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

24. Family-Based Treatment 545chemically dependent families have experienced. These issues may not need tobe covered to effect abstinence initially, but unresolved grief can “eat away” atprogress unless it is brought to terms.More particular to this issue, it is important to recognize that most substanceabusers have been fulfilling a script prescribed by family history. Similarto Walsh’s (1978) finding that, in comparison with “normals,” people whobecome schizophrenic are more likely to have been born close to the time whena grandparent died, Reilly (1975) has noted that addicted people are frequentlydealt with as replacements, or “revenants,” of other family members who werelost, often unexpectedly. Reilly also observed a tendency for adolescents whoabuse substances to be named after a relative who was an alcoholic. His observationis supported by a national survey of adults in the United States byStanton, Adams, Landau, and Black (1998) in which it was found that drug- oralcohol-dependent people were three times more likely to be named after a relativewith a substance abuse problem than were people named after relativeswith no such problem. An example is the case of the young man, “Pat,” mentionedearlier: He was named after, and viewed as very similar to, his paternalgrandfather who manufactured illegal alcohol during the Prohibition period.Pat was later pressured by his paternal grandmother—who called Pat her “prideand joy”—to fill in as a replacement for the longtime boyfriend who had lefther (Stanton, 1992; Stanton & Landau-Stanton, 1990).Transitional family therapy specifically deals with the kinds of loss andscripting dynamics mentioned above. The material revealed in the genogram asto when the problem began in the family’s history, and the loss and grief thatlikely attended that onset, are dealt with in a direct manner. The family istaken back to the point of loss and symbolically “goes through” it again from apresent-day vantage point. This joins the poles of past, present, and future—spanning the family’s generations. The process also depathologizes those membersfrom the past who had problems, and reinstates them, instead, as peoplewho may have been pained and besieged. By granting the forebears their honorableplace, honor is also bestowed on the living, their descendants. Suchuncovering and rebuilding gives the family members the kind of informationthat can free them up to make a choice: Whether to keep, revise, or replace theintergenerational instructions (scripts) that have been carried down. In otherwords, it helps the family come to grips with the question of whether, and how,to move on in life. In experience with several thousand cases, as well as moresystematic qualitative study with over 200 clinical and nonclinical families,TFT has shown great promise in bringing about long-term change in the intergenerationalfamily addiction pattern (Landau & Stanton, 2000).Stage 6: Ending TherapyIn the ideal course of therapy with substance-abusing families, treatment comesto an end when the clients and therapist agree to stop meeting regularly. Family