This TIP also offers guidance for addiction treatment program administrators, supervisors, and clinical/program directors (called “administrators” for brevity) working in behavioral health programs and agencies that provide SUD treatment and recovery support services. Although not strictly a cognitive-behavioral approach, this technique is included here because it incorporates behavioral procedures, such as shaping and reinforcing clients’ statements about the need for change, and has as a goal the development of strategies for changing behavior. This approach seeks to develop a conditioned aversion in the client by associating an aversive event with alcohol. Treatment involves either pairing stressful or painful stimuli (e.g., nausea or electric shock) with actual alcohol consumption or pairing images of drinking with images of unpleasant scenes or experiences.

Results of Treatment Outcome Studies

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). Moos (2011) noted that social factors protect people from developing SUDs and may also help them initiate and maintain recovery. These processes “are reflected in the active ingredients that underlie how community contexts, especially family members, friends, and self-help groups, promote recovery” (Moos, 2011, p. 45). Clients also are taught strategies for coping with urges to drink and refusing offers to drink.

Effectiveness of Cognitive-Behavioral Approaches

In examining the evidence for family-based interventions for adolescents, Rowe (2012) identified several effective treatments, including multidimensional family therapy, multisystemic therapy, ecologically based family therapy, functional family therapy, and brief strategic family therapy. These reviews concluded that family treatments were effective for treating adults and adolescents with SUDs. As previously mentioned, all primates learn how to regulate their affect from their primary attachment figures through the attachment system and modeling. Parents who have substance use problems will likely have their own affect dysregulation that may have preceded or resulted from their substance use. Consequently, development of healthy affect regulation will be difficult for children and adolescents to achieve. Children may present to a social worker in direct practice at community mental health center or a school setting.

Family Approaches To Support Ongoing Recovery

The negative impacts of parental SUDs on the family include disruption of attachment, rituals, roles, routines, communication, social life, and finances. Families in which there is a parental SUD are characterized by an environment of secrecy, loss, conflict, violence or abuse, emotional chaos, role reversal, and fear. All four models focus on the need to develop a supportive bond with the client, although this is highlighted most in MI and MET.

Emotional Cutoff

• 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.
• Understanding the family’s specific developmental stage can help with assessing the interventional needs of a family.
• Alexandra MacLean, MA, of Partnership to End Addiction, manages National Families Support Technology Assistance Center on behalf of the Partnership, working to advance positive family-driven partnerships between service providers and families to provide family support across the lifespan.
• Understanding these normative stages will help counselors better perceive a family’s presenting problems, including SUDs.

Use externalizing language (e.g., “the drinking,” not “her drinking”) to help the client and family members disengage substance use from negative identity conclusions. Making the SUD an external focus substance abuse counseling of attention allows everyone to work as a team to defeat it. A genogram can also help family members see their current problems from a wider perspective and identify strengths and resources.

Appropriateness of Integrated Family Counseling for SUDs

Psychoeducational interventions can also inform families about and provide referral to community-based family supports like Al-Anon and Nar-Anon. Some family-based interventions in the following sections are SUD-specific adaptations of general family systems approaches. Each description includes an overview and goals of the approach, supporting research specific to SUD treatment, and relevant techniques and counseling strategies.

From individual to multiple family counseling formats, family-based interventions can include a combination of family members (e.g., couples or siblings), the entire family, an individual family member, or several family groups at one time. In family counseling, the units of treatment are the family and the individual within the context of the family system. Peer recovery support services for people with SUDs have demonstrated efficacy in helping people initiate and sustain recovery (Bassuk, Hanson, Greene, Richard, & Laudet, 2016). A family-focused peer recovery support specialist is a nonclinical provider who is trained and supervised in providing education, support, and resources to family members who have a family member with an SUD. Family peer recovery support specialists have lived experience of having a family member with an SUD, mental disorder, or co-occurring disorder.

What are the Benefits of Family Systems Therapy