Medical Family Therapy in Alcohol and Drug Treatment
The prevalence rates of licit and illicit substances in the United States of America (USA) suggest that medical family therapists (MedFTs) and other behavioral health providers will undoubtedly encounter individuals or families struggling with substance use. In any given year, around half of Americans use alcohol, a quarter are binge alcohol users (i.e., five or more drinks on a single occasion), and about 6.5% are heavy alcohol users (i.e., those who binge 5 or more days in a 30-day period) (Substance Abuse and Mental Health Services Administration 2014). For illicit drugs, around 9.4% of Americans are current users, the majority of which are using marijuana (SAMHSA, 2014). A MedFT involved in an integrated behavioral healthcare (IBHC) team to treat alcohol, and drug issues will need to be aware of the complex physiological and social effects that substances can have, as well as the interplay of these factors on the disorder. In some cases, patients may see the use as benign and underreport it, and it may have unexpected effects on the patient or family system that are not immediately recognizable. Other patients may present for treatment for a different problem while at the same time having an undiagnosed or untreated substance use problem. MedFTs are crucial members of treatment teams who can attend to these intricacies.
Glossary of Important Terms in Alcohol and Drug Treatment
The physical and/or psychological dependence on one or more psychoactive drug.
The practice of using drug action in the body to address/treat behavioral health issues; or, the field of medicine that addresses the use of medications to help treat or correct mental health illness and drug addiction.
The repeated use of licit or illicit substances can lead to a physiological reliance on the substance, which may include tolerance and withdrawal symptoms.
The use of several drugs either in succession or at the same time to achieve a certain effect.
Any substance that directly alters normal functioning of the central nervous system (CNS) when it is taken by means of injection, ingestion, inhalation, snorting, or absorbed by blood.
A state of consciousness caused by substance use that will reinforce the dependence on substance use.
Drugs used to treat behavioral health illnesses, including, but not limited to, antidepressants, antipsychotics, and anxiolytics.
The harmful or dangerous use of psychoactive substances, including alcohol and other licit or illicit chemical substances (e.g., prescription medication, marijuana, cocaine), that creates significant distress in the individual’s life.
The need for an increased amount of alcohol or drugs of abuse to experience an effect from use (this occurs after repeated use)—or the body’s ability to consume greater amounts of a substance with the same physiological or psychological impact.
The abnormal physical or psychological response to the discontinuation of use of a licit or illicit substance that has the capability to produce physical dependence. Common withdrawal symptoms may include sweating, fever , vomiting, anxiety, insomnia, and muscle pain—or the body’s attempt to reach homeostasis after a history of psychoactive drug use/abuse. Symptoms experienced by the individual will depend on several factors related to substance of abuse, frequency, and severity of use.
- Akhavain, P., Amaral, D., Murphy, M., & Cardon Uehlinger, K. (1999). Collaborative practice: A nursing perspective of the psychiatric interdisciplinary treatment team. Holistic Nursing Practice, 13, 1–11. https://www.ncbi.nlm.nih.gov/pubmed/10196897
- Al-Anon Family Groups. (2011–2017). Al-Anon family groups: Strength and hope for friends and families of problem drinkers. Retrieved from http://www.al-anon.alateen.org/
- Alcoholics Anonymous. (2017). What is A.A.? New York, NY: Alcoholics Anonymous World Services. Retrieved from http://www.aa.org/pages/en_US/what-is-aa
- Alcoholics Anonymous. (2014). A brief history of the Big Book. New York, NY: Alcoholics Anonymous World Services.Google Scholar
- *Alexander, B. K. (1987). The disease and adaptive models of addiction: A framework evaluation. Journal of Drug Issues, 17, 47–66. https://doi.org/10.1177/002204268701700104.
