THE ADDICTION CYCLE AND FAMILY CRISES
As emphasized in Chapter 1, the behavior of the
addict is part of a cyclical process
of crisis and resolution involving the family of origin. This behavior, including enrollment in treatment
programs, being hospitalized, and
relapsing, typically serves to detour interpersonal conflicts that the family has been unable to resolve.
One of our major therapeutic
assumptions is that effective therapy involves keeping the problem within the family so
that an inter-personal crisis can
emerge, which the therapist can then help the family to resolve. In order to test this assumption, we attempted to ascertain whether successful therapeutic outcome
was related to the emergence and
resolution of major interpersonal crises.
THE NATURE AND RESOLUTION OF THE CRISIS
Thirty-nine families
involved in the AFP were studied for the oc-currence of major crises during the course of therapy.* Therapists in the project filled out questionnaires asking them
(1 ) if there was a major crisis
during the course of therapy; (2) to describe the nature of this crisis and other crises; (3) if this crisis
was successfully resolved; (4) if the
therapist considered the treatment of the addict and his family a successt The crisis could have ( I.) been
intensifying at the time of intake
(2) resulted from
standard restructuring moves within
therapy ; or (3) been intentionally induced by the therapist
In 36 of the 39 families a major crisis involving
the addict emerged during therapy. The
addict's behavior varied from threat-ening
to leave therapy, to the use of illegal drugs, to criminal activity, and, in one case, to a threat of violence within
the family therapy session itself. Of
the three families without crises, two dropped out of treatment before a crisis emerged, while a
third—which remained longer in
therapy—simply experienced no crisis. In the group of 36
families where there was a clear crisis (usually
involving the addict), the therapist
worked with family members in an attempt to resolve the crisis manifested by the addict in a way that
kept him drug-free; the goal was to
interrupt the usual drug cycle in which the addict acted out to -save- the family from other problems.*
Commonly, this took the form of urging the parents to pull together against the
addict, and, at the same time,
encouraging the addict's autonomy from his family. For example, in one family where the addict had been
arrested for stealing merchandise, the
therapist got the parents to refuse to pay the damages, while also working with the addict around returning to work. In another family (described in in
which the addict had taken illegal
drugs, the therapist was in constant contact with the family over a complete weekend as they worked at
detoxifying the addict in the family's home.
In these 36 cases with
crises the therapist was asked to indicate whether or not the crisis was successfully resolved. Resolution was indicated in 26 cases. In the remaining 10 cases
crises occurred but were not resolved ) or there were multiple crises but only some were resolved
Family Types without Crisis
Resolution
A major hypothesis of this chapter is that much of
the crisis-like behavior revolving
around the addict is a detour for larger issues in the family, usually involving the parents.
Therefore, treatment is more likely
to be successful if these larger issues are either overtly or covertly resolved. Conversely, cases in which
these issues are not resolved
tend to follow one of three courses: (1) no crisis occurs and the family aborts treatment (3 of the 13 cases in
which no crisis either occurred or
was resolved); (2) the addict throws up a smokescreen of crises that prevents the therapist from dealing
with the family crises occur in the family early in treannent
