Towards an Integrated Approach to a Family Intervention for Co‐occurring Substance Abuse and Schizophrenia

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate.     

Influence of a Family‐Focused Substance Use Preventive Intervention on Growth in Adolescent Depressive Symptoms

Preparing for the Drug Free Years (PDFY) is a preventive intervention that targets parenting behaviors, family interaction patterns, and adolescent substance use, factors that have been shown to predict depression among teenagers. Effects of PDFY on trajectories of self‐reported adolescent depressive symptoms from 6th through 12th grade were examined. Latent growth curve modeling was used to analyze data from 429 rural adolescents from schools assigned randomly to an intervention or a control condition. PDFY reduced the rate of increase in depressive symptoms during adolescence. Mediation of the intervention effect on depressive symptoms through reduced polysubstance use was tested; the indirect effect was only marginally significant. Findings have implications for understanding the relationship between adolescent depressive symptoms and substance use, and for preventing these outcomes.     

Integrated Substance Abuse and Child Welfare Services for Women: A Progress Review

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.     

Substance Abuse among African-American Children: A Developmental Framework for Identifying Intervention Strategies

Abstract

Substance abuse has devastating effects on the lives of African-American children and adolescents who are both directly and indirectly victims of this problem. This article discusses child and adolescent substance abuse from a psychosocial developmental perspective within an Africentric paradigm. The authors explore contributing and intervention factors related to substance abuse that impact developmental milestones. They delineate preventive tactics for addressing the problem of substance abuse and delineate implications for social work practice.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Treatment For Suicidal Thoughts and Behavior: A Review of Family‐Based Interventions

The purpose of this article is to review the scientific evidence on the effects of family based interventions for suicidal ideation and behavior. We conducted an extensive search of electronic databases using a comprehensive search strategy. This search resulted in 16 studies that tested 13 interventions for treating suicidal ideation and behavior using family based interventions. Of the interventions identified, three yielded an overall improvement in suicidal ideation and behavior while an additional three interventions produced partial improvement in mental health symptoms. These studies targeted suicidal ideation and behavior in youth or adolescents while no studies examined family interventions for adults with suicidal ideation and behavior. The limitations of these studies and the need for additional research are examined.     

Seeking to Engage ‘Hard‐to‐Reach’ Families: Towards a Transferable Model of Intervention

This paper describes an exploratory evaluation of the Peers Early Education Partnership ‘Room to Play’, an innovative and experimental ‘drop‐in’ service seeking to attract and engage ‘hard‐to‐reach’ families in one of the most deprived areas of a Midlands city. Located in a shop unit of a busy community shopping centre, it offers play and learning activities for children, and provides opportunities for parents to talk to practitioners in a neutral and supportive environment. Through a mixed methods design, the authors attempted to document the core components of a potential transferable model of intervention, within challenging research constraints.     

The Career‐O‐Gram: A Postmodern Career Intervention

The authors examine the usefulness of postmodernism in career counseling. Specifically, a case is made for broadening career counseling theories and techniques to feature the contextual influences inherent in each individual's unique career history. A career intervention, titled the Career‐O‐Gram, is introduced as a tool for exploring contextual influences on career development. A case study is presented to demonstrate the application of the Career‐O‐Gram.     

Timing Preferences for Women’s Family‐Life Transitions: Intergenerational Transmission Among Migrants and Dutch

This study examines the transmission of preferences regarding the timing of family‐life transitions of women among migrant and native Dutch families. We study how and to what extent parental preferences, migrant origin, and family characteristics affect the child’s timing preferences. We use parent and child data (N= 1,290) from the Netherlands Kinship Panel Study (2002, 2003) and the Social Position and Provisions Ethnic Minorities Survey (2002). Regression analyses reveal that parental timing preferences regarding family‐life transitions are strongly associated with the timing preferences of their children. Analyses also show that these preferences strongly vary by migrant origin, educational level, and religious involvement. The process of intergenerational transmission, however, is found to be very similar among migrants and Dutch.     