- *American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.Google Scholar
- American Society of Addiction Medicine. (2011). The definition of addiction. Retrieved from http://www.asam.org/docs/default-source/public-policy-statements/1definition_of_addiction_long_4-11.pdf?sfvrsn=4
- Barrowclough, C., Haddock, G., Beardmore, R., Conrod, P., Craig, T., Davies, L., … Wykes, T. (2009). Evaluating integrated MI and CBT for people with psychosis and substance misuse: Recruitment, retention and sample characteristics of the MIDAS trial. Addictive Behaviors, 34, 859–866. https://doi.org/10.1016/j.addbeh.2009.03.007 CrossRefPubMedGoogle Scholar
- Barnes, G., & Farrell, M. (1992). Parental support and control as predictors of adolescent drinking, delinquency, and related problem behaviors. Journal of Marriage and Family, 54, 763–776. http://www.jstor.org/stable/353159
- Beck, A. (1979). Cognitive therapy and emotional disorders. Madison, CT: Penguin Group.Google Scholar
- Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused approach. New York, NY: W. W. Norton.Google Scholar
- Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33, 221–228. https://doi.org/10.1016/j.jsat.2007.06.001
- Callon, C., Wood, E., Marsh, D., Li, K., Montaner, J., & Kerr, T. (2006). Barriers and facilitators to methadone maintenance therapy use among illicit opiate injection drug users in Vancouver. Journal of Opioid Management, 2, 35–41. Retrieved from https://www.researchgate.net/profile/David_Marsh3/publication/6487367_Barriers_and_facilitators_to_methadone_maintenance_therapy_use_among_illicit_opiate_injection_drug_users_in_Vancouver/links/56786f9008aebcdda0ebd8bf.pdf
- Castro, F., & Alarcón, E. (2002). Integrating cultural variables into drug abuse prevention and treatment with racial/ethnic minorities. Journal of Drug Issues, 32, 783–810. https://doi.org/10.1177/002204260203200304
- Center for Substance Abuse Treatment. (1999). Brief cognitive-behavioral therapy. In Brief interventions and brief therapies for substance abuse (pp. 51–77). Rockville, MD: Substance Abuse and Mental Health Services Administration. Google Scholar
- Dakof, G., Cohern, J., Henderson, C., Duarte, E., Boustani, M., Blackburn, A., Venzer, E., & Hawes, S. (2010). A randomized pilot study of the Engaging Moms Program for family drug court. Journal of Substance Abuse Treatment, 38, 263–274. https://doi.org/10.1016/j.jsat.2010.01.002
- de Shazer, S., & Isebaert, L. (2003). The Bruges model: A solution-focused approach to problem drinking. Journal of Family Psychotherapy, 14, 43–52. https://doi.org/10.1300/J085v14n04_04
- Drake, R., Mueserk K., Brunette, M., McHugo, G., (2004). A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27, 360–374. http://dx.doi.org/10.2975/27.2004.360.374
- Drummond, C., Kouimtsidis, C., Reynolds, M., Russell, I., Godfrey, C., McCusker, M., … Porter, S. (2005). The effectiveness and cost effectiveness of cognitive behaviour therapy for opiate misusers in methadone maintenance treatment: A multicentre, randomised, controlled trial. Drugs: Education, Prevention & Policy, 12, 69–76. Retrieved from https://kar.kent.ac.uk/id/eprint/16974 Google Scholar
- Enoch, M. (2013). Genetic influences on the development of alcoholism. Current Psychiatry Reports, 15, 412–421. https://doi.org/10.1007/s11920-013-0412-1
- Finkelstein, N. (1994). Treatment issues for alcohol- and drug- dependent pregnant and parenting women. Health & Social Work, 19, 7–15. https://doi.org/10.1093/hsw/19.1.7
- *Fischer, M. S., Baucom, D. H., & Cohen, M. J. (2016). Cognitive-behavioral couple therapies: Review of the evidence for the treatment of relationship distress, psychopathology, and chronic health conditions. Family Process, 55, 423–442. https://doi.org/10.1111/famp.12227.
