Do Close Family Relationships Help With Addiction Recovery

Chapter 6. Family-Based Services

Substance use disorders exist within several social contexts, one of which is the family. Family members, whether they are from the family of origin or family unit of choice, are important forces in a client's life. Each client has a family unit, a family history, and a family story that play important roles in recovery. Many clients come from substance-using families and have been raised with alcohol abuse or drug employ as part of their lives. Addressing this legacy is part of their recovery. In addition, a client's family members oftentimes have significant substance utilize and other psychiatric problems of their own. Intensive outpatient handling (IOT) programs that accept a comprehensive approach to evaluating the family are likely to identify other individuals who would do good from being admitted to a substance corruption or mental health treatment program. Some family members may be in treatment already. For these reasons, many IOT programs incorporate a family systems approach. Family education, family therapy, and other services are necessary in an IOT plan's process and so that the contributions and influence of family unit members back up recovery.

A complete discussion of family therapy for substance use disorders in IOT programs is not within the telescopic of this TIP. This chapter introduces features of family involvement in IOT programs and briefly discusses family therapy as an enhanced service that IOT programs may offer or, more than oft, to which they may refer clients and their families. The Center for Substance Abuse Treatment has developed TIP 39, Substance Corruption Treatment and Family unit Therapy (CSAT 2004c ), that addresses how a substance employ disorder affects the family, how family unit therapy works to change the interactions amidst family members, and the integration of family therapy into substance abuse handling.

Families of people who corruption substances live in a world shaped past substance use. This globe may include inconsistent behaviors and few or very rigid rules. Family members may have difficulty expressing their emotions, achieving intimacy, and solving bug. They frequently may feel but may non express anger, shame, guilt, sadness, and hopelessness. To function, families oftentimes subscribe to the following: don't trust, don't experience, and don't talk. The outcome can be an unhealthy environment in which individuals may exist isolated, engage in subversive alliances, be overly involved with other family unit members, or develop significant medical and stress-related bug.

Increasingly, treatment professionals view substance use disorders from a family systems perspective (Crnkovic and DelCampo 1998). Research findings document a relationship between family unit involvement in handling and positive outcomes and attest to the need for family-based services (Rowe and Liddle 2003). Family unit interest in treatment seems to work equally well for adults and adolescents (Stanton and Shadish 1997). When the family is set up and able to shift from old, negative behaviors to new, healthier ones, family members become collaborators in the treatment procedure (Edwards and Steinglass 1995). Most IOT programs do non offering couples- or family-based therapies (Fals-Stewart and Birchler 2001). However, potential benefits of family therapy are such that IOT programs should have well-established links with organizations that provide these services.

No affair how alienated family members may exist, they are critical to the forcefulness and duration of the customer's recovery. Family unit members are the individuals who were office of the client's life before treatment and will be part of his or her life afterwards treatment. Family unit-based services that are part of IOT help ensure that family functioning adjusts to and positively influences the recovery of the customer.

Planning for Family Interest

IOT planning for family-based services involves defining the client's family in wide and flexible terms, setting essential goals, and determining the desired outcomes.

Defining the Family

In recent years, the concept and definition of family take broadened significantly to include people who are important to the customer. These people can include a spouse, a boyfriend or girlfriend, a same-sexual activity partner, parents, siblings, children, extended family members, friends, co-workers, employers, members of the clergy, and others. The term "family unit of origin" commonly is used to describe individuals related by blood, such as parents, grandparents, and siblings. The term "family unit of selection" is used to describe a family unit created by marriage, partnership, or friendships and other associations.

When determining the client's concept of family unit, the primal is to identify who volition be supportive of recovery and who might seek to undermine it. The treatment provider can begin this process by creating a genogram (see appendix six-A) to assess the family of origin or option. Similarly, a social network map (see appendix 6-B) can help the counselor identify and sympathize the family of origin and family of pick.

• Creating a family unit genogram. This technique renders the client'due south family unit relationships schematically and helps the advisor place trends or patterns in the family unit history and sympathize the client'southward current situation. As treatment progresses, the genogram is revised to reverberate new cognition and changes in the family (CSAT 2004c ).

• Assessing the client's social supports with a social network map. A social network map displays the links among individuals who have a mutual bond, shared social condition, like or shared functions, or geographic or cultural connection. Highly flexible, social networks form and disband on an ad hoc ground depending on specific need and interest. A social network cess is used in social service arenas, including substance abuse treatment. When the assessment is used in IOT, individuals are identified who tin support the customer or participate in the treatment process (Barker 1999).

Goals and Outcomes of Family unit Services

I main goal of involving families in treatment is to increment family members' understanding of the client's substance utilise disorder as a chronic disease with related psychosocial components. Edwards (1990) states that family-based services can accept the post-obit effects:

• Increase family back up for the customer's recovery. Family sessions tin increase a customer's motivation for recovery, especially as the family unit realizes that the customer'south substance use disorder is intertwined with problems in the family.

• Identify and support change of family patterns that piece of work confronting recovery. Relationship patterns amongst family members can work confronting recovery by supporting the client'south substance apply, family conflicts, and inappropriate coalitions.

• Prepare family members for what to expect in early recovery. Family members unrealistically may wait all problems to misemploy quickly, increasing the likelihood of thwarting and decreasing the likelihood of helpful support for the client's recovery.

• Educate the family unit well-nigh relapse warning signs. Family members who understand warning signs can aid prevent the client's relapses.

• Help family unit members understand the causes and furnishings of substance use disorders from a family perspective. Nigh family members practice not understand how substance apply disorders develop or that patterns of behavior and interaction have developed in response to the substance-related behavior of the family member who is in treatment. Information technology is valuable for individuals in the family to gain insight into how they may be maintaining the family's dysfunction. Counselors should assist family members accost feelings of anger, shame, and guilt and resolve issues relating to trust and intimacy.

