Substance Abuse Treatment and family therapy - NAADAC

262 Pages·2005·0.97 MB·English

Substance Abuse Treatment
And Family Therapy
A Treatment
Improvement
Protocol
TIP
39
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov FAMILY
THERAPY
Substance Abuse Treatment
And Family Therapy
This TIP, Substance Abuse Treatment and Family Therapy, addresses
how substance abuse affects the entire family and how substance
abuse treatment providers can use principles from family therapy
to change the interactions among family members. The TIP
provides basic information about family therapy for substance
abuse treatment professionals, and basic information about
substance abuse treatment for family therapists. The TIP presents
the models, techniques, and principles of family therapy, with
special attention to the stages of motivation as well as to
treatment and recovery. Discussion also focuses on clinical decision
making and training, supervision, cultural considerations, special
populations, funding, and research. The TIP further identifies
future directions for both reasearch and clinical practice.
Collateral Products
Based on TIP 39
Quick Guide for Clinicians
Quick Guide for Administrators
DHHS Publication No. (SMA) 05-4006
Printed 2004
Reprinted 2005
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
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THERAPY
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9
Substance Abuse Treatment
And Family Therapy
Edward Kaufman, M.D.
Consensus Panel Chair
Marianne R.M. Yoshioka, M.S.W., Ph.D.
Consensus Panel Co-Chair
A Treatment
Improvement
Protocol
TIP
39
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857
Acknowledgments considered substitutes for individualized client
care and treatment decisions.
Numerous people contributed to the develop-
ment of this TIP (see pp. ix, xii, and appen-
dices E, F, and G). This publication was pro- Public Domain Notice
duced by The CDM Group, Inc. (CDM) under
All materials appearing in this volume except
the Knowledge Application Program (KAP)
those taken directly from copyrighted sources
contract, number 270-99-7072 with the
are in the public domain and may be repro-
Substance Abuse and Mental Health Services
duced or copied without permission from
Administration (SAMHSA), U.S. Department
SAMHSA/CSAT or the authors. Do not repro-
of Health and Human Services (DHHS). Karl
duce or distribute this publication for a fee
D. White, Ed.D., and Andrea Kopstein,
without specific, written authorization from
Ph.D., M.P.H., served as the Center for
SAMHSA’s Office of Communications.
Substance Abuse Treatment (CSAT)
Government Project Officers. Christina
Currier served as the CSAT TIPs Task Leader. Electronic Access and Copies
Rose M. Urban, M.S.W., J.D., LCSW, CCAC,
of Publication
CSAC, served as the CDM KAP Executive
Deputy Project Director. Elizabeth Marsh Copies may be obtained free of charge from
served as the CDM KAP Deputy Project SAMHSA’s National Clearinghouse for Alcohol
Director. Shel Weinberg, Ph.D., served as the and Drug Information (NCADI), (800) 729-
CDM KAP Senior Research/Applied 6686 or [phone]; TDD (for hearing
Psychologist. Other CDM KAP personnel impaired), [phone], or electronically
included Raquel Witkin, M.S., Deputy Project through the following Web site:
Manager; Susan Kimner, Managing Editor; www.samhsa.gov/centers/csat/csat.html.
Pamela Dronka, former Editor/Writer;
Michelle Myers, Editor/Writer; Sonja Easley,
Recommended Citation
Editorial Assistant; and Jason Merritt, KAP
Manager of Collateral Products. In addition, Center for Substance Abuse Treatment.
Sandra Clunies, M.S., I.C.A.D.C., served as Substance Abuse Treatment and Family
Content Advisor. Special thanks go to Therapy. Treatment Improvement Protocol
Rosemary McGinn, J.D., CASAC, for her (TIP) Series, No. 39. DHHS Publication No.
contributions to chapter 6, Program and (SMA) 05-4006. Rockville, MD: Substance
Policy Issues. Jonathan Max Gilbert, M.A., Abuse and Mental Health Services
Helen Oliff, B.S., David Sutton, B.A., Catalina Administration, 2004.
Bartlett, M.A., and Randi Henderson, B.A.,
B.S. served as writers.
Originating Office
Practice Improvement Branch, Division of
Disclaimer
Services Improvement, Center for Substance
The opinions expressed herein are the views of Abuse Treatment, Substance Abuse and Mental
the Consensus Panel members and do not nec- Health Services Administration,
essarily reflect the official position of CSAT, 1 Choke Cherry Road, Rockville, MD 20857.
SAMHSA, or DHHS. No official support of or
DHHS Publication No. (SMA) 05-4006
endorsement by CSAT, SAMHSA, or DHHS
Printed 2004
for these opinions or for particular instru-
Reprinted 2005
ments, software, or resources described in this
document are intended or should be inferred.
The guidelines in this document should not be
ii Contents
Contents
What Is a TIP?............................................................................................................vii
Consensus Panel ..........................................................................................................ix
KAP Expert Panel and Federal Government Participants....................................................xi
Foreword..................................................................................................................xiii
Executive Summary.....................................................................................................xv
Chapter 1—Substance Abuse Treatment and Family Therapy................................................1
Overview......................................................................................................................1
Introduction.................................................................................................................1
What Is a Family?..........................................................................................................2
What Is Family Therapy?.................................................................................................4
Family Therapy in Substance Abuse Treatment.....................................................................8
Goals of This TIP.........................................................................................................18
Chapter 2—Impact of Substance Abuse on Families..........................................................21
Overview....................................................................................................................21
Introduction................................................................................................................21
Families With a Member Who Abuses Substances.................................................................23
Other Treatment Issues..................................................................................................28
Chapter 3—Approaches to Therapy ...............................................................................31
Overview....................................................................................................................31
Differences in Theory and Practice...................................................................................31
Family Therapy for Substance Abuse Counselors .................................................................49
Substance Abuse Treatment for Family Therapists................................................................64
Chapter 4—Integrated Models for Treating Family Members ..............................................73
Overview....................................................................................................................73
Integrated Substance Abuse Treatment and Family Therapy...................................................73
Integrated Models for Substance Abuse Treatment................................................................85
Matching Therapeutic Techniques to Levels of Recovery.......................................................105
Chapter 5—Specific Populations..................................................................................109
Overview...................................................................................................................109
Introduction..............................................................................................................109
Age..........................................................................................................................110
Women.....................................................................................................................114
Race and Ethnicity......................................................................................................116
Sexual Orientation.......................................................................................................130
People With Physical or Cognitive Disabilities....................................................................131
People With Co-Occurring Substance Abuse and Mental Disorders .........................................136
Rural Populations.......................................................................................................138
iii
Other Contextual Factors..............................................................................................141
Chapter 6—Policy and Program Issues.........................................................................147
Overview...................................................................................................................147
Primary Policy Concerns..............................................................................................147
Program Planning Models.............................................................................................149
Other Program Considerations.......................................................................................160
Directions for Future Research.......................................................................................161
Appendix A: Bibliography...........................................................................................165
Appendix B: Glossary ................................................................................................193
Appendix C: Guidelines for Assessing Violence................................................................197
Appendix D: Resources..............................................................................................201
Appendix E: Resource Panel.......................................................................................205
Appendix F: Cultural Competency and Diversity Network Participants................................207
Appendix G: Field Reviewers.......................................................................................209
Index......................................................................................................................211
CSAT TIPs and Publications........................................................................................231
iv Contents
Figures
3-1 Overview of Key Elements for Inclusion in Assessment......................................................39
3-2 Basic Symbols Used in Genograms ...............................................................................42
3-3 Eugene O’Neill Genogram..........................................................................................43
3-4 Individual, Family, and Environmental Systems..............................................................56
4-1 Facets of Program Integration.....................................................................................74
4-2 Levels of Counselor Involvement With Families...............................................................80
4-3 Techniques To Help Families Attain Sobriety................................................................103
4-4 Techniques To Help Families Adjust to Sobriety ............................................................104
4-5 Techniques To Help Families in Long-Term Maintenance .................................................106
Contents v

