Chapter 10 alcohol

Important for the client to be given credit for the therapeutic WORK being done

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Therapist should:

Acknowledge the feelings of the individual Resist talking the individual out of those feelings

Activity groups

Activity or project is undertaken Helps clients to identify areas of strength and weakness in interpersonal relationships

Self-Help for Families: Al-Anon

Advocates that the only person anyone can change or control is oneself

Self-Help for Families:Alateen

Alateen - Focuses on teenagers with an alcohol-dependent parent

Behavioral couples therapy

Assumes that the couple's interactions reinforce drinking Focuses on building alternative behaviors that support abstinence

Family Involvement in Alcohol Treatment: Couples and Family Therapies

Behavioral couples therapy Community Reinforcement and Family Training (CRAFT) Multidimensional family therapy Family support network

Community Reinforcement and Family Training (CRAFT)

Brief therapy for the family member who lives with a treatment-resistant partner Provides actions that can be taken against domestic violence

Therapeutic Relationship

Client-clinician relationship is not based on liking one another

Motivational enhancement therapy

Combines assessment and feedback Draws upon the principles of motivational interviewing

Problem-solving groups

Develop an awareness of potential stressful situations, identify the old, habitual response patterns, recognize how these patterns have created problems, and then to try new behaviors

Multidimensional family therapy

Directed at substance-abusing adolescents Aimed at providing coping and problem-solving skills

Community Reinforcement and Family Training (CRAFT)..

Emphasizes actions that can be taken to defuse escalating arguments or conflicts

Group work

Explore new behaviors Instill hope in one another

Family Involvement in Alcohol Treatment

Guidelines Concentrate on the interaction and not the content Teach family members how to check things out communication is huge Discourage the tendency to lay blame on someone else (which alcoholics OFTEN do!)

Individual Counseling: Education

Helps a client handle feelings of guilt and low self-esteem Successful recovery is related to a client's understanding of an alcohol use disorder as a medical condition

Relapse prevention:Common elements

Identifying high-risk relapse situations and developing strategies to deal with them --Seeing relapse as a process, not as an event Dealing with drug and alcohol cues and cravings Facing social pressures Creating and nurturing a supportive social network

Boomerang effect

In the process of being kind to and understanding of others, the members are in turn forced to accord themselves similar treatment

Family Interventions

Introduced by the Johnson Institute (an advocacy group) in Minneapolis Successful treatment can occur in a number of situations in which the initial entry into treatment might be coercive - hitting "rock bottom" not necessary Best treatment outcomes are those in which the stakes are quite clear

Family Issues: Recovering families must:

Learn to communicate in direct ways and to trust one another

Case manager

Liaison and advocate with external groups or the courts - pretty important to keep balance and good communication between rehab and legal mandates

Johnson-Style Intervention

Meeting of family, other concerned persons, and the affected individual under the direction of a trained clinician - INTERVENTION!!! Family members: Present incidents related to drinking that has caused concern, in an objective, straightforward manner

A Relational Intervention Sequence for Engagement (ARISE)

Modification of the Johnson-style intervention Uses a stepped approach and begins with the least demanding option Therapist acts as a consultant and coach to the concerned family members FIRST, who then meets the alcohol-drug-involved member

Administrative tasks

NEED to run the rehab

Psychoeducational groups

Organized around a lecture, film, or presentation by a specialist in the substance abuse field, followed by a group discussion

Family support network

Outpatient treatment program for substance-abusing adolescents

Support groups

Promote self-awareness, support abstinence, and help identify the ways in which people sabotage themselves

Individual Counseling: Observation

Provides data for making hypotheses Therapist should guide the conversation to cover everything transpiring in the individual's life

Types of Groups

Psychoeducational groups Support groups Problem-solving groups Activity groups

Family Issues: children

Reassured as they might assume they are the cause of the problem

Self-disclosure

Sharing the facts of one's life and speaking of one's feelings and values

Individual Counseling: Feedback

Therapist provides accurate and specific descriptions of the client's behavior Therapist's willingness and ability to simply describe what is observed is a potent therapeutic tool Allows clients to see how their drinking compares to that of others

Avoiding possible mis-steps

Therapist should not take on tasks that clients can do for themselves Counselors avoid anything that might cause the individual discomfort

Family Issues: Problems prompted by entering treatment

Unrealistic expectations for treatment Family members feel guilt and remorse after listening to the affected person's views