Why do we work with families?
Family involvement is a core characteristic of effective services and programs for young people with AOD problems (Bruun & Mitchell, 2012). Meta-analyses, reviews and recent research studies consistently report that involving family members in AOD treatment increases the likelihood of adolescent engagement and a positive outcome (Chassin, Knight, Vargas-Chanes, Losoya, & Naranjo, 2009; Copello, Velleman, & Templeton, 2005; Muck et al., 2001; Schuetz & Berry, 2009; Waldron, Kern-Jones, Turner, Peterson, & Ozechowski, 2007; Williams & Chang, 2000).
Risk and protective factors operating within the family system are among the most significant predictors of AOD and related psychosocial difficulties such as offending behaviour among young people (Copello et al., 2005; Kumpfer, Whiteside, Greene, & Allen, 2010; Luthar, 2006; Mitchell et al., 2001; Spooner, Hall, & Lynskey, 2001).
Many aspects of the family environment and dynamics are related to risk of substance misuse. Factors such as maltreatment, neglect, parental substance misuse and coercive or inconsistent parenting are all risk factors, but family strengths can provide a buffer or promote resilience in the presence of environmental risk factors (Vimpani & Spooner, 2003). Key family strengths found to be most influential in positive youth outcomes include cohesion or bonding, communication of positive family values, and active and interested supervision (Kumpfer et al., 2010).
Even in families where risk factors are highly pronounced, and protective factors appear to be absent, families may possess resources that can help a young person who wants to make changes in his or her life and who needs more support from people who care.
Even when relationships with family members have been fraught and disappointing, most adolescents want to improve these relationships and to get more care and support from their families (Green, Mitchell, & Bruun, in press). Long after therapeutic relationships with workers are over, relationships with family members mostly endure, and the more supportive these can be, the more chances the young person has of achieving their goals.
In recognition of this, numerous practice guidelines underscore the importance of working with the parents and families of adolescents who are misusing substances (Liddle, 2004). From a purely practical perspective, securing caregiver involvement (or at least support) may often be essential to engage younger adolescents in AOD services, because they tend to be dependent on parents or caregivers for the basic necessities of life.
There is a rapidly growing body of research demonstrating the effectiveness of several types of family therapy or family-based interventions in the treatment of AOD and related problems in adolescents (Austin, Macgowan, & Wagner, 2005; Chassin et al., 2009; Dennis et al., 2004; Hogue & Liddle, 2009; Liddle, 2010; Muck et al., 2001; Vaughn & Howard, 2004). Several of these are now recognised as ‘well-established’ (Multidimensional Family Therapy) (Austin et al., 2005; Dennis et al., 2004; Hogue & Liddle, 2009; Liddle, 2010; Vaughn & Howard, 2004) or ‘possibly’ (Functional Family Therapy) (Austin et al., 2005; Vaughn & Howard, 2004) efficacious evidence-based treatments for substance abuse in adolescents.
In addition, a variety of family-based interventions have been found to be effective in reducing risk factors and enhancing protective factors for substance misuse (Gilvarry, 2000; Kumpfer, Alvarado, Tait, & Turner, 2002; Leung, Kennedy, Kelly, Toumbourou, & Hutchinson, 2010; Loxley, Toumbourou, & Stockwell, 2004; Mitchell et al., 2001), reducing the initiation of drug use by adolescents (Kumpfer et al., 2010; Leung et al., 2010) and reducing the amount of alcohol use (Leung et al., 2010).
Family Therapy can be a relatively intensive and lengthy intervention. It is not widely available, and is generally beyond the role of youth AOD workers in Australia. However in communities where they are available, and when resources allow, it may be appropriate for youth AOD services to employ a specialist family therapist or to refer families to another service that offers family therapy.
The practice elements contained in this module are drawn from, and commonly found, in evidence-based models of family therapy, but they do not extend to the provision of formal family therapy. This module has selected and configured practice elements that are feasible for delivery by youth AOD workers with no formal training in family therapy.
Aims of the ‘Working with families’ module
In the context of youth AOD services the aims of working with families are to:
- Engage families in the care and support process as far as possible;
- Motivate family members as supporters of their young person, and
- Build the capacity of family members to provide emotional and practical support that assists the young person along a positive developmental pathway.
Within youth AOD services the goals of family focused interventions do not extend to solving most of the family’s problems or correcting entrenched dysfunctional patterns of interaction. Action on these goals is the domain of specialist family therapy.