A Multiple Case Study Comparison of Normal Private Preparatory School and Substance Abusing/mood Disordered Adolescents and Their Families

Article excerpt

Historically, the nuclear family has been viewed as the central institution of human society with the major responsibility for socializing children. A child or adolescent's ability to learn socially and psychologically acceptable behavior depends largely "upon the interactive processes in the family, between the family and society, and, finally, on the internal dynamics of the child's or adolescent's personality" (Miller, 1986, p. 45). Frequently, the child or adolescent's inability to internalize appropriate behavioral standards and expectations has been traced, in part, to the family's dysfunctional interaction patterns.

Family factors are frequently implicated with regard to the issue of adolescent substance abuse. The etiology of this abuse is multidimensional. Factors such as age, economics, social or ethnic group, peer pressure, developmental issues, and family dynamics all may contribute to its development. An important area of focus is the interpersonal family dynamics that may maintain the symptomatology of substance abuse behavior. Family dynamics that have been observed in some families where adolescents engage in substance abuse are: emotional distancing, parental uninvolvement, low parental expectations for adolescents, parental passivity, multigenerational substance abuse, and deviant behavior (Kandel, 1980). The families of substance-abusing adolescents reportedly engage in more scapegoating, are more authoritarian, converse less openly and equally than do other families, and have been described as dysfunctional in many areas of family interaction (Gantman, 1978). In contrast, healthy families have been typically described as incorporating several characteristics which are generally not observed in families of substance abusing adolescents such as: expression of clear and direct communication patterns, commitment to one another, ability to foster and maintain relationships within the community, and effective use of problem-solving skills.

Studies directed at characterizing the family of the substance-abusing adolescent tend to suggest that these families lack cohesion and are split by dyadic alliances; that is, both parents do not relate in a unified manner to the adolescent (Fishman, Stanton, & Rosman, 1982). With regard to the identification of problem-solving skills in this population, Kaufman (1980, pp. 44-45) found that, in a study of family patterns of heroin addicts, "frequently the crisis created by the drug-dependent member is the only way the family gets together and attempts some problem solving. . . ." Currently, adolescent inpatient substance abuse programs appear to either utilize an adult substance abuse model, address the problem of substance abuse as a general clinical issue, or utilize a combination of the two approaches. There is a lack of knowledge regarding the specific family factors that are related to adolescent substance abuse behavior. Consequently, preventive and treatment measures often lack focus and direction that could be gained through a descriptive analysis of specific features of these families.

The presence of conflict between parents, the presence or absence of extra-familial supports, and distortion and confusion in the communication between family members has generally been found to be more prevalent in families of adolescents who have been treated in clinical settings for a variety of disorders, including substance abuse. It has been found that adolescents do not make serious intrapsychic changes unless their families are ready to deal with them in a new way. The adolescent, as part of a family system, may be expressing the relationships within the family system in which he or she exists, or could be acting as a scapegoat for family issues and frustration (Wilson & Soth, 1985; Haley, 1987). Thus, it is apparent that family issues and dynamics must be addressed if change is to occur. Additionally, problem solving in families of adolescents who have experienced emotional or substance abuse problems is believed to be less effective than that which occurs in healthy families. …