Family Therapy and Drug Abuse: A National Survey

The following report describes the results of a national study of the role of family therapy in the drug abuse field. Characteristics of agencies that work with families are described, as well as the demographic characteristics and psychological problems of the clients most apt to be treated in family therapy. The study also looks at the role and structure of family therapy in the ecological system of the treatment institutions. A profile of the family therapists who are responsible for providing services to families is presented. An attempt was made to assess agencies' level of development with regard to family therapy by using an instrument, The Progress Index for Family Therapy Programs. Generally, findings indicated that there is considerable variation in expertise. More extensive training in family therapy techniques was of major concern, particularly among clinics with a heroin addict population.     

Case Studies in the Family Treatment of Drug Abuse

This article, with case illustrations, attempts to demonstrate that drug-abuse behavior can be understood more clearly in the light of family loyalties and unresolved family crises than from the perspective that drug abusers are social deviates.1 Drug abuse is viewed as symptomatic, as a signal that both drug abuser and his or her family are having difficulty in getting past a particular stage in the natural unfolding life cycle of a family. Treatment of drug abuse is seen primarily as helping the family to become "unstuck," thereby freeing the individual's and family's energy for the task of self-development and growth rather than expending it to maintain rigid patterns of interaction in an attempt to prevent change.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Family Relationships as a Predictor of Post-Treatment Drug Abuse Relapse: A Follow-Up Study of Drug Addicts and Their Spouses

This study examined family-of-origin (FO) characteristics of drug addicts and their spouses, who participated in an in-home drug treatment program. Discriminant analysis revealed a set of FO characteristics that differentiated between 25 men who remained drug-free for six months after detoxification and 25 men who suffered a relapse. This set of FO characteristics successfully predicted relapse 30 months later. Men who remained drug-free for the entire period maintained closer relationships with healthy than with unhealthy families, whereas those who relapsed maintained closer relationships with unhealthy families. Compared with those who relapsed, men who remained drug-free also maintained closer relationships with their spouses' families. The findings are discussed in terms of the family system's view of drug abuse, as well as their implications for family-based intervention.     

Family Assisted Contingency Management within the Context of Evidence-Supported Treatment for Child Neglect and Drug Abuse

Contingency management (CM) has extensively been shown to be effective in reducing substance use disorders, but its effects in reducing child maltreatment have yet to be determined. The current study provides preliminary support for the utilization of an innovative family-assisted CM component in 18 mothers who were referred to an evidence-supported behavioral treatment for concurrent child neglect and drug abuse by Child Protective Service caseworkers. In the examined CM, participants were invited to indicate from a list of common actions incompatible with child neglect (i.e. positive parenting actions), the extent to which these actions had been experienced utilizing a 3-point scale (almost never, sometimes, almost always). For each item that was indicated to be almost never or sometimes experienced, the participants were queried to indicate if the neglect incompatible action should be targeted as a therapeutic goal. Contingencies were subsequently established in which the participants were rewarded by involved family members for their completion of therapeutic goals. At baseline, results indicated that there was a negative association between the number of neglect incompatible parenting actions that were infrequently experienced and child abuse potential. A hierarchical multiple regression analysis showed that the number of neglect incompatible actions targeted as therapeutic goals at baseline, but not the number of positive parenting actions experienced infrequently at baseline, predicted reduced child maltreatment potential following treatment. These findings suggest the examined CM may assist evidence supported behavioral treatment specific to child neglect and drug abuse.     

Editorial: Drug Abuse and AIDS

Abstract

The present article presents an overview of the behavioral and psychological components which have been found to be associated with Type A behaviors in children and adolescents. Each component is discussed within the context of the assessment device used to measure it. with methodological concerns being addressed whenever appropriate. Using both observational methods and self-report questionnaires. the four major behavioral components of adult Type A behavior; competitive-achievement striving, time urgency, aggressiveness-hostility and impatience have been found in child/adolescent Type A subjects. Type A children have a lower self-esteem, a more external locus of control and higher anxiety level than their non-Type A counterpart. Coping mechanisms for stress and characteristic cognitions may differ in Type A subjects as they progress from childhood through adolescence. Recommendations for future research are presented.     

