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

24. Family-Based Treatment 549(Stanton & Todd, 1981; Stanton, Todd, et al., 1982). The families of addictsare particularly difficult to engage in such an endeavor. Fathers, in particular,often appear threatened by treatment and defensive about their contribution tothe problem. Because many have drinking problems themselves, they may alsofear being blamed.Experienced family therapists, recognizing this hesitancy to participate intherapy, work hard to recruit families into therapy. They do not rely on otherfamily members to do the recruiting, because this approach often fails. Instead,they work energetically and enthusiastically to extend personal invitations tothe reluctant. With emotionally healthier families, one telephone call mayenable a therapist to reassure family members that their contributions areimportant to the solution of the substance abuse. With less healthy families, itmay be necessary to meet on “neutral turf” (e.g., a restaurant), to write multipleletters, or even (Stanton, Steier, & Todd, 1982) to pay family members for participationin treatment. Wermuth and Scheidt (1986) and Stanton and associates(Stanton & Todd, 1981; Stanton, Todd, et al., 1982) have describedengagement procedures in considerable detail, the latter group also presenting21 principles for getting reluctant families into therapy.Control of the CaseTo shift the responsibility for dealing with the substance abuser’s problems tothe family, a family therapist needs to have command of the case. The familytherapist must be allowed (e.g., by other elements in the treatment system) todirect the overall case management, including the treatment plan, the use ofmedication and drug tests (see below), and decisions about hospitalization.When one therapist is in charge, substance abusers are less likely to manipulaterelationships among treatment professionals.Stanton, Todd, and colleagues (1982) estimated that approximately halfthe effectiveness of treatment of drug addicts and their families depends on theefficiency and cohesiveness of the treatment system. If family members receivevaried advice, they often end up arguing about the therapy rather than workingtoward recovery. Cohesion in the treatment system of substance abusers necessarilyincludes the self-help programs used by their families. Again, it is vital fortherapists to know the local self-help groups and to collaborate with them forthe sake of their clients.Medication and ManagementFamily therapists who work with substance abusers and their families must haveat least a basic knowledge of pharmacology. This information aids them duringthe detoxification process and reduces the overcaution in the use of medicationsthat sometimes occurs among less informed therapists.