From structure to strategy with the families of solvent abusers

A psychiatric out-patient sample of forty-five teenage solvent abusers and their families is described. Most lived in socially deprived areas. In this necessarily unrepresentative clinic sample family psychopathology was characterized by (i) adult intimacy-avoidance and (ii) a powerful, collusive alliance between mother and adolescent. These were linked in a circular pattern of systemic dysfunction, social and generational influences tending to strengthen homeostatic rigidity. Structural and strategic treatment approaches are described with case illustrations and discussed. At the six-month follow-up a good outcome was recorded in three-quarters of the treated cases but the effects of sample bias and 'soft' evaluative data should be borne in mind.