Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
THE RECOVERY MODEL The recovery model was originally based within the 12-step approaches and continues to be a model at the forefront of substance use treatment. This model suggests that recovery is a voluntary lifestyle and not just behavior change focused on reducing substance use. Instead, the aim is a holistic lifestyle change in which the individual is actively involved in recovery and responsibility. This model allows for clients to take a role in their recovery while also improving their lives through abstinence or harm reduction approaches (Straussner, 2014). HARM REDUCTION The harm reduction approach (Erickson et al., 2015) grew in opposition to the traditional abstinence-only approach. Harm reduction focuses on reducing the harm related to substance use by encouraging the individual to determine substance use goals that are not necessarily abstinence-only goals; commit- ting to using clean needles is an example of a harm reduction intervention for users of injection drugs. This is not to say that harm reduction discourages abstinence-only goals; instead, it allows individuals to develop goals that are in line with their values but that encourage reducing consequences of substance use. For example, such goals can include reducing drinking by eliminating binge drinking (or heavy episodic drinking episodes) or drinking on only one day per week and having only one standard drink on that day. Such a goal allows indi- viduals to engage in drinking with their friends if they choose, but at a level that reduces the harm that drinking was having on their lives. FAMILY TREATMENT Family therapy may be necessary for individuals whose sub- stance use has detrimentally affected relationships in the family (Straussner & Fewell, 2011). Because of the great influence substance use can have on family dynamics, and vice versa, many inpatient, residential, and intensive outpatient treatment centers include family members in treatment. In addition, families and significant others can positively influence a client’s treatment outcomes. Responses to the needs of families have led to a variety of treatment models that include psychoeduca- tion, couple and family therapies, and multi-family groups. Self-Assessment Question 3. There is growing evidence that families and significant others of the individuals with a SUD can: A) Have little effect on the outcome of treatment. B) Positively influence treatment outcomes. C) Be employed as sources of collateral information about the client’s substance use only. D) Help with logistics of treatment but should otherwise be separated from treatment.
According to O’Farrell and Feehan (1999), there are three key family-based approaches in relation to substance use. The family disease approach , for example, posits that substance use disorder is a disease of the entire family, not just the individual using the substance. This approach directs the clinician to encourage family members to attend Al-Anon and other family-oriented support groups and treatments. In this approach, the client and family receive separate therapy. The second model is the family systems approach , in which the substance use is viewed as a part of the family system. Within this model, all family members, including the individual who is using the substance, attend therapy together to identify and intervene with family roles, alliances, and communica- tion patterns that are intertwined with the addiction. The therapist focuses on identifying family systems that can be changed or accessed in an effort to reduce substance use and support sobriety. Client and family also receive treatment together in the third model, which is focused on a behavioral approach . This treat- ment takes a contingency management approach in which individuals are rewarded for maintaining abstinence through family interactions in the form of encouraging and positive comments from significant others that affect client confidence. The family is engaged in this reinforcement process and serves to help maintain abstinence. If this approach is effective for an individual, it is a treatment that has the possibility to be main- tained over the long term if the family continues to reinforce abstinence. This reinforcement can be helpful in abstinence and recovery (Manuel et al., 2012). Community reinforcement and family training (CRAFT; Manuel et al., 2012) is a research-based treatment directed at the family as a unit and is the best-known approach for rein- forcing sobriety and discouraging the addiction. This approach teaches family and friends effective strategies for helping their loved one to change and for feeling better about themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her and the addic- tion by teaching families how to relate to the member with a SUD while avoiding both detachment and confrontation. Community reinforcement and family training emphasize eight components: 1. Focusing on family members’ motivation to change by assessing consequences of substance use. 2. Teaching interpersonal skills, allowing non-substance- using family members to provide encouragement and nonantagonistic feedback to the substance-using family member with new communication skills. 3. Assessing positive interactions among the family members and increasing those interactions. 4. Ignoring the family member who uses substances when he or she is using the substances so as not to reinforce that behavior.
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