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.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

Parental assessment of the adjustment of children following abduction by the other parent

We present a multiple regression model that explores post-return adjustment of school-age children who experienced abduction by a parent. The model includes: a) child and family characteristics preceding abduction, b) characteristics of the abduction experience, and c) child and family characteristics following return. Overall, the model accounts for 21% of the variance in post-return adjustment of children (p.05). The most salient finding is that post-return adjustment of children was best explained by characteristics of the child and family before the abduction occurred. Domestic violence perpetrated by one or both parents was the most significant factor.     

Three-term contingency patterns in mother-child verbal interactions during first-language acquisition

Selections from a large longitudinal data set of verbal interactions between a mother and her child are presented. Two sets of three-term contingency sequences that seemed to reflect maternal rewards and corrections were noted. Both the antecedents as well as the immediate consequences of maternal interventions are presented to explore training and learning processes. The observed frequencies of three-step sequences are compared to those expected based upon Markov-chain logic to substantiate the patterning of the interactions. Behavioral conceptualizations of the learning process are supported by these analyses, although their sufficiency is questioned. It is suggested that maternal rewards and corrections should be integrated with perceptual, cognitive, and social learning conceptualizations in a skill-learning approach to explain the complexity of language transmission and acquisition processes.     

The utility of verbal and behavioral assessments of value.

Subjects lived in a laboratory apartment for up to 30 days, engaging in ordinary activities such as reading, sewing, and artwork. The amount of time devoted to each activity was recorded and compared with periodic verbal ratings of the amount of time devoted to the activities. The verbal and observational assessments of the time distribution were very similar, but there were some discrepancies. Based on self-reports and on observation of time actually devoted to the activities, contingencies were arranged in which time devoted to one activity produced time available for a second activity. When the contingency relation was based on behavioral assessment, predictions of time redistribution were more accurate than when the relations were based on verbal assessment. The close correspondence between observed distributions of time and verbally assessed distributions was probably due to the well-specified situation and rigorous assessment methods. Contrary to some cognitive-behavioral accounts, the contingency results suggest that verbal assessment is not necessarily preferable to observation when the two make discrepant predictions. It is suggested that verbal reports might be used more often in behavior analysis in place of lengthy or difficult observations, and attention is drawn to a personality model that parallels important components of behavior analysis.     

Toward a theory of verbal behavior

This paper is a reply to an accompanying set of six commentaries by Sidman; Hayes and Barnes; Schusterman, Kastak, and Reichmuth; Tonneau and Sokolowski; Lowenkron; and Moerk. Those commentaries were prompted by our article “On the Origins of Naming and Other Symbolic Behavior” (1996), which was, in turn, followed by 26 commentaries and a reply. In the course of the present reply, we further develop the naming account to embrace more complex verbal relations such as same, different, more, and less. We also examine what we see as the lack of conceptual coherence in equivalence theories, including relational frame theory, and the disparities between these accounts and the findings from empirical research.     

Ethnic differences in psychiatric disorders among adolescent substance abusers in treatment

The present study describes the diagnostic profile of over 800 adolescents admitted to residential therapeutic community programs for treatment of drug abuse and related problems. The relationship between race/ethnicity and psychiatric disturbance is examined, and the association among these factors to outcome is investigated. Over 90% of the sample had a DSM-III-R nonsubstance diagnosis. There were significant differences among the race/ethnic groups on attention deficit-hyperactivity and the disruptive behavior and affective disorders. In general, African-American adolescents yielded the lowest rates of disturbance across all categories of disorders. There was no relationship among race/ethnicity, psychiatric disturbance, and 1-year posttreatment outcomes.     

Coping, competence, and aggression prevention: Part 2. Universal school-based prevention

Coping—competence theory yields a structural model of the development of persistent aggression in which current challenge encounters determine future life outcomes and competence. Driven by this model, universal, school-based prevention programs would aim in multiple ways to promote prosocial coping among high-risk, resilient, and advantaged youth from kindergarten through high school. Expected benefits of prosocial coping would include: less aggressive behavior, fewer adverse life outcomes (e.g., school dropout, police arrest, teen pregnancy, conduct, mood, and substance-use disorders), and a more competent self-definition and social reputation. Five stages are described that may prove useful in creating prosocial schools and neighborhoods supportive of youth in transition away from antisocial coping and deviant peers.     

A PRELIMINARY COMPARISON OF REINFORCER ASSESSMENT METHODS FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

We evaluated the relative treatment utility of a verbal forced-choice questionnaire, child nomination, and direct observation for identifying the most potent reinforcers for children with attention deficit hyperactivity disorder. Results demonstrated that all three methods were more likely to disagree than to agree, that a forced-choice format may enhance verbal reinforcer assessment, and that further development and evaluation of verbal reinforcer-assessment methods are needed.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.