HANDLING CRISES

HANDLING CRISES

In many addicts' families, crises are a way of life. It sometimes seems

as if they would be unhappy if they did not have a periodic crisis to activate them. They appear to swing from one crisis to the next as a way of charting and maintaining their lives, just as Tarzan swings through the jungle from one supportive vine to another. It is therefore not surprising that a family crisis can be anticipated as change starts to occur in therapy and the addict stops or curtails his drug taking. This is probably a necessary feature of change (see Chapter 8). It can be expected to occur 3 or 4 weeks into treatment.* Most commonly, it will revolve around the parents' marital relationship, with them talking about, or taking steps toward, separation or divorce. This puts tremendous pressure on the abuser to become dirty again in order to reunite his family. At such times, the therapist will need to devote considerable time and energy to resolving the crisis in a different way than has occurred in the past. He will have to be accessible and perhaps constantly on call. His goal is to get the parents to hold together in relation to the IP and not let them separate, at least until this storm is weathered. If the transition is handled skillfully, treat-ment is usually on the way to a successful outcome, for succeeding crises will be easier for the family to cope with; a previously recurrent pattern has been broken and real change has occurred.

The therapist wants to contain the crisis within the family, preventing matters from getting out of control and avoiding spillover into other systems. At such times it is best to avoid steps that take the pressure off the family, particularly hospitalization, increasing medi-cations such as methadone, or kicking the IP out of the home precipi-tously. This is partly because the therapist and family rarely have major input or control in these other contexts, including the context of the peer or drug subculture. Their ability to manage or intervene in these social systems is minimal. Equally important, the family of origin is the strongest and most logical support system for dealing with such crises. The IP is one of their own, they have likely had to deal with his crises in the past, and they are usually more motivated to be involved this time. Therefore, it behooves the therapist to mobilize the family around the crisis and put them to work to resolve it.

An additional benefit of generating a crisis is that it brings about a situation in which individuals and systems are more amenable to change.66 Times of crisis are pivotal points at which the system can move radically in either a functional or a dysfunctional direction. The key factor here is that movement is more possible at such times, allowing the therapist maximal influence.