Chapter 8 - Family Involvement

Cocaine addiction contributes to a variety of family difficulties, affecting the family system as well as individual members. The burden and emotional pain can be great. Family members may exhibit behaviors intended to help the addicted member, but which ultimately have an adverse impact. Family involvement is important in the treatment of addiction (O’Farrell and Fals-Stewart 1999, pp. 287-305).

There is an association between relapse and social supports across a range of addictions. Involving the family or significant other of the addicted client in individual or multiple family group sessions can reduce the risk of relapse. Such involvement has many potential benefits:

• It provides the counseling staff with an opportunity to learn about the client’s family, observe how family members interact, and gain input from the family.
• It can facilitate compliance with treatment. If a client feels pressure to remain in treatment to satisfy the requests of the family, he or she may maintain this involvement even during periods of low motivation. This buys the client time for motivation to improve.
• It provides members of the family with an opportunity to verbalize their concerns, questions, experiences, and feelings related to the addicted family member.
• It offers the client an opportunity to hear how the family experiences the addiction.
• It offers the client the opportunity to receive support from the family.
• The family can receive education and support from other families, which may lessen the burden experienced. Anger, worry, confusion, and other emotional reactions can be shared, and strong, negative feelings may be diffused.
• Family members can be taught about and encouraged to attend support groups such as Nar-Anon or Al-Anon.
• Family members can learn about behaviors that they should avoid, which are considered enabling.
• Family members can learn about strategies that can help them cope better with an addicted relative.
• Family members can learn about strategies to take care of themselves so that all the recovery efforts are not simply directed at the addicted person.
• Family members with a psychiatric or addictive disorder who appear to need help themselves can be encouraged to seek help, and referrals can be facilitated.

The GDC model includes a one-time Family Psychoeducational Workshop (FPW) conducted during the first month of treatment (Daley and Raskin 1991; Daley et al. 1992). Psychoeducational workshops have been used with all types of psychiatric and addictive disorders. Such workshops have a positive impact on participants by lessening the family’s burden, increasing helpful behaviors, and decreasing unhelpful behaviors.

A variety of formats can be used for FPWs. Although the CCTS offered a single, 21/2 hour FPW workshop, these workshops can be offered for longer periods of time or for more than one day. A brief FPW was necessary in the CCTS because of the research design. Because the CCTS focused on evaluating the efficacy of individual treatments for addiction, an extensive family program would have made it difficult to interpret research findings. In community-based programs, however, using a variety of family approaches is recommended, including multiple family groups, family psychoeducational workshops, individual family sessions, sessions with individual family members based on a specific need, and referral to family-related self-help programs.

FPWs are semi-structured sessions in which a group of clients and their families are provided with specific information about addiction and recovery. Support is also provided, and families are encouraged to share their questions, concerns, and feelings. Because this is not a therapy group, the workshop leaders must make sure that it doesn’t become a context for sharing deep-seated emotional feelings. Strong feelings are always present in these workshops, and some sharing of emotion is necessary. However, opening up families too much can be counterproductive, so education and support are the main areas of focus. Interactive discussion is encouraged in the context of increasing participants’ understanding of addiction and recovery.

Educational videotapes can be used to help present information and stimulate discussion. It is helpful to provide written literature to clients that relates to the workshop content. Usually after a FPW, one or more family members will have personal questions or concerns that they wish to discuss with the workshop leader.

The specific material covered in family psychoeducational workshops will depend on the amount of time available. Following are the topics most commonly addressed in the CCTS family workshops:

• Overview of substance abuse and dependence: Prevalence, symptoms, causes, and basic concepts (e.g., various degrees of substance use problems, denial, obsession, compulsion, tolerance, psychiatric comorbidity, etc.).
• Effects of substance use disorders: Impact on the individual, family system, and individual members, including children.
• Overview of recovery: Recovery issues for the affected person (physical, psychological or emotional, social, family, spiritual, other) and how to measure outcome.
• Overview of treatment resources: Treatment approaches for the affected individual and treatment resources.
• How the family can help: Enabling behaviors for the family to avoid, and behaviors that are helpful in supporting the addicted family member’s recovery.
• Family recovery issues: How a family member can heal from the adverse effects of addiction and involvement in a close relationship with an addicted family member.
• Self-help programs: Programs available for addicted clients and family members, how they can help, and how to gain access to them.
• Relapse: Common warning signs of relapse, the importance of relapse prevention planning, how the family can be involved, and how to deal with an actual lapse or relapse of an addicted family member.

Families benefit from written information on any of the topics listed above. Families can continue to read and learn about addiction and recovery if written materials are provided or recommended. In addition, educational videos provide an excellent mechanism to gain information and insight, and they often facilitate excellent discussions among families.

In Appendices E and F, some books, pamphlets, and educational videos are listed that can be used in family psychoeducational programs or recommended to clients or families.

References