Family Treatment Programs Must Have Multiple Goals

In the early 1980s, alcohol and drug abuse treatment facilities began offering programs to family members of clients who were in treatment. The advent of these programs was not only welcomed by family members, but also long overdue. 

As you know, families took a back seat to the addict in many ways. For example, unless the addicted family member received treatment, families were ignored. Also, the addict was always considered the primary concern and family members were the supporting cast at best. Slowly the importance of the family in cases of an addicted family member became more important. For example, it was realized that there were more family members of addicts than there were addicts; that families can play an important role in helping to support sobriety; and that family members deserved to be treated for exposure to addiction with or without the addicted family member going into treatment. It appeared that family involvement was the next step to improve outcomes of addiction treatment for addicts. In fact, by the end of the 1980s almost all residential treatment programs offered family programs. 

Either by design or custom these new family programs appeared to have a singular goal which was to support the sobriety of the addicted family member. This sounded fine, but what about the individual goals of family members and what about collective goals of the family? In most cases the goals have been too limited. 

Families need multiple treatment goals. At a minimum these would include: 

• Emotional and behavioral ways to encourage and support sobriety and recovery in an addicted family member
• Recovery from addiction for individual family members and for the entire family system
• To reduce the  intra- and intergenerational transmission of addiction to current and future family members

The first of these goals included such tasks as how to support sober behavior, learn how to communicate with the substance abuser in a positive manner, and learn necessary techniques to live with addiction. The common theme of these goals was to support the recovering addict. As important as these goals were we can imagine a family member quietly asking, “What about me?” These goals did not focus on recovery for family members.

Family programs began to expand and as their importance became more obvious, so too did the needs of individual family members. Thus the second goals of family treatment began to evolve. This second goal addressed the needs of individual family members as well as the family systems. The family system theories of Murray Bowen, Virginia Satir, Nathan Ackerman, Salvador Minuchin, and many others were utilized to develop recovering families. The advent of managed care resulted in solution-focused therapy for individuals. This second goal affirmed and reaffirmed the right to recovery from addiction for families and their members. An important aspect of this second goal was that the concept of recovery began to expand beyond the addict. Initially, this expansion was horizontal. That is, its focus was on only one generation, which meant the addict and his or her immediate family. However, it was soon recognized that addiction was passed from one generation to another.

The third goal of family treatment should be to reduce the intergenerational transmission of addiction. It is this goal that I seldom see in the design of most family treatment programs. Yes, indirectly recovery for the addicted family member or members of the family might reduce addiction in the next generation, but rarely is it a manifest goal of treatment programs. The closest we came to addressing this goal was the emergence of the children of alcoholics’ movement of the 1980s and 1990s. This movement was not originally focused on the intergenerational transmission of addiction, but rather on the impact that parental addiction had on the lives of children of all ages. In many ways, the children of alcoholics’ movement helped to achieve the second goal of family treatment by facilitating recovery for individual members of the family. 

This individual recovery emphasis, however, again reflected on the current generation or intragenerational transmission. Although the tremendous focus on children of alcoholics from the 1980s and 1990s no longer dominates discussion as it once did. It should not be lost, but rather become a vital part of family treatment programs. Since that time research has discovered and in many cases validated that addiction often passes from one generation to the next. For example, consider some of the following research findings:

• The role of genetics contributes an understanding of the abuse and use of substances (Young, Rhee, Stallings, Corley, & Hewitt, 2006; Comings, Muhleman, Wu, & MacMurray, 2000)
• Children of alcoholics (28.6 percent of all US children) have increased risk for early onset of alcohol use, increased binge drinking, and more rapid progression of problem development (Grant, 2000; Hill & Yuan, 1999; Bröning et al., 2012; Chassin, Currran, Hussong, & Colder, 1996). 
• Children of alcoholics are five times more likely to develop AOD problems, including tobacco dependence, than children without parental alcoholism (Chassin, Rogosch, & Barrera, 1991).
• Children of substance abuse other than alcohol are eight times more likely to develop a drug use disorder than children in families without drug disorders (Ford et al., 2011).
• Between 33 and 40 percent of children of alcoholics develop substance use disorders (Merikangas et al., 1998).

Many of these findings have been known for years, while others have increased our understanding and the risk factors of being raised in an addicted family. Although the role of genetics and neuroscience contributed greatly to the understanding of addiction, one of the most consistent findings about the mechanism of transmission of addiction to the next generation is environmental. The most important environmental factor is the family—especially the role of parenting. For example, children of alcoholics might be at risk due to genetics, but we must realize as well that the majority of children of alcoholics are raised in an alcoholic family. Thus the combination of genetics and environmental factors produce a synergistic affect. 

The importance of reducing intergenerational transmission of addiction cannot be overemphasized as a third goal of any successful family treatment program. 

 

Bröning, S., Kumpfer, K., Kruse, K., Sack, P. M., Schaunig-Busch, I., Ruths, S., . . . Thomasius, R. (2012). Selective prevention programs for children from substance-affected families: a comprehensive systematic review. Substance Abuse Treatment, Prevention, and Policy, 7, 23. 

Chassin, L., Currran, P. J., Hussong, A. M., & Colder, C. R. (1996). The relation of parent alcoholism to adolescent substance use: A longitudinal follow-up study. Journal of Abnormal Psychology, 105(1), 70–80.  

Chassin, L., Rogosch, F., & Barrera, M. (1991). Substance use and symptomatology among adolescent children of alcoholics. Journal of Abnormal Psychology, 100(4), 449–63. 

Comings, D. E., Muhleman, D., Wu, S., & MacMurray, J. (2000). Association of the N-acetyltransferase 1 gene (NAT1) with mild and severe substance abuse. Neuroreport, 11(6), 1227–30.

Ford, E. S., Anda, R. F., Edwards, V. J., Perry, G. S., Zhao, G., Li, C., & Croft, J. B. (2011). Adverse childhood experience and smoking status in five states. Preventive Medicine, 53(3), 188–93. 

Grant, B. F. (2000). Estimates of US children exposed to alcohol abuse and dependence in the family. American Journal of Public Health, 90(1), 112–5.  

Hill, S. Y., & Yuan, H. (1999). Familial density of alcoholism and onset of adolescent drinking. Journal of Studies on Alcohol, 60(1), 7–17. 

Merikangas, K. R., Stolar, M., Stevens, D. E., Goulet, J., Preisig, M. A., Fenton, B. . . . Rounsaville, B. J. (1998). Familial transmission of substance use disorders. JAMA Psychiatry, 55(11), 973–9. 

Young, S. E., Rhee, S. H., Stallings, M. C., Corley, R. P., & Hewitt, J. K. (2006). Genetic and environmental vulnerabilities underlying adolescent substance use and problem use: General or specific? Behavior Genetics, 36(4), 603–15.