Efficacy of Family Therapy for Drug Abuse: Promising but Not Definitive
Liddle, Howard A., Dakof, Gayle A., Journal of Marital and Family Therapy
By all accounts, drug abuse continues to be an enormous public health and social problem. Lifetime incidence of alcohol and drug abuse is nearly 20% (Helzer & Pryzbeck, 1988). In one recent year, 13 million Americans were diagnosed as alcoholics, and 14.4 million used illegal drugs (Institute of Medicine [IOM], 1990). On a typical day in 1987-1988, approximately 5.5 million individuals were in need of drug treatment (IOM, 1990). This number includes approximately 1 in 50 people in the general population,(1) more than 1988, approximately 5.5 million individuals were in need of drug treatment (IOM, 1990). This number includes approximately 1 in 50 people in the general population,(1) more than one third of all prison and jail inmates, and more than one fourth of all parolees and probationers. The total estimate of individuals in need of drug treatment is about 2.7% of the United States population 12 years or older. Given the known co-occurrence of drug problems with clinical disorders such as conduct disorder, antisocial behavior in adults, and depression, and the fact that drug abuse is underdiagnosed when it is co-morbid, this estimate may be conservative.
Substance abuse disorders are a threat to public health and result in considerable costs for the abuser, his or her family, and the community. From the perspective of the affected individual and family, there are lost jobs, family disruption, financial instability, and physical and psychological abuse. On the part of society, there are victims of drug-related crime and accidents, and the financial burden incurred from costs of law enforcement, incarceration or placement, medical care, and treatment (Lipsitt & VandenBos, 1992). Drug abuse is a major topic of public debate. The "war on drugs" launched in the 1970s under the Nixon administration has been maintained by succeeding Republican and Democratic administrations. The American public evidences an episodic concern about drug abuse and about one of its most common sequelae, violence. Few would deny that overall drug abuse policy with its emphasis on interdiction and incarceration has had mixed results (e.g., Currie, 1993; Suarez, 1995).
The role of family relationships in the creation and maintenance of drug and alcohol problems has been articulated for some time (Blum, 1972; Kaufman, 1985; Stanton, 1985; Wynne et al., in press). Family therapy approaches have been established as viable interventions for drug and alcohol abuse (O'Farrell, 1989; Stanton, 1979; Steinglass, Bennett, Wolin, & Reiss, 1987). However, despite indications about the centrality of families in the formation of drug abuse and the acceptance of family therapy as a concept (Coleman & Davis, 1975; Menicucci, Wermuth, & Sorenson, 1988), family therapy is still practiced inconsistently in contemporary drug abuse treatment settings (DATOS-A, 1993; Menicucci & Wermuth, 1989).(2)
The distinction between family therapy and family-involved interventions reflects the varied ways in which family interventions are understood and used in drug abuse research and practice communities.(3) In its classic or traditional form, family therapy rests on the connection between family relationships and the formation and continuation of drug abuse. Within this paradigm, family relationships, because of their presumed causative role in the creation of the disorder, are the primary target of intervention (Stanton, 1979). In the family-involved or family-based treatment models, families are not afforded the same place at conceptual or intervention levels. Family, including marital interaction, may be regarded as one of many target areas of intervention (e.g., McLellan, Arndt, Metzger, Woody, & O'Brien, 1993). Furthermore, involvement of the family does not mean that the practitioner attempts to change family interaction or relationships directly. One may instead involve the family in adjective or information-providing ways only. …