• Have advantage of family strengths. Family members who demonstrate positive attitudes and supportive behaviors encourage the client's recovery. Information technology is important to identify and build on strengths to support positive change.

• Encourage family members to obtain long-term support. Every bit the customer begins to recover, family members need to take responsibleness for their own emotional, concrete, and spiritual recovery.

A comprehensive IOT program views the client equally function of a family organisation. When the family is involved in treatment, the following treatment outcomes are possible:

• The customer is encouraged to enter handling.

• The customer is motivated to remain in treatment.

• Relapses are minimized.

• A supportive and healthy surroundings for recovery is provided.

• Other family unit members who may need handling or other services are identified and treated.

• Changes in the family's longstanding dysfunctional patterns of communication, behavior, and emotional expression may protect other family members from abusing substances.

Engaging the Family in Treatment

Difficulties with engaging the family unit in treatment oft are cited as reasons for not using a family systems approach and, in many cases, substantial obstacles be. Family unit members may be resistant, or the customer may be ambivalent or object to the family'due south involvement in treatment. But given the potential benefits associated with taking a family arroyo to service delivery, engaging the family in handling is worthwhile.

Strategies To Engage the Family

The following approaches have proved helpful in encouraging families to engage in the treatment of a family member:

• Include family members in the intake session. The advisor can involve family members in the handling process from the beginning. If a family unit member makes the initial call to the program, the counselor tin can inquire that person to come with the client. If the customer calls, the customer tin be asked to bring a family unit member. If the client is reluctant at this point, the advisor can gently encourage the client to include family members but should not go far a status of the person's entry into handling. In another approach, the counselor can ask, "Who close to you is concerned most your substance apply and might be willing to serve equally a support to you during your recovery?" The client then might be asked to invite these supportive people to come to the initial intake interview. During the intake interview, family members can be asked to complete a brief written family cess. A more than comprehensive family unit systems approach tin involve multiple individual and family interviews. These interviews and other early meetings with the family develop back up from a family that is empowered to address systemic issues. Similarly, the initial meeting helps family members acquire about substance utilize disorders, their influence on a family, and the services the program can offer to the family (see Exhibit 6-1).

  Exhibit half dozen-1. Suggestions for Engaging Family Members at Intake

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  Emphasize the need to assemble data from family members.

  Country the program'southward policy most family members' participation in treatment.

  Indicate the programme'southward want to hear family members' concerns well-nigh the client's substance abuse.

  Admit family unit members' influence over the client and their desire to help.

  Make clear that family unit members' participation will help the customer on the route to recovery.

  Emphasize how the program tin help family unit members maintain a relationship with the client and manage their ain feelings (anger, frustration, depression, and hopelessness).

• Use client-initiated appointment efforts. The counselor and customer interact on a programme to engage family unit members in treatment. The client tin be given the opportunity to invite chosen family members to participate in the programme. If this try is unsuccessful, so, with the client's written permission, the advisor telephones, visits, or sends a personal note to the identified family members. Federal confidentiality rules require that client permission be documented (CSAT 2004b ).

• Offer a written invitation. The IOT provider can give the customer written invitations, with the clinic's contact information, to deliver to family members. Giving the client the invitations allows the provider to determine whether the client is willing to involve family members in treatment and which family unit members the client wants to involve in the process. The invitation briefly describes the treatment program and identifies activities family unit members will be asked to participate in. For example, a family member may be asked to attend family unit education sessions, complete an assessment questionnaire, remove all substances from the domicile (if applicable), participate in family counseling sessions, or attend a celebration of the completion of a handling phase.

• Offer incentives. Incentives may help address recruitment problems. Family unit members tin be provided with coupons (e.g., for pizza, movies) for attending sessions or completing assignments. Refreshments also assist family members feel welcome. In addition, providers tin facilitate transportation (e.thou., arrange carpools) and childcare services and remove other obstacles to family unit members' participation.

• Plan picnics or dinners for families. Multifamily picnics and dinners are a office of some IOT programs and tin can be scheduled for holidays or weekends. These events can exist held on the programme's grounds or in nearby parks or community centers and provide a supportive and nonthreatening environment where individuals tin take fun and learn about substance use disorders, recovery, and the IOT program. The client and family unit members are asked to bring a dish, but all are welcome. Immediately afterwards the repast, a counselor conducts an hr-long educational session covering topics such every bit recovery support groups, family-oriented services, and characteristics of substance utilize disorders. Participants are told of the educational nature of the sessions when invited.

• Employ customs reinforcement training (CRT) interventions. CRT interventions have improved the memory of family members in handling and induced people who abuse substances to enter treatment (Meyers et al. 1998, 2002). Among other strategies, the CRT approach teaches family members that substance abuse is not a moral declining but a illness and that they are non the crusade of and cannot be the cure of their loved one's substance use disorder. They besides learn to identify and pursue their ain interests, communicate in nonjudgmental means, encourage drinking of nonalcoholic beverages during social occasions, manage unsafe situations, and talk over treatment entry with the family member who abuses substances when the consequences of abuse are astringent (Kirby et al. 1999b ).

• Use the resources of the programme. To create a family-friendly environment, IOT staff at all programme levels need to piece of work together toward the goal of engaging families. For instance, flexible program hours and big offices or meeting rooms may be needed to adjust family schedules and big families. Safe toys should be fabricated available for children and so that they are less likely to disrupt a session. Forepart role staff should exist trained to encourage and reinforce the efforts of family members who call or come up in with the client for the initial visit. Programs tin can organize their client record systems and procedures so that staff members have easier access to family-related information for each client.