What Is a TIP?
Treatment Improvement Protocols (TIPs), developed by the Center for
Substance Abuse Treatment (CSAT), part of the Substance Abuse and
Mental Health Services Administration (SAMHSA), within the U.S.
Department of Health and Human Services (DHHS), are best-practice
guidelines for the treatment of substance use disorders. CSAT draws on
the experience and knowledge of clinical, research, and administrative
experts to produce the TIPs, which are distributed to a growing number
of facilities and individuals across the country. The audience for the
TIPs is expanding beyond public and private treatment facilities as alco-
hol and other drug disorders are increasingly recognized as a major
problem.
CSAT’s Knowledge Application Program (KAP) Expert Panel, a distin-
guished group of experts on substance use disorders and professionals in
such related fields as primary care, mental health, and social services,
works with the state alcohol and drug abuse directors to generate topics
for the TIPs. Topics are based on the field’s current needs for informa-
tion and guidance.
After selecting a topic, CSAT invites staff from pertinent Federal agen-
cies and national organizations to a Resource Panel that recommends
specific areas of focus as well as resources that should be considered in
developing the content for the TIP. Then recommendations are commu-
nicated to a Consensus Panel composed of experts on the topic who have
been nominated by their peers. This Panel participates in a series of dis-
cussions; the information and recommendations on which they reach
consensus form the foundation of the TIP. The members of each
Consensus Panel represent substance abuse treatment programs, hospi-
tals, community health centers, counseling programs, criminal justice
and child welfare agencies, and private practitioners. A Panel Chair (or
Co-Chairs) ensures that the guidelines mirror the results of the group’s
collaboration.
A large and diverse group of experts closely reviews the draft document.
Once the changes recommended by the field reviewers have been
vii