Clientsinvolved in the abstinence-contingent program had fewer cocaine-positiveurine samples, fewer days of drinking, fewer days of homelessness, and moredays of employment during the followup period than those in the standardtreatment. A number of substance abuse treatment strategies have derived from operantlearning principles. While they are often incorporated into broad-spectrumcognitive-behavioral approaches, they have also been used as independent formsof treatment. Common elements of behavioral treatments based on theories ofoperant learning include contingency management, behavior contracting, communityreinforcement, and behavioral self-control training. The following sectionsdescribe some of the elements used in brief behavioral therapies based on theoperant learning model.
Family Dynamics that Influence Addiction
Marlatt and Gordon posit that one source of possiblerelapse risk has to do with the degree of stress or daily hassles that theclient experiences (Marlatt and Gordon,1985). They suggest that when the demands and obligations aclient feels («shoulds») outweigh the pleasures the individual can engage in(«wants»), then his life is out of balance. In response to these feelings, the individualcould begin making decisions that gradually lead toward possible relapse.The goal is to help the individual find a better balance, increasinginvolvement in pleasant and rewarding activities while reducing the leveland sources of stress. Although there has been more researchon alcohol-related effect expectancies (Goldman, 1994), there has been an increased interest indrug-related expectancies (Brown,1993).
Substance Use Disorder Treatment and Family Therapy: Updated 2020 [Internet].
Because of its narrow focus on a specific target problem, this therapeutic approach works well with many SUD treatment strategies. Behavioral couples and family counseling promote the recovery of the family member with an SUD by improving the quality of relationships, teaching communication skills, and promoting positive reinforcement within relationships. The multidimensional approach suggests that behavior change occurs via multiple pathways, in different contexts, and through diverse mechanisms.
Adolescent Community Reinforcement Approach
When family members change their thinking about and responses to substance misuse, the entire family system changes. These systems-level changes lead to positive outcomes for the family member who is misusing substances and improved health and well-being for the entire family. It is challenging to provide family-oriented case management or referral and coordination of services while doing family counseling. You are working with a family system made up potentially of many family members, who may each require other treatment or social services. This requires an appreciation for each family member’s needs and a concerted effort to coordinate other agencies’ services to satisfy multiple needs. Actively link individual family members to case management services or peer providers who can work collaboratively with you to coordinate the multiple service needs of the family.
- Initially conceptualized by Murray Bowen (1978) as part of an intergenerational family model, a genogram is a comprehensive pictorial map of a family’s health, communication, relationship, vocational, and other psychosocial patterns within and across three or more generations of the family.
- The addiction treatment field has adapted family systems approaches to address the unique circumstances of families in which substance misuse and SUDs occur.
- In this vein, MET may be especially effective for individuals who are not yet committed to change because they are especially likely to benefit from a supportive, goal-directed and structured relationship with a counselor (Rohsenow et al., 2004).
- Before determining whether to use family-based interventions, you should conduct a family interview.
In this procedure,the client is asked to imagine as vividly as possible a sequence of eventsthat begin by seeing his favorite bar; this is typically accompanied byincreased craving. As the person proceeds further in imagining entering thebar, sitting down, ordering a drink, and so on, the substance abuse counseling initial sense of cravingshifts to mild discomfort. As he visualizes beginning to take a drink andtastes the alcohol, he is then asked to imagine becoming violently sick andvomiting (Rimmele et al., 1995). Many mental health organizations also have online directories of licensed therapists.
Emotional Cutoff
Family Recovery Support Groups
2 Theories of Substance Use / Addiction
