drug abuse and family ,

1. Rev Jobin JohnRev Jobin John
DirectorDirector
Nairmalya Coumselling & de addiction centre Peyad TVM 573Nairmalya Coumselling & de addiction centre Peyad TVM 573
+91-9496847734+91-9496847734

3. INTRODUCTION:
Substance abuse often been described as “Family
Disease”
Apparent Genetic Predispositions
Environmental (Family)context within which an
individual is raised

4. HISTORY OF INVOLVING FAMILIES IN THE
TREATMENT OF ALCOHOL DEPENDENCE
1960 - Professionals began to consider families of
alcohol dependents in the treatment.
1966 - Treatment centre in Minnesota hired a social
worker to deal with families of PWADS
1970 – Family is seen as pathology(relapse due to
EE)

5. Contd….
1980 – Family as carer
1985 - Family therapist began to acknowledge the
need for development of clinical approach to work
with alcohol affected families.
1990 - Family as partners in treatment

6. Characteristic of Families with
Substance Abuse
High degree of chaos, conflict, unpredictability and
inconsistent messages to children about their worth
Breakdown of traditional rituals & rules, less cohesive
Poor communication/ strained IPR
Inadequate or multiple role functioning

7. Contd…..
Domestic violence
Child abuse or neglect
Sexual abuse
Poor adjustment
Emotional problems

8. Family therapy views the family as a whole, rather
than the individual as a basic unit of pathology
It focuses on the dysfunctional system of interacting
personalities, the communication patterns of
individual members of the family, and how it
contributes in maintaining alcohol abuse in the
member.

9. Why include family?
Rich resource for the recovery of addicts
Aspects of family functioning and interaction patterns -
associated with Rx duration, abstinence
 Families demonstrating low expressed emotion as indicated
by warmth, an appropriate level of involvement, and less
criticism. Less likely to relapse than those from families of high
expressed emotion (O’Farrell, Fals-Stewart 1998).
Family member can positively impact the substance user

10. Contd….
Interaction and consequent social reinforcement
from within the family environment may often
influence alcohol related behaviors
Play a significant role in reinforcing the adaptive
behaviors.

11. Contd….
Delay relapse and
Fewer drinking days
Family involvement in treatment is not only
beneficial for the individual but also the negative
impact of the addictive behavior on family members
can be reduced.
One traditional method that incorporates the family
is Al-Anon, a self-help approach

12. Whom to involve:
Parents
Spouse
Siblings
Any other significant family
members

13. Approaches to FT in S Abuse:
Family Disease Model,
Family Systems Theory, and
Behavioural Family Theory

14. Family Disease Model
 Proposes that both the problem drinker and
his or her family members have a disease
Progressive disease, and family members of
the alcoholic are thought to suffer from
codependency

15. Family Disease Model
Alcoholics and co-dependents are treated
separately,
Wherein family members receive education
about alcoholism and co-dependency, as well
as individual or group therapy to improve their
own psychological wellbeing
(Mc Crady, 1989).

16. Family Systems Theory
Symptom of the family’s dysfunction
(Stanton et al., 1982).
Presence or absence of alcohol or drugs becomes
the
defining factor in family interactions.
Family members adapt to the substance use
behavior
they also serve to help maintain the substance use
Individual behaviours occur not in isolation but in
the context of the system in which the individuals
find themselves

17. Behavioural family theory
Suggest that substance abusers from happy families
with good communication are less likely to relapse.
Goals: To reinforce positive interactions among
family members and decrease negative behaviours or
interactions associated with drinking
Family members learn communication skills and
techniques to reward the drinkers’ sobriety.

18. Goals of Family Intervention:
To reduce or eliminate abusive
drinking and support the alcoholic’s
effort to change.
Persuade the family to change alcohol
related interaction patterns (e.g.
nagging about past drinking but
ignoring current sober behavior)

19. Goals:
Help the couple to repair the extensive relationship
damage they incurred during many years of conflict
over substance used.
 Help the abstinent substance user and their spouse
to engage in behaviors which are more pleasing to
each other
Help them to find solutions to relationship
difficulties that may not be directly related to the
substances used.

