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

540 V. TREATMENTS FOR ADDICTIONSless.” Second, therapists should want family members to feel both helpless andhopeless—that is, to “hit bottom,” if they have not done so already. Third,therapists must not look for a single strategic intervention to reverse the multitudeof problems in these families but should work patiently in a simple,straightforward manner.It is also during this stage that the TFT therapist considers publicly constructinga time line with the family (Stanton, 1992). By now, enough informationabout both the nuclear and the extended family should have been collectedto provide a clear picture of how family life events have contributed tothe onset of the family’s problems. Stanton (1992) gives as an example a 17-year-old male, “Pat,” who initiated substance abuse when an aunt with whomhe was very close went through a divorce, and whose abuse became heavy whenhis close, 19-year-old cousin (the aunt’s son) died suddenly in a traffic accident.The family finally entered therapy when his paternal grandmother and her liveinboyfriend of many years broke up, and she tried to induce Pat to leave hisnuclear family and move 1,000 miles away to live with her.Finally, many family therapists work to get the substance abuser to AA,Narcotics Anonymous (NA), or Cocaine Anonymous (CA) as the final step inthe second stage of therapy. Bepko and Krestan (1985) suggest that it is notadvisable for therapists to argue with clients about the value of AA, but theyshould describe AA and its purpose “in a way that is palatable to the particularclient” (p. 103). Most family therapists emphasize that AA is one of the mosteffective treatments for addiction. We help each substance abuser find a groupwith which he or she feels comfortable, then encourage attendance for a whilebefore making a decision whether to continue. For the individuals who feeluncomfortable with AA’s use of the “Higher Power,” we recommend secularsobriety groups (Christopher, 1988).Stage 3: Halting Substance AbuseIn family therapy, there always comes a moment of truth. As a result of thechanges in their family members’ behavior and the firm position of the therapist,substance abusers suddenly become aware that they are going to have tochoose between their families and their drugs. Substance abusers, when consistentlyconfronted (or abandoned) by parents, spouses, children, friends,employers, and perhaps even recovering people in self-help groups and/or atherapist, often “hit bottom” and turn to the therapist for help in changingtheir ways.At this juncture, Steinglass and colleagues (1987) suggest that there arebasically three ways for therapists to proceed. First, when physical dependenceon alcohol or drugs is identified, the therapist should arrange safe detoxificationfor the addicted person and refuse to continue therapy unless this option iscompleted. Without medical intervention, the addict’s independent with-