AODS 153: Introduction to Family Counseling in Substance Use Treatment

Описание: In "old school" substance use treatment, the model was that the person with the substance use disorder was "the problem" and all the destruction and dysfunctional dynamics in the substance user's family system was created by their "disease." The idea was that if you extricated or removed the person with the substance use disorder from the family system, put them in treatment, and “healed them from the disease of addiction,” then you could plop them back into the family system and everything would magically get better!

That typically isn't how it works. Research has shown, as anyone who has lived through a family system where there is substance abuse knows first-hand, that the interpersonal dynamics in a family system are enmeshed and intertwined with the substance use disorder. In fact, while the substance use definitely impacts the family system, the family system itself influences and impacts the substance use. Much like the classic game “Twister,” if there are enmeshed and twisted family dynamics that remain in place--dynamics that may have contributed to or enabled the substance use disorder within the family system--then when the person with the substance use disorder returns to the family system, the strong tendency is to go back to the same patterns that existed prior to treatment. Think of the classic game of “Twister” (if you don’t know it, Youtube it). If a person has to step out of the game to go answer the door, when they get back to the game they have to conform their body back into the twisted shape it was in before to fit back into the system. In other words, treating an individual for a substance use disorder without assessing and potentially treating the family system can be a recipe for relapse.

[Note that there is no single definition of what exactly family or a family system entails, particularly as different cultures and belief systems influence that definition. For the purposes of this lecture, we will use the United States Substance Abuse and Mental Health Services Administration (SAMHSA) definition for treating “family” in substance use treatment: family implies an enduring involvement on an emotional level and for practical purposes can be defined as the individual’s closest emotional connection (Center for Substance Abuse Treatment, 2004, p. xvi).]

SAMHSA recognized the importance of including the family in substance use treatment nearly 20 years ago and convened a panel of experts in the field to devise a set of recommendations for how to include families in substance use treatment. The product of that collaboration was “Treatment Improvement Protocol (TIP) 39: Substance Abuse Treatment and Family Therapy” (Center for Substance Abuse Treatment, 2004).

TIP 39 proposed a collection of best practices and therapeutic approaches to assess the family systems of persons with a substance use disorder, the impact of the substance abuse on the family system and the family system's impact on the substance use, and the development of appropriate interventions to address family dynamics that could contribute (positively or negatively) to relapse prevention. Those recommendations have since been widely accepted across the country and in the substance use treatment field.

When SAMHSA first published the treatment improvement protocol on counseling families in substance use treatment, most substance use treatment programs did not include family counseling (SAMHSA, 2004, p. xvii). This has improved greatly since the publication of TIP 39 and subsequent research into the effectiveness of including the family in substance use treatment. A more recent survey found that 65% of substance use treatment programs in the United States were regularly including family counseling in treatment and 85% of programs include marital or couples counseling with the primary partner of the person who is in treatment.

This introductory lecture on family counseling in substance use treatment will lay the foundation for the key concepts and skills required to assess and treat family systems in substance use treatment. Subsequent lectures will delve into more detailed assessment and intervention techniques.

Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series, No. 39. HHS Publication No.(SMA) 15-4219. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 2004.

Substance Abuse and Mental Health Services Administration. (2017). National Survey of Substance Abuse Treatment Services (N-SSATS): 2016. Data on substance abuse treatment facilities. BHSIS Series S-93, HHS Publication No. (SMA) 17-5039. Rockville, MD: Substance Abuse and Mental Health Services Administration.