- Glasner-Edwards, S., Tate, S. R., McQuaid, J. R., Cummins, K., Granholm, E., & Brown, S. A. (2007). Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression. Journal of Studies on Alcohol and Drugs, 68, 663–672. 10.15288/jsad.2007.68.663 CrossRefPubMedGoogle Scholar
- Goldstein, R., & Volkow, N. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12, 652–669. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462342/
- Hettema, J., Miller, W., & Steele, J. (2004). A meta-analysis of motivational interviewing techniques in the treatment of alcohol use disorders. Alcoholism-Clinical and Experimental Research, 28, 74A–74A (supplement).Google Scholar
- Hodgson, J., Lamson, A., Mendenhall, T., & Tyndall, L. (2014). Introduction to medical family therapy: Advanced applications. In J. Hodgson, A. Lamson, T. Mendenhall, and D. Crane (Eds.), Medical family therapy: Advanced applications (pp. 1–9). New York, NY: Springer.Google Scholar
- Ilgen, M., Wilbourne, P., Moos, B., & Moos, R. (2008). Problem-free drinking over 16 years among individuals with alcohol use disorders. Drug and Alcohol Dependence, 92, 116–122. https://doi.org/10.1016/j.drugalcdep.2007.07.006
- *Inaba, D. S., & Cohen, W. E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (8th ed.). Medford, OR: CNS Publications.Google Scholar
- *Juhnke, G. A., & Hagedorn, W. B. (2013). Counseling addicted families: An integrated assessment and treatment model. New York, NY: Routledge.Google Scholar
- Kerr, D., Capaldi, D., Pears, K., & Owen, L. (2012). Intergenerational influences on early alcohol use: Independence from the problem behavior pathway. Development and Psychopathology, 24, 889–906. https://doi.org/10.1017/S0954579412000430
- Landry, M. J. (1996). Overview of addiction treatment effectiveness. HHSPub. No. (SMA) 96–3081. Rockville, MD: Diane Publishing.Google Scholar
- Li, D., Zhao, H., & Gelernter, J. (2011). Strong association of the alcohol dehydrogenase 1B gene (ADH1B) with alcohol dependence and alcohol-induced medical diseases. Biological Psychiatry, 70, 504–512. https://doi.org/10.1016/j.biopsych.2011.02.024
- Liddle, H. A. (2002). Multidimensional family therapy for adolescent cannabis users, cannabis youth treatment (CYT) series (Vol. 5). Rockville, MD: Center for Substance Abuse Treatment (CSAT). Retrieved from http://files.eric.ed.gov/fulltext/ED478685.pdfhttp://files.eric.ed.gov/fulltext/ED478685.pdf
- Liddle, H., & Dakof, G. (1995). Efficacy of family therapy for drug abuse: Promising but not definitive. Journal of Marital and Family Therapy, 21, 511–544. https://doi.org/10.1111/j.1752-0606.1995.tb00177.x CrossRefGoogle Scholar
- Liddle, H., Dakof, G. A., Henderson, C. E., & Rowe, C. L. (2011). Implementation outcomes of mutli-dimensional family therapy-detention to community (DTC): A reintegration program for drug-using juvenile detainees. International Journal of Offender Therapy and Comparative Criminology, 55, 587–604. https://doi.org/10.1177/0306624X10366960 CrossRefPubMedGoogle Scholar
- *Lieber, C. S. (2012). Medical and nutritional complications of alcoholism: Mechanisms and management. New York, NY: Springer.Google Scholar
- Lieber, C. S. (2003). Relationships between nutrition, alcohol use, and liver disease. Alcohol Research & Health, 27(3), 220–231. Retrieved from https://pubs.niaaa.nih.gov/publications/arh27-3/220-231.htm?ref=vidupdatez.com/image Google Scholar
- Marijuana and the Law. (2016). Marijuana and the law. Retrieved from http://www.marijuanaandthelaw.com/
- Marlowe, D. (2003). Integrating substance abuse treatment and criminal justice supervision. Addiction Science & Clinical Practice, 2, 4–14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851043/?report=reader
- Mathers, B. M., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S. A., … Mattick, R. P. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. The Lancet, 372, 1733–1745. https://doi.org/10.1016/S0140-6736(08)61311-2 CrossRefGoogle Scholar
- Maude-Griffin, P. M., Hohenstein, J. M., Humfleet, G. L., Reilly, P. M., Tusel, D. J., & Hall, S. M. (1998). Superior efficacy of cognitive behavioral therapy for urban crack cocaine abusers: Main and matching effects. Journal of Consulting and Clinical Psychology, 66, 832–837. https://doi.org/10.1037/0022-006X.66.5.832 CrossRefPubMedGoogle Scholar
