CM focused initially on the use of vouchers and prizes that were contingent on substance-free urine samples, but then evolved to emphasize rewards for goal-directed activities that could have continuing benefits. CRA focuses more directly on changing clients’ life contexts to provide rewards for remaining substance-free and increase the likelihood of pleasurable activities. MI and MET use reinforcement to affirm clients’ strengths, promote behavior consistent with clients’ values, and selectively reward clients’ motivation for change. The first wave of CM interventions was based on the idea that the provision of rewards (such as vouchers or prizes) contingent on not using substances (that is, for drug-free urines) was the active ingredient of treatment that effectively reduced substance use. CBT and alternative treatments that do not explicitly focus on teaching coping skills (such as MET, TSF, and interaction-focused group treatment) tend to be equally effective in increasing self-efficacy and alcohol-specific and general coping skills (e.g., see Litt et al., 2003).
Family Recovery Support Groups
Potential rewards can be vouchers or prizes, clinic privileges such as rebates of treatment fees and take-home methadone, and housing and employment (Petry, 2000; Petry et al., 2000). Every brain, and every person is different; we must look at biology as one potential factor in a substance use disorder. The field of Social Services is working to move beyond a moral model of substance use disorders.
Why Do Training and Specialization Matter?
However, Lyons and Woods intheir meta-analysis of 70 different rational-emotive therapy studies foundthat increased effects correlated with longer treatment times (Lyons and Wood, 1991). More researchneeds to be conducted looking at the effect of treatment duration substance abuse counseling on theefficacy of these therapies. Treatment, therefore, is directed primarily at changing distorted or maladaptivethoughts and related behavioral dysfunction. Cognitiverestructuring is the general term given to the process of changing theclient’s thought patterns.
Initial Integration of Families Into SUD Treatment
All family counseling approaches for SUD treatment refect the principles of systems theory. Systems theory views the client as an embedded part of multiple systems—family, community, culture, and society. Family counseling approaches specific to SUD treatment require SUD treatment providers to understand and manage complex family dynamics and communication patterns. They must also be familiar with the ways family systems organize themselves around the substance use behaviors of the person with an SUD. Substance misuse is often linked with other difficult life problems— for example, co-occurring mental disorders, criminal justice involvement, health concerns including sexually transmitted diseases, cognitive impairment, and socioeconomic constraints (e.g., lack of a job or home). The addiction treatment field has adapted family systems approaches to address the unique circumstances of families in which substance misuse and SUDs occur.
Acknowledge Stages of Change
- Appreciating the importance of adapting family counseling methods to ft family values and the cultural beliefs and practices of the family’s larger community.
- The gains in these areas diminish following treatment, but self-efficacy and coping skills remain higher than they were at intake.
- Family members can learn how to express anger appropriately and safely via structured family counseling.
- In this context, Smith and colleaguesreported positive outcomes for dependent users of both alcohol and cocainewho received chemical aversion procedures as part of their treatment incomparison to those who did not receive similar treatment (Frawley and Smith, 1990; Smith et al., 1997).
- Family Check-Up (FCU) is a brief assessment and feedback intervention that targets family risk factors linked to substance use, including lack of parental monitoring and low-quality parent-child relationships (Hernandez et al., 2015).
In the 1980s and 1990s, Berg and Miller (1992) and de Shazer (1988) developed a family counseling approach to help family members find solutions to their problems instead of using the problemsolving approach of structural and strategic counseling. The main assumptions of solution-focused therapy are that pinpointing the cause of problematic family functioning is unnecessary and that counseling focused on solutions to specific problems is enough to help families change. BSFT is effective in long-term reductions in adolescent arrests, incarcerations, and externalizing behaviors like aggression and rule-breaking (Horigian, Feaster, Brincks, et al., 2015). Couples counseling helps couples take substance misuse out of the equation, harness partner support to positively reinforce the client’s efforts to remain abstinent, and change relationship dynamics to promote a family environment that is more conducive to ongoing recovery.
- When family members change their thinking about and responses to substance misuse, the entire family system changes.
- In addition to increasing drug abstinence, similar voucher systems have beeneffective in maintaining attendance of methadone clients at a job-skillstraining program (Silverman et al.,1996).
- Recovery supports can include spouses, intimate partners, CSOs, parents, extended family members, friends, community members, spiritual mentors, teachers, clergy, recovering peers, employers and coworkers, case managers, and primary care and behavioral health service providers.
- These findings show that CRA contains active ingredients of treatment, although they do not clarify which specific aspects of CRA are most important.
- Individuals with SUDs cannot be understood and treated effectively without considering the impact on the whole family.
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