Introduction
The family of Martha Smith is introduced for analysis in the chosen case study. The woman had complex relationships with her first husband due to regular physical and emotional abuse, but, according to her words, her second husband, Antoine, has become “the best thing that’s ever happened.” However, recently, Antoine has begun drinking from time to time, resulting in behavioural changes within their family. A mental health assessment is required to understand how to help this family and predict the development of more serious problems. Family treatment concepts and goals should be properly identified to choose the most appropriate family support system and interventions in addiction work. The first part will contain the description of interactions and problems in Martha’s family. The second part will focus on therapeutic assessments and interventions for counsellors to help Antoine and Martha stabilize their family relationships. Antoine was referred to the counselling agency to discuss the current issues of substance use and suggest changes for the whole family.
Antoine’s Family: Genogram and Family Description
In the case, Antoine Adams (47 years) is the second husband of Martha Smith (37 years), who has two children, George (14 years) and Natalie (16 years), from the first marriage with Steven Spry. The couple has been in a strong and supportive relationship for the last ten years and has given birth to one child, John (10 years). Still, Martha experienced physical and emotional abuse when she was with Steven, which explains her decision to end those relationships and create a better living environment for her children.
Recently, Antoine has been arguing with Martha about his impaired driving charge, possible drinking problems, and hostile relationships with children. Natalie admits smoking pot at school is a common activity for youth. George prefers withdrawing from family activities when Antoine is at home. Martha, in her turn, thinks that Antoine does not have severe drinking problems and explains his concerns as an outcome of “bad luck.” The child protection agency was involved after the neighbour called the police and reported a lot of screaming at Martha’s house. Natalie’s and George’s family history has several critical issues: their granduncle died of a drug overdose, their grandmother was diagnosed with a suicide attempt, and their great-grandfather had liver cirrhosis and long-term alcohol abuse. Although no specific information about Antoine’s family is mentioned, his current family members have several risk factors contributing to their mental health changes. Thus, this family needs additional help and evaluation to deal with hostile relationships and suspected alcohol or other drug (AOD) abuse.
Level of Substance Abuse and Its Impact on the Family
Two guidelines are offered to assess the severity of Antoine’s substance use and its impact on the family. Patterson et al. (2009) created a general assessment plan consisting of five main steps: initial assessment, ruling out potential harm issues, possible substance abuse, and biological problems, and general psychosocial assessment. The Substance Abuse and Mental Health Services Administration (SAMHSA, 2005) recommends paying specific attention to such problems as criminal activity, joblessness, and child abuse/neglect before determining family therapeutic interventions. Thus, it is important not only to examine the environment but also to clarify the impact of the environment and other external factors. According to Felitti (2003), substance addiction is not a brain disease caused by poor genetics but an understandable or compulsive decision to use materials due to specific life experiences. It is not correct to use the absence of information about Antoine’s blood-related family as a reason for a limited or inappropriate diagnosis. The evaluation of the family situation will help to diagnose the client and reveal the severity level of his AOD abuse problem and the impact of additional factors.
The presenting problems that bring Antoine to therapy are hostile relationships with children and suspicion of alcohol abuse. Using the opinion of his wife, Martha, there is no drinking problem because he has few drinks after work. Still, the conflict with Natalie that ended with her storming out of the house cannot be ignored. The reasons for George’s unwillingness to cooperate with Antoine remain unclear because no attempted solutions have been made at the moment. A single initial problem of conflicting relationships between the father and children is identified.
The potential issues of harm include the history of family violence and abuse with the first husband, Steve. Both children observed Steven’s threats at a young age, which could explain their fears and desire to avoid a man who drinks. Substance abuse possibility is noticed in Natalie, who does not reject smoking pot. Antoine has currently developed drinking habits because of his suspended license and the impossibility of driving for work. The man worries about the risk of losing his income for the family. Biological and neurological factors are missing in Antoine’s history, while Natalie and George have relatives with severe mental health problems like alcohol abuse and suicidal attempts. Taking the Alcohol Use Disorders Identification Test (AUDIT), the Mental Status Exam (MSE), and the Short Mental Status Questionnaire is required for Antoine to detect biological changes in intellectual functioning, judgment, mood, and behaviour (Patterson et al., 2009). The man answers all questions clearly and gives explanations without aggression. The general psychosocial assessment reveals that the client is eager to cooperate and demonstrates good communicative skills and awareness of the situation.
At the same time, there are several external factors that might affect the evaluation of the situation. According to the SAMHSA’s guidelines (2005), the facts of criminal activity and joblessness play an important role. Although the man and his wife deny the impact of alcohol abuse on his behaviour, the current outcomes are evident. His behaviour is not normal because of his inability to make rational and correct decisions. Besides, the success of his treatment and recovery depends on cooperation with his significant others (SOs) (Miller et al., 2011). Two out of three children are not eager to support their step-father because of personal reasons and the history of abuse, which was not directly related to the client. In general, the severity of substance use in Antoine should be defined as medium because of his license problems and drinking habits. Still, family therapy with SOs is recommended because of the behaviours of elder children and the necessity to enhance mutual understanding and cooperation.
