M. Duncan Stanton

Research on Marital and Family Therapy

This chapter has been written with both clinicians and reseachers in mind. Regarding the former, we believe that it is important for the practicing clinician or clinical student to know what conclusions safely can be drawn from existing research on marital and family therapy and to know which areas are still speculative as far as research evidence is concerned. We also will raise a number of design issues in the belief that clinicians need to be sophisticated consumers of journal articles and research. Finally, we recognize that nonresearchers are often in a position to have an important influence on future research.

Outcomes with the ARISE approach to engaging reluctant drug- and alcohol-dependent individuals in treatment.

Our goal was to explore, through a Stage I NIH clinical study, the effectiveness of a manual‐driven, timely response method for helping the “concerned other” get resistant substance abusers into treatment/self‐help with minimum professional time/effort. A manual‐driven protocol, “A Relational Sequence for Engagement (ARISE),” was applied with 110 consecutive, initial calls/contacts from concerned others; no cases excluded for research, refusal, or other reasons. The research was conducted at two upstate New York outpatient drug/alcohol clinics. Participants were concerned others who called regarding a cocaine, alcohol, or “other drug” abuser (N = 110); participating family/friends: 11 ARISE clinicians; and 110 substance abusers. ARISE is a graduated continuum starting with the least demanding option/stage, increasing effort as needed to engage substance abusers in treatment/self‐help. Stage I: Coaching the concerned other to arrange a meeting of significant others, inviting the substance abuser; Stage II: 1 to 5 additional meetings (median = 2); Stage III: A modified Johnson “Intervention.” Primary outcome variables were substance abuser engagement (or not) in treatment/self‐help; days between first call and engagement; clinician time/effort. Predictors were concerned other, substance abuser, and clinician demographics; number of participants per case; and Collateral Addiction Severity Index. ARISE resulted in an 83% success rate (55% at Stage I). Median days to engagement was 7 (IQR = 2 to 14). Average total time (telephone, sessions) per case was 1.5 hours. Treatment/self‐help chosen was 95% treatment and 5% self‐help. Number of family/friends involved correlated 0.69 with a success/efficiency index. Conclusions. A call from a family member or concerned other for help in getting a loved one into treatment is a rich opportunity for treatment professionals and agencies to engage substance abusers in treatment. These initial calls are similar to referral calls from EAPs or probation officers looking to get an individual started in treatment. ARISE provides an effective, swift, and cost‐efficient option for engaging substance abusers in treatment or self‐help. The more significant others involved, the greater the success of treatment engagement.

The Family and Drug Misuse: A Bibliography

Increasing interest in family factors in the genesis and maintenance of nonalcoholic drug misuse and dependence has resulted in the generation of a large number of publications, particularly since 1973. In addition, a growing number of investigators working in drug abuse areas which have not primarily been family focused, have begun to include more relevant family information in their research efforts. Thus the overall size of the body of literature has increased exponentially. In fact, at least 14 attempts to review or list this literature have been published to date. However, these have limitations, either because they are no longer up-to-date or because they only address circumscribed aspects of the field. The purpose of this paper will be to provide as complete and current a bibliographic listing as possible of the reports which have emerged in the area up through early 1978.

Drugs, Vietnam, and the Vietnam Veteran: An Overview

Highlights are presented on the issue of drug use among servicemen in Vietnam and its aftereffects. Two stages of Vietnam drug use are identified-a period of increasing marijuana use followed by the 1970 influx of highly potent heroin to which 1/5 of the enlisted troops were addicted at some time during their tour. The major contributing factors appear to be: (1) the need of troops in stressful combat situations for self-medication, escape, and hedonistic indulgence; (2) the relaxation of taboos against drug use in the United States; and (3) the availability of illicit drugs at low cost, which was apparently the result of profiteering by a number of South Vietnamese officials. Related to the above was the growing disenchantment with the war and the progressive deterioration in unit morale. These drugs are seen as serving many of the functions performed by alcohol in earlier millitary conflicts. There is no hard evidence that duty performance in Vietnam was seriously affected by drug use. Since 95% of those who were addicted to narcotics in Vietnam have not become readdicted, the situation does not appear to be as severe as originally supposed. Myths as to the persistence and intractibility of physiological narcotic addiction were dispelled. A major negative effect has been the difficulty that soldiers with less-than-honorable discharges due to drug abuse have had in obtaining jobs. Other long-term effects from drug use are less clear and are difficult to separate from the overall effects of the war.

Drug Use Surveys: Method and Madness*

There are many measurement problems inherent in the drug survey field, e.g., defining dosages and choosing user categories. This paper discusses the pros and cons of interview techniques, mailed questionnaires, and group-administered questionnaires. The particular importance of the social psychology of the data gathering process is noted, including the provision of anonymity for the respondents and the establishment of credibility for the investigators. Means for dealing with these and also for improving reliability and validity are discussed, along with reasons for performing a survey, the nature and intent of the questions asked, and some other political and ethical issues.

Engaging “Resistant” Families in Treatment. I. Getting the Drug Addict to Recruit His Family Members

For family therapy to have any effect on correcting drug problems, the family must obviously be involved. However, such families are often resistant to treatment. This paper describes techniques in working with the addicted member toward recruiting his family for therapy. A sequential approach to the initial interview is presented. Interview rationale, structure, and strategy are outlined, along with examples of common resistances and therapeutic counters. The model and techniques are potentially applicable to other types of symptomatic families as well.