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

24. Family-Based Treatment 547SPECIAL CONSIDERATIONS IN FAMILY THERAPYA number of special clinical considerations concern family therapists whenthey work with substance abusers and their families. The most salient of theseconsiderations are discussed next. Interested readers will find insightful discussionsof many of the day-to-day issues that face family therapists in the varioustexts referenced previously.Engaging the Substance Abuser in Treatment or Self-HelpIt is well known within the substance abuse field that, at least in the UnitedStates and Canada, in any given year the vast majority (90–95%) of peoplewho are actively abusing drugs or alcohol do not obtain help for their problems(e.g., Kessler et al., 1994; Sobell, Cunningham, & Sobell, 1996). Consequently,recent years have seen considerable attention devoted to the means for gettingreluctant substance abusers either to enroll in treatment, or to begin attendinga self-help group such as Alcoholics Anonymous or Narcotics Anonymous. Atleast 11 different approaches have been developed that involve family membersand/or significant others toward this end. Ten of the approaches have beenexamined in 19 outcome studies (nine of which included Hispanic cases) acrossthree countries. Reviews of this literature (e.g., O’Farrell & Fals-Stewart, 2003;Rowe & Liddle, 2003; Stanton, 1997, 2004) indicate that significant progress isbeing made in terms of certain of these approaches both becoming more effective,and explicating their methods so others may apply them.Regarding the results from the aforementioned 19 engagement outcomestudies, Stanton (2004) has both summarized the various methods themselvesand compared them as to results. His review applied an “intent-to-treat” criterion,that is, that a method’s effectiveness should be gauged on the proportionof cases that become engaged of those to whom it is offered. Otherwise, if only10 of 100 cases agree to attempt an approach, and nine of those succeed, theapproach may claim “90% success” for what is actually 9% success.Some rather surprising findings emerged from this synopsis. For instance,the well-known Johnson Institute “Intervention” actually succeeds in engagingin treatment/self-help only 0–36% of cases (average across studies = 20%).These low rates seem to be due to the fact that many of the people, such as familymembers, who are trying to get help for a substance abuser believe that theconfrontive and secretive Intervention process is too stressful and damaging torelationships. Thus, many families have refused to proceed with Intervention.Some other findings from this review of outcome studies are as follows:1. Later (1995 on) studies generally attained higher engagement successrates than earlier studies (69 vs. 52%).2. Adult drug users appear to be easier to engage than adult alcoholics (78