CRISIS RESOLUTION AND THE ADDICTION CYCLE
THE ATMOSPHERE of perpetual crisis and even
life-and-death drama in which the heroin addict and his family live is evident in
the following excerpt from an initial
session:
The addict arrived drunk, having been fired from
his job, and having wrecked his truck on the way to see the therapist for their initial meeting. When the
therapist suggested that he contact his father, the addict responded
by stating, "He wouldn't come down no way; my father has no
interest in me whatsoever. I OD'd one time and my father went out and
took out a $50,000 insurance policy on me and after 4 months he got mad because
I didn't die, and wanted me to start paying for the insurance policy.-
In Chapter 1, a conceptualization is presented
of drug addiction as part of a complicated, homeostatic system of
interlocking feedback mechanisms that allows the family to maintain
pseudostability. The dramatic events that characterize these
families, such as drug overdose, criminal activities, and episodic involvement in
treatment programs, are seen as symptomatic of a larger process—the
inability of the addict and his family of origin to separate. In these families
it is possible to
detect a recurring pattern of the crisis process and how the family -solves- such crises: family tension
triggers the addict's drug-related
behavior; other family members (e.g.,
parents) then focus attention upon the addict, thereby diverting their
energies from the
Appreciation is extended to
Maria Rychlicki, MAC, and Susan Carle for assist-ance in preparation of the
data presented in the latter part of this chapter.
The course of successful treatment can be described
as a shift within the parent-addict
triad from an initial structure in which the addict is viewed as responsible for the system's instability, to an eventual position of shared responsibility. In
this second structure the parents
maintain a clear hierarchical status, permitting the addict to leave the system without drugs and without carrying
the burden of future family problems.
When treatment is successful in allowing the addict to stop -making problems- for his family, the family is faced with
an interpersonal crisis. The therapist's ability to guide the family through this crisis—and prevent it from spilling
over into extra-familial systems—will
determine the extent to which a new structure within the triad can be maintained, allowing for a lasting change.
It is our
experience, and the position taken in this book, that this crisis is predictable in families of drug addicts
and that successful treatment is largely dependent on the therapist's ability
to anticipate the events and phases
through which the family passes, as well as to remain in control of them. The present chapter describes ( I ) the rationale
for a crisis-oriented family therapy with drug addicts, (2) the nature of the crisis and its relation to the
addiction cycle, and (3) the relation
between crisis resolution and outcome in 37 families treated within the Addicts and Families Program
(AFP).
M. DUNCAN STANTON/THOMAS C. TODD
