Alcohol Problems: Identification and Intervention
Communication Decision-making Intimacy Finances Sexual incompatibility Management of family responsibilities Child behavior problems Parenting
If one person is drinking heavily, that drinking is likely to be contributing to the family’s presenting problems. Your challenge is to understand how the drinking may be playing a role in the presenting problems, and to articulate this understanding to the family. For example: Therapist: “Although I am hearing, loud and clear, that you don’t want to talk about your drinking, I am concerned that it may somehow be connected with the concerns the two of you came in with. You both said that you wanted help in becoming better parents, and that you were having too many arguments about discipline and rules. From what you’ve been telling me, I have a hunch that the different feelings you each have about John’s drinking and his time away from the house may be affecting your ability to come to agreement about rules for your kids.” Even if drinking is not centrally related to the problems that brought a family into treatment, one family member’s drinking might be creating barriers to successful progress in treatment. You may explain that you are raising drinking as an issue because of problems encountered in progressing in treatment. Noncompliance with homework assignments, observing that specific types of assignments fall apart (e.g., having a couple go out together, or discuss a problem during the evening), or feeling bewildered about aspects of a family’s functioning, are all clues that the drinking might be a contributing factor. Feedback about the linkages between drinking and lack of progress in treatment also can be used to introduce the topic of alcohol into therapy. Applying Principles of Choice The principle of “choice” becomes prominent as alcohol issues are explored more fully, but even in the initial discussion, you must keep this principle in mind. After first discussing drinking, you can give the family a choice about the degree to which the topic is pursued in any one session. You also can be clear that discussing drinking is not
22