For example, a positive reinforcer may tell the family member how much the CSO enjoys spending time with him when he is not smoking marijuana or going to a movie with him after a day without drinking. The underlying assumption of CRAFT is that environmental contingencies are important in promoting treatment entry (Bischof, Iwen, Freyer-Adam, & Rumpf, 2016). The counselor’s role in CRAFT is to work with family members to change the way they interact with the person who has an SUD and that, in turn, will have an impact on his or her substance use behaviors. Behavioral family counseling emphasizes daily support for abstinence as in BCT, but focuses less on sharing rewarding activities and practicing communication skills at home. These adaptations provide a better ft with the developmental needs (e.g., increased autonomy, separation) of an emerging adult living with a parent. Research supports the efficacy of this adaptation over individual treatment on treatment retention, increased abstinence, and reduced substance misuse (O’Farrell & Clements, 2012).
What Qualities Should You Look for in a Substance Abuse Counselor?
Many adult children of alcoholics or addicts struggle with intimacy and trust in their romantic relationships and have difficulty expressing their feelings and loving themselves. I highly recommend working with a therapist who is experienced in working with adult children of alcoholics/addicts and codependency. Another question is whether some of the active ingredients are more salient than others either in the short- or long-term. For example, CM rewards for abstinence are especially effective during treatment, whereas the CRA focus on engagement in satisfying activities may be better at changing clients’ life contexts.
Chapter 3—Family Counseling Approaches
- Given the view that dysfunctional behavior, including substance abuse, isdetermined in large part by faulty cognitions, the role of therapy is to modifythe negative or self-defeating automatic thought processes or perceptions thatseem to perpetuate the symptoms of emotional disorders.
- Family systems therapy is no different, whether you’re using it as a strategy for addiction recovery or for unpacking other issues.
- More knowledge about the active components of effective treatment is needed to enhance our understanding of the underlying processes of change, improve training programs for counselors, and contribute to better substance use outcomes.
- A review of outcome studies evaluating the efficacy of relapseprevention interventions indicates that the support for relapse preventionis more equivocal (Carroll,1996b).
- A review of the evidence found that any kind of brief psychoeducation, including family-based interventions, reduces relapse, increases medication adherence, and improves social functioning of people with serious mental illness (SMI; Zhao, Sampson, Xia, & Jayaram, 2015).
- CBT is one of the most popular therapies in addiction medicine, and counselors use it to treat a variety of addictions.
Treatment occurs in natural environments such as the home, school or neighborhood, and it has been proved to reduce ratesof incarceration and substance abuse. Prize-based incentives reward drug-free screens with a chance to win a prize by drawing from a bowl. Some experts worrythat prize-based incentives might promote gambling behavior, but studies do not show an association between the therapyand gambling. Studies indicate EMDR can relieve symptoms of PTSD after three 90-minute sessions. Patients with severe PTSD symptoms,such as combat veterans, usually require more sessions than individuals with less severe symptoms.
Whom To Involve in Integrated Family Counseling for SUDs
In fact, relatively little is known about these proximal outcomes, the extent to which they flow from highlighting them in treatment, or whether they depend on how much counselors focus on bonding, structure, and goal-direction. Just as people with SUDs are at risk for a return to substance misuse after initiating recovery, family members can also experience a “relapse” or return to old behaviors and strategies for substance abuse counseling trying to manage the stress of living with a relative’s active substance use. Family members are often acutely aware of the signs that a relative is using again. Seeing such signs may activate family members’ anxiety, anger, and feelings of helplessness; it can trigger old behaviors like blaming, shaming, ineffective communication, neglecting self-care, and becoming overly responsible for family functioning.
History of Family-Based Interventions in SUD Treatment
Assess risk and protective factors of the individual, parents, family, and extrafamilial systems. Creating a family recovery maintenance notebook with educational handouts, homework exercises, in-session exercises, and journal notes on new insights and awareness, the effectiveness of problem-solving and communication strategies, and topics and questions for further exploration. You can help the family make a hypothesis about the causes of SUDs and create “mini-experiments” to address alcohol misuse in the family. You and the family will collaborate to develop specific criteria to assess the relative success of the mini-experiments.
What are the Benefits of Family Systems Therapy
All the family therapy models share the basic principal of family systems theory that is that the individual cannot be fully understood or successfully treated without first understanding how that individual functions in his or her family system. Individuals who present in our clinical settings can be seen as “symptomatic,” and their pathology can be viewed as an attempt adapt to their family system so as to maintain homeostasis. A parent with a SUD, who is mood altered, preoccupied with getting high or spending significant amounts of time recovering from the effects of substances, may miss the opportunities to foster healthy attachment. Consequently, the intricate attachment system that is built on hundreds of thousands of reciprocal and implicit interactions between infant and attachment figure will be affected. Eye contact, tone, volume and rhythm of voice, soothing touch, and the ability to read the needs of the infant are all intricate building blocks of attachment. Just as humans need a physiological immune system to fight off disease and illness, likewise, the relational attachment system provides protection against psychological problems and illness.
Diverse cultures and belief systems influence definitions, and because cultures and beliefs change over time, concepts of family are not static. In some cultures, the definition of family is narrow and determined by birth, marriage, or adoption. In other cultures, more expansive definitions include in the concept of family those individuals who share a household, values, emotional connections, and commitments.
Assertive Continuing Care
Feedback refers to the circular way in which parts of a system communicate with each other. The process of feedback is how the parent–child attachment relationship is formed. In a family system, a wife may identify that she abuses pain pills because her husband ignores her and she is depressed.
Thus, CRA integrates a focus on the client’s overall social context with cognitive-behavioral interventions and CM-based incentives. The key ideas are to make a sober lifestyle more rewarding than substance use and to use social, familial, recreational, and vocational rewards to assist in the recovery process (Meyers and Squires, 1998). 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 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.
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