TIP 39 Substance Abuse Treatment And Family Therapy

260 Pages·2012·2.56 MB·English

Substance Abuse Treatment
And Family Therapy
A Treatment
Improvement
Protocol
TIP
39
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
1  Choke  Cherry  Road
Rockville,  MD  20857
Acknowledgments Electronic Access and Printed
Copies
This publication was produced under the
Knowledge Application Program (KAP)
This publication may be ordered from or
Contract, number 270-99-7072 with the
downloaded from SAMHSA’s Publications
Substance Abuse and Mental Health Services
Ordering Web page at
Administration (SAMHSA), U.S. Department
http://store.samhsa.gov. Or, please call
of Health and Human Services (HHS). Karl
SAMHSA at 1-877-SAMHSA-7 (1-877-726-
D. White, Ed.D., and Andrea Kopstein,
4727) (English and Español).
Ph.D., M.P.H., served as the Center for
Substance Abuse Treatment (CSAT)
Government Project Officers. Christina Recommended Citation
Currier served as the CSAT TIPs Task
Center for Substance Abuse Treatment.
Leader.
Substance Abuse Treatment and Family
Therapy. Treatment Improvement Protocol
Disclaimer (TIP) Series, No. 39. HHS Publication No.
(SMA) 15-4219. Rockville, MD: Substance
The opinions expressed herein are the views
Abuse and Mental Health Services
of the consensus panel members and do not
Administration, 2004.
necessarily reflect the official position of
SAMHSA or HHS. No official support of or
endorsement by SAMHSA or HHS for these Originating Office
opinions or for the instruments or resources
Quality Improvement and Workforce
described are intended or should be inferred.
Development Branch, Division of Services
The guidelines presented should not be con-
Improvement, Center for Substance Abuse
sidered substitutes for individualized client
Treatment, Substance Abuse and Mental
care and treatment decisions.
Health Services Administration, 1 Choke
Cherry Road, Rockville, MD 20857.
Public Domain Notice
All materials appearing in this volume except
HHS Publication No. (SMA) 15-4219
those taken directly from copyrighted sources
Printed 2004
are in the public domain and may be repro-
Revised 2005, 2006, 2008, 2009, 2010, 2012,
duced or copied without permission from
2014, and 2015
SAMHSA or the authors. Citation of the
source is appreciated. However, this publica-
tion may not be reproduced or distributed for
a fee without the specific, written authorization
of the Office of Communications, SAMHSA,
HHS.
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 Co­Occurring 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
Figures 
3­1 Overview of Key Elements for Inclusion in Assessment ......................................................39

3­2 Basic Symbols Used in Genograms ...............................................................................42

3­3 Eugene O’Neill Genogram ..........................................................................................43

3­4 Individual, Family, and Environmental Systems ..............................................................56

4­1 Facets of Program Integration.....................................................................................74

4­2 Levels of Counselor Involvement With Families ...............................................................80

4­3 Techniques To Help Families Attain Sobriety ................................................................103

4­4 Techniques To Help Families Adjust to Sobriety.............................................................104

4­5 Techniques To Help Families in Long­Term Maintenance .................................................106

Contents v

What Is a TIP?
Treatment Improvement Protocols (TIPs) are developed by the
Substance Abuse and Mental Health Services Administration (SAMHSA)
within the U.S. Department of Health and Human Services (HHS). Each
TIP involves the development of topic-specific best-practice guidelines
for the prevention and treatment of substance use and mental disorders.
TIPs draw on the experience and knowledge of clinical, research, and
administrative experts of various forms of treatment and prevention.
TIPs are distributed to facilities and individuals across the country.
Published TIPs can be accessed via the Internet at
http://store.samhsa.gov.
Although each consensus-based TIP strives to include an evidence base
for the practices it recommends, SAMHSA recognizes that behavioral
health is continually evolving, and research frequently lags behind the
innovations pioneered in the field. A major goal of each TIP is to convey
"front-line" information quickly but responsibly. If research supports a
particular approach, citations are provided. When no citation is provid-
ed, the information is based on the collective clinical knowledge and
experience of the consensus panel.
vii
viii
Consensus  Panel

Note:  The  information  given  indicates  each  participant's  affiliation  during  the  time  the  panel
was  convened  and  may  no  longer  reflect  the  individual's  current  affiliation.
Chair Daniel  Santisteban,  Ph.D. 
Research  Associate  Professor 
Edward  Kaufman,  M.D. 
University  of  Miami 
Editor  in  Chief 
School  of  Medicine 
American  Journal  of  Drug  and  Alcohol  Abuse 
Miami,  Florida
Dana  Point,  California
Carol  Shapiro,  M.S.W. 
Executive  Director 
Co­Chair
Family  Justice  Center 
Marianne  R.  M.  Yoshioka,  M.S.W.,  Ph.D.  New  York,  New  York
Associate  Professor 
Columbia  University
Panelists 
School  of  Social  Work 
New  York,  New  York Fred  U.  Andes,  D.S.W.,  M.S.W.,  M.P.A., 
LCSW 
Assistant  Professor  of  Sociology 
Workgroup  Leaders
New  Jersey  City  University 
Mary  M.  Gillespie,  Psy.D.,  CASAC  Jersey  City,  New  Jersey
Professor 
Hudson  Valley  Community  College  Paul  Curtin,  M.A.,  CAC,  NCAC  II 
Saratoga  Springs,  New  York President 
Alcohol  Services,  Inc. 
Gloria  Grijalva­Gonzales  Syracuse,  New  York
Certified  Sr.  Substance  Abuse  Case 
Manager/Counselor  Jo­Ann  Krestan,  M.A.,  MFT,  LADC 
San  Joaquin  County  –  Office  of  Substance  Family  Therapist/Writer 
Abuse Private  Practice 
Allies  Project  Surry,  Maine
Stockton,  California
Eric  E.  McCollum,  Ph.D.,  LCSW,  LMFT 
I. Andrew Hamid, Ph.D., M.S.W., MFT, CSW  Professor  and  Clinical  Director 
Professor  Virginia  Tech  Falls  Church 
Columbia  University  Marriage  and  Family  Therapy  Program 
School  of  Social  Work  Falls  Church,  Virginia
New  York,  New  York
Margaret  McMahon,  M.T.S.,  M.S.,  M.S.W.
David  Rosenthal,  Ph.D.  Clinician
Executive  Director Licensed  Certified  Social  Worker 
Lower  East  Side  Harm  Reduction  Center Private  Practice 
New  York,  New  York Washington,  DC
ix