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TIP 39: Substance Abuse Treatment and Family Therapy Substance Abuse Treatment And Family Therapy A Treatment Improvement Protocol TIP 39 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment www.samhsa.gov FAMILY THERAPY Substance Abuse Treatment And Family Therapy This TIP, Substance Abuse Treatment and Family Therapy, addresses how substance abuse affects the entire family and how substance abuse treatment providers can use principles from family therapy to change the interactions among family members. The TIP provides basic information about family therapy for substance abuse treatment professionals, and basic information about substance abuse treatment for family therapists. The TIP presents the models, techniques, and principles of family therapy, with special attention to the stages of motivation as well as to treatment and recovery. Discussion also focuses on clinical decision making and training, supervision, cultural considerations, special populations, funding, and research. The TIP further identifies future directions for both reasearch and clinical practice. Collateral Products Based on TIP 39 Quick Guide for Clinicians Quick Guide for Administrators DHHS Publication No. (SMA) 05-4006 Printed 2004 Reprinted 2005 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Substance Abuse Treatment and Family Therapy TIP 39 FAMILY THERAPY Substance Abuse Treatment And Family Therapy Edward Kaufman, M.D. Consensus Panel Chair Marianne R.M. Yoshioka, M.S.W., Ph.D. Consensus Panel Co-Chair A Treatment Improvement Protocol TIP 39 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 Acknowledgments considered substitutes for individualized client care and treatment decisions. Numerous people contributed to the develop- ment of this TIP (see pp. ix, xii, and appen- dices E, F, and G). This publication was pro- Public Domain Notice duced by The CDM Group, Inc. (CDM) under All materials appearing in this volume except the Knowledge Application Program (KAP) those taken directly from copyrighted sources contract, number 270-99-7072 with the are in the public domain and may be repro- Substance Abuse and Mental Health Services duced or copied without permission from Administration (SAMHSA), U.S. Department SAMHSA/CSAT or the authors. Do not repro- of Health and Human Services (DHHS). Karl duce or distribute this publication for a fee D. White, Ed.D., and Andrea Kopstein, without specific, written authorization from Ph.D., M.P.H., served as the Center for SAMHSA’s Office of Communications. Substance Abuse Treatment (CSAT) Government Project Officers. Christina Currier served as the CSAT TIPs Task Leader. Electronic Access and Copies Rose M. Urban, M.S.W., J.D., LCSW, CCAC, CSAC, served as the CDM KAP Executive of Publication Deputy Project Director. Elizabeth Marsh Copies may be obtained free of charge from served as the CDM KAP Deputy Project SAMHSA’s National Clearinghouse for Alcohol Director. Shel Weinberg, Ph.D., served as the and Drug Information (NCADI), (800) 729- CDM KAP Senior Research/Applied 6686 or (301) 468-2600; TDD (for hearing Psychologist. Other CDM KAP personnel impaired), (800) 487-4889, or electronically included Raquel Witkin, M.S., Deputy Project through the following Web site: Manager; Susan Kimner, Managing Editor; www.samhsa.gov/centers/csat/csat.html. Pamela Dronka, former Editor/Writer; Michelle Myers, Editor/Writer; Sonja Easley, Editorial Assistant; and Jason Merritt, KAP Recommended Citation Manager of Collateral Products. In addition, Center for Substance Abuse Treatment. Sandra Clunies, M.S., I.C.A.D.C., served as Substance Abuse Treatment and Family Content Advisor. Special thanks go to Therapy. Treatment Improvement Protocol Rosemary McGinn, J.D., CASAC, for her (TIP) Series, No. 39. DHHS Publication No. contributions to chapter 6, Program and (SMA) 05-4006. Rockville, MD: Substance Policy Issues. Jonathan Max Gilbert, M.A., Abuse and Mental Health Services Helen Oliff, B.S., David Sutton, B.A., Catalina Administration, 2004. Bartlett, M.A., and Randi Henderson, B.A., B.S. served as writers. Originating Office Practice Improvement Branch, Division of Disclaimer Services Improvement, Center for Substance The opinions expressed herein are the views of Abuse Treatment, Substance Abuse and Mental the Consensus Panel members and do not nec- Health Services Administration, essarily reflect the official position of CSAT, 1 Choke Cherry Road, Rockville, MD 20857. SAMHSA, or DHHS. No official support of or endorsement by CSAT, SAMHSA, or DHHS DHHS Publication No. (SMA) 05-4006 for these opinions or for particular instru- Printed 2004 ments, software, or resources described in this Reprinted 2005 document are intended or should be inferred. The guidelines in this document should not be ii Contents Contents What Is a TIP?............................................................................................................vii Consensus Panel ..........................................................................................................ix KAP Expert Panel and Federal Government Participants ....................................................xi Foreword ..................................................................................................................xiii Executive Summary .....................................................................................................xv Chapter 1—Substance Abuse Treatment and Family Therapy................................................1 Overview......................................................................................................................1 Introduction .................................................................................................................1 What Is a Family? ..........................................................................................................2 What Is Family Therapy?.................................................................................................4 Family Therapy in Substance Abuse Treatment .....................................................................8 Goals of This TIP .........................................................................................................18 Chapter 2—Impact of Substance Abuse on Families ..........................................................21 Overview ....................................................................................................................21 Introduction................................................................................................................21 Families With a Member Who Abuses Substances .................................................................23 Other Treatment Issues ..................................................................................................28 Chapter 3—Approaches to Therapy ...............................................................................31 Overview ....................................................................................................................31 Differences in Theory and Practice ...................................................................................31 Family Therapy for Substance Abuse Counselors .................................................................49 Substance Abuse Treatment for Family Therapists................................................................64 Chapter 4—Integrated Models for Treating Family Members ..............................................73 Overview ....................................................................................................................73 Integrated Substance Abuse Treatment and Family Therapy ...................................................73 Integrated Models for Substance Abuse Treatment................................................................85 Matching Therapeutic Techniques to Levels of Recovery.......................................................105 Chapter 5—Specific Populations ..................................................................................109 Overview...................................................................................................................109 Introduction ..............................................................................................................109 Age ..........................................................................................................................110 Women .....................................................................................................................114 Race and Ethnicity ......................................................................................................116 Sexual Orientation.......................................................................................................130 People With Physical or Cognitive Disabilities....................................................................131 People With Co-Occurring Substance Abuse and Mental Disorders .........................................136 Rural Populations .......................................................................................................138 iii Other Contextual Factors ..............................................................................................141
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