• Provide a safe, welcoming surroundings. Family members may be anxious or reluctant to participate in the treatment procedure. A welcoming environment encourages them to participate despite their concerns. A safety, clean, and cheerful meeting space is important. Skillful lighting, a well-marked and well-maintained exterior, culturally appropriate décor, comfortable furniture, and amusements for children convey the message that family members are welcome, valued by the treatment team, and essential to the recovery of the client. Ice-breaking activities, uncomplicated games, and role-play activities can make the group coming together inviting and encourage family involvement.

Overcoming Barriers to Engaging Family Members in Treatment

Not all family members participate in the treatment procedure. Sometimes individuals are reluctant to go involved with treatment, even though they intendance nigh the customer. Women are more likely to be involved in their male partners' handling; men are less likely to participate in their female person partners' handling (Laudet et al. 1999). Also, the client may non want family members to exist involved considering of threats of domestic violence or past abuse by a family member, guilt almost the substance abuse, fear that family secrets may be revealed, concern about adding to the family brunt, or other reasons. All family members who do participate must feel free to raise pertinent issues, even if another family member objects. Because of the risk of domestic abuse that comes with raising hard bug, providers must appraise advisedly the potential for violence within the family (CSAT 2004c ).

Despite these barriers, the IOT provider is encouraged to accept every possible action to engage families of clients in the treatment procedure. Improve client retention, fewer relapses, improved family functioning, and family healing are all possible outcomes (O'Farrell and Fals-Stewart 2001).

Supportive supervision of the counselors providing these family services

• Gives staff members confidence that they are providing advisable levels of service while addressing clinical problems that inevitably arise

• Ensures that counselors and staff members empathise their limitations in working with family members

• Guards confronting counselors and staff members attempting to provide therapy for which they have not been trained

When working with families, programs can brand use of existing partnerships with agencies and groups that provide enhanced family unit services, individual counseling for other family members, health care, and financial and legal services to support clients' families.

Family Services

Family members

• May need guidance on how to address many bug that can arise during early recovery

• May take questions or misconceptions about substance use disorders

• May need to detect salubrious ways to handle their justifiable feelings of anger, frustration, shame, helplessness, guilt, and sadness that stem from attempts to fix the client's substance use disorder

• May need the counselor's intervention to empathize and avoid behaviors that contribute to the client'southward connected use of alcohol and drugs

The types of services described in this department tin support the efforts of family members as the customer moves through the course of treatment. Although every family unit is different, and the pace of recovery varies from family to family, a sample treatment calendar is provided in Exhibit 6-ii. IOT services tin help family members in accomplishing the tasks described in the calendar.

Exhibit 6-ii. A Treatment Calendar for Family Members

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Get-go stage: i–5 weeks
• Commit to treatment.
• Empathise that a substance apply disorder is a chronic illness.
• Support abstinence.
• Begin to identify and discontinue behaviors that support substance use.
• Learn virtually the family back up groups:
	• Al-Anon (www​.al-anon.alateen.org)
	• Nar-Betimes (www​.naranon.com)
	• Families Anonymous (www​.familiesanonymous.org)
Eye phase: 6–twenty weeks
• Assess the human relationship with the client.
• Develop a realistic perspective on addiction-related behaviors then the family member remains involved with the client but establishes some protective personal altitude.
• Work to eliminate behaviors that encourage the client'southward substance use (i.e., enabling behaviors).
• Move past behaviors that are primarily a response to the client's substance utilise (i.e., codependence).
• Seek new means to enrich the family fellow member'southward life.
• Begin practicing new communication methods.
Advanced stage: 21+ weeks
• Work to develop a healthy, balanced lifestyle that supports the client and addresses personal needs.
• Exercise patience with recovery.
• Evaluate and accept changes, adaptations, and limitations.

Family unit Education Groups

Family instruction groups provide information nearly the nature of a substance utilize disorder; its furnishings on the client, the family unit, and others; the nature of relapse and recovery; and family dynamics. These groups oftentimes motivate families to become more involved in treatment.

The family education group typically meets weekly for 2 to 3 hours, oftentimes in the evening or on weekends, and includes between 10 and 40 individuals. The grouping is facilitated past a counselor and commonly covers these topics:

• Medical aspects of habit and dependence

• Relapse and relapse prevention

• Addiction as a family disease

• Subconscious refusal to admit that the customer has a substance apply disorder (i.e., denial)

• Enabling behaviors

• Communication

• Reasons for testing and monitoring of the client

• Leisure time planning

• Parenting skills

• Community support groups and resources

Group members listen to lectures, hash out topics, and engage in exercises that help them get knowledgeable about substance use disorders and their furnishings on the family.

Multifamily Groups

Multifamily groups can be thought of as microcosms of the larger community. They offer more opportunities for learning, accommodation, and growth than practice groups of 1 client and family members. These groups provide family unit members with a sense of normalcy and a support network. Individuals larn that other families face similar difficulties. This discovery may reduce the stigma and shame commonly found amid families struggling with substance use disorders. Families often showroom mutually supportive, spontaneous involvement with 1 another and reinforce one another's problemsolving approaches. Cross-learning—in which, for example, a human learns to empathize his wife meliorate by listening to other husbands and wives—is ane of the most powerful furnishings of multifamily therapy. Incorporating multifamily groups into IOT has been shown to increase the length of treatment for female person clients, increment completion rates for men, and amend family functioning and children's behavior (Boylin and Doucette 1997; Meezan and O'Keefe 1998). Treatment providers written report that having more than i generation present in the group tin help establish a family's commitment to forbearance and recovery (Conner et al. 1998).

