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

52 II. ASSESSMENT OF ADDICTIONHow substance abuse precipitated the family problems or, conversely, how familyproblems triggered substance abuse needs to be investigated in the course ofthe evaluation. Third, the reinforcement contingencies, if any, exercised by thefamily on the member with the substance abuse problem need to be analyzed. Itthus needs to be determined whether substance abuse is ignored, punished, orpositively reinforced. Fourth, the roles and status of each family member mustbe understood to the extent that individual maladjustment, conflict, and instabilitycontribute to overall family dysfunction that in turn propels one memberto consume alcohol or other psychoactive drugs.Five self-report instruments are commonly used to quantify family functioning.The Family Environment Scale (FES; Moos, 1974; Moos & Moos,1981) was the first instrument developed to evaluate family system functioning.The FES evaluates three major dimensions: (1) Relationships, (2) PersonalGrowth, and (3) Systems Maintenance. Each major dimension consists of severalscales. The Relationship dimension encompasses scales that measure familyconflict, cohesion, and expressiveness. The Personal Growth dimension includesscales that evaluate the family’s emphasis on independence and achievement,as well as intellectual, religious, and recreational pursuits. The SystemsMaintenance dimension contains scales that measure the family’s success atorganization and control. The Self-Report Family Inventory (SFI) is based onthe theoretical orientation of the Beavers Systems Model of Family Functioning(Beavers & Hampson, 1990). It measures health/competence, level andtype of conflict, communication patterns, cohesiveness, leadership, and emotionalexpression.Epstein, Baldwin, and Bishop (1983) developed the Family AssessmentDevice (FAD) to evaluate current level of family functioning. The FAD can beadministered to children as young as 12 years of age. In addition to providing ageneral functioning score, the FAD provides useful information pertaining toaffective involvement, behavior control, family roles, problem solving, communicationpatterns, and affective responsiveness.The Family Assessment Measure (FAM) focuses on the individual perceptionsof each family member (Skinner, Steinhauer, & Santa Barbara, 1983;Steinhauer, Santa Barbara, & Skinner, 1984). The family system characteristicsassessed by the FAM include affective involvement, control, role performance,task accomplishment, communication patterns, affective expression, and valuesand norms.The Family Adaptability and Cohesion Evaluation Scales (FACES),developed by Olson, Russell, and Sprenkle (1980, 1983) and Olson and colleagues(1989) for both research and clinical applications, is another frequentlyused measure of family functioning. It takes only 10–15 minutes to administerand is appropriate for children (ages 10–12). It assesses three dimensions offamily functioning: cohesion (degree of emotional bonding), adaptability (familypower/roles/rules), and communication (dyadic patterns/styles).