Rev Jobin JohnRev Jobin John
DirectorDirector
Nairmalya Coumselling & de addiction centre Peyad TVM 573Nairmalya Coumselli...
INTRODUCTION:
Substance abuse often been described as “Family
Disease”
Apparent Genetic Predispositions
Environmental (...
HISTORY OF INVOLVING FAMILIES IN THE
TREATMENT OF ALCOHOL DEPENDENCE
1960 - Professionals began to consider families of
a...
Contd….
1980 – Family as carer
1985 - Family therapist began to acknowledge the
need for development of clinical approac...
Characteristic of Families with
Substance Abuse
High degree of chaos, conflict, unpredictability and
inconsistent message...
Contd…..
Domestic violence
Child abuse or neglect
Sexual abuse
Poor adjustment
Emotional problems
Family therapy views the family as a whole, rather
than the individual as a basic unit of pathology
It focuses on the dy...
Why include family?
Rich resource for the recovery of addicts
Aspects of family functioning and interaction patterns -
a...
Contd….
Interaction and consequent social reinforcement
from within the family environment may often
influence alcohol re...
Contd….
Delay relapse and
Fewer drinking days
Family involvement in treatment is not only
beneficial for the individual...
Whom to involve:
Parents
Spouse
Siblings
Any other significant family
members
Approaches to FT in S Abuse:
Family Disease Model,
Family Systems Theory, and
Behavioural Family Theory
Family Disease Model
 Proposes that both the problem drinker and
his or her family members have a disease
Progressive di...
Family Disease Model
Alcoholics and co-dependents are treated
separately,
Wherein family members receive education
about...
Family Systems Theory
Symptom of the family’s dysfunction
(Stanton et al., 1982).
Presence or absence of alcohol or drug...
Behavioural family theory
Suggest that substance abusers from happy families
with good communication are less likely to r...
Goals of Family Intervention:
To reduce or eliminate abusive
drinking and support the alcoholic’s
effort to change.
Pers...
Goals:
Help the couple to repair the extensive relationship
damage they incurred during many years of conflict
over subst...
Case work for Families (CWF)
Four goals:
(a) Facilitate and maintain abstinence,
(b) Promote work and economic independe...
Interventions:
Customized or tailored to the individual needs of the client
CWF should provide services in eight areas:
...
Training should be integrated into treatment
Empathic treatment approach, gender specific
Should incorporate interventi...
PHASES OF
INTERVENTION
Role of Spouse/family Members
Do not suspect
Develop trust
Do not discuss the individual's previous drinking
problems a...
Contd…
Provide +ve feedback
Provide alternative activities
Deal with interpersonal problems
Improve communication and ...
Contd…
Identify potential risk factors for
relapse: meeting with specific situations,
stressors at home or at work situat...
Ensure periodic follow-up
Ensure proper medication compliance
Supervise medication
Act as “Early Warning system”.
Common warning signs of relapse,
importance of relapse prevention,
how the family can be involved, and
how to deal wit...
Skills required:
Developing therapeutic alliance listening
/empathizing considering each person’s view
Making contacts
...
Advantage of FI
learn about strategies to take care of themselves so
that all the recovery efforts are not simply directe...
lessen the burden
offers the client the opportunity to receive support
from the family.
to verbalize their concerns, qu...
Advantage of FI
Inspiring motivation to change
Preparing clients to enter treatment.
Engaging and retaining clients in ...
Problems & Challenged Faced
LT substance use-neglect of fly roles-shame & guilt
with children-marital therapy not fly the...
Problems & Challenged Faced
Joint fly-more than 1 substance using individual
Severe fly pathology involving marital/dome...
Problems & Challenged Faced
Challenging with consanguineous marriage-elders in
family
Joint family-protect patient and m...
Research study
Studies of Family involvement in treatment alcohol and
drug dependent show that
Increased abstinence,
ha...
Ashok Kumar & Nirmala (2008) in their study
on “social support among abstinence and non-
abstinence alcohol dependents’ f...
Scales for Family Assessment:
 Marital Quality Scale, Shah, 1995 NIMHANS
The Dyadic Adjustment Scale: Spanier (1976)
Th...
Family interventions for substance use diorders
Family interventions for substance use diorders
Family interventions for substance use diorders
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Family interventions for substance use diorders

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Family interventions for substance use diorders

  1. 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
  2. 2. INTRODUCTION: Substance abuse often been described as “Family Disease” Apparent Genetic Predispositions Environmental (Family)context within which an individual is raised
  3. 3. 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)
  4. 4. 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
  5. 5. 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
  6. 6. Contd….. Domestic violence Child abuse or neglect Sexual abuse Poor adjustment Emotional problems
  7. 7. 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.
  8. 8. 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
  9. 9. 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.
  10. 10. 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
  11. 11. Whom to involve: Parents Spouse Siblings Any other significant family members
  12. 12. Approaches to FT in S Abuse: Family Disease Model, Family Systems Theory, and Behavioural Family Theory
  13. 13. 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
  14. 14. 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).
  15. 15. 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
  16. 16. 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.
  17. 17. 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)
  18. 18. 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.
  19. 19. 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
  20. 20. 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). .
  21. 21. 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
  22. 22. PHASES OF INTERVENTION
  23. 23. 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
  24. 24. Contd… Provide +ve feedback Provide alternative activities Deal with interpersonal problems Improve communication and avoid criticism at home Alert friends
  25. 25. 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
  26. 26. Ensure periodic follow-up Ensure proper medication compliance Supervise medication Act as “Early Warning system”.
  27. 27. 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.
  28. 28. Skills required: Developing therapeutic alliance listening /empathizing considering each person’s view Making contacts Balancing interaction Managing emotions Formulation of goals
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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.
  35. 35. 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).
  36. 36. 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
  37. 37. 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

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