Drug Abuse in the Sales Force

Drug abuse in the workplace is a national problem of frightening proportions and there is no reason to suspect that the nations's sales forces should be immune. This study examines the problem of sales force drug abuse and reports the findings of a nationwide survey of field sales managers concerning the extent of drug abuse in the nation's sales forces, the methods of dealing with the problem, and factors related to drug abuse problems in the sales force. Implications for sales managers, sales management educators and trainers, and researchers in the field of sales and sales management are also discussed.     

Family of Origin Violence and Courtship Abuse

Research has shown that family of origin violence is related to later courtship and marital abuse. Few researchers, however, have distinguished between observed and received violence as a child and expressed and received abuse in adult relationships. Questionnaires addressing these issues were completed by 336 undergraduates. Results indicated that 75% of the sample had expressed threats or actual violence and 64% had received such abuse in an intimate relationship. Only 25% had been publicly identified as a result of the violence. In this sample, 30% had parents who abused each other. Less often, the mother (9.1%) or father (8.5%) had been the sole abuser. Most (76.4%) had been abused as children. Multiple regression indicated that being abused as a child predicted receiving and expressing violence as an adult.     

Her Body Speaks: The Experience of Dance Therapy for Women Survivors of Child Sexual Abuse

This qualitative, phenomenological study explores the experiences of dance therapy for 5 women who had been sexually abused as children. Using in‐depth, largely unstructured interviews, the women reflect on their dance therapy experiences and on their perceptions of the role of these experiences in their psychological healing. Analysis of these data revealed 6 common themes related to the women's sense of spontaneity, permission to play, struggle, freedom, intimate connection, and bodily reconnection. The implications of the findings are discussed in terms of the therapeutic nature of dance therapy and how this therapeutic modality facilitates change and healing in clients' lives.     

Suicide and Drug Abuse in the Medical Community

ABSTRACT: In the United States each year the equivalent of an average-size medical school graduating class commits suicide, with the highest incidence occurring in the decade following the completion of training. Of these suicides, 20% to 30% are associated with drug abuse and 40% with alcoholism. Various problem areas are considered. Role strain, leading to excessive drug use in an attempt to increase work efficiency, is coupled with a denial of the physician's own dependency needs and gratification. The problem of identity occurs in relation to the exaggerated sense of duty and obligation the physician feels in attending to the demands of the patients and their families. Medicine as magical thinking is also discussed, revealing the physician's belief in his own immunity, which is strenuously tested when he actually sets up in practice. The community's high regard for the physician further complicates the situation. Too little has been done about working with emotional problems of medical students during their training and after they begin to practice. Unfortunately, physicians feel uncomfortable in turning to colleagues for help; rather, they tend to isolate themselves, resorting to alcohol and drugs. One should question the selection of medical students and their overall training, not only in terms of academic learning but also with more consideration for the stresses and strains of the future career.     

The Theological Relevance of Addressing Caretaker Needs in Cases of Family Elder Abuse

ABSTRACT

Family elder abuse/neglect is significant contemporary problem. Although social attention is being given to the needs of the victims, this paper explores the possible theological relevance of also addressing the needs of the caretaker/victimizers. Four major topics are introduced including (1) the reality of family elder abuse/neglect, (2) religious/moral bases for addressing the problem of abuse/neglect, (3) an examination of family caretaker problems, and (4) theological/moral rationale for addressing caretaker needs. This paper hypothesizes that by identifying and addressing the needs of the caretaker, significant steps may also be taken towards possible intervention and prevention.     

Family Dynamics and Substance Abuse: A Preliminary Study

The authors discuss family patterns of interaction that are thought to contribute to the maintenance of substance abuse. Preliminary research findings pertaining to the interaction patterns are also presented. The data suggest that these families are often highly interdependent, that in about 50% of the cases they ideally desire some sort of triangulation between parents and offspring, and that in about 50% of the cases they have or are working toward a hierarchical reversal. Therefore, in addition to evaluating characteristics of the substance abuser, the authors recommend that counselors consider the nature of relationships within the client's family of origin.     

Family Dynamics and Drug Overdoses*

ABSTRACT: In a study of 40 patients who had taken an overdose, and with the relatives of 18 of these subjects, a pattern of family factors that appeared relevant to the choice of drugs was found. These family factors included: (a) a specific expectation that the person would use drugs; (b) an identification with another suicidal family member; (c) a high level of oral preoccupation and oral fixation; (d) trauma in the life history associated with food or orality; and (e) a direct participation of other family members in the suicidal act. The direct study of family interactions in evaluating suicidal potential is recommended for its unique diagnostic and therapeutic implications.