IJSP-2010(3-4) - Indian Association For Social Psychiatry

Mukherjee et al
I. Cognitive-behavioural treatment
Cognitive-behavioural treatment of couples: The treatment
model described here follows logically from cognitivebehavioural
theory (McCrady & Epstein, 1995). This model
for conceptualizing drinking problems necessitates
intervention at multiple levels with the individual, the spouse,
the marital relationship, and other social systems in which the
drinker is involved.
Cognitive-behavioural treatment of family members of the
alcoholics: Families of alcoholics often function as well as
nonalcoholic families if the alcoholic is able to achieve stable
abstinence. If the alcoholic continues to drink and is unwilling
to seek treatment, a number of cognitive-behavioural
interventions can be utilized to improve the coping of family
members. These interventions are:
Unilateral Family Therapy: Unilateral Family Therapy (UFT)
(Thomas & Ager, 1993) has been developed to treat families
in which an alcoholic family member is unwilling to reduce or
quit drinking or seek treatment. The main goal of UFT is to use
family members, usually spouses, as a positive rehabilitative
influence to motivate the alcoholic family member to change
drinking behaviour or seek treatment for alcohol problems.
This approach was designed to be most suitable for attracting
the most 'unmotivated, treatment resistant' (Meyers, 1996).
Therapy focuses on three areas of intervention: The coping of
the spouse, the interactions of the couple and the individual
alcoholic or identified patient.
The Community Reinforcement Approach (CRA) (Sisson &
Azrin, 1993): Like UFT, CRA also uses family members,
generally spouses or parents, as a positive rehabilitative
influence. Family members provide information on the
alcoholic's drinking pattern and discuss the problems caused
by the alcoholic's drinking. A plan for getting the alcoholic into
treatment is developed with the family member that can be
implemented quickly at any time. Early evaluations of the
effectiveness of CRA for families are promising and this
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approach appears to be particularly effective in families in
which parents are trying to encourage their children to seek
treatment (Meyers, 1996).
II. Family systems treatment
Systems theory focuses on pattern recognition and explains
individual behaviour within the context of larger systems such
as the marriage, family or community. Different systems theory
models place differential emphasis on three concept areas:
Wholeness, organization and relationships (Steinglass, 1978).
Family systems model began to influence the alcohol field in
the 1970s. Family system theory as applied to alcohol
dependence is richly detailed by Steinglass et al (1987).
Another important concept of alcoholism-oriented family
systems therapy is that of family homeostasis. Steinglass et al
(1987) define homeostasis as a family's need to maintain the
family behaviour and environment within an acceptable range.
In the alcoholic family, change in the alcoholic's drinking
necessitates a change in the family's basic organization and
regulatory system. Interventions are rooted in the
developmental perspective of the family systems approach,
the family life history model (FLH) (Steinglass et al, 1987)
which divides the family life cycle into early, middle, and late
phase developmental stages. Each phase presents particular
systemic tasks and the role of alcohol in the Alcoholic Family
varies depending on life cycle phase. Using reframing
techniques, the therapist explains to the family the functions
that alcohol serves (McKay et al, 1996). As outlined by
Steinglass et al (1987), family systems therapy as applied to
alcoholic families has four general stages. The first stage,
diagnosing alcoholism and labeling it as a family problem, is
conducted by the therapist during an evaluation with the
family. The primary goal of this stage is to determine whether
the family fits the description of an alcoholic family or a family
with an alcoholic member. Removing alcohol from the family
system is described by Steinglass and colleagues (1987) as
the second stage of treatment in which alcoholism has been
labeled a family problem. The third stage treatment is
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