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

24. Family-Based Treatment 539home at night, clearing the table, rinsing out a glass after having a drink of milkrather than leaving the glass on the counter, asking how the other’s day was,giving a back rub, and so on” (p. 161). These various pleasure-inducing actionshelp to increase “the overall rewardingness of the relationship, which wouldenable the couple to more willingly work on problematic aspects of the relationship,while making the overall relationship more fun” (p. 161). In a sense,the newer, positive experiences compete with and crowd out the older, “nastier”ones.Regarding self-help groups, family therapists often refer family members toAl-Anon, Nar-Anon, Alateen, Alatot, and related programs at this stage,encouraging clients to shop around until they find groups that are “sociallycompatible and geographically accessible” (Davis, 1987, p. 56). According toBepko and Krestan (1985), the goal of this involvement is to help the familymembers “shift their role behavior significantly both in the interest of theirgreatest well-being and with the expectation that a change in their part of thefamily interaction will eventually lead to the drinker’s sobriety” (p. 104). Davis(1987) suggests that therapists must consistently assign visits to self-helpgroups, because participation in groups enhances family therapy in severalways. Participation in self-help groups encourages detachment from substanceabusingbehavior, provides validating experiences and 24-hour crisis supportthrough sponsors, and emphasizes personal responsibility (Davis, 1987).Many family therapists supplement the work of self-help groups by helpingthe spouses of substance abusers to achieve a greater degree of emotionaldetachment. Berenson begins by getting spouses of alcoholics into supportgroups, usually Al-Anon or other spouses’ groups (Stanton, 1981b). Next, heprepares spouses for the impending period of pain and depression, perhaps evennoting that they may have suicidal thoughts as a part of “hitting bottom.”Finally, Berenson helps spouses gain distance from their alcoholic partners,often by suggesting brief separations (e.g., a week away from home) in order topromote differentiation. Berenson warns spouses that their alcoholic partnersmay try to get them back by intensifying the symptom, usually by increaseddrinking.At this point Berenson may involve the alcoholics more in therapy, empathizingwith how isolated and alone they may feel. Concomitantly, he helpsspouses stick to the plan, so that the drunks have a chance to get sober. He tellsspouses that they should not expect the alcoholic to improve but suggests thatwhen they realize that the alcoholics cannot be controlled, the alcoholics maybe able to make a change for the better. Berenson does not support hostilemoves against the alcoholic but only supports moves the spouses make forthemselves.Berenson has suggested several helpful rules for therapists working throughthis stage of family therapy (Stanton, 1981b). First, therapists must have noexpectations that change will occur; rather than “hoping,” they must be “hope-