Multifamily groups typically engage several clients and their family members in group exercises that teach them how to develop good for you communication techniques, avoid enabling behaviors, reduce codependence, and get help. Until a multifamily grouping coalesces, information technology may exist helpful for members' participation to be structured (e.g., talking only about themselves, non near the person in IOT).

IOT providers should foster an temper of acceptance and emotional safety so that learning occurs in a relaxed setting. Group sessions generally are scheduled weekly and concluding for 2 to 4 hours with group size ranging from 12 to xxx members (6 to eight families) (Crnkovic and DelCampo 1998). Clients' recovery may be aided by the inclusion of supportive individuals from exterior the family (e.g., sponsors, friends, religious leaders, co-workers). The consensus console recommends that multifamily groups be co-led past two therapists trained in this process. Membership may change often, and clients and their families join the grouping as others graduate from the treatment program.

Family Therapy Groups

In 1997, Stanton and Shadish conducted a meta-analysis that compared the effectiveness of family unit education, family therapy, and other forms of family intervention for people with substance use disorders. Their results suggested family unit therapy is more effective than family education groups and other family unit services. However, family therapy tin be delivered just by specially trained therapists. Xl-two States require that people practicing as family therapists exist licensed. In well-nigh States, a family therapist must have a master's caste to practise independently (CSAT 2004c ). Family therapy addresses the dynamics in the family that may encourage substance abuse and offers support for changing these dynamics. It emphasizes that the family every bit a dynamic system, non merely the inclusion of family unit members in handling, is the hallmark of family therapy (CSAT 2004c ). These sessions may include individual family, couples, and child-focused therapy. (Family therapy for adolescents is discussed in chapter 9.) Because not all IOT programs provide these types of therapy groups, providers should consider establishing referral agreements with other community service organizations that provide family therapy.

Individual family therapy

This type of therapy helps family members look at their interactions and identify the factors in the family that contribute to a substance employ disorder. Family members are encouraged to restructure negative patterns of behavior and communication into interactions that are more conducive to recovery for anybody. Through family unit therapy, adults and children express to the client how beliefs has affected them and how new coping skills now are affecting their lives. The client has the opportunity to use new skills learned in treatment and to receive constructive feedback from family members in a prophylactic surround. During these sessions, families may address bug such equally irresponsible behavior, indebtedness, substance use in the home by other family unit members, availability of booze on special occasions, and how to reveal handling and recovery to others. The content of these sessions varies significantly, based on the needs and motivations of the family unit members. Family unit therapy may be scheduled monthly or more frequently.

Couples therapy

Couples counseling is useful in improving sure aspects of functioning in families with substance use disorders (O'Farrell and Fals-Stewart 2002). This therapy focuses on improving a couple's human relationship and reducing problems related to substance abuse. The spouse or significant other is taught to reinforce abstinence, subtract behaviors that cue substance use, and avoid protecting the customer from the adverse consequences of substance use. Both partners are taught to increase positive exchanges, improve communication, and piece of work together to solve issues. The number of sessions tin can exist half-dozen or more and can include sessions for one couple or groups of couples (Fals-Stewart et al. 1996).

Child-focused therapy

Play and structured recreational activities for children and parents can reduce conflict in families with substance use disorders. In groups with their children, parents are taught parenting and problemsolving skills and are given information nearly normal babyhood development. Parents recovering from substance use disorders have a hazard to experience pleasurable recreational activities with their children (e.g., volleyball, soccer) and larn to interact with them in a structured, therapeutic setting. Older children can be educated about substance use and how it tin bear on them and their families.

Family Retreats

Some IOT providers take found that family retreats tin exist effective in helping families harmed by substance use disorders, although inquiry is unavailable on this topic. Participants can take important steps toward healing damaged relationships. Some participants have described family retreats as the most of import aspect of their experience in treatment.

Most family retreats cover 2 days, usually over a weekend; participants spend nights at dwelling house. Retreats provide clients and their family members with the opportunity to piece of work intensively with ane another to address powerful emotions such as shame and guilt and to restore lost intimacy and trust. Participants take office in education sessions, exercises, and grouping activities. Day 1 activities can include family education on

• Communication skills

• Experiencing and working with feelings

• Developing trusting relationships inside the family

• Creating good for you expectations

• Reestablishing roles

Participants receive an assignment the evening of mean solar day ane to work on at dwelling. Assignments may focus on developing relapse contracts, reading from journals, or sharing positive family memories. Solar day 2 can focus on a therapeutic consequence during which

• Participants talk over the assignments they completed the night before.

• Family members are encouraged to tell i another important things, which may never have been said or discussed earlier.

• Family sculpting exercises are conducted; this activity dramatically illustrates relationships and advice patterns that need to alter. In family sculpting, each family member takes a plow positioning the other family members in relation to one another, posing them as he or she sees fit, and explaining the choices (CSAT 1999a ).

Programs that conduct retreats detect that executing a "contract for participation" with the client helps ensure that the retreats are well attended. Therapists may need to assist the client in recruiting family members to attend. Retreats should exist staffed by therapists who are experienced in managing highly emotional events.

Support Groups for Families

Common-help groups provide the continuing emotional, educational, and interpersonal support that family members often need as clients consummate their handling. Attending support group meetings helps family members conform to changes being made past the recovering member and begin new lives of their own. Family support groups may be sponsored on an ongoing basis by the IOT program or consist of community-based fellowships such as Al-Anon, Nar-Betimes, Alateen, Adult Children of Alcoholics (www.adultchildren.org), Adult Children Anonymous (www.12stepforums.net/acoa.html), and Families Anonymous.