In and Out of Enactments: A Relational Perspective on the Short- and Long-term Treatment of Substance Abuse

This paper examines the contribution of a psychodynamic relational perspective to the treatment of substance abuse. Two cases of different lengths are presented to illustrate the therapeutic factors that contributed to successful recovery and long-term abstinence. Follow-up information on the successful outcome of both cases was available 7 years after the initiation of treatment. We discuss the critical role that the experience and processing of enactments played in both cases. Carol Ganzer, PhD, MSW, LCSW is on the faculty of the Institute for Clinical Social Work. She is a past president of the Chicago Association for Psychoanalytic Psychology and serves on the editorial boards of Clinical Social Work Journal and Beyond the Couch. She maintains an independent practice of psychotherapy and consultation in Chicago. Eric D. Ornstein, MA, LCSW, is a Clinical Associate Professor at Jane Addams College of Social Work, University of Illinois at Chicago. He is a field liaison in the College’s Field Division and currently teaches crisis intervention and field instruction workshops. He is on the Board of the Illinois Society for Clinical Social Work and Chair of their Education Committee.     

The Effects of a Family Systems Intervention on Co‐Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co‐occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8–16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co‐occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post‐baseline, and from the comorbid class at baseline to the internalizing class at 18 months post‐baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes.     

Towards an Integrated Understanding of Critical Upheavals: From Crisis to Contentious Politics to “All‐Encompassing Contentious Crisis”

This article advances a general, comprehensive approach around the concept of “all‐encompassing contentious crisis” to studying critical upheavals and their historical impacts. This interpretative framework aims to reorient how we think about extraordinary events by providing a rubric for converting the scheme of seemingly unrelated destructive upheavals into an integrative model of constructive development. It appropriates the theoretical insights developed in political science and sociology to enrich historical inquiry and, furthermore, to turn crisis into a more precise and full‐fledged model of development. It is hoped that this synthesized model can not only help to lessen the barrier between historians and social scientists but also bridge the gap between event and structure in explaining historical change.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

INCOME: A Culturally Inclusive and Disability‐Sensitive Framework for Organizing Career Development Concepts and Interventions

This article demonstrates how the INCOME model (S. Beveridge, S. Heller Craddock, J. Liesener, M. Stapleton, & D. Hershenson, 2002; D. Hershenson & J. Liesener, 2003), developed with special reference to persons with disabilities and from diverse backgrounds, provides a framework for organizing, selecting, and implementing concepts from career theories and career intervention practices. Rather than using stages or processes typical of existing career development theories, this framework uses J. E. Helms's (1995) multicultural construct of statuses, which may occur or recur in any order or combination. The 6 career statuses in the INCOME framework, which occur across demographic and cultural groups, are Imagining, iNforming, Choosing, Obtaining, Maintaining, and Exiting.     

Adolescents in Treatment: Effects of Parental Substance Abuse on Treatment Entry Characteristics and Outcomes

SUMMARY

Research strongly supports an increased risk of substance use disorders among the adolescent children of addicted parents. However, little documentation exists of how these adolescents fare when they present for treatment. This article uses data taken from a two-state study on the effects of adolescent substance abuse treatment to examine the characteristics of adolescents with substance-abusing parents and their outcomes following an episode of outpatient treatment. Although such adolescents enter treatment with greater problem severity in a range of areas, outcomes appear similar to adolescents with no substance-abusing parents. The impact of family and individual counseling on outcomes was also examined, demonstrating mixed results for adolescents with substance-abusing parents.     

A Randomized Controlled Trial Assessing the Efficacy of Cognitive Behavioral Therapy for Substance‐Dependent Domestic Violence Offenders: An Integrated Substance Abuse‐Domestic Violence Treatment Approach (SADV)

The current study evaluates a therapy for substance‐dependent perpetrators of partner violence. Sixty‐three males arrested for partner violence within the past year were randomized to a cognitive behavioral substance abuse‐domestic violence (SADV; n = 29) or a drug counseling (DC; n = 34) condition. Seventy percent of offenders completed eight core sessions with no differences between SADV and DC conditions in the amount of substance or aggression at pretreatment. SADV participants had fewer cocaine‐positive toxicology screens and breathalyzer results during treatment, were less likely to engage in aggressive behavior proximal to a drinking episode, and reported fewer episodes of violence than DC participants at posttreatment follow‐up. SADV shows promise in decreasing addiction and partner violence among substance‐dependent male offenders.