The treatment of people with addiction disorders is more effective when families are involved in the process. This is showed by many recent researches and also by our direct experience during the last 10 years. The main purpose of family involvement is the improvement of the alliance between care-givers and family: a program of psycho-educational training, made of a mix of information about the complexity of the phenomena and the teaching of communication skills, is requested to manage the change.
The following paper wants to describe the birth and development of the Parent Training , as a group approach, in our outpatient service.
The paper also wants to show the huge importance of building a good therapeutic relationship with parents in order to improve the healing of patients.
Why applying the Parent Training?
One of most important aims of Parent Training is helping parents to enhance their understanding of the addiction; this is mostly obtained thus improving a better communication with the children, staying closely in touch with the care-givers entitled to manage the rehab project.
In the outpatient service I work for, the family is one of the actor of the treatment since the beginning of the therapy; families are assessed, treated and involved in each step of the project. We are certain that a true change is impossible without the change of the social reference system, so we try to help the family, together with the patient.
Patients are mostly treated with psychotherapy, pharmaceuticals and social skill groups.
Families are involved with interviews, family therapy and PT groups. Our team is made of medical doctors, psychologists, nurses and social workers; we work tightly with weekly meetings and daily communications. We are also connected through computerized medical records, to make a very close project and to test day after day what we are doing. So we can say that family is one of the main actor of change toward healing.
We started the Pt groups in 1993.
At the beginning they were so naïve, but over 20–years-of experience and study, gave us an effective pattern ,able to improve the family communication skills and the knowledge about drugsor other kinds of addiction . The PT groups were used mostly in our daily rehab centre, to let the parents know the rules of the community
Groups were composed of 15/20 people, attending 6 meetings, of a couple of hours each, leaded by a social worker and an educator.
Till 2002, we had 73 people taking part to the PT groups, an average of 10 a year.
Since 2004, we have been studying new strategies to include in the program the parents of the outpatient service; so we had also to modify the program of the group and the structure of the single meeting. During these years we assisted also to a change of clinical and cultural epistemology: the family becomes an active protagonist of the therapy, instead of being the main reason of the substance abuse by one of its members.
Until 2004, we used to include in the groups different relatives as wives, sons, daughters, nephews and so on. But after a supervision of the PT groups, we decided to include only the parents, not only biological ones, but everyone playing a parental role with the patient.
The general rules and contents of the PT groups are not substantially changed: they continue to be psycho-educational groups; they are focused on learning the right assertive communication, the communication tricks to come out of a poisoned relationship caused by the presence of addiction disorder; PT’s goal is that of recovering an effective educational role of parents during the treatment.
We are a little team: a social worker, a psychologist, an educator and a psychologist supervisor.
The psychologist, the educator and the social worker can be leader, co-leader or observer in the group, it depends on the matter treated in the session. They fix a program based on the features of the group components, trying to keep to the general aim of PTs as far as possible.
Parents are invited to meet the individual care-givers operating in our service or in other services working in the surrounding districts.
When parents are selected, they are called for an interview which is performed by one of the members of the Pt Team (it depends on staff availability) with the aim to gain information.
Data are useful to better schedule the program of Pt and to best customize the topics of sessions, according to the family features of a specific group.
The standard program of Parent training envisages 8 meetings on monthly basis, coping with the follow topics:
The family alliance with the therapists and the importance of it
The bio-psycho- social theory of addiction disease
The behaviour observation and the way to learn this ability
The assertive communication, the way to reach it and the advantages to use it
The validation and the general techniques to improve functional behaviours
The techniques to stop negative behaviours
We use different tools in each session, it depends on the matter dealt with, for instance: frontal lesson, brain storming, role playing, micro group work, free guided discussion, mindfulness and so on. Each session ends with homework to be done before attending next session.
Before next session, the team organizes a meeting to make a check and a schedule.
We discuss within the group dynamics, we compare ourselves about the meeting management, we analyse the observations that members make during the session, we examine the Likert scale of agreement given at the end of each session. Higher is the score, better is group evaluation. During the last session we usually decide a date for each parent‘s individual feedback interview. We also identify the date of the group follow up over three months.
The individual feed-back is used to share with parents if the aim planned at the beginning of the experience has been reached.
The group follow up is intended to verify how things have changed and also to collect suggestions for the next experience.
The next step is to forward the results of treatment to colleagues that addressed the parents to our service; the outcome reveals if goals have been met or not. .
We use the PDCA model criteria (plan, do check act) to schedule the next group, because we exploit the experience and we try to transform it in good practice, with great satisfaction for us. We also identify the details of the next session.
Roles and competences
In our methodology a definite group leader does not exist, because this role depends on the topics of the session and on the opportunities to intervene in a certain situation or in a particular dynamic in the group. Each session has a leader, a co-leader and sometimes an observer . In the past, the team work was composed of three therapists, a psychologist (cbt trained) a social worker specialized in family treatment and group leading , an educator working in a daily rehab centre.
Since last group, there are two leaders: a psychologist and a Social worker, and we noted that things are evolving at best.
We have to be really flexible, competent in assertive method, in behavioural cognitive theory and in mindfulness.
Much experience in family treatment is needed to be able to head a so complicated group, where we deeply enter in relational couple mechanisms. Each group we lead need also to be lucky!
We have to help parents to overcome the sense of fault and failure caused by the illness of the relative involved; we have to be able to stimulate the will to change towards a better way of communication.
We teach the problem solving technique; we also suggest the best way to validate the patients and all the family components.
A further skill for the group leaders is to be able to be a “model” taking active part into the “role playing” exercises.
In our opinion the Pt is extremely ethic because it implements a unique and full program for families.
The leaders have also the aim of prompting the component awareness; this way parents become more effective through the sessions in managing their addicted relative.