When a family support group is sponsored by the IOT program, it usually meets weekly. Family members can talk over issues and concerns that arise because of the client's recovery and reconnection with the family. Such groups offering continuity for family members during the difficult treatment and recovery periods. Surrounded by familiar program staff members and other family participants, family members build on the momentum of their previous experiences in treatment. Examples of the problems discussed include parenting, decisionmaking, conflicts, sexual functioning, intimacy, anger management, mood swings, reestablishing trust, adjusting roles, learning what is "normal," renegotiating relapse prevention contracts, and substance employ by other family members.

Customs-based 12-Footstep support groups such as Al-Anon, Nar-Anon, and Alateen are independent from the IOT plan. Because family members may be reluctant to initiate contact with such groups, IOT providers can assistance family members by providing information about meetings, such as what happens at these meetings, the rituals observed, who attends, how meetings are conducted, the purpose of the meetings, and where to notice them. Members of mutual-help groups can exist invited to give talks to the family members in the IOT program. Providers likewise should emphasize that the meetings are anonymous. By encouraging family members to attend at least 3 meetings earlier deciding whether to continue, the IOT provider increases the probability that family unit members accept a positive experience and continue to attend. IOT staff can encourage members of multiple families from the program to attend meetings together so that they can reinforce and reassure one another.

Family unit Clinical Issues in IOT

Various questions, concerns, and behaviors are presented by family members during IOT sessions. The complexity of human relationships and interactions is revealed in treatment and can challenge both participants and counselors to use the opportunities and experiences therapeutically. Long suppressed acrimony, family unit secrets, shame, and confusion may surface. Family members may harbor feelings and thoughts that tin can affect the client and the family adversely and that crave resolution within a therapeutic environment.

Unrealistic Expectations Virtually Treatment Outcomes

Family unit members frequently have unrealistic expectations about handling and the client's recovery. Family members may not understand the nature of a substance use disorder or are unable to have that it is a chronic, relapsing disease and recovery is a lifelong process. Some family unit members, for case, can be so fatigued and emotionally depleted from the stress of living with the person who abuses substances that they have unrealistic hopes for treatment. Strategies and solutions to address unrealistic expectations and common fallacies about treatment and recovery include the following:

• Informing the family early in treatment well-nigh common but unrealistic expectations. By gently raising this effect early on in handling during individual family sessions, the IOT advisor can draw attention to and begin to dispel any fallacies. The counselor tin probe for related family unit beliefs, answer family members' specific questions, and provide real-life examples before unrealistic expectations lead to an undermining of family and client functioning. This process also can identify specific educational needs.

• Using a variety of formats to provide clear, understandable information about substance apply disorders. A family education group is a basic component of IOT programming that is constructive in debunking many fallacies about substance employ disorders. For instance, the group can be used to dispel the thought that once a client is in treatment, he or she will stop having the urge to use; that one time utilise stops, everything will be "perfect"; or that doctors and counselors will teach how to get well. A counselor can obtain or develop written materials (fact sheets, brochures, posters) at appropriate reading levels and in relevant languages. These materials demand to exist bachelor at the program facility and distributed to family members at intake and during treatment. A cursory, informative video tin can be played during family sessions, in counselors' offices, or in the waiting room.

• Reaching many family unit members. It is of import to brainwash as many family members as possible and to ensure that the most influential family members go knowledgeable most substance utilise disorders and so redirect other family unit members if necessary.

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Changing Realities: Working With Clients Who Are Estranged From Their Families

In i IOT program, some clients revealed that they did not participate in family groups, family nights, and other family-oriented activities because they had no family. The clients had been ostracized past or estranged from family members for an extended menstruation.

The counselors suggested that clients and staff rename the "family unit" events and then that clients could feel more comfortable bringing other individuals such as co-workers or friends who fabricated upward their family of choice. Instead of Family Night, the program sponsored Support Network Night.

The results

• Participation in the events increased. More clients and their supporters attended handling activities.

• Clients were encouraged to build an abstinent support network that included friends, co-workers, neighbors, or others also equally members of their family of origin.

Family Responses to Relapse

Clients tin can relapse, and family members may exist unwilling or unable to exist empathetic or nonjudgmental virtually episodes of relapse. Typically, relapse is an unpopular topic with family members. If relapse occurs, counselors demand to exist prepared for a range of emotional responses from families, including acrimony, panic, arraign, depression, spitefulness, and relief. Some families may abandon or withdraw from the client; others may attempt to engage the customer in substance-using activities; still other families may be caught in patterns of depression and resignation or panic and fear.

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Living the Treatment Process

Anthony's wife and son were relieved and optimistic when he entered handling. Soon they would be able to enjoy the husband and father they had missed during many years of substance abuse. As the weeks passed, however, Anthony's family grew more aroused and disappointed. He rarely spent time with them and was always at recovery meetings. He showed fiddling interest in their lives and was not physically or emotionally available to them. "I thought treatment would make our lives amend, but information technology'southward only not true," said his wife.

Counselor's response

• Validate the feelings of family unit members.

• Explicate that Anthony's recovery requires his full attention. For a time, he will be unable to devote much attention to the needs or expectations of others. Merely as his recovery progresses and chance of relapse recedes can he become less cocky-focused.

• Talk over the warning signs of relapse.

• Emphasize the family unit members' demand to focus on enhancing their ain lives, independent of the fond loved ane, including involvement in support groups such as Al-Anon.

The post-obit therapeutic options may help counselors in assisting families that may experience a family unit member'due south relapse:

• Prepare the family members as well every bit the client for the possibility of relapse. Family members are likely to be the first to know when a client relapses. IOT programs focus on strengthening the client'southward relapse prevention skills, but families likewise need assistance. IOT staff members can help families

  • Understand that relapse can happen and that each family unit reacts in unique ways.

