaway shelters. Runaway youth and their families (N = 36) were engaged into a 15-session ecologically-based family therapy (EBFT) intervention. Fewer days between the pretreatment assessment and the first therapy session, as well as less perceived parental care, predicted more therapy sessions attended. No relationship was found between level of substance use and treatment attendance. The findings highlight the importance of engaging families in therapy soon after the youth's arrival to the shelter, as treatment motivation may decrease as the crisis lessens.     

Variables Associated with Therapy Attendance in Runaway Substance Abusing Youth: Preliminary Findings

Service providers and researchers note that youth with substance abuse problems are difficult to engage in treatment and, when engaged, often drop out early. Estimates of the alcohol and drug abuse rate of runaway youth range from 70% to 95%. This study evaluated predictors of therapy attendance in a sample of substance abusing youth recruited through two southwestern runaway shelters. Runaway youth and their families (N = 36) were engaged into a 15-session ecologically-based family therapy (EBFT) intervention. Fewer days between the pretreatment assessment and the first therapy session, as well as less perceived parental care, predicted more therapy sessions attended. No relationship was found between level of substance use and treatment attendance. The findings highlight the importance of engaging families in therapy soon after the youth's arrival to the shelter, as treatment motivation may decrease as the crisis lessens.     

Integrating Internal Family Systems and Solutions Focused Brief Therapy to Treat Survivors of Sexual Trauma

In a recent study 56% of women and 37% of men were survivors of childhood sexual abuse. These individuals who experience sexual trauma may experience depression, anxiety, post-traumatic stress disorder (PTSD) or substance use disorders (Devlin et al., in Fam J 27(4):359–365, 2019). While there are several treatment approaches specifically developed to target trauma and its effects, (e.g., trauma focused cognitive behavioral therapy, and eye movement desensitization and reprocessing) we propose that integrating internal family systems therapy (IFS) and solution focused brief therapy (SFBT) offers a brief, systemic way to improve family relationship patterns in families where one member has experienced sexual trauma. A case vignette is used to show the integration of these two approaches.

     

The family empowerment program: an interdisciplinary approach to working with multi-stressed urban families

The family empowerment program (FEP) is a multi-systemic family therapy program that partners multi-stressed families with an interdisciplinary resource team while remaining attached to a "traditional" mental health clinic. The rationale for this model is that far too often, families presenting at community mental health centers struggle with multiple psychosocial forces, for example problems with housing, domestic violence, child care, entitlements, racism, substance abuse, and foster care, as well as chronic medical and psychiatric illnesses, that exacerbate symptoms and impact traditional service delivery and access to effective treatment. Thus, families often experience fragmented care and are involved with multiple systems with contradictory and competing agendas. As a result, services frequently fail to harness the family's inherent strengths. The FEP partners the family with a unified team that includes representatives from Entitlements Services, Family Support and Parent Advocacy, and Clinical Staff from the agency's Outpatient Mental Health Clinic practicing from a strength-based family therapy perspective. The goal of the FEP is to support the family in achieving their goals. This is accomplished through co-construction of a service plan that addresses the family's needs in an efficient and coherent manner-emphasizing family strengths and competencies and supporting family self-sufficiency.     

EEG Biofeedback for Addictive Disorders—The State of the Art in 2004

This paper reviews studies of brainwave biofeedback as a therapeutic technique for substance use disorder. This modality is attractive as a medication free, neurophysiologic, and self actualizing treatment for a substance based, brain impaired and self-defeating disorder. Three approaches are described and the literature for each reviewed. Alpha–theta occipital feedback was originally employed to facilitate autosuggestion in hypnagogic states to augment standard therapy approaches in substance abuse treatment programs and appears most suited for chronic treatment resistant alcoholics. Beta augmentation feedback in conjunction with alpha/theta feedback has been employed in mixed substance abuse and stimulant abuse with good results. Individualized brainwave biofeedback based on correcting EEG abnormalities, or based on addressing comorbid conditions is a third approach that has been described, and may be most appropriate where confounding comorbid conditions are present. Although effectiveness in certain hard to treat populations (conventional treatment resistant alcoholics, crack cocaine addicts, cognitively impaired substance abusers) is promising, better-designed controlled studies are needed.     

