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Emphasize to the family the need for positive to the health and safety of the family members, reinforcement of the recovering person advise them to take the help of neighbors or
Caution the family against constantly bringing up even the law. past issues and putting the recovering person
If the person is not motivated for treatment and Family Counseling down for all the problems that he/she had created repeatedly troubles or threatens them, teach the in the past. family members to set limits by not yielding to his/her threats, and to take the help of other in Drug Addiction resources to handle such threats. Stage vi: Coping with Relapse
Encourage the family to keep in touch with the counselor even if the drug user is unprepared to Family members often find it difficult to accept that change. There are critical times such as illness, the process of recovery is uneven. They would like withdrawal, or following threat of job loss, when Introduction to believe that once the dependent person is the individual can be persuaded by the family to admitted into a treatment program, he will remain seek treatment. In the meantime, their contact Families of drug-dependent persons face a number of problems including drug-free for life. A lapse or relapse may come as a with you will provide the family emotional support violence, disruption of family rituals, separation, divorce, inappropriate role models rude shock. They are not prepared to deal with the and the strength to cope. and economic difficulties. Addiction does not burst into the family the way a situation, and feel hurt and betrayed. heart attack would; instead it creeps in slowly and silently, until it is finally detected Indications for referral to family therapy Developing Community Drug Rehabilitation and Workplace Prevention Programme and it is perhaps only then faced by the family. However, by that time it has left Process In certain situations simply counseling the family may (AD/IND/94/808) its mark on each family member.
Emphasize to the family that relapse is very not be adequate, and referral to family therapy may Ministry of Social Justice and Empowerment common during recovery be needed, if there is a specialized family therapy Shastri Bhawan, New Delhi - 110 001 Addiction (drug dependence) is not a condition which once treated can be
Stress the need for continuous and regular facility. Indications for family therapy include: Tel : 3388580 Fax : 3384918 completely cured. A chronic and relapsing condition, it is always likely to topple follow-up
Frequent relapses precipitated by interpersonal United Nations International Drug Control Programme, Regional Office for South Asia the individual back to the same situation of dependence if the individual and
Advise the family to bring the individual to the problems within the family EP 16/17, Chandragupt Marg, Chanakyapuri, New Delhi - 110 021 his/her family do not take adequate precautions. treatment center at the earliest in the event of
Family problems that tend to maintain the Tel : 4104970, 71, 72, 73 Fax : 4104962, 63 E-mail : [email protected] a relapse. dependence of the individual Treating drug dependence therefore involves more than just getting the drug International Labour Organization
Non-compliance of family members with the user to stop using drugs. It also involves counseling the family and thus improving Core 4B, IIIrd Floor, India Habitat Centre, Lodi Road, New Delhi - 110 003 Handling crises and emergency situations counseling process. family relationships and functioning. Tel : 4602101 Fax : 4602111 E-mail : [email protected]
If the drug user gets very violent and is a threat European Commission 65 Golf Links, New Delhi - 110 003 Tel : 4629237, 38 Fax: : 4629206 Email : [email protected] Steps in Family Counseling

National Centre for Drug Abuse Prevention There are different steps in family counseling, which are carried out in the course Ground Floor, West Block 1, Wing 7, Rama Krishna Puram, New Delhi - 110 066 of sessions with the client and his/her family. In an ideal situation, the counselor Tel : 6173257 Fax : 6173257 E-mail : [email protected] should follow the steps in the sequence given here; for instance, it is important Acknowledgements to make a proper assessment of the impact of the client’s drug use on the Principal Author : Ms. Maria Christine Nirmala, NIMHANS family, before counseling the family. In reality, families often come with different Scientific Editor : Dr. Pratima Murthy Coordinated by : UNDCP, Regional Office for South Asia Design : Lopez Design

