The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a guide for substance abuse treatment providers to incorporate family therapy techniques into substance abuse treatment. The guide "Substance Abuse Treatment and Family Therapy" also includes information to provide family counselors with basic information about treatment models and the role of 12 step self-help programs in substance abuse treatment.

Substance Abuse Treatment and Family Therapy," SAMHSA's Treatment Improvement Protocol (TIP) #39, includes a discussion of treatment models that integrate substance abuse treatment and family therapy. These models can serve as a guide for joint treatment of the addicted person and his or her family and others with close emotional connections. Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance abuse. SAMHSA's Center for Substance Abuse Treatment (CSAT) develops the TIPs based on experience and knowledge of clinical, research, and administrative experts.

TIP #39, like the others in the series, is a key element in SAMHSA's mission of building resilience and facilitating recovery for people with or at risk for mental or substance use disorders by providing best-practices guidance to clinicians, program administrators and payors. TIPs are intended to bridge the gap between the research and the needs of practicing clinicians to use the most scientifically sound and effective methods as they provide services to people who abuse substances. The TIP explains that family therapy in substance abuse treatment can help by using the family's strengths and resources to find ways for the person who abuses alcohol or drugs to live without substances of abuse and to ameliorate the impact of chemical dependency on both the patient and the family. Family therapy, the TIP says, can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another.

However, the TIP warns substance abuse counselors that they must always be aware that family-counseling techniques should not be used where a batterer is endangering a client or a child. The first priority is safeguarding all parties. The TIP warns that family counseling for women with substance use disorders is appropriate except in cases of ongoing partner abuse. Further, women who have lost custody of their children may be strongly motivated to overcome their substance abuse since often they are working to get their children back.

The TIP identifies various family structures and how substance abuse may impact these families.

• A client who lives alone or with a partner - In this situation both partners needs help. If one is chemically dependent and the other is not, issues of codependence arise.
• Clients who live with a spouse or partner and minor children - Most available data indicate that a parent's drinking problem often has a detrimental effect on children. The spouse of the person abusing substances is likely to protect the children and assume the parenting duties of the parent abusing substances. The effect on children is worse if both parents abuse alcohol or drugs.
• A client who is part of a blended family - Stepfamilies present special challenges and substance abuse can become an impediment to a stepfamily's integration and stability.
• An older client with grown children - Additional family resources may be needed to treat the older adult's substance use disorder. There may be issues of elder maltreatment that must be reported to local authorities.
• An adolescent substance abuser living with his or her family Ð Siblings in the family may find their needs and concerns ignored while their parents react to the continuous crises involving the adolescent who abuses alcohol or drugs. If there is a parent who also abuses substances, this can set in motion a combination of physical and emotional problems that can be very dangerous.

The TIP notes that often family counselors do not screen for substance abuse because therapists are not familiar with the questions to ask or the cues provided by their clients. It also emphasizes that substance abuse counselors should not practice family therapy without proper training and licensing, but they should know enough to determine when a referral is indicated.

For more information on the TIP series, go to http://www.treatment.org/Externals/tips.html.