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Substance Abuse Treatment and Family Therapy (Revised) Part 2 Contents Substance Abuse Treatment and Family Therapy (Revised) Part 2 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 Other Contextual Factors ..............................................................................................141 iii Chapter 6—Policy and Program Issues .........................................................................147 Overview...................................................................................................................147 Primary Policy Concerns ..............................................................................................147 Program Planning Models .............................................................................................149 Other Program Considerations .......................................................................................160 Directions for Future Research.......................................................................................161 Appendix A: Bibliography ...........................................................................................165 Appendix B: Glossary.................................................................................................191 Appendix C: Guidelines for Assessing Violence................................................................195 Appendix D: Resources ..............................................................................................199 Appendix E: Resource Panel .......................................................................................203 Appendix F: Cultural Competency and Diversity Network Participants................................205 Appendix G: Field Reviewers.......................................................................................207 Appendix H: Acknowledgments....................................................................................209 Index ......................................................................................................................211 CSAT TIPs and Publications........................................................................................231 iv Contents 4 Integrated Models for Treating Family Members Overview In families in which one or more members has a substance abuse problem, In This substance abuse treatment and family therapy can be integrated to pro- Chapter… vide effective solutions to multiple problems. Counselors and therapists from the two disciplines seldom share similar professional training; Integrated consequently, the integrated treatment models described in this chapter Substance Abuse can serve as a guide for conjoint treatment approaches. Treatment and Family Therapy The two disciplines can be integrated to a greater or lesser extent, rang- ing from simple staff awareness of the importance of the family to fully Integrated Models integrated treatment programs. This chapter discusses the advantages for Substance and limitations of integrated treatment models. The extent to which Abuse Treatment counselors are involved with families also can vary, and the extent of this involvement depends on several factors. Matching Therapeutic Care must be taken in the choice of an integrated therapeutic model. Techniques to The theoretic basis of a number of models is given along with the tech- Levels of Recovery niques and strategies that are commonly used. Integrated Substance Abuse Treatment and Family Therapy Most substance abuse treatment agencies serve a variety of clients—men and women, young and old, homeless and affluent individuals, from every racial and ethnic majority and minority group—with a wide range of substance abuse profiles. On any given day, a substance abuse treat- ment counselor may work with a 15-year-old girl caught with marijuana in her school locker, a 45-year-old woman whose drinking spiraled out of control after her husband's death, and a 35-year-old man faced with legal trouble stemming from his chronic use of crack cocaine. Some clients may be new immigrants with language and cultural barriers that affect treatment. Others with co-occurring medical or psychiatric disor- ders may require integrated treatment for the two problems. Some 73 clients may have decided to stop abusing sub- to treatment are the best arguments for inte- stances, while others may wonder “what the big grating substance abuse treatment and family deal is about smoking a little dope.” When fam- therapy. Integrated models of treatment would ilies are included in substance abuse treatment, also avoid duplication of services, discourage the needs, problems, and motivations are an artificial split between therapy for family exponentially increased. problems and substance abuse treatment, and effectively and efficiently provide services to The array of client needs, multiple family influ- clients and their families. ences, and differences in counselors’ training and priorities, along with the difficult nature of Combining substance abuse treatment and most substance abuse problems, suggest that family therapy requires an integrated model. the family therapy and substance abuse treat- This term, for the purposes of this TIP, refers ment fields
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