Theoretical Base of Family Approaches to Substance Abuse Treatment
In reviewing the case study about Martha’s family, substance abuse treatment is required for several purposes. First, the child protection agency recommended counselling for Antoine to predict the development of severe addiction disease because of his drinking habits. Second, the emotional concerns of Natalie and George cannot be ignored because both children demonstrate behavioural changes and family-related problems. McCrady et al. (2003) offered several models for working with families and understanding the characteristics of substance use disorders (SUDs). The family system model is the choice for a counsellor in Antoine’s case because it helps to observe the behaviour of alcoholics and their interactions with SOs (McCrady et al., 2003). According to this theoretical framework, alcohol may perform certain positive functions to distinguish the roles of each family member (McCrady et al., 2003). Family is a complex social system where individuals interact and provoke the necessary influence: what happens to one member happens to everyone (Boudreau, 2004). A family assessment is required for all members to identify the roots of alcohol and emotional problems (Hudak et al., 2005). In the current family, substance misuse is not only Antoine’s but Natalie’s problem.
The benefits of the chosen model are related to the possibility of improving family relationships. The supporters of this model address family lifestyles, rituals, and beliefs individually and collectively (McCrady et al., 2003). The acquisition or loss of roles explains the desire to use alcohol as a solution. Thus, attention to communication, a living environment, emotions, and health issues makes counsellors choose the family systems model. At the same time, some families cannot control their complaints, identify their traumatic triggers, or find a desire to participate in family therapy. These weaknesses affect the treatment process and prevent family connection sometimes. Martha’s family (blood relatives) has a history of abusive relationships, alcohol use disorders, and mental health problems. In Antoine’s case, no genetic information is identified, and his abilities to control alcohol use mostly depend on his attitudes and desire. The man has already faced some problems with his driving license and his wife’s children, who do not listen to him. Thus, the family systems model should help all family members to understand their concerns and improve their behaviours.
Family Treatment Concepts to Work with Martha’s Family
Cooperation with Martha and his family is not an easy task for a counsellor because multiple factors have to be taken into consideration. Regardless of the existing problems, the role of the family remains significant because they support various treatment roles and report change (Hendrickson et al., 2004). It is not enough to identify a problem, offer treatment, and observe positive health outcomes in a short period. There are many family treatment concepts that might determine and affect the course of recovery. Hendrickson et al. (2004) recommend family psychoeducation, support, and consultation, among others. Therapists should understand that each approach has its unique purpose and implementation mode. Consultations are necessary to obtain family history and current information; psychoeducation reveals the threats of substance abuse; support helps family members discuss their concerns (Hendrickson et al., 2004). Sometimes, the most damaged families succeed in therapeutic treatment when they have an expert to initiate communication and indicate problematic areas for discussion. The choice of these concepts can be explained by the necessity to invite all of Martha’s family members to therapy and stabilize their relationships.
Still, there are also many factors that can challenge family involvement in therapy. Such concepts as denial, shame, and multiple demands are not always visible but still critical in family therapy. Hendrickson et al. (2004) admit that some families are uninformed about their mental health diseases, while others deny the presence of problems that need interventions. Both adults and youth experience shame in admitting they need help or live in a family with its member having an addiction (Hendrickson et al., 2004). Finally, some therapists prefer to place several purposes in treatment, and not all family members are ready or eager to complete all tasks and get confused about multitasking. The evaluation of hidden concerns and individual tasks is chosen to help Martha’s family take a simple and clear way to improve their relationships. Antoine has to solve his alcohol abuse, Natalie should learn the threats of pot smoking, George needs to speak about his concerns, and Martha must stop avoiding problems and find solutions.
Treatment Goals and Considerations
The assessment of Antoine and his family’s needs proves the necessity of defining specific treatment goals and considerations and offering professional help. The relationships between the children and Antoine are tense because George does not want to cooperate, and Natalie overacts to Antoine’s interference with her life. Martha does not recognize drinking as a problem of her husband that might affect these relationships. Finally, John’s academic and athletic success does not require much attention, leading to parental neglect in his particular context. Thus, seven treatment goals should be considered:
- To welcome and inform all family members about the reasons for visiting the agency and understanding their basic problems. Family involvement has a “double benefit” for addiction work because it helps to reveal the challenge and offer social support (Skinner et al. 2014). Thus, all participants should comprehend why they are invited and what expectations should be identified.
- To initiate communication between all family members. As soon as all participants start talking under the expert’s supervision, they will be able to learn what causes problems in their family.
- To focus on the roles of Martha and Antoine in the family. When parents recognize the level of responsibility and the impact of their drinking habits on their children, they compare the outcomes and promote behavioural changes.
- To investigate Natalie’s behaviour and explain the shortages of pot smoking. Her impulsivity and the inability to support calm communication may be explained by the impact of substances on the system.
- To find out the reasons for George not cooperating with Antoine. Several questions and recommendations should be given to assure the boy trusts his parents and speak about his concerns aloud.
- To concentrate on John and his progress as a student and athlete. If the boy does provoke conflicts, it does not mean his role in the family can be diminished. Parents need to support each child, and more attention to John is expected.
- To find alternatives for Antoine’s drinking and reduce the use of alcohol. The family has had bad experiences in the past, affecting their current emotions and feelings. Still, their current mental health assessment is not severe, and communication, together with education, can stabilize the situation (Skinner et al. 2014). Common activities like picnics, games, or public visits may be offered to rally all family members.
Conclusion
The intention of the child protection agency to help Martha’s children and protect them against Antoine, whose drinking habits provoke concerns, has resulted in the necessity to work with the whole family. In fact, each member of this family has to be assessed to reveal the most effective therapeutic interventions. Martha should not neglect her husband’s drinking problems, while Antoine needs to understand his role as a head of the family where physical and emotional abuse has been a threat for some period. George and Natalie must learn not to compare Antoine with Steve because the former does not use power to solve conflicts. Finally, despite the absence of serious issues in John, his role in the family is critical, and his cooperation with his parents and siblings is required. Thus, family involvement in treating suspected AOD is the goal to be achieved in the preferred family systems model.
References
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