Many individuals who engage in substance abuse and develop formal substance use disorders operate under the impression that their behavior affects only them; however, someone who has a substance use disorder does not have a circumscribed condition that affects them alone.
The individual’s behavior affects many others, most importantly members of their family and close friends.
The person with a substance use disorder actually resembles an individual with a communicable disease who brings certain aspects of their disorder into the home, affecting the way members of the family behave and function. Even if other family members do not use drugs or alcohol or have no other compulsive behaviors, they are still impacted by the actions of the individual with the substance use disorder.
For instance, family members may inadvertently attempt to punish or sanction the member with the substance use disorder when they believe the person has used alcohol and drugs, whereas they may inadvertently reinforce the person when they are sober. In some cases, family members may actually reinforce the dysfunctional substance abuse of the affected sub-unit. In family therapy, the members of the family are often referred to as sub-units, and the family consists of the entire unit.
Members of the family may perform these behaviors overtly or may not be aware of them. They may believe that they are actually helping the person, but the reality of the situation is not quite that simple. Family members may be constantly on alert for deception and engage in confrontational behaviors with the affected member; the affected member may feel punished and that they are singled out unfairly; and other family members draw the family’s attention to the person’s substance abuse to avoid other family conflicts.
The systemic model of family therapy recognizes that treatment for substance use disorders often involves the individual with the disorder getting specific individual treatment and the family getting treatment to learn to communicate in a healthier and more functional manner.
A substance use disorder intervention is an action by a group of concerned family members, friends, coworkers, etc., of an individual who has a suspected substance use disorder. The goal is to persuade the person to get treatment for their problem. The group will typically follow some formal plan of action that organizes the process and results in it being more efficient and more likely to reach its goal. In a basic intervention, the following occurs:
How the Systemic Family Model Works in an Intervention
- The intervention group holds its initial meetings to plan the intervention without the participation of the individual with the substance use disorder. The meetings are “secret.”
- Following the planning stage, the intervention is performed.
- During the intervention, the individual with the substance use disorder is confronted regarding their behavior, and the group members explain how the person’s behavior affects them.
- The group encourages the individual to get treatment for the substance use disorder.
- If the individual chooses not to enter treatment, the members of the group impose sanctions or consequences, such as cutting ties, withdrawing financial support, withdrawing other forms of support, etc.
- If the person enters treatment and is successful, but relapses later, the group may perform another intervention.
Family Systems Therapy
According to scholarly sources, such as the book Family Systems/Family Therapy: Applications for Clinical Practice, the basic assumptions of Family Systems Therapy propose the following:
- Individuals with any type of mental health disorder, including a substance use disorder, can be more effectively treated if the treatment also takes the person’s relationship with their family members into consideration.
- The structure of the person’s family is an important component to consider when treating an individual who is in recovery or who needs to get treatment. Not taking the family into account results in an incomplete approach to treating the individual.
- Individuals cannot be understood when they are isolated from one another, but instead, they are best understood as part of their family unit.
- In Family Systems Therapy, both the family unit and the individual are treated together.
- Family members may also seek individual treatment for specific issues.
- The person with a substance use disorder is also expected to attend formal substance use disorder treatment and participate in family therapy.
Systemic Family Intervention
In the systemic family model of intervention, the following takes place:
- The intervention group consists of family members only and a professional.
- The family hires a professional intervention specialist or a mental health worker with experience in the treatment of substance use disorders and in performing interventions.
- The intervention specialist organizes a series of meetings and calls the person with a substance use disorder to invite them to the meetings from the beginning. During this initial contact, the interventionist does not confront the person with the substance use disorder but may explain the reason for the meetings.
- Meetings occur involving the interventionist, family members directly involved, and the person with the substance use disorder. They are not secret planning sessions.
- The group discusses the general nature of substance use disorders and how they affect the health of the person with the disorder. The interventionist often discusses the nature of addiction and its effects on family members and others. This is done in a general psychoeducational format without using specific examples from the family.
- The interventionist may discuss various types of treatment for individuals with substance use disorders and often will concentrate on the specific substance use disorder in question. For example, if the target person has an alcohol use disorder, a stimulant use disorder, cannabis use disorder, etc., the interventionist will discuss specific issues associated with that disorder.
- The group may also discuss how the individual’s behavior affects members of the family.
- The interventionist discusses how the communication styles of the family members can be adjusted to allow everyone to communicate and express their feelings and thoughts in a clear, concise manner.
- The intervention specialist may discuss how the family affects the individual’s behavior and may contribute to that person’s substance abuse.
- The person is encouraged to get treatment.
- The interventionist also encourages family members to get treatment and social support, such as by going to support groups like 12-Step meetings (Al-Anon or Alateen).
- The process often consists of five or more meetings.
- In the best outcome, the family unit agrees to participate in therapy to address the situation. This can include individual substance use disorder therapy for the subject of the intervention individual, family therapy for the family, support group involvement for everyone, etc.
- The group begins to exert more gentle pressure for treatment as more meetings are completed.
- Once all of the individuals who need treatment agree to get it, the intervention process is complete. If some members still decline treatment, there may be consequences associated with this.
- Treatment often continues after the intervention process is complete. Therapies and social support group involvement may continue for years depending on the specific issues being addressed.
Family Systems Therapy has a good body of empirical evidence to support its use. However, there is a paucity of research evidence regarding the effectiveness of these types of substance use disorder interventions in getting individuals into treatment and keeping them there.
A similar model of intervention that also includes the subject of the intervention in the planning stages as opposed to holding secret meetings is the ARISE model (A Relational Intervention Sequence for Engagement).
ARISE has some evidence to suggest that it is effective in certain instances.
A major drawback to using a formal substance use disorder intervention is that in many cases individuals plan the intervention but do not follow through with the actual event. Getting the subject involved from the beginning in the planning stages avoids this issue, as they are part of the process from the very beginning.