THE
ADDICTION CYCLE. CRISIS RESOLUTION, AND
OUTCOME
We
examined the 39 cases to see whether there was the expected relationship between crisis
resolution and outcome. The degree of success was measured by the
extent to which the addict abstained from legal or illegal
opioid use (the addiction cycle) during the 6 months following the end of
treatment. In those families where a major crisis did not occur
during therapy, we predicted poor outcome, since the addiction cycle
had not been challenged. In families where a crisis was manifested by
the addict during treatment, and where this crisis was not resolved,
treatment was also expected to be unsuccessful.
More positive outcomes were anticipated in cases where the addictive crisis was successfully handled, setting the stage for other family issues to emerge and be resolved. Based upon the typology described earlier, these emerging family problems could take one of four forms, with the particular form expected to be related to outcome.
The expected order of the forms, from best to worst outcome, was
(1 ) family issues were resolved without reaching crisis proportions;
(2) such crises developed and were clearly resolvable by the therapist
More positive outcomes were anticipated in cases where the addictive crisis was successfully handled, setting the stage for other family issues to emerge and be resolved. Based upon the typology described earlier, these emerging family problems could take one of four forms, with the particular form expected to be related to outcome.
The expected order of the forms, from best to worst outcome, was
(1 ) family issues were resolved without reaching crisis proportions;
(2) such crises developed and were clearly resolvable by the therapist
which was expected to allow the addict to
continue to improve and move toward more autonomy from his family; (3) in
families where interparental issues were not resolved, continued improvement on
the part of the addict was less likely; to the extent that the addict did improve, such improvement
was likely to be offset by physical illness of a parent or the
emergence of significant problems in a sibling; (4) in the fourth type of family,
the breakdown of the addiction cycle was followed by a chain reaction
of violence and even death.
The type of reaction mentioned above, in item 4,
was unusual in our sample, occurring
in only 4 of 39 cases. When it occurred, the violent reaction was not necessarily precipitated by the therapy, but
seemed to be an example of the level of crisis under which some of these families attempted to survive, never seeking
professional help.* Exactly what
would constitute a helpful intervention in this type of family is beyond the scope of this chapter, but it
seems that the development of methods for identifying them prior to treatment would be a fruitful direction for future research.
The topic of interest here is the relationship of
crisis occurrence and resolution to
outcome. However the family patterns described are, although important, too refined to detect any correlations in our own sample of 39 cases; for example, some
"types- had as few as 3 families. Consequently, it was decided to compare outcome based on one distinction: those families where the
therapist considered the addictive crisis to be successfully resolved versus
those families in which either no
crisis occurred or the occurring crisis was not success-fully resolved. A listing of the various
categories, and the number of families
in each, is presented in Table 2.
Outcome data addressing the primary issue of opioid
addiction, in the form of days free
of legal opiates (e.g., methadone) and days free of illegal opiates during the first 6 months posttreatment, were available for the IP in 37 of the families; for two
families these data were incomplete
and thus insufficient for inclusion here (see Chapter 17 for a detailed explanation of the methods for
obtaining and calculating outcome
data). An outcome was classified as -Good- for a given IP if he was free of that particular class of drugs for more than
Inspection of these distributions revealed that,
for illegal opiates, 18 of 25 families in which crisis resolution was
attained had Good outcomes (i.e., 72%), whereas Good outcomes
occurred in only 5 of 12 (41.7%) of the families in which either no
crisis or no crisis resolution occurred. This difference, using a one-tailedt test for
the difference between two proportions, was
significant at the .05 level. For use
of legal opiates, 17 of the 25 families that resolved the crisis (68%) had Good outcomes, while 5 of 12 (41.7% ) of
the families without crisis resolution had Good outcomes—a difference signifi-cant at the .10 level using the same one-tailed
test.
These results tend to support the idea that
occurrence and resolution of a crisis within the course of
therapy are important variables in helping the addict to both get off
and remain off opioids, that is, to break the addiction cycle. Certainly
this is a topic that merits further investigation with larger samples,
more detailed meas-ures, and continuous sampling throughout
treannent.
M. DUNCAN STANTON/THOMAS C. TODD