We can talk of Parent training like an “evidence based instrument for addiction therapy.
We believe that the Parent training therapeutic strategy is a precious tool to improve the addiction treatment: it makes to give the right and scientific info about the features of addiction disease easier.
It is also a good way to teach effective strategies to help the healing of patients.
The most improved skills, evaluated at the end of the group sessions, are those related to communication and to the ability to manage the relational conflicts.
The colleagues working for others services and sending us families give us this kind of feed-back.
So, we are still here to recommend our groups, year after year, the good results we reached. This year, we have a group of 20 people, which is a very high number, but actually this is an indicator of interest and effectiveness.
- t is the acronym of “Servizio per le tossicodipendenze” , it is the outpatient unity for the treatment of addiction . It is a public service of the Italian welfare system . In this unit a multi professional team works together to overcome the addiction problems .
Azrrin N.H., Acierno R., Kogan E.S., Donohue V.A., Besalelel V.A., Mcmahon P.T. (1995); Follow up results of Supportive versus Behavioral Therapy for illicit drug use; Behavioural Research and Therapy, Vol 34, 1, 41-46.
Briesmeister J.M., Shaefer C.E. (1998); Handbook of Parent Training; New York: Wiley.
Brofenbrenner U. (1986); Ecologia dello sviluppo umano; Bologna: Il Mulino.
Cirillo S., Berrini, R., Cambiaso, G., Mazza, R. (1996); La famiglia del tossicodipendente; Milano: Raffaello Cortina Editore.
Copello A. & Orforf J. (2002); Addiction and the family: is it time for services to take notice of the evidence?; Addiction, 97, 1361-1363.
Copello A., Orford J., Velleman R., & Al. (2000); Methods for reducing alcohol and drug related family harm in non-specialist settings; Journal of Mental Health, 9(3), 329-343.
Fergusson D.M. & Horwood L.J. (1997); Early onset cannabis use and psychosocial adjustment in young adults; Addiction, 92(3), 279-296.
Hawkins J., Catalano R., Miller J. (1992); Risk and protective factors for alcohol and other problems in adolescence and early adulthood: Implications for substance abuse prevention; Psychological Bullettin; 112, 64-105.
Kendler K.S. Prescott C.A. (1998); Cannabis use, abuse, and dependence in a population-based sample of female twins; American Journal of Psychiatry, 155 (8), 1016-1022.
Kendler K.S., Karkowski L.M., Prescott C.A. (1999); Causal relationship between stressful life events and the onset of major depression; American Journal of Psychiatry; 156(6), 837-841.
Liddle H. (2004); Family-based therapies for adolescent alcohol and drug use: research contributions and future research needs; Addiction, 99s(2), 76-92.
Liddle, H.A., Dakof, G.A. & Al. (2001); Multidimensional family therapy for adolescent drug abuse: results of a randomised clinical trial; The American Journal of Drug and Alcohol Abuse, 27(4), 651-688.
Mammana G. (1993); Il piacere dell’identità; Foggia: DI. TE. Edizioni scientifiche.
Marlatt G.A., VandenBos G.R. (1997); Additive behaviors: Readings on etiology, prevention and treatment; Washintong DC: American Psychological Association.
Meyers R.J., Miller W.R., Hill, D.E. & Tonigan J.S. (1999); Community Reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment; Journal of Substance Abuse; 10, 1-18.
Miller R.W. 2003; A collaborative approach to working with family, Addiction, 98, 5-6.
Miller W.R., Meyers R.J. e Tonigan J.S. (1999); Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members; Journal of Consulting and Clinical Psycology; 67, 688-697.
True W., Xian H., Scherrer J. & Al. (1999); Common genetic vulnerability for nicotine and alcohol dependence; Archives of General Psychiatry; 56, 655-661.
Tsuang M.T., Lyons M.G., Eisen S. & Al. (1998); Co.occurence of abuse of different drugs in men: The role of drug specific and shared vulnerabilities; Archives of General Psychiatry; 55(11), 967-972.
Zanusso G., Davanzo A.A., Michelon M. (1998); Comportamenti familiari nella tossicodipendenza. Strumenti per cambiare.; Milano: Franco Angeli.
Zanusso G., Giannantonio M. (1996); La riabilitazione psicologica del tossicodipendente: la Comunità terapeutica; Milano: Franco Angeli.
Dott.ssa Rosita Mazzi
I am Rosita Mazzi a Social Worker specialized in family therapy
and Drug addiction treatment.
First degree in Social Work taken at Pisa University in 1984
Second degree in Sociology taken at Bologna University in 1991.
Job title: Social worker
Agency: public health service named “Ser.t “in Ausl of Reggio Emilia,Italy
I have been employed in this agency since 1989.
My e-mail addresses: Rosita.firstname.lastname@example.org or
I am specialized in drugs addiction, especially in the work with families of the patients in On 2014 I came in USA, invited from Temple University Harrisburg Pa and Nasw Pensilvania chapter: I made a lecture titled: By walking we make the path: ra research about families treatment in addiction disease.
I built this way a symbolic bridge between American and Italian social workers . I am still in touch with some of American collegaues with whom I share contents about our job.
Dott.sa Chiara Panciroli
I am a psychotherapist , i took my degree in Padova university, Italy on 2003 .
I am specialized in cognitive behavioral treatment .
I work in a a private service where I treat different kind of patients .
I am also . supervisor for teachers in public school,
Supervisor for colleagues
supervisor and expert trainer for several kind of professionals.
I am also a school psychologist
I work since 2003 with the public service for addiction treatment , especially for parent training groups.
Statement of permission:
The article is original, has not been published elsewhere, and is not under consideration by any other publication or electronic medium.
Rosita Mazzi Scandiano August 4th 2017
Our authors want to hear from you! Click to leave a comment