Drug Rehab Guide

A Unique Experience

Family Therapy in Drug Rehab

Basic treatment models include:

Family-based therapy
Brief motivational therapy
Cognitive behavioral therapy (CBT)
Parent training

Family-based therapy and ecological family therapy have been the most frequently tested and show the most positive results, followed by brief motivational interventions. Family-based therapy attempts to “restructure problematic family interaction patterns associated with substance use, while behavioral approaches applied principles of operant and social learning within the family context to promote pro-social behaviors and reduce substance abuse” (Becker, et al. 2008). Most programs, 78 percent, include group sessions as a significant characteristic of treatment.

The family-based therapy approach is defined as any modality involving parents as essential participants in treatment. The most used family-based treatment approaches are:

(1) Brief strategic family therapy
(2) Family behavior therapy (FBT)
(3) Functional family therapy
(4) Multidimensional family therapy (MDFT)
(5) Multisystemic therapy (MST)

Of these, MDFT demonstrates, both clinically and statistically, significant favorable outcomes at drug rehab treatment termination and 1-year follow-up.

The Functional Family Therapy Model (FFT) is an integrative ecological model that combines a family system view of family functioning with behavioral techniques and a multisystemic emphasis. Early FFT sessions focus on enhancing treatment engagement and increasing the family’s motivation for change, using techniques such as relabeling and emphasizing family member interrelatedness (Waldron et al. 2008). At follow up, more than 50 percent showed reductions in substance use with improvements in areas of functioning.

Multidimensional family therapy (MDFT) is a therapy of multiple subsystems, a comprehensive, multisystemic assessment where each area of the addict’s life is assessed (Liddle et al. 2001). It is also an outpatient, family-based treatment for substance abuse. It was influenced by the strong traditions of family therapy models in the substance abuse field (Liddle, et al. 2001). It targets the psychosocial functioning of individual family members, the family members’ relationships, and influential social systems outside the family (Liddle 2003). MDFT focuses on developmental aspects of the self, as well as the family and, indirectly, the peer context (Liddle et al. 2001). MDFT interventions are based on research-derived knowledge about addict and family development and drug abuse and problem behavior formation (Liddle et al. 2001). In drug rehabs, this treatment addresses the individual characteristics of the addict (e.g., cognitive mediators such as perceptions of the harmfulness of drugs; emotion regulation processes [drug use as coping or as a manifestation of distress]), the parent(s) (e.g., parenting practices, parental stress), and other relevant family members (e.g., presence of drug using adults); as well as the interaction patterns (e.g., emotional disconnection) that link to the development and continuation of drug use and related problem behaviors (Liddle et al. 2001). Family sessions were used throughout but were sometimes proceeded by individual sessions with the parent and/or addict (Liddle et al. 2001). The approach builds social competence, pro-social behaviors, anti-drug use attitudes and behaviors, a non-deviant peer network, and more developmentally facilitative family relationships. This treatment has shown the highest level of evidentiary support, both clinically and statistically significant outcomes at treatment conclusion as well as follow-up. Also, MDFT treatment showed significant improvement in family functioning. This treatment targeted parenting practices, and that these changes in parenting were correlated with reductions in the addict’s drug abuse and problem behaviors (Liddle et al. 2001). It is MDFT, with its multiple targets of the addict’s and parent’s individual functioning, and individualized attention to parenting practices, family relationships, and the adolescent’s extra familial environment that showed the overall best results (Liddle et al. 2001).

Multisystemic therapy (MST) views individuals as “nestled within a complex of interconnected systems that encompass individual, family, and extra familial (peer, school, neighborhood) factors. The treatment focus is on changing dysfunction processes that occur in these other systems (Waldron et al. 2008). MST is widely recognized as an effective treatment for conduct disorder and has been widely disseminated (Waldron et al. 2008). However, MST alone did not improve substance use outcomes (Waldron et al. 2008).

Another family therapy method is Multifamily Educational Intervention (MEI). This treatment blends features of psycho educational with multifamily treatment (Liddle et al. 2001). MEI consists of three of four groups of families, which are guided by theoretical principles from family systems, social support theory, and psycho educational approaches to family interventions. The intervention format consists of focused and structured, content-specific group discussions, didactic presentations that included handouts, skill-building exercises, individual family problem solving within a group meeting of several families, and homework assignments. Intervention content consists of learning alternative forms of stress reduction, family and individual risk and protective factors, improving family organization rules and limit setting, and improving family communication and problem solving abilities (Liddle et al. 2001). In this particular study, the Beavers Interactional Competence Scales showed that MEI had significantly higher family competence than addicts assigned to MDFT. However, at termination, MEI only reported 32 percent in significant reduction in drug use while MDFT reported 42 percent (Liddle et al 2001). From intake to follow-up periods, it was shown that MEI families deteriorated on the family functioning scales while MDFT parents and addicts became more functional and developmentally facilitative (Liddle et al. 2001).

Cognitive behavioral therapy (CBT) models explicitly aim to modify cognitive processes, beliefs, and individual behaviors or environmental reinforces associated with the addict’s substance use (Becker & Curry 2008). CBT is a frequently used therapeutic approach, but it is commonly integrated into others, especially family systems therapy and motivational enhancement/brief interventions (BIs) (Winters et al. 2008). CBT and family interventions both include individual and conjoint family sessions, but the cognitive-behavioral condition emphasizes self-monitoring, communication and problem-solving skills training, contingency contracting, and substance-refusal skills (Waldron et al. 2007). Overall findings indicated that both CBT and MDFT significantly reduced substance use and externalizing and internalizing symptoms at post treatment and follow-up. However, compared with CBT, youth in MDFT evidenced sustained treatment effects up to 1 year after termination from drug rehab, showing significantly greater reduction in psychological involvement with drugs and frequency of drug use other than cannabis. Also, compared with CBT, those receiving MDFT were significantly more likely to be abstinent at 1-year follow-up (Hogue et al. 2006). Diamond and Josephson found that those receiving FFT combined with CBT or FFT alone had fewer days of drug use at 4- and 7-month follow-ups than did others in CBT alone and group therapy.

Parent training aims to teach parents the skills needed to promote effective coping, problem solving, communication, and/or parental monitoring (Becker & Curry 2008). This therapy technique can change parent-addict relationship through enactment; a sequence of individual and joint parent and patient session used for form a shuttle diplomacy gives an in vivo picture of existing family relationships and a technique to shape new kinds of family interactions (Liddle 2003). Waldron et al. found that both the FFT and parent training groups showed significant reductions in substance use of more than 50 percent at follow-up, with improvements in other areas of functioning as well (Waldron et al. 2007).