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

546 V. TREATMENTS FOR ADDICTIONStherapists tend to agree to stop when they believe that the serious structuraland functional problems that have maintained substance abuse have beenreplaced with new family rules, roles, and interactional patterns. Optimally,substance abuse has not been replaced with other addictive behaviors. Familytherapists tend to tolerate socially acceptable “addictions” (e.g., “workaholism”)as long as family members tolerate them.In TFT, as the therapist hands over control to the family, a renewed commitmentfor support is requested from the network. Strategic predictions aremade, helping the family to understand the likelihood that the substance abusermay once again test their commitment to his or her abstinence. Plans are madefor dealing with this possibility. Finally, a formal, end-of-treatment ritual isdesigned and orchestrated by the family (Landau & Stanton, 2000).The length of therapy and the specific definition of successful treatment varywidely among models of therapy and among individual families. Stanton andTodd (1992), in describing their brief therapy model for treating drug addicts,have broadly stated that therapy is appropriately concluded when “adequatechange has occurred and been maintained long enough for the family to feel asense of real accomplishment” (p. 56). Adherents of other models would not evenattempt to reorganize family structure in the ways prescribed in our fifth stage.Instead, they conclude treatment when family members feel satisfied that theproblems originally presented have been resolved (e.g., Heath & Ayers, 1991).Once all parties agree to cease regularly scheduled sessions, occasionalinoculatory follow-up sessions (“checkups”) may be scheduled, one at a time, atintervals of 2–6 months. Therapists make it clear that clients are welcome toschedule future appointments at any time and to cancel sessions that seemunnecessary. Therapy clients, like medical patients, are not necessarily madepermanently “healthy,” even after a course of treatment. The door to the therapist’soffice, like that of the family physician, remains open (Heath, 1985).Family therapy sometimes ends unexpectedly and prematurely, at least asseen by the therapist. No matter how skilled the therapist, and no matter whatthe stage of treatment, families generally stop coming to therapy when theywant. In such circumstances, responsible therapists make every reasonableeffort to determine whether client families are satisfied or dissatisfied with servicesrendered and to respond accordingly. They offer additional services orreferrals for any family member, as well as professional opinions about remainingproblems and caveats, when appropriate.In conclusion, the six-stage model presented here is intentionally inclusive.We have made no effort to spell out or resolve differences among modelsof family therapy, or to examine the differences between treating drug addictsand alcoholics. Instead, we have broadly sketched a viable course of treatmentfor families with substance-abusing members. Clinicians may wish to emphasizesome stages of therapy more than others.