Family Types with Crisis Resolution
We looked further at the aforementioned 26 families
in which the therapist reported successful resolution of the major crisis—a
crisis that almost always involved the drug-related behavior of the addict (the addiction cycle). Our assumption was that the
continued im-provement of the addict would be followed by the emergence
of other family problems, usually between the
parents. The therapist would then attempt to help the family deal with these
additional problems in a way that did not involve the addict. For
example, in one case the mother's drinking
problem emerged and the father threatened to leave the family. The therapist encouraged the parents to stay to-gether, since a separation at this point might be
interpreted by the addict as being
his responsibility, encouraging a relapse. At the same time, the addict was told that the therapist was
better equipped to handle the problem than the addict, and that the most
helpful thing for him to do would be
to continue work on his own career interests. The addict's continued
improvement seemed assured when the thera-pist convinced the father to take the mother to Alcoholics Anonymous and become involved in her care.
The successful blocking of the addiction cycle
resulted in the emergence of interpersonal problems in the family in all 26
cases; in 17 of them, these later problems assumed crisis proportions. The relationship between the
addiction cycle and the masked family prob-lem tended to assume one of
four forms:
1. In some families, it was possible both to (a)
get the family to change its behavior toward the addict and deal success-fully with crises around his
behavior, and (b) produce major shifts in the parents' behavior without an
explicit crisis de-veloping between the two of them. This pattern
emerged in 9 of the 26 cases. Examples, such as in Chapters 10 and 11, included
the therapist supporting the father to be more effective and the mother less involved, and
having the parents accept this shift without other problems developing (such as
threats of divorce, the mother becoming depressed, the father
drinking, etc.). We
2.
Another group of cases expected to be successful
were those in which the addictive
crisis was resolved, and other family problems
emerged that also proved to be resolvable. Nine of the 26 cases were of
this type. For example, in one case the addict became hysterical as other family problems emerged, threatening suicide, provoking a crisis at his job, and/or
using illegal drugs. After the parents
pulled together to avert such behavior, and the son was successfully detoxed
from methadone, both the mother and the father began to display similar
crisis-like behavior. The mother disclosed to the therapist that she was
developing "nerv-ous symptoms-
and the father revealed that he had a drinking problem that was becoming worse. In this type of family it is important
to normalize these complaints as part of the thera-peutic process. For example, the therapist
explained that this was common during
this stage of the treatment. Both parents had worked so hard to cure their son of heroin that they needed to feel a period of nervous exhaustion, or -a bit
low,- and would probably begin to
experience differences between themselves. This set the stage for the
emergence of a major family issue: the maternal
grandmother had lived in the home for several years. This had become
such a long-term taboo topic that both parents feared that discussion of it would destroy the family. However, the experience of working to cure their son of
heroin had strengthened the
relationship between the parents. They had shared something with each other and were therefore able to deal with the grandmother as well. The decision to
put the grandmother in a nursing home
was followed by a period of relative
peace between the parents and their son continued to improve.
3.
In a third type of family, the addiction cycle
masked problems in another family member that were not resolvable within the constraints of a concentrated, brief
therapy model. In these families, as the addiction cycle was broken, another
member of the family became vulnerable
and was handicapped in a real way. This was not -deterioration- in the
usual sense, but more a maintenance of the
status quo, or perhaps of -first-order-change.rs6
We found four cases of this type. In one family, the therapist was able to mobilize the parents to
thwart the addict's
efforts to leave treatment and his job as he
approached the end of a planned period of detoxification from
methadone. Yet as the addiction cycle was broken, both parents
literally broke down. The father was hospitalized for a heart
attack and the mother threatened to leave home. The family
responded to this threat in a way that kept the addict uninvolved,
although other family members took his place in rescuing the
parental couple: the sister divorced her husband and returned
home to live, and another sibling began to use illegal drugs. In a
similar family, a brother began to use drugs after 2 years of abstinence,
following the IP's detox from methadone. In a third family, the father's drinking problem became
worse as his son remained free of drugs. The therapist's efforts toward getting the
mother to help her husband through this problem initially required psychi-atric hospitalization of
the father. Treatment was successful in freeing the addict of his
addiction and a I -year follow-up indica ted that he had remained drug-free and had completed
an apprentice-ship that allowed him to become
successfully self-employed; yet, he
remained living with his mother and in a follow-up interview it appeared
that he and his mother talked about his father much in the same way that the mother and father had previously talked
about him.
Families of this type
may at first appear quite similar to those of Type 2 (above), in that crises
occur in other family members.
However, the Type 3 families are considerably more persistent in maintaining a symptomatic member once
the ad-diction cycle has been broken,
and the crises that they do generate are
usually more intense and difficult to manage than in the second type. Further,
although the addict's functioning may appear
dramatically improved from where he was at the beginning of treatment, the separation from his family may
remain mar-ginal, with other family
members taking his place in rescuing the family through self-destructive
acts. Cases such as this usually require
additional sessions to reach a point of stability and re-organization without major problems.
4. In a fourth type of family (four cases),
breaking the addiction cycle provoked
a crisis worse than the addiction cycle itself. It would appear that these families are tightly enmeshed and that their structures for resolving conflict
are so fragile that when stressed to
resolve crises in a different way they explode
Addit onal Considerations
Some might view the above typology of crisis resolution as one of "therapeutic systems" rather than of addicts' families rani- therapist. The four categories were defined ex post facto, having been derived from various classes of observed family behaviors. However, these behaviors emerged within a context that also included a therapist. It is possible that some families might have shown patterns that were more or less dysfunctional than actually occurred here, given a dif-ferent therapist, or given the same therapist making different inter-ventions. It is difficult to completely separate therapists' contributions from the family events used for categorization.
On the other hand, we do not consider all 26 families to be interchangeable, that is, that they were assigned to one of the four types primarily due to their therapists' operations. In fact, therapeutic factors are partially controlled, since all the families at least resolved the addiction crisis. In sum, we believe the typology has validity as a
Related to the above, it might be instructive to examine an extreme example of the kind of reaction that can occur in some families when little or no family-oriented 'intervention is attempted. This case was not seen in family therapy because it was not eligible for our family-treatment program. We knew about them because we initially tried to engage them in therapy, before their ineligibility was determined. The addict continued in the standard methadone program and as he approached detoxification, he became involved in criminal behavior and initiated violence toward the family, seemingly as a harbinger of the events to follow. His actions marked the beginning of a disasterous chain of events within the family that resulted in five deaths. Three brothers and a nephew died of drug overdoses and the father died in the hospital of a heart attack. This family clearly demonstrates the interlocking nature of addicts' families, giving a picture of the extremes to which the dysfunctional cycle can swing
M. DUNCAN STANTON/THOMAS C. TODD
