Also ask about important events like births, graduations, marriages, and deaths and how those events may be linked to the current substance misuse (Shellenberger, 2007). Their input will help you understand how the family system is organized around and reacts to the behavior (Gehart, 2018). The substance abuse counseling next task is to explore the family’s strengths and positive ways they have managed the disruptions to family life caused by substance misuse. Your first priority should be to form an alliance with the mandated client without “taking sides” with the client regarding the need for treatment.
The Lost Child
Providing educational handouts for the client and family members to take home and review. Use them starting with the least intensive (e.g., counseling and Al-Anon or CRAFT) before moving to the most intensive. The key to successful family work is to maintain a focus on engagement and collaboration with the family throughout treatment. Suggesting an out-of-session assignment for each relative present (if he or she agrees to further counseling) as a way for them to take a small step toward change (van Wormer & Davis, 2018). History of criminal justice involvement, including arrests for driving under the influence and periods of incarceration.
Goals of Integrated Family Counseling for SUDs
Should the client attribute her substance abuse tointernal, stable, and global characteristics (e.g., “I’m nothing but anaddict; there’s nothing that I can do to stop using”), then it is likelythat she will feel angry, depressed, hopeless, and helpless. These reactionsare less likely to occur and to be less pronounced for individuals who aremore firmly committed to the goal of abstinence or moderation and for thosewho have maintained such goals longer. If the individual does not have the necessaryrestorative coping skills to deal with them and to counteract the impact ofa negative attributional style, it is more likely that an initial slip willcontinue on as a full-blown relapse (Stephens et al., 1994).
Initial Integration of Families Into SUD Treatment
- At times, family members can be too emotionally taxing for one person, which is why an emotional cutoff can be helpful.
- If the client usedsubstances primarily to cope with negative mood states, then therapy mayfocus on understanding how the client’s interpretation of events led to thenegative moods.
- These components of CRA are based on a combination of principles drawn from the four theories described earlier.
- A number of the behavioraltechniques described here are also used by therapists usingcognitive-behavioral therapy.
- The family behavior loop map is a step-by-step behavioral chain analysis of the family’s interactions and the sequence of events that lead to substance use behaviors and episodes when the client with an SUD refrains from substance use (Liepman, Flachier, & Tareen, 2008).
Additionally, many therapists and patients in treatment have agreed that family systems therapy is effective. Involve supportive family members and other recovery supports in developing and implementing the continuing care plan; ask for their help to address barriers to continued treatment engagement. 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. Counselors begin with substance-focused interventions to promote abstinence, then add relationship-focused interventions after abstinence is stable, with an emphasis on teaching communication skills and increasing positive relationship activities (O’Farrell & Schein, 2011). Relapse prevention interventions occur during the final phase of BCT (Klostermann & O’Farrell, 2013). The MDFT treatment format includes individual and family sessions, sessions with various family members, and extrafamilial sessions.
- Making the SUD an external focus of attention allows everyone to work as a team to defeat it.
- Conversely, negative expectancies arethought to act as a disincentive and contribute to reduced drinking or druguse (McMahon and Jones, 1993;Michalec et al., 1996).
- Only if clients feel a positive therapeutic rapport and trust the social worker will they disclose substance use.
- Recognizing the therapeutic value of working with family members, not just the individual with SUD, as they deal with SUDs.
- Your goal is to help families recognize their strengths, address family dynamics, and build effective relationship skills.
For example, when one partner’s drinking is interfering with a couple’s relationship, the drinking partner needs to change the drinking behavior. At the same time, the nondrinking partner may need to change his or her negative communication pattern of blaming and judging the drinking partner and shift to a positive communication pattern that reinforces nondrinking behavior. Please note that each family member may be at a different stage of change or level of motivation regarding the behavior change that he or she needs to make to improve family functioning. Actively link family members to community-based family recovery supports (e.g., Al-Anon) and additional behavioral health or social services, when appropriate. After the family interview and assessment process, initial family counseling sessions should focus on building a relationship with the entire family. The only times to exclude someone are if he or she is intoxicated or under the influence of drugs (“high”), has severe psychiatric symptoms (e.g., hallucinations, delusions, severe mania), has threatened violence, or a combination of these.
Issue 2. How well do the presumed active ingredients predict treatment outcomes?
Set boundaries in early family sessions by establishing some rules for interactions, including no “labels” or name calling. You can also reframe “denial” as precontemplation, one of the stages of the SOC model and simply an indication that the family member is ambivalent and not quite ready to change. The SUD treatment field has promoted the myth that family counseling that includes the client with SUD may bring up painful feelings for the client that will somehow lead to a return to use or jeopardize the client’s recovery.
Understanding Families
He postulated that at the time of an infant’s birth, the primary relationship, usually with the mother but not always, serves as the template for all subsequent relationships throughout the life cycle. It is through this relationship, at a prelanguage level, that infants learn to communicate and relate to their environment. The way in which the primary caretaker responds to these cues will establish the quality of the attachment.
Thematerial covered in these interventions can be categorized into a number ofbroad classes. The skills to be taught are either specific to substanceabuse (e.g., coping with craving, refusing an offer of alcohol or drugs) orapply to more general interpersonal and emotional areas (e.g., communicationskills, coping with anger or depression). Some might be viewed as essential and would beexpected to be used for all clients, while others would be viewed as moreelective in nature and would be selected for a particular individual basedon the functional analysis. The ability to individually tailor the skillstraining to the client’s needs represents one of the strengths of CBT. While Ellis and Beck have similar views about the prominent role that cognitionsplay in the development and maintenance of substance abuse disorders, theirtheories differ in considering how the therapist should treat irrational ormaladaptive cognitions.
- Acknowledging the value of relationships within the family and extrafamilial social networks as critical sources of support and positive reinforcement.
- In addition to doing an initial strengths assessment, maintain a strengths-focused lens throughout counseling to set a positive tone for family sessions and enhance family members’ motivation to address challenging problems (Tuerk, McCart, & Henggeler, 2012).
- Self-efficacy expectancies aredetermined in part by the individual’s repertoire of coping skills and anappraisal of their relative effectiveness in relation to the specificdemands of the situation.
It is helpfulto have very concrete emergency plans, including the phone numbers ofindividuals supportive of the client’s recovery process. Including familymembers in the planning process is important because they are often betterable than the client to see the warning signs of an impending relapse. Substance abuse counseling is a specialized field within mental health that focuses on helping people overcome addiction to drugs, alcohol, and other substances. The goal is to reduce risk factors for addiction,such as unemployment, family conflict, abuse and conduct issues. It uses techniques such as contingency managementand behavioral contracting, in which a patient agrees to a written contract with a therapist. As children transition into adulthood they are still strongly affected by their parents as their parents are by them.
