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

24. Family-Based Treatment 543fears about relapse, and facilitate minor structural changes in the family toallow adequate parenting (Bepko & Krestan, 1985). Changes in parenting practicesare especially vital when the recovering substance abuser is an adolescent(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; Waldron et al., 2001).Whenever a relapse into drinking or drug taking occurs, the question ofresponsibility arises. Who is responsible for the relapse? Although conventionaldrug treatment programs and many individual therapists either thrust theresponsibility on the substance abuser or accept it themselves, family therapiststend to assign the responsibility to the abuser’s family. As Stanton and Todd(1992) suggested, “It should be remembered that the addicted individual wasraised by, and in most cases is still being maintained by, his family of origin. It isthus with the family that responsibility rests, and the therapist should help thefamily either to accept it or to effectively disengage from the addict so that theaddict must accept it on his or her own” (p. 55, original emphasis).Similarly, the therapist must assign credit to the entire family when creditis due (Stanton, 1981c). Each member, particularly the often-neglected spouse,is praised for his or her contribution to the growing “health” of the family. Byidentifying and rewarding individual contributions, family therapists spread theglory that is usually bestowed on recovering abusers and promote long-lastingchanges in family interaction.Stage 5: Family Reorganization and RecoveryWhereas families in Stage 4 remained organized around substance abuse andtherapy was focused on resolving difficulties with substance abuse, Stage 5 isconcerned with helping families move away from interaction focused on substanceabuse issues and toward fundamentally better relationships. Here, thesubstance abuser is stabilized and “clean and sober.” Therapy now focuses ondeveloping a better marriage, establishing more satisfactory parent–child relationships,and perhaps confronting long-standing family-of-origin and codependenceissues.Steinglass and colleagues (1987) called this process “family reorganization”(p. 344). Although some families restabilize before reaching this phase andremain organized around alcohol issues (“dry alcoholic” families), we haveobserved that for others, the previous stages of therapy culminate in a seriousfamily crisis. This crisis then leads to disorganization and ultimately to a fundamentallydifferent organizational pattern that is encouraged in this stage oftherapy.Bepko and Krestan (1985) enumerated four goals for their analogue of thisstage, which they have termed “rebalancing” (p. 135):