The opinions expressed in this publication do not necessarily represent the official policy of the United Nations International Drug Control Programme, Family Counseling Ministry of Social Justice and Empowerment, ILO and the European Commission. 5 problems or expectations. The counselor will then about. The counselor is basically supportive, Process Handling peer pressure Coping with stressful situations b. Management of time: Without the drug, the have to be flexible, and select and use the appropriate listening and communicating understanding to Compare drug dependence with any other
Explain to the family that peer pressure is one of Generally, dependent persons tend to use drugs as individual will be left with a lot of time on his/her intervention. Different sessions may address different the relative. physical illness: the most important factors leading to relapse a way of coping with stressful situations. They need hands. If this time is not managed wisely, it can issues and should be structured according to the
Just as any physical illness affects your ability to re-learn adaptive coping strategies to deal with lead to boredom, which may trigger a relapse. Family members often feel that the best needs of family members. to function normally, e.g. your appetite, sleep such situations. Coping strategies are of two types, The family can help by: solution is for the individual to avoid contact Stage ii: Assessment of the Problem and work, drug addiction too affects emotion-focused and problem-focused:
Helping the individual schedule activities with drug users, and therefore prevent the these functions.
Encourage the family to listen supportively to the
Not letting him/her be alone too often person from meeting such friends. This does Stage i: Ventilation Addiction affects a number of areas in life. Before
Drug addiction can be treated like any physical person. Getting emotional support from the family
Engaging the person in some mutually not solve the problem, and may even make intervention, the counselor should have a illness. However its treatment is not ‘one-time’, helps greatly in facing problems. This is emotion- interesting activity. the person defensive and hostile towards the Addiction is often understood as a problem stemming comprehensive understanding of the impact of like treating cholera and malaria. It is rather an focused coping family. Every individual needs friends. from the lack of voluntary control. Family members often addiction on the family. illness that needs life-long precaution and care,
For problem-focused coping, educate the entire c. Role functions: With progressive addiction, the Therefore such avoidance is not feel angry, disappointed and frustrated because they as with diabetes. family about the process of problem solving. drug user often reduces or stops taking always possible. think the person takes the drug deliberately. The spouse Process
The earlier the illness is identified and treated, Using a systematic approach to problem solving responsibility and playing his/her role within the and children of the drug-dependent person are unable The counselor needs to talk to available family the easier it is to control, similar to any other lets people feel that they have control over family. Another family member takes up his/her to discuss the problem with anyone due to the stigma member(s) on the following aspects: chronic illness.
The individual thus needs to be helped to cope problems in their lives. As the problems are put role. Once the drug user recovers, he/she may be attached to such issues, and keep all their emotions
Knowledge about drug dependence Discuss the pattern with which the problem started with peer pressure by teaching him/her skills of in a different perspective and significant family keen to take on that responsibility or role again (for bottled up. Very often, negative emotions towards the
The reactions of family members towards the in the client, right from first-use of drugs, and how drug refusal, without affecting the relationship with members become involved in finding a solution, example, earning for the family, making decisions). drug user are not expressed, and there is a lot of anger, drug user it progressed. drug-using friends. the drug user in recovery feels unburdened and Family members may be hesitant to restore these hostility and resentment towards the person. The family
Changes in the roles played by family members lowers his/her chance of relapse as a roles and responsibilities to the recovering user - member is often on the brink of ‘giving up’.
The effect of addiction on the drug user’s job Handling craving dysfunctional way of coping. because of a lack of trust, doubt, or because
Available social support that the family members Stage iv: Relapse Prevention Explain to the family that craving is one of the main someone else has taken up that role. Defining (or Ventilation helps family members unburden their have in terms of immediate family, friends and problems of continuing addiction, and that the redefining) the role of the recovering drug user in pent-up emotions and feelings. This intervention other tertiary support groups (like the church, A tendency to relapse is typical of the nature of individual is likely to come across many situations Stage v: Substance-free Lifestyle the context of the family is very important in order provides emotional support by listening, being self-help group etc.) drug dependence. While the individual may be that trigger craving. The family can help by: to reintegrate the person within the family. sympathetic and non-judgmental, and
The maintaining factors for drug use in terms of: motivated to give up the drug when first seeking
Encouraging the individual to express craving A person who has been spending most of their acknowledging the family members’ feelings. It allows craving, withdrawal, negative moods, peer treatment, the will-power to stay sober is not to them time getting, using or recovering from the effects
Discuss this issue very carefully and tactfully with rapport to be built up with the family members so pressure, coping with stress, handling pain, family sufficient by itself in the long run. The individual
Not panicking, as craving can be handled in ways of drugs, does not know what to do with himself/ the family that further counseling becomes effective. problems and any others. needs to be equipped with very practical strategies other than using drugs herself, with the time and the extra money available
Encourage both the client and the family to to handle high-risk situations. The family needs to
Understanding that the process of craving is after quitting drugs. This can be troublesome for discuss the issue and try to understand each Process Family members’ perceptions of these issues is useful provide support in these efforts. temporary the recovering user. other’s views Rapport building to understand, as they may be quite different from
Giving him/her something to eat or drink. The  The client needs to be helped to accept the
Introduce yourself the drug user’s own perceptions. Such differences Process craving is often reduced when a person’s hunger Process lack of trust from family members due to a
Ask for general information like the individual’s can be addressed in the intervention.
Educate the client and his/her family members or thirst is quenched a. Management of finances: Drug dependence is number of experiences of broken promises

Family Counseling name, occupation etc., instead of identifying them that drug dependence can be a chronic and
Talking it through when craving occurs associated with many financial losses. During  The family also needs to be counseled on the only as the patient’s relative relapsing condition, and that will-power alone is
Distracting the individual by playing a game, recovery the person is often confronted with need to normalize the activities of the
Assure the individual of confidentiality. Stage iii: Psycho-education not enough for staying sober reading, going to a movie, listening to music or financial difficulties of which he/she was earlier individual and encourage role responsibility
Enquire about the problems that the family Make the family aware that they need to assist going out to visit some relatives, etc. unaware. Encourage the family to work with the  Both need to sit together with the counselor and member has been facing and just allow them Members of the family generally expect the drug- the individual in identifying common relapse individual towards: establish contracts on what each needs to do
to talk. dependent person to have voluntary control over triggers (It is important for you as the counselor to help the Clearing debts (This issue cannot be handled through a one- drug use. They need to be educated about the
Educate both client and family members on how family think of alternatives, rather than directly
Budgeting current expenses time resolution, but is something that will recur The course of the interview is determined by the individual’s problem as an illness that cannot be to handle these triggers. suggesting solutions. This will help the family accept
Investing for the future. and will need to be handled each time.) family member and what he/she would like to talk cured by will-power alone. responsibility for following them through.)

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