Family Therapy

Theoretical Underpinnings

The theoretical underpinnings of family therapy for addiction contrast with many individually oriented treatment approaches, particularly with regard to the issue of etiology. Whereas individually oriented theories may identify singular causal factors in the development of addiction (e.g., disease process, faulty thinking), family therapy practitioners employ systems-oriented concepts to conceptualize addiction. For instance, in family systems approaches, the concept of reciprocal determinism may be used to describe how addiction both affects and is affected by all other family members, while the concept of circular causality may similarly be used to explain how interpersonal dynamics and communication patterns could initiate or support addictive behavior (e.g., through complaints about current or previous substance use). It is further posited that family members continually attempt to establish and maintain a sense of equilibrium or balance in the family system so that if one member is abusing substances, that individual's behavior serves as a central organizing principle that ends up providing stability to the family system. Addiction, then, can be understood as a homeostatic maintaining force that provides the family with stability and counteracts efforts to change. In the literature pertaining to family treatment for addiction, a distinction can be made between two general approaches: family systems-oriented therapies and behaviorally based family therapies. Family systems-oriented therapies focus on changing the organization and functioning of the family system by improving interpersonal relationships, communication, and interactions within the family. It is assumed that improved family functioning will circumvent supporting addiction as a homeostatic maintaining force, which in turn will result in a change in substance abusing behavior. Many family therapies for addiction are also grounded in behavioral principles and techniques. Although there is much overlap in the underlying principles and applications of these two broad categories (e.g., in the attention paid to cognitive processes, reciprocal determinism, and homeostasis), [Page 398]behavioral family therapies emphasize the role of operant and classical conditioning in the development of addiction. From this perspective, substance use is considered to be reinforced by physiological effects, increased opportunity for social interaction, and by family members when they attend to addictive behavior or when they protect the user from the negative consequences of his or her actions. The overall therapeutic goal is to reinforce positive interactions among family members and decrease negative behaviors or interactions associated with addiction.

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