The outcomes, treatment parameters, adolescent characteristics, and implementation factors are reviewed to help practitioners select the most appropriate treatment for adolescents in their or their agencies care. Overall, the key active ingredients of CBT and BFC involve aspects of all four of the theories described earlier (Table 4). The emphasis in CBT on reducing positive expectancies for substance use, enhancing resistance self-efficacy, and improving skills in coping with high-risk situations reflect elements of social learning and stress and coping theories. BFC relies on many of the presumed active ingredients of substance abuse counseling CBT, especially goal-direction and structure as exemplified by behavioral change agreements and sobriety contracts, which are consistent with social control theory. Growing evidence for the common active ingredients of treatment espoused here also has important implications for the goals of therapist training.
- Recognition of family-based SUD interventions as effective has since increased, and funding has improved.
- The impact of substance misuse, mental illness, trauma, and family strengths on relationship patterns (e.g., enmeshment, conflict, emotional cutoffs, or emotional support and closeness).
- These interventions are designed to systematically identify family strengths and weaknesses and develop a treatment plan.
- In contrast, MET asks clients to consider normative feedback about their substance use and its consequences.
Network Therapy
Family counseling is a collection of family-based interventions that reflect family-level assessment, involvement, and approaches. The model views families as systems, and in any system, each part is related to all other parts. A change in any part of the system will bring about changes in all other parts (Becvar & Becvar, 2018). Family counseling uses family dynamics and strengths to bring about change in a range of diverse problem areas, including SUDs. 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. Normative feedback and increasing the discrepancy between current and desired behavior should help to motivate and sustain change, especially when the information is shared with an empathic, directive counselor.
Relapse Prevention for Families
In solution-focused brief therapy, the counselor helps the family develop a detailed, carefully articulated vision of what the world would be like if the presenting problem were solved. The counselor then helps the family take the necessary steps to realize that vision. Because of its narrow focus on a specific target problem, this therapeutic approach works well with many SUD treatment strategies. Research shows lower levels of adolescent substance use and risk for SUD diagnosis when parents complete the FCU intervention (Hernandez et al., 2015). A systematic review and meta-analysis found that FCU as part of a larger school-based approach reduced marijuana use among adolescents (Stormshak et al., 2011; Vermeulen-Smit, Verdurmen, & Engels, 2015). A lack of parental involvement in the activities of their children predicts later substance use, according to research.
Holistic/Integrative Therapy
- This approach has been found effective with alcohol use disorders 78, and a four-session version (Motivational Enhancement Therapy, or MET), produced favorable outcomes in the NIAAA Project MATCH Study 79.
- Assess risk and protective factors of the individual, parents, family, and extrafamilial systems.
- Consequently, development of healthy affect regulation will be difficult for children and adolescents to achieve.
- Bev goes into a panic and starts screaming at him when she sees the car in the garage, even though Harry has not been drinking.
- By proposing a means by which family therapy can be moved to the forefront of addiction treatment, it places the family perspective at the center of its approach and provides a multifaceted alternative to the prevalent individual-focused model.
Your goal is to help families prevent SUDs in current and future generations by encouraging parenting practices that help prevent SUDs in children, improve SUD treatment outcomes in adolescents, and enhance the family recovery process. Initially conceptualized by Murray Bowen (1978) as part of an intergenerational family model, a genogram is a comprehensive pictorial map of a family’s health, communication, relationship, vocational, and other psychosocial patterns within and across three or more generations of the family. It provides information about marriages, divorces, births, geographical locations, deaths, and illness over the generations. It also depicts family patterns, events, and relationships, including emotional closeness, enmeshment, conflict, and emotional cutoffs (Platt & Skowron, 2013). Genograms are useful to discuss in psychoeducational sessions, family interviews, and assessments (Platt & Skowron, 2013). The genogram is both an assessment instrument and a counseling intervention (Gehart, 2018).
Who Benefits From Family Systems Theory?
Each description includes an overview and goals of the approach, supporting research specific to SUD treatment, and relevant techniques and counseling strategies. Family counseling had its origins in the 1950s, adding a systemic focus to previous understandings of the family’s influence on an individual’s physical health, behavioral health, and well-being. Leverage the family to influence change— Encourage family members to support and enhance each other’s desire, abilities, reasons, and need to make important lifestyle changes, including shifts away from substance misuse.
- Some new models are accruing evidence for specific populations and are on their way for testing their effectiveness in community settings.
- The therapist encourages the family to behave as they would usually behave if the counselor were not present, by for example, asking them to speak with each other about the concerns that bring them to therapy, rather than directing comments to the therapist.
- With respect to effectiveness, CBT and relapse prevention programs result in substance use outcomes that are comparable to those obtained by MET, TSF, and 12-step aftercare programs (Babor and Del Boca, 2003; Brown et al., 2002; Finney et al., in press).
- If the client agrees to family involvement in treatment, get signed privacy/confidentiality releases and then schedule an initial family interview.
- SUD treatment services, which at first were mainly residential, began to incorporate family activities into their programs.
Many others are intergenerational within the household and include extended family members, such as grandparents, uncles, aunts, cousins, other relatives, and close friends. Still other types are adoptive or foster and other families whose members are not biologically related and instead come together by choice. Different family constellations often present specific and predictable challenges. For instance, in newly formed blended families, conflicts are typical between parents on how to parent and between a parent and stepchild on the rights of who can discipline, who holds authority, and so forth.