  • Take that their reactions to the relapse crisis do not necessarily betoken that the family is in deep trouble.

  • Fix a plan that identifies steps the family will have if relapse occurs.

  • Identify ways that family unit members can support 1 another.

  • Seek help if the plan fails.

• Assist family members in engaging support services and resources. Customs-based support groups such as Al-Anon, Nar-Betimes, Alateen, and Alatot (for children of parents who abuse alcohol) are available in about areas and are indispensable sources of help for many families. Family members should exist encouraged to attend meetings regardless of the customer's recovery status. In these groups, family members focus on their own needs, accept what they cannot change, and engage in healthy, satisfying activities. To facilitate attendance, some IOT programs offering these groups infinite at their facility. Others sponsor their ain family back up groups, led past alumni of the programs, that are open to all who wish to attend for every bit long as they desire.

• Seek interventions for private family members when their responses to relapse are unhealthy. The IOT counselor needs to be alert to the possibility that relapse by a client may require additional family interventions and referrals to other service professionals. For example, another family member also may exist in recovery and may need additional assistance from a support group. Another family member may get depressed equally a result of the client's relapse, or an adolescent may act out. The client and other family unit members may benefit from psychological or psychiatric interventions.

Sabotage by Family Members

A family can sabotage the customer'due south progress when i or more family members acquit in ways that undermine the client's abstinence or treatment. For case, family unit members may keep to apply or leave alcohol or drugs where the customer is probable to see them. They may state to the client or others that the client is probable to fail or may refuse to let the client use the family car to become to a back up coming together or treatment session. Examples of successful clinical approaches to discourage demolition and encourage positive participation are as follows:

• Schedule individual family sessions to talk over the specific behaviors that are sabotaging recovery efforts.

• Discuss culling behaviors that back up recovery, and offering back up for making the behavioral changes.

• Determine whether individual therapy is needed, and back up family members with a referral to a family therapist as appropriate.

• Work with family members to create a contract that specifies how their behavior is to modify.

• Monitor progress.

Family unit Life Without Substance Corruption

As recovery begins, some family unit issues resolve with abstinence. Issues of trust and worries nearly how the family unit will exist different are likely to emerge. Here are a few common questions and some suggested answers on how IOT counselors can help families:

1. How do we reestablish trust?

   • Teach family members that a lack of trust is a normal and natural reaction in early recovery simply, at the same time, the recovering person may sense this lack of trust and may get angry or lamentable.

   • Betoken that the newly abstinent member may suffer from a "time warp" in which a week seems more like a month. Such different perceptions of fourth dimension can add to conflict around the trust issue considering the client may wait the family's trust after what is, in reality, but a short period of abstinence.

   • Discuss the thought that mistrust transforms into trust only as the client maintains forbearance and demonstrates positive changes in behavior. Ask the customer to accept that family members may not trust him or her for a flow.

   • Propose that family members hold to extend their trust incrementally to the client. For example, an adolescent client may be given permission to employ the family auto for an outing if the boyish's school attendance is satisfactory for a specific period.

2. How do we have fun over again?

   • Suggest creating new family unit rituals to supervene upon old ones that involved substance utilise.

   • Suggest establishing and celebrating "family" abstinence anniversaries.

   • Encourage participation in events sponsored by Al-Anon, Nar-Anon, and other family unit support groups.

   • Urge participation in multifamily groups sponsored by the treatment program.

   • Enquire each member to identify a favorite "family fun" action for the entire family to relish.

   • Inquire members to consider separate couples and parent-kid activities to create new relationships between family members.

   • Ask members to keep a family journal that includes ideas, feedback, and comments from family members on various activities, rituals, and other family unit events.

3. What do we say to friends, neighbors, and assembly nigh treatment and recovery?

   • Assist family members in discussing and coming to decisions almost what data they want to share with others and when. Write down this data, give it to all family members in the form of an agreement, and accept each member sign the agreement.

   • Review the privacy and confidentiality provisions that govern treatment programs with family members to remind them that providers will not discuss these topics with others and that family members are in control of what others know. Use family support group sessions to discuss this issue and then that members learn from the experiences and examples of other families.

   • Have family members "rehearse" situations they are likely to encounter to practice advisable responses.

4. First the bottle, now the meetings. Will information technology e'er go better?

   • Acknowledge that the spouse or pregnant other is disappointed and frustrated.

   • Point out that recovery is the first and near important goal during this hard menstruation and that people in recovery often immerse themselves in recovery activities with the same intensity with which they used substances.

   • Assist the spouse or meaning other in focusing instead on his or her own recovery and in attending Al-Anon, Nar-Anon, or other support groups.

Appendix 6-A. Format and Symbols for Family Genogram^*

The genogram is useful for engaging the customer and significant family members in a discussion of important family unit relationships. Squares and circles identify parents, siblings, and other household members, and an enclosed foursquare or circle identifies the customer. Marital status is represented by unique symbols, such every bit diagonal lines for separation and divorce. Different types of connecting lines reflect the nature of relationships amidst household members. For instance, 1 solid line represents a afar relationship between two individuals; iii solid lines correspond a very close relationship. Other key data, such equally arrest information, are written on the genogram as advisable.

^*Source: New Jersey Division of Addiction Services, New Jersey Section of Health and Senior Services.

This sample genogram depicts a family that initially was seen equally a shut, loving family unit. The son, John, had come under the influence of some "bad friends" and had get involved in abusing and selling substances. While expressing their willingness to help, the family denied the seriousness of the state of affairs and minimized any issues in the nuclear or extended family.

