DBs Unit 6

DB 6.1: Patterns of Interaction in Families with Addiction

Families impacted by addiction often exhibit specific interaction patterns that perpetuate the cycle of substance use. Understanding these patterns is critical to effectively treating the entire family system. Four common patterns include enabling, denial, conflicts, and role reversal: DBs Unit 6.

Enabling

Family members often act to shield the addicted person from any consequences. For instance, a husband may make excuses for his wife’s behavior so that the wife will not be embarrassed or lose her job. Enabling encourages dependence on drugs since it eliminates the necessity for taking responsibility; this factor makes it more difficult for people with addiction to seek assistance.

Denial

Typically, families may minimize or deny the seriousness of addiction. For example, a mother may minimize her child’s behavioral changes, attributing those changes to stress rather than substance use. This denial is a barrier to intervention in that the family does not see a need for professional services.

Conflicts

Trust and communication are abused in addiction, thus leading to frequent arguments. For instance, a husband may fight with his partner over some financial losses incurred due to substance use. Chronic conflict makes the home environment tense, and thus, self-medication becomes a quick way out (Radcliffe et al., 2019).

Role Reversal

As one of the effects of substance abuse, children may have to act responsibly by helping look after their young siblings and even bring up the whole family, a duty that the parent should handle. This might cause mental breakdowns and development issues in children, so they need to be supervised.

These patterns intrude on the greatest sources of family functioning, including the assignment of ineffective communication in any discussion; it always goes around blame or avoidance. Understanding is usually replaced with criticism and suspicion (Nawi et al., 2021). It controls parenting abilities as well as their many inconsistent rules or overcompensations for the addicted member. Conflict management becomes reactive rather than proactive, and families lack an understanding of addiction as a disease, thus reducing empathy for the affected member.

Addressing these patterns requires tailored family therapy to rebuild trust, establish healthy boundaries, and foster accountability. For example, interventions like psychoeducation can help families understand addiction’s impact, reducing enabling and denial behaviors while improving communication (Hamid et al., 2024).

References

Hamid, B., El-Hamady, M., Elazab, W., & Mahmoud, M. (2024). Patterns of interactions between family members and its relation to drug addiction. Benha Journal of Applied Sciences (BJAS), 23(9), 2024. https://journals.ekb.eg/article_359870_d2b87045822ca51ec441bc1ce71ed8e7.pdf

Nawi, A. M., Ismail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R. A., Amit, N., Ibrahim, N., & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11906-2

Radcliffe, P., Gadd, D., Henderson, J., Love, B., Stephens-Lewis, D., Johnson, A., Gilchrist, E., & Gilchrist, G. (2019). What role does substance use play in intimate partner violence? A narrative analysis of in-depth interviews with men in substance use treatment and their current or former female partner. Journal of Interpersonal Violence, 36(21-22), 088626051987925. https://doi.org/10.1177/0886260519879259

DB 6.2: Levels of Counselor Involvement and Family Therapy Approaches

Counselor involvement in family systems varies by the needs of the family and the severity of addiction-related issues. Each level offers unique opportunities for engagement.

Minimal Involvement

At this level, counselors provide information to the families on addiction and its effects. For instance, counselors can give educational materials or short workshops on identifying signs of substance use. This approach is ideal when families are in the early stages of awareness, whereby education rather than therapy will be needed or is their primary requirement, as noted by Stevens and Smith (2018). As such, while this is effective in raising awareness, minimal involvement lacks depth for families with entrenched issues.

Moderate Involvement

This level involves support groups or semi-structured sessions focused on shared concerns. For example, parents of adolescents experiencing substance addiction might participate in a support group to learn coping strategies and share experiences. Moderate involvement nurtures connectedness and empathy among family members while focusing on relational dynamics (Hogue et al., 2021).

Intensive Involvement (Level 5)

Here, the counselor directly intervenes in the family with therapeutic input, always adapting to the family members’ needs. For instance, a counselor may be involved in resolving enabling behaviors, developing communication, and rebuilding broken trust among family members. This level is suitable for families that have had extended dysfunction resulting from addiction (Institute for Solution-Focused Therapy, 2022).

One valuable family therapy approach at Level 5 is Solution-Focused Brief Therapy (SFBT). The method focuses on the strengths and solutions rather than the problems. It helps the family set achievable goals and builds on previous successes.

For instance, a family might work on developing small, consistent communication patterns, like a weekly meeting to discuss concerns about the household. SFBT engenders hope and helps families make lasting changes by underlining what works (Stevens & Smith, 2018).

Moreover, SFBT excels in its practicality and time efficiency, particularly for crisis-hit families. This falls in line with the general purpose of family-centered addiction counseling, which includes trying to reinstate balance and resilience throughout the family system.

References

Hogue, A., Becker, S. J., Wenzel, K., Henderson, C. E., Bobek, M., Levy, S., & Fishman, M. (2021). Family involvement in treatment and recovery for substance use disorders among transition-age youth: Research bedrocks and opportunities. Journal of Substance Abuse Treatment, 129(65), 108402. https://doi.org/10.1016/j.jsat.2021.108402

Institute for Solution-Focused Therapy. (2022). What is solution-focused therapy? Institute for Solution-Focused Therapy. https://solutionfocused.net/what-is-solution-focused-therapy/

Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12–25. https://doi.org/10.1037/a0014160

DB 6.3: Angela’s Case and Family Dynamics

Angela’s blended family system plays a significant role in her treatment. Blended families often have unclear boundaries and increased stress that may exacerbate drug use problems. Angela’s stepfather has an active crack addiction, bringing chaos into the home environment and normalizing drug use while sabotaging recovery efforts.