- McCance, E. F., Price, L. H., Kosten, T. R., & Jatlow, P. I. (1995). Cocaethylene: Pharmacology, physiology and behavioral effects in humans. Journal of Pharmacology and Experimental Therapeutics, 274, 215–223. Retrieved from http://jpet.aspetjournals.org/content/jpet/274/1/215.full.pdf PubMedGoogle Scholar
- *Mee-Lee, D. (Ed.) (2013). The ASAM criteria: Treatment criteria for addictive, substance-related and co-occurring conditions (3rd ed.). North Bethesda, MD: American Society of Addiction Medicine.Google Scholar
- Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change, vol. 2. New York, NY: Guilford.Google Scholar
- *Miller, W. R. & Clunies, S. (Eds.) (2000). Enhancing motivation for change in substance abuse treatment. Rockville, MD: Diane Publishing.Google Scholar
- Miller, W. R., Westerberg, V. S., & Waldron, H. B. (1995). Evaluating alcohol problems in adults and adolescents. In R. Hester and R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed., pp. 61–88). Boston, MA: Allyn & Bacon.Google Scholar
- Morgenstern, J., Blanchard, K. A., Morgan, T. J., Labouvie, E., & Hayaki, J. (2001). Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: Within treatment and posttreatment findings. Journal of Consulting and Clinical Psychology, 69, 1007–1017. https://doi.org/10.1037/0022-006X.69.6.1007 CrossRefPubMedGoogle Scholar
- Myrick, H., & Anton, R. F. (1998). Treatment of alcohol withdrawal. Alcohol Research and Health, 22, 38–43. Retrieved from http://login.ezproxy.lib.umn.edu/login?url=http://search.proquest.com/docview/222384220?accountid=14586
- *National Association for Addiction Professionals. (2009). The basics of addiction counseling: Desk reference and study guide. Module 1: The pharmacology of psychoactive substance use, abuse and dependence (10th ed.). Alexandria, VA: NAADAC.Google Scholar
- *National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research based guide. Retrieved from http://www.drugabuse.gov/publications/principles-drug-addiction-treatment
- Nolen-Hoeksema, S., & Hilt, L. (2006). Possible contributors to the gender differences in alcohol use and problems. Journal of General Psychology, 133, 357–374. https://doi.org/10.3200/GENP.133.4.357-374
- *O’Farell, T. J., & Fals-Stewart, W. (2006). Behavioral couples therapy for alcoholism and drug abuse. New York, NY: Gilford Press.Google Scholar
- Overeaters Anonymous. (2017). Overeaters anonymous: You are not alone anymore! Rio Rancho, NM: Overeaters Anonymous. Retrieved from https://oa.org/
- Rational Recovery (2017). Rational recovery: How to quit your addiction right now—for life. Rational Recovery Systems, Inc. Retrieved from https://rational.org/index.php?id=94
- *Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38, 59–81. https://doi.org/10.1111/j.1752-0606.2011.00280.x.
- Rowe, C. L., & Liddle, H. A. (2003). Substance abuse. Journal of Marital and Family Therapy, 29, 97–120. https://doi.org/10.1111/j.1752-0606.2002.tb00386.x CrossRefPubMedGoogle Scholar
- SAMHSA’s National Registry of Evidence-based Programs and Practices. (2017). Intervention summary: Twelve step facilitation therapy. Retrieved from http://legacy.nreppadmin.net/ViewIntervention.aspx?id=358
- Secular Organizations for Sobriety. (2016). SOS: Together we can recover. Los Angeles, CA. Retrieved from http://www.sossobriety.org/what-we-do
- Slesnick, N., & Prestopnik, J. L. (2004). Office versus home-based family therapy for runaway, alcohol abusing adolescents: Examination of factors associated with treatment attendance. Alcoholism Treatment Quarterly, 22, 3–19. https://doi.org/10.1300/J020v22n02_02 CrossRefPubMedPubMedCentralGoogle Scholar
- SMART Recovery. (1994–2017). SMART Recovery: Self-management and recovery training. Retrieved from http://www.smartrecovery.org/intro/
- Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings, NSDUH Series H-48, HHS Publication No. (SMA) 14–4863. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Google Scholar
- Szapocznik, J., & Kurtines, W. M. (1989). Breakthroughs in family therapy with drug-abusing and problem youth. New York, NY: Springer.Google Scholar
- Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158, 2027–2032. https://doi.org/10.1176/appi.ajp.158.12.2027
- Wright, L., Watson, W., & Bell, J. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.Google Scholar
- Zucker, R. A., & Gomberg, E. S. (1986). Etiology of alcoholism reconsidered: The case for a biopsychosocial process. American Psychologist, 41, 783–793. http://dx.doi.org/10.1037/0003-066X.41.7.783