When the discussion was extended to 1 of John's maternal uncles, Mrs. G. admitted that her brother had been arrested a number of times for heroin possession. Questions virtually the maternal grandmother's reaction to John's "problem" caused the united family front to begin to dissolve. It became apparent that Mrs. G.'s mother took an "insensitive position" regarding John'due south substance apply disorder and there was a serious estrangement between her and her daughter. In discussing the details of the uncle's criminal activity (which was a family secret that fifty-fifty John and his brothers did not know), information technology emerged that Mrs. G. had for years agonized over her female parent'south pain. Now, desperately afraid of reliving her parents' experiences, Mrs. G. had stopped talking to her mother. John's brothers felt free to open and expressed their resentment of their brother for putting the family unit in this position.

Mr. G., who had been most determined in denying any family bug, at present talked about the sense of betrayal and failure he felt because of John's actions. It was only through the leverage of the family's experience that the family'southward present conflict became evident.

Source: New Bailiwick of jersey Division of Habit Services, New Jersey Section of Health and Senior Services.

Appendix 6-B. Family Social Network Map^*

Designing a social network map is a practical strategy to survey various aspects of social back up available to clients and their families. Mapping a client'southward social network is a two-stage process. Showtime, the client uses a segmented circle to categorize people in the network (eastward.chiliad., friends, neighbors). Then, a grid is used to record a client'south specific responses most the supportive or nonsupportive nature of relationships in the network (Tracy and Whittaker 1990). This approach allows both clinicians and clients to evaluate (one) existing breezy resources, (ii) potential breezy resources not currently used past the client, (3) barriers to involving resource in the customer's social network, and (4) whether to incorporate particular informal resource in the formal treatment program. Mapping also tin can identify substance-using behaviors of individuals in the customer'due south social network. The map takes an average of xx minutes to complete and provides a concise merely comprehensive picture of a family unit's social network. Practitioners study that the social network map identifies and assesses stressors, strains, and resources within a client's social surround (Tracy and Whittaker 1990). This interactive, visual tool allows clients to become actively engaged and gain new insight into how to find support inside their social networks.

Instructions

Pace one. Explain to the customer that yous would similar to take a look at who is in the customer's social network by putting together a network map. The client tin use a first name or initials for each important person in his or her life; either the clinician or the client can enter the names in the appropriate segment of the circumvolve shown beneath.

Sample script. Retrieve dorsum over this past month, say since [date]. What people accept been of import to you? They may have been people you saw, talked with, or wrote letters to. This includes people who made yous feel good, people who fabricated you feel bad, and others who just played a role in your life. They may be people who had an influence on the way you made decisions during this fourth dimension.

There is no right or incorrect number of people to place. Right now, merely listing every bit many people as you can call up of. Do y'all want me to write, or practice y'all want to do the writing? First, think of people in your household—whom does that include? Now, going around the circle, what other family members would you include in your network? How nearly people from work or school? (Proceed effectually each segment of the circle.) Finally, list professional people or people from formal agencies whom you accept contact with.

Look over your network. Are these the people you would consider role of your social network this by month? (Add together or delete names as needed.)

Step two. Number the sections of the circle 1 through 7, equally shown in the Area of Life section of the grid (exhibit 6-3). If there are more than 15 names on the circle, the client selects the summit 15 people to enter on the social network grid. Transfer the 15 names and the numbers that stand for to the sections of the map to the social network filigree. Names of people in the network also should be put on private slips of paper for the client to utilize in preparing the network grid.

Exhibit 6-3. Social Network Grid Used in Conjunction With Network Map

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ID________		Area of life	Physical support	Emotional support	Information/ advice	Critical of client	Direction of help	Closeness	How oftentimes seen	How long known
Respondent		1. Household	1. Inappreciably ever	ane. Inappreciably always	1. Hardly always	ane. Hardly ever	i. Goes both	i. Never very	0. Does not see	1. < 1 year.
_______________		2. Other family	2. Sometimes	ii. Sometimes	2. Sometimes	2. Sometimes	ways	shut	1. Few times/yr.	two. i–five yrs.
Name #		three. Work/school	3. Almost always	3. Well-nigh always	3. Almost always	3. Most always	2. Yous to them	2. Sort of close	two. Monthly	3. > 5 yrs.
		4. Organizations					3. They to yous	3. Very close	3. Weekly
		5. Other friends							iv. Daily/twice or more per week
		6. Neighbors
		vii. Formal services
	01
	02
	03
	04
	05
	06
	07
	08
	09
	ten
	11
	12
	13
	xiv
	15

Step three. Afterwards the names from the social network map have been added to the leftmost column of the social network filigree, inquire the customer to consider the nine categories in the column headings. The client uses the 15 slips of paper with the names from the social network map to reply, sorting the slips into groups respective to the numerical options that back-trail each category in the grid. For example, when because how disquisitional of the client each individual in his or her life is, the client sorts the slips into piles representing those who (1) inappreciably ever, (2) sometimes, or (3) most ever criticize. The proper noun of each person and the appropriate number for his or her level of support are so entered onto the network grid in each life surface area. The finished grid gives an overall flick of support in the customer'due south social network.

Sample script. Now, I'd like to learn more nigh the people in your network. I've put their names on this network filigree with a number for the area of life. Now I'm going to enquire a few questions about the means in which they help yous.

The first iii questions have to exercise with the types of support people requite you. Who would be available to help you out in concrete means? For instance, who would give you a ride if you lot needed i or pitch in to assistance you with a big chore or wait after your belongings for a while if you were abroad? Divide your cards into iii piles: those people you can hardly always rely on for concrete aid, those you can rely on sometimes, and those you'd almost always rely on for this type of help.

