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© 2003 Psychiatric Times. All rights reserved. Family Therapy Approaches to Alcoholismby Elizabeth Fried Ellen, L.I.C.S.W. Psychiatric Times September 1998 Vol. XV Issue 9 In the past 25 years, a number of treatment modalities have developed that incorporate increasingly sophisticated family therapy perspectives to help alcoholics and their families through the recovery process. Alcoholism is correlated with a myriad of relational ills, including increased rates of marital and family violence, inadequate parenting, sexual dysfunction, and general domestic discord (Rotunda et al., 1995; Murphy and O'Farrell, 1996; O'Farrell and Murphy, 1995), as well as with increased rates of divorce (O'Farrell, 1992). Alcoholism also takes a heavy financial toll on alcoholics and their families due to employment instability and legal system involvement (Rotunda et al., 1995). Research and clinical studies have indicated that marital and family problems may not only precipitate abusive drinking, but also can maintain a pattern of excessive drinking once it has developed and derail sobriety in abstinent alcoholics (O'Farrell, 1992). Researchers have noted higher levels of conflict, negativity and competitiveness, and lower-than-average levels of expressiveness, cohesion and conflict-resolution skills in alcoholic families. Researchers did not find significant differences in overall dysfunction between alcoholic families and nonalcoholic but distressed families (Rotunda and O'Farrell, 1997). "In one form or another, there is general acknowledgment that family issues are very important in alcohol and drug abuse in general," Peter Steinglass, M.D., told Psychiatric Times. Steinglass, who is the executive director of the Ackerman Institute for Family in New York City, added that the challenge is to translate that awareness into clinical practice. "The question is how to use the family effectively in the treatment venue." Traditional attempts at family inclusion largely have segregated treatment for the alcoholic and his or her family (Steinglass, 1994; O'Farrell, 1992; Rotunda and O'Farrell, 1997). Treatment oriented toward a family disease model generally treats alcoholics individually, while treatment for family members often revolves around education about alcoholism and referral to 12-step programs (such as Al-Anon) specifically geared toward family members. This theoretical approach posits that alcoholism is a progressive disease over which the alcoholic has no control and that sobriety is possible only through strict adherence to 12-step principles. In keeping with this model, family members are taught that they must learn to give up a sense of personal responsibility for the alcoholic family member's drinking and sobriety, and disengage from active efforts to affect abusive drinking patterns. Behavioral Couples Therapy Perhaps the best known model for the use of behavioral couples therapy (BCT) in the treatment of alcoholism is the Counseling for Alcoholics' Marriages (CALM) Project, a program run by the Harvard Medical School Department of Psychiatry at the Veterans Administration Medical Center in Brockton, Mass., and other Boston-area sites.