The first element is Family Engagement, as enhancing family members’ involvement and investment in the therapy of the young adult who is struggling is key.
- For example, for a parent who feels reluctant to engage in therapy, a therapist might share something like: “You and I together are trying to help her not go under. This isn’t going to be easy, but I’m going to push you to hear her point of view and you’re not always going to agree. I’m going to help her bring things to you, and to help you hear her.”
- For a teen who is feeling unsure about the value of family therapy for them, a therapist might share something like: “Your mom seems upset about your grades dropping. That’s important and we will spend time talking about it, but I’m just as interested in hearing how you feel things are going for you. I want therapy to be a place where you can talk about what you think is going well, going not so well, and what you would like to be different.”
Family Engagement interventions typically take place during the initial phase of treatment, though investment and goal setting are continually revisited in family therapy for addiction.
Family behavior change
The fourth element, Family Restructuring, aims to change the way the family system is governed; that is, to shift underlying beliefs, premises and family rules.
- For example, there may be a trend in the family that when someone is upset, they don’t talk about it and are meant to handle it alone. A family therapist might help the family become aware of this premise, and might introduce new beliefs about the value in speaking with each other about difficult feelings. There may also be beliefs about different roles two different parents occupy, and family therapists can help identify a shared way that both parents can respond to their child.
Family members are encouraged to understand the dynamics of their family, and how these dynamics are linked to the problematic behavior. It ends up prompting shifts in attachment and emotional processes between family members.
Even without formal family therapy, parents can begin to think about how they can be resources for their teen, and how relationships could shift in their families to better support a teen who is struggling with substance use. Parents should be curious about their son or daughter and his/her life in a non-judgmental manner.
- What is your child thinking and feeling?
- What is your child hopeful about or worried about?
- What does your child think is good about using drugs?
- Is there anything your child worries about related to drugs, or about risks of the behavior?
- What does your child believe that you do not properly understand or value?
We know that engaging in these conversations can be very difficult, so parents shouldn’t be afraid to seek support on their own to do so, or be discouraged if it at first it doesn’t feel successful when they aim to engage in a more skillful conversation with their teen.
If a parent’s approach to substance use is based on punishment, the teen is less likely to talk about their substance use and whether they are worried about themselves or a friend. This does not mean that behavior doesn’t have consequences, but that parents should position themselves as resources for their teens rather than act as probation officers. Limit setting is important, and consistency is the most important part of limit setting — for example, if your child misses curfew and the consequence is a week of being grounded, it’s very important to follow through as opposed to just grounding him or her for a day or two. We also know that the most effective way to change behavior is through positive reinforcement, so in addition to boundaries and consequences for less healthy choices, parents can look for opportunities to positively reinforce the healthy choices the teen is making in their everyday life.
Because we know some teens do use substances, parents should encourage their teens to avoid drugs but also talk about reducing risk if they or people they hang out with do use drugs. Also, providing fact-based and honest drug education makes parents more credible and again more likely to be someone their teen comes to for advice or help.
The relationship with your child is the most important thing to attend to – don’t lose sight of this core value when you’re legitimately concerned about your son or daughter’s substance use. Stay focused on the positive relationship and your lifelong bond with them, and offer compassion and love. It is truly the most important thing and has the biggest positive influence on their behavior.