Now, who would exist available to give you emotional support? For example, who would condolement you if you were upset or heed to you talk near your feelings? Again, split your cards into three piles. (Continue through residue of the questions.)

Clinical Application

Mapping a client's social network provides a visual and numerical depiction of the client's significant relationships. The following aspects of social functioning are highlighted:

• Network size

• Availability of support

• Criticism client faces

• Closeness

• Reciprocity

• Direction of help

• Stability

• Frequency of contact

^*Source:Tracy and Whittaker 1990, pp. 463–466. Reprinted with permission from Families in Society (www.familiesinsociety.org), published past the Alliance for Children and Families.

Appendix 6-C. Resources for Family unit-Based Services

Publications and Videos

A helpful reference is Family Therapy: An Overview (Goldenberg and Goldenberg 1985). This book presents a comparison of six theoretical models of family therapy, including the psychodynamic, experiential/humanistic, structural, advice, and behavioral models. Meyers and colleagues (2003) offering an overview of community reinforcement and family therapy (CRAFT) that emphasizes the approach's empirical support. Using concerned family members and friends, CRAFT works to bring those who deny they have a substance employ disorder into handling.

American Outreach Association (AOA) (www.americanoutreach.org). AOA is a private, nonprofit organization that produces pamphlets to help families cope with booze and substance abuse. The pamphlets can exist downloaded from AOA's Web site. Topics include strategies on against children who employ substances, effective means for parents to communicate with their children, and means to aid someone with alcohol and drug abuse issues.

Films for the Humanities and Sciences (www.films.com). This organisation offers 150 educational films on substance corruption, covering topics such every bit treatment issues and the effects of addiction on family members and including a series on young adults and substance corruption.

Gerald T. Rogers Productions (www.gtrvideo.com). This company produces films and videos on substance abuse for many audiences, from first graders to families with members who corruption substances.

Hazelden Foundation (www.hazeldenbookplace.org). Hazelden Bookplace is an online resource center and market place for products and services from Hazelden Publishing & Educational Services and provides resources to assist individuals, families, and communities forbid and recover from substance employ and related disorders.

Johnson Constitute (johnsoninstitute.org). This organization offers books, booklets, and videos that are distributed through the Hazelden Bookplace Web site. Some family-related videotapes bachelor are Parenting Bug for Recovering Families, The Child and Me: Parenting for Prevention, The Enabler, Intervention, and Intervention: How to Help Someone Who Doesn't Want Help.

National Families in Activity (NFIA) (www.nationalfamilies.org). NFIA is a national drug pedagogy, prevention, and policy center with the mission of helping families prevent substance abuse among children by promoting science-based policies. NFIA offers books, pamphlets, and afterschool programs to keep young people substance gratuitous. NFIA has collaborated with other organizations on several projects, including Allied Systems Strengthening Families Project and the Drug-Free America Foundation.

NIMCO, Inc. (world wide web.nimcoinc.com). This organization offers videos on booze, tobacco, and drug education and prevention topics. Videos cover such issues as drinking and driving, steroid utilize, substance corruption in the workplace, and the effects of substance abuse on the heed and body.

Pyramid Media (world wide web.pyramidmedia.com). This company offers films and videos nigh substance abuse that are appropriate for training, educational groups, and individual and family unit viewing.

Substance Abuse and Mental Health Services Administration's National Clearinghouse for Alcohol and Drug Information (NCADI) (www.ncadi.samhsa.gov). NCADI is a national resources center funded by the Federal Government that offers a large inventory of publications and videos for treatment professionals, clients, families, and the full general public, including Alcoholism Tends To Run in Families. This fact sheet presents of import information about the influence of parental alcoholism on children and families. It considers evidence that links alcoholism to dysfunctional marital relationships, child abuse, depression, physical problems, and impaired school performances, among other undesirable effects.

Moyers on Addiction: Shut to Home (world wide web.pbs.org/wnet/closetohome). This is the online companion to the PBS testify. It features existent-life stories of struggles with addiction, information on treatment and prevention, and downloadable resources such every bit family guides, viewer'due south guides, teacher's guides, and health professional's guides to the PBS series.

Family unit Support Groups

Adult Children of Alcoholics (ACOA) (www.adultchildren.org). ACOA is a 12-Step, 12-Tradition program that offers support for grown children of parents with alcohol or drug addiction.

Al-Anon family unit groups (www.al-betimes.org). Al-Anon is a fellowship of relatives and friends of people who have alcohol issues who share their experiences, strengths, and hopes. Members believe that alcoholism is a family illness and that inverse attitudes can aid recovery. The program is based on the 12 Steps and 12 Traditions of Alcoholics Bearding.

Families Anonymous (FA) (www.familiesanonymous.org). FA is a 12-Footstep, common-assistance, recovery support group for relatives and friends of those who accept alcohol, drug, or behavioral problems. FA pamphlets, booklets, newsletters, and daily inspirational thought volume are written by the members.

Nar-Anon family unit groups (www.naranon.com). Similar to Al-Anon, Nar-Anon is a fellowship of relatives and friends of people who abuse substances and offers a constructive program for members to achieve peace of heed and to gain hope for the future. Contact information is available in local telephone directories.

National Asian Pacific American Families Confronting Substance Abuse (www.napafasa.org). This nonprofit organization is dedicated to addressing the booze, tobacco, and drug issues of Asian and Pacific Islander (API) populations in the continental United States, Hawaii, and the six Pacific Island jurisdictions, likewise equally elsewhere. Its nationwide network consists of approximately 200 API and human being service organizations, and its Web site lists resource, services for public and professional audiences, and current activities.

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Source: https://www.ncbi.nlm.nih.gov/books/NBK64085/

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