20. Case work for Families (CWF)
Four goals:
(a) Facilitate and maintain abstinence,
(b) Promote work and economic independence,
(c) Address safety from violence for women and
children, and
(d) Improve family functioning

21. Interventions:
Customized or tailored to the individual needs of the client
CWF should provide services in eight areas:
 Substance abuse,
Employment
 Mental health,
Physical health,
Parenting,
Family relationships,
 Domestic violence, and
Basic needs (housing, transportation, and child care).
.

22. Training should be integrated into treatment
Empathic treatment approach, gender specific
Should incorporate interventions at the level of the
organization to foster effective collaboration through
changing organizational culture and capacity building

23. PHASES OF
INTERVENTION

25. Role of Spouse/family Members
Do not suspect
Develop trust
Do not discuss the individual's previous drinking
problems and consequences with others
Eliminate the stimulus cues from the home
Reinforce the dry habit

26. Contd…
Provide +ve feedback
Provide alternative activities
Deal with interpersonal problems
Improve communication and avoid criticism
at home
Alert friends

27. Contd…
Identify potential risk factors for
relapse: meeting with specific situations,
stressors at home or at work situation, crisis and
conflicts, and certain emotional states may trigger
a relapse.
Identify the behavior that may indicate a
potential relapse: restlessness, boredom, frequent
spells of anger, frequent returning home late,
spending large sums of money

28. Ensure periodic follow-up
Ensure proper medication compliance
Supervise medication
Act as “Early Warning system”.

29. Common warning signs of relapse,
importance of relapse prevention,
how the family can be involved, and
how to deal with an actual lapse or relapse of an
addicted family member.

30. Skills required:
Developing therapeutic alliance listening
/empathizing considering each person’s view
Making contacts
Balancing interaction
Managing emotions
Formulation of goals

31. Advantage of FI
learn about strategies to take care of themselves so
that all the recovery efforts are not simply directed at
the addicted person.
learn about better coping strategies
behaviors that they should avoid, which are
considered enabling
Referrals for family members with a psychiatric
disorder

32. lessen the burden
offers the client the opportunity to receive support
from the family.
to verbalize their concerns, questions, experiences,
and feelings related to the addicted family member.
Can be a motivating factor
To maintain recovery

33. Advantage of FI
Inspiring motivation to change
Preparing clients to enter treatment.
Engaging and retaining clients in treatment.
Increasing participation and involvement.
Improving treatment outcomes.
Encouraging a rapid return to treatment if symptoms
recur

34. Problems & Challenged Faced
LT substance use-neglect of fly roles-shame & guilt
with children-marital therapy not fly therapy
Marital commitment-contemplating separation-poorly
motivated-needs individual session
Consent refuse by spouse parents
Having extramarital affairs , or more than 1 wife

35. Problems & Challenged Faced
Joint fly-more than 1 substance using individual
Severe fly pathology involving marital/domestic
violence , child sexual abuse , ‘fly secrets’ n decline
the therapy
Adult children of Alcoholics resistant-anger n
hostility towards them

36. Problems & Challenged Faced
Challenging with consanguineous marriage-elders in
family
Joint family-protect patient and make a scapegoat of
the spouse
Women substance users are greatly stigmatized n
poor social support.

37. Research study
Studies of Family involvement in treatment alcohol and
drug dependent show that
Increased abstinence,
happier relationships and
fewer separations than individual-based treatment,
substantial reduction in domestic violence,
better outcome in both alcohol and drug abuse and
superior to individual based treatment,
 children helped more than individual-based treatment
for both alcohol and drug abuse.
(Azrin, Sisson, Kelley & Fals-Stewart, 2002; McCrady,(Fals-Stewart,
Birchler & O'Farrell, 1996).

38. Ashok Kumar & Nirmala (2008) in their study
on “social support among abstinence and non-
abstinence alcohol dependents’ found that
those who were maintaining abstinence for
more than 2 yrs;
had strong family social support, self
motivation;
were regular for treatment and follow up

39. Scales for Family Assessment:
 Marital Quality Scale, Shah, 1995 NIMHANS
The Dyadic Adjustment Scale: Spanier (1976)
The Family environment scale: Moos and Moos
Family Interaction Pattern Bhatti et al 1986
The conflict Tactics Scale: Strauss 1979
Parenting Bonding Scale: Parker, Tupling, Brown
Children of Alcoholics Screening Test; Pilat and Jones