Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

24. Family-Based Treatment 535From the beginning, family therapists work to establish alliances with thesenior sober family members. If the abuser is an adolescent or young adult, thetherapist tries to engage both parents in these alliances whenever possible. Parentsare kept working together and are steered away from discussing their maritaldifficulties, which could divide them and deter them from the primary objectiveof therapy (Stanton & Todd, 1992). This alliance forms the basis for establishingappropriate parental influence in families with substance-abusing adolescents(Alexander & Parsons, 1982; Fishman et al., 1982; Henggeler & Borduin,1990; Landau & Garrett, 1998; Liddle & Hogue, 2001; Piercy & Frankel, 1989;Stanton & Landau-Stanton, 1990; Szapocznik & Kurtines, 1989; Todd &Selekman, 1991).Family therapists’ alliances with sober family members and parents of substanceabusers help them motivate their clients. Family members are the mosteffective motivators known. Even the most evangelistic therapist cannot do aswell. Thus, by forming alliances and encouraging sober family members to stepup the pressure, family therapists help motivate substance abusers to pursue andmaintain sobriety. Similarly, other professional helpers (e.g., school counselors,teachers, police officers, and probation officers) can be enlisted to exert benevolentinfluence. Here, the family therapist serves as coach, promoting the effectiveuse of every reasonable threat, promise, and consequence to encourageabstinence. Later, therapists encourage families to serve as recovering addicts’sponsors to help prevent relapse. For an interesting example of the motivatinginfluence of a family member, we recommend Heard’s (1982) rich descriptionof how a deathbed wish of a deceased grandfather was used to promote recoveryin a 23-year-old heroin addict.Family therapists consider it extremely important during this stage toassume a nonblaming stance (Alexander, Waldron, Barton, & Mas, 1989;Stanton & Todd, 1992) toward the entire family. We find that the confrontingtechniques used in group therapy with substance abusers tend to fan the fires ofresistance and to inspire counterattack. Challenges can still be offered to families,but they must be expressed in nonpejorative ways. Many family therapistsuse positive interpretation when they comment on family members’ behavior.Stanton and Todd (1992) have referred to this as “ascribing noble intentions”or “noble ascriptions” (see also, Stanton, Todd, et al., 1982). Examples includestatements such as “He’s defending the family like any good son would” and“You’re trying your best to be a good mother.” Such statements tune into boththe caring and frustration that most family members experience, and seem tolessen client resistance and promote compliance.Steinglass and colleagues (1987) emphasized that it is essential to label thesubstance abuse as a family problem and to convince the family members thatthey are all essential players in the recovery process. Writing about alcoholism,these authors stated that whenever alcoholism is identified as a problem, the