Thirdly, Angela’s close relationship with her mother signifies that the most important factor in her treatment will involve her mother. However, her mother’s fear of Angela becoming like her stepfather may lead to enabling, such as not confronting her (Stevens & Smith, 2018).

Level 5 is the appropriate level of involvement for Angela’s family, which includes intensive therapeutic interventions. This is necessary because Angela’s addiction is interwoven into her family dynamics through her stepfather’s behavior and her mother’s enabling. Family-based therapy at this level will address Angela’s substance use in concert with broader family patterns that perpetuate it. Such an approach can help the family understand their roles in supporting Angela’s recovery (Institute for Solution-Focused Therapy, 2022).

The stepfather’s substance use brings significant treatment challenges. His continued substance use and cycling in and out of recovery contribute to a toxic environment that might sabotage Angela’s progress. He should be incorporated into the therapy whenever possible but with specific boundaries on his involvement. If he does not accept treatment, his absence should be addressed within the family sessions to ensure that it does not perpetuate enabling or disrupt Angela’s progress.

Multidimensional Family Therapy (MDFT) is the ideal model for this case. MDFT combines individual and family sessions in a way that tackles substance use and enhances family functioning. It would help Angela learn healthier ways to cope and help her mother learn to set healthy boundaries and constructively involve the stepfather. MDFT treats the whole and, therefore, is especially well-suited to blended families’ unique struggles with addiction (Liddle et al., 2009).

References

Institute for Solution-Focused Therapy. (2022). What is solution-focused therapy? Institute for Solution-Focused Therapy. https://solutionfocused.net/what-is-solution-focused-therapy/

Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12–25. https://doi.org/10.1037/a0014160

Stevens, P., & Smith, R. L. (2018). Substance use counseling: Theory and practice (6th ed.). Pearson Education, Inc.

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DB 6.1

• In your reading, several patterns of interaction are likely to be present in families with addiction. In thinking about these patterns, please discuss 4 of the 6 and share how these might be important to understand and treating a family system riddled by the disease of addiction. How might effectiveness of communications, supportiveness or negativity, parenting skills, conflict management, and understanding of the addictive disease be effected as a result of the family’s patterns? Please be sure to provide examples to support your claims.

NOTE: You must make at least 1 substantial posting and 2 substantial replies to this thread. You must participate in the Unit discussion board (making postings/replies) at least 3 days per unit to qualify for full credit and also have at least 1 posting by Wednesday at midnight. You also must use APA style in your posting and replies so please use in-text references and provide a reference to give proper credit to the authors.

DB 6.2

• Your readings are excellent in providing a general introduction to multiple therapy systems which can be useful in creating positive change in the family system. In thinking about the levels of counselor involvement with the family, what are your general impressions about each level and in which circumstances might a human service provider engage at each level? Please use examples to support your claims.
• Additionally once in Level 5, the human service provider is active in providing therapeutic interventions with the family. Please discuss one family therapy approach that you have not focused upon previously in your discussions. Please summarize your thoughts on this approach and how it might be useful in your future work.

NOTE: You must make at least 1 substantial posting and 2 substantial replies to this thread. You must participate in the Unit discussion board (making postings/replies) at least 3 days per unit to qualify for full credit and also have at least 1 posting by Wednesday at midnight. You also must use APA style in your posting and replies so please use in-text references and provide a reference to give proper credit to the authors.

DB 6.3
Angela is an 18 year old female who is presently working on her GED while working at a local fast food restaurant. She lives with her stepsister in the same town as her mother and stepfather. She has not had contact with her biological father since she was 2 months old. While at work, her friends urged her to try crack and since she was offered it 1 year ago her life has changed significantly.

She uses daily before, during, and after work and her mother has noticed that she has dropped in weight and is unable to consistently meet the responsibilities of work, home, and family. Angela is close with her mother and confided that she needs help. The only “problem” is that her stepfather is an active crack addict as well and cycles in and out of recovery networks as well as the jail system. Angela’s mother fears that her daughter will fall into the same cycle.

• -How might Angela’s family system composition be a factor in her treatment (e.g. blended family, etc.)?
• -Which level of involvement might be appropriate for Angela’s family based on the information shared?
• -How might issues of Angela’s Stepfather impact treatment? How would you approach this issue?
• -Which of the integrated models below could be the first to try in an attempt for positive change in this family and why (use your book or research via the internet the model name below)?
  • -Structural/strategic family therapy (Stanton 1981a; Stanton et al. 1982)
  • -Multidimensional family therapy (Liddle 1999; Liddle et al. 1992, 2001)
  • -Multiple family therapy (Kaufman and Kaufmann 1992)
  • -Multisystemic therapy (Henggeler et al. 1996)
  • -Behavioral and cognitive–behavioral family therapy (O’Farrell and Fals‐S tewart 2000)
  • -Network therapy (Galanter 1993)
  • -Bowen family systems therapy (Bowen 1974)
  • Solution‐focused brief therapy (Berg and Miller 1992)

Readings:

• Please review Chapter 9 in Stevens and Smith (2018) to further explore the effects of addiction on families.
• Please read SAMSHA’s (2010) Chapter 2 in TIP 39 by clicking HERE.
• Please read SAMSHA’s (2010) Chapter 4 in TIP 39 by clicking HERE.