Rimmele andcolleagues also recommended covert sensitization as a highly effective andportable treatment component which, unlike chemical or electric aversiontherapies, can be used at any time and in any setting as a self-controlstrategy (Rimmele et al., 1995). Regular assessment and measurement of progress are integral to effectivebehavioral therapy. Decisions about the length of treatment are made on thebasis of these assessments, rather than according to a formula or theoreticalassumption about how long therapy should take. Each individual is approached asa unique case, albeit one to which broad principles can be applied.
Family Systems Therapy and the Genogram
Another likely reason for the relative effectiveness of MI and MET is the explicit attention to strengthening clients’ self-efficacy and responsibility for and commitment to change, which is consistent with stress and coping theory. In this vein, compared to MI clients who used weak commitment language (e.g., “I will try to stop using”), clients who used strong commitment language (e.g., “I am determined to stop using”) were more likely to achieve abstinence outcomes up to 12 months later. The strength of clients’ commitment statements provided unique predictive information about outcomes beyond prior levels of substance use (Amrhein et al., 2003). Clients’ acceptance of personal responsibility for change and resulting commitment language may be the key mediating factor between the emphasis in MI and MET on bonding and goal direction, normative feedback, and eventual substance use outcomes. Consistent with social learning theory, the emphasis on normative feedback about the client’s substance use and potential problems from use, and attempts to alter personal norms about use, are key processes in MI and MET.
Incorporating the Concept of Systems Into Family Models
Just as the provision of these ingredients of treatment appears to foster better outcomes, iatrogenic effects may occur when they are lacking. In this vein, about 10% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. The main mediating mechanisms appear to involve an increase in self-blame and learned helplessness and a decline in the sense of personal control (Moos, 2005). Since a paramount goal of treatment is to do no harm, these findings highlight the importance of extending our knowledge about the positive and negative processes involved in treatment. These components of CRA are based on a combination of principles drawn from the four theories described earlier. CRA emphasizes aspects of social control theory in noting that the counselor needs to be supportive, structured, and goal-directed.
Regular Sessions
Family members learn to focus on their own mental, physical, emotional, social, and spiritual needs while still supporting their relative’s recovery. When appropriate, refer for assessment or individual counseling family members or recovery supports who have their own substance use or mental health concerns—or refer them to family therapy to address family issues beyond your scope of practice. The role of the counselor is to emphasize substance abuse counseling times when the problem (e.g., substance use behavior) does not occur and help the family identify achievable solutions that enhance motivation and optimism for behavioral change (Klostermann & O’Farrell, 2013). Sequential treatment implements family-based approaches after initial SUD treatment. Some SUD treatment programs keep family involvement minimal until the individual with the SUD has obtained and maintained recovery.
Family Approaches To Support Ongoing Recovery
- Ask about current violence and criminal justice involvement and adjust your counseling approach accordingly.
- Facilitate contact between your client’s recovery supports and a peer recovery support specialist, if available, to link them actively with and expedite participation in community-based programs.
- The husband’s abstinence has amplified the couple’s sense of being strangers in the same house, which initially became apparent when their children moved out.
- Figure 4-10shows a number of distorted addictive thoughts and more rational alternativesthat the therapist might help develop and practice over the course of cognitiverestructuring.
- Two advantages of CBT are that it is relatively brief in duration and quiteflexible in implementation.
Sociocultural interventions often stress the strengths of clients and families in specific contexts; such interventions include job training, education and language services, social skills training, and supports to improve clients’ socioeconomic circumstances. Other interventions may involve community- and faith-based activities or participation in mutual-help groups to alleviate stress and provide support. Rather than focusing solely on individuals who have SUDs, family counseling widens the focus by shifting attention to clients and their whole families. This shift in focus supports identification of goals as a family group and as individuals within that group. It also creates a transparent atmosphere that helps individuals with SUDs see that their families are not blaming them for their addiction or ganging up on them to seek treatment.
Chapter 1—Substance Use Disorder Treatment: Working With Families
Because substance abuse behavior is learned, it can be changed byteaching the client more adaptive, alternative behaviors aimed at achieving thesame rewards. Figure 4-3provides anoverview of some of the advantages of behavioral theories of substance abuse anddependence and their treatment. Decades of scientific research on addiction treatment have found behavioral, motivational and family-based therapiesto effectively treat substance use disorders. Other therapies such as EMDR and 12-step facilitation therapy are alsobacked by a plethora of research. Functional family therapy is also based on the idea that dysfunctional family interactions create and support problematicbehavior.
- American Addiction Centers offers family therapy at many of our rehab centers across the country.
- Pilot testing of this adapted approach shows promising outcomes (Sheidow, McCart, & Davis, 2016).
- You can also use the initial interview to determine how the family functions, identify major family problems, and identify the family’s perception of how the SUD has affected their family and each member (Schumm & O’Farrell, 2013b).
- Clients in the contingent vouchercondition, compared to those who received vouchers on a noncontingent basis,reported decreased craving for cocaine and significantly increased cocaineabstinence.
Developmental Stage
Work collaboratively with your client to develop a plan for identifying supportive family members and recovery supports; inviting them to an initial counseling, family group session, or psychoeducational session; and deciding what issues will be addressed. Helping clients achieve long-term stability using a variety of SUD treatment tools. For example, avoiding relationships with others who are actively misusing substances, initiating medication-based treatment, attending mutual-aid support programs, and developing contingency contracts are all potential options. You can help clients and their family members initiate and sustain recovery from substance use disorders (SUDs) by actively involving family members in treatment. Before jumping to educating family members about medications and how important medication adherence is for individual and family stability, explore both the client’s and the family’s perspective about medication and its role in family functioning.
- Assertive continuing care involves weekly home visits during the three-month period after a teenager is discharged froma drug rehab facility.
- These services can range from less intensive (e.g., general case management support services) to more intensive (e.g., wraparound services, assertive community treatment programs) (Rapp et al., 2014).
- Other therapies involve people in recovery voluntarily helping animals at shelters or having animals during traditionaltherapy sessions.
- Although family counseling may temporarily shake up the family system and activate intense feelings, these feelings are a normal part of any counseling experience.
- A safe living environment, supportive family and friends, affiliation with a spiritual or faith-based community, and participation in recovery support groups.