Employed couple families and substance abuse: The tip of the iceberg

In 60 percent of 80 employed couple families seeking treatment, substance abuse was a rarely mentioned, largely unemphasized complication. These families are analyzed to illustrate the unique problems of employed couple families and how these facilitate substance abuse. An argument is made for family therapy as the treatment of choice where employed couple, substance abusing families are involved. Traditional substance abuse interventions may be futile and even destructive in some ways to those families.This paper is based on an invited presentation to the. 1986 Fall Conference of the Michigan Alcohol and Addiction Association and the Michigan Association for Marriage and Family Therapy. Robert E. Lee, PhD, is a Diplomate in Clinical Psychology of the American Board of Professional Psychology (ABPP) in private practice at 28336 Franklin Road, Southfield, MI 48034.     

Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

Engaging the severely dysfunctional family in treatment: basic considerations

The severely dysfunctional family is a clinical phenomenon that includes families with a wide range of serious symptoms. These families have been characteristically difficult to engage in treatment, and many do not respond well to traditional family therapy techniques. Some of these families do respond to innovative approaches such as paradox. However, many agencies do not have the capability to implement such highly specialized procedures, nor do all severely dysfunctional families respond well to these techniques. Thus, this paper presents a generic approach to the severely dysfunctional family; the emphasis is on facilitating engagement and maintaining sensitivity to the family's need for stability.     

DRUG ABUSE AND THE FAMILY

The Family and Drug Abuse Symposium held on July 10–12, 1975, brought together individuals who possess clinical and/or research expertise in the area of family research and substance abuse. The purpose of the symposium was directed toward assessing the current state of knowledge in the field and delineating directions for future work. The role of family interaction in causing or maintaining a drug abuse problem has only recently become the focus of research and innovative treatment efforts. This special section is intended to acquaint therapists and researchers with recent work in the field; the papers are revised versions of materials originally prepared for the symposium. This first paper offers a brief overview of the symposium and summarizes issues that arose from each of the four workshops: I. Psychosocial Research; II. Clinical Observations; III. Clinical Programs; and IV. Recommendations Made to the National Institute on Drug Abuse. The next paper is a review of recent studies in research and treatment that have approached substance abuse from a family viewpoint. Other research methods that appear relevant to the study of families with a drug-abusing member are discussed. Three commentaries on this review follow. The last paper describes an extensive effort to implement and evaluate family therapy within an existing drug treatment facility.     

A Supervision Approach for Teaching Structural/Strategic Therapy in a Limited Setting

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

Temperament Pathways to Childhood Disruptive Behavior and Adolescent Substance Abuse: Testing a Cascade Model

Temperament traits may increase risk for developmental psychopathology like Attention-Deficit/Hyperactivity Disorder (ADHD) and disruptive behaviors during childhood, as well as predisposing to substance abuse during adolescence. In the current study, a cascade model of trait pathways to adolescent substance abuse was examined. Component hypotheses were that (a) maladaptive traits would increase risk for inattention/hyperactivity, (b) inattention/hyperactivity would increase risk for disruptive behaviors, and (c) disruptive behaviors would lead to adolescent substance abuse. Participants were 674 children (486 boys) from 321 families in an ongoing, longitudinal high risk study that began when children were 3 years old. Temperament traits assessed were reactive control, resiliency, and negative emotionality, using examiner ratings on the California Q-Sort. Parent, teacher, and self ratings of inattention/hyperactivity, disruptive behaviors, and substance abuse were also obtained. Low levels of childhood reactive control, but not resiliency or negative emotionality, were associated with adolescent substance abuse, mediated by disruptive behaviors. Using a cascade model, family risk for substance abuse was partially mediated by reactive control, inattention/hyperactivity, and disruptive behavior. Some, but not all, temperament traits in childhood were related to adolescent substance abuse; these effects were mediated via inattentive/hyperactive and disruptive behaviors. This work was supported by NIAAA grant R01-AA12217 to Robert Zucker and Joel Nigg, NIAAA grant R37-AA07065 to Robert Zucker and Hiram Fitzgerald, and NIMH grant R01-MH59105 to Joel Nigg. Martel was supported by 1 F31 MH075533-01A2. The authors thank the participants and Susan Refior, the long term MLS Field Director, whose steadfast commitment and support have made this study possible.     

Engaging high risk families in community based intervention services

Involving high risk families in community based intervention services constitutes a major challenge facing service delivery in the fields of mental health and substance abuse. Mental health and substance abuse programs typically experience high rates of failure to enroll families in services, as well as high rates of drop-outs from treatment. With family-based intervention programs, those involving all the members of the family or household participation by the entire family is a key to having a successful program. The NIDA funded Youth Support Project tests such a home and family based Family Empowerment Intervention in a randomized field trial which targets families of juvenile offenders. This intervention is delivered three times a week by paraprofessionals who are supervised by a licensed clinician. We discuss the guiding principles and success of our enrollment activities and discuss their implications for other family-based services.     

Experiential Activities in Family Therapy: Perceptions of Caregivers and Youth

Novel and creative therapeutic modalities have been developed in an effort to increase motivation in family therapy for adolescents and families. Many of these approaches incorporate experiential activities or “family play”, which provides a supplemental approach to traditional talk therapy. Incorporating experiential activities into family therapy sessions has been shown to increase engagement and enhance participation in therapy. Therefore, to understand how families view experiential activities within family therapy, we interviewed nineteen adolescents (age 12–17) and their parents/caregivers who were receiving family therapy augmented with experiential activities. We asked a series of open-ended questions to understand the families’ experiences concerning how they initially felt about participating in family therapy and their perceptions of the experiential activities. The activities involved experiential interactions and skill-building exercises that elicited active participation from all family members and encouraged further discussions. Topics of these activities focused on problem areas the family had identified, such as anger management, problem-solving, improving communication, substance use, expressing feelings, coping, etc. Results showed that most caregivers and youth found the experiential activities helpful in creating positive family interactions and developing communication skills. Caregivers and adolescents noted that the activities increased their desire to participate in family therapy sessions and they were more motivated to engage in the treatment process. Clinicians using the methods discussed in this intervention should be aware of the study’s limitations. Implications for clinical practice and research are discussed.     

A supervision approach for teaching structural/strategic therapy in a limited setting

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.     

Family treatment approaches to drug abuse problems: a review.

This review covers the literature that has emerged specifically on the family treatment of drug abuse problems. Following a brief discussion of patterns and structures prevalent in drug-abusing families, 68 different studies or programs (discussed in 74 papers) are compared as to their techniques and results. These are categorized within the following modalities: marital treatment, group treatment for parents, concurrent parent and identified patient treatment, treatment with individual families (both inpatient and outpatient), sibling-oriented treatment, multiple family therapy, and social network therapy. A table presents the various studies, along with the types of results they provide. Outcomes are contrasted for the 14 studies that quantified their results. The final section presents implications for the following areas: treatment activities (clarification of technique, family recruitment, direction and effectiveness of treatment, confidentiality, and treatment delivery systems), training, prevention, and future research (outcome, technique and responsibility). It is concluded that family treatment for drug abuse is gaining widespread acceptance and shows considerable promise for dealing effectively with problems of this type.     

Couple Therapy and Addictions

Abstract

Therapies for alcoholism, substance abuse, and other addictions traditionally focus on characteristics of individuals such as behaviors, thoughts, and emotions. These kinds of programs tend to target problems inside the abusing person rather than a relational system. Treatments that are more recent locate the problems within systems of people. Regardless of the locus or cause of the abuse or addiction, seen as arising from disease processes, systemic dynamics, or other mechanisms that lead to unfortunate habits and behaviors, utilizing the individual's partner or family in therapy has become an important part of successful treatment. This article reviews models of couple treatment for alcoholics and substance abusers in terms of initiation into treatment, primary treatment, and relapse prevention.