Hi XXXXXXX

It is difficult to understand addiction problems solely based on the classical behavioural approach or in terms of a neuro-biological approach alone. This is because addiction is a very complex construct and therapists are increasingly realizing the significance of the family systems approach in the understanding, prevention and treatment of addictive disorders.

It is a well-known fact that the family of an ‘addict’ is closely intertwined with and significantly influencing his / her behaviours. In many cases, family dynamics itself is a major factor in promoting or perpetuating addictive behaviours. It has been found that there are a lot of inconsistent behaviours and a sense of lack of rules within the family system. Spouses can often engage in “enabling behaviours”. There can also be feelings of resentment, anger or shame and such negative feelings can greatly influence the addict’s behaviours. Therefore, it makes a lot of sense to incorporate the concepts of systems approach in the prevention and treatment of addiction disorders.

In the family systems approach itself, there are traditional models as well as contemporary models. The traditional models of systems therapy derive their roots from family therapy, or more precisely, the family systems therapy. The basic concept is that people with addiction problems should not be approached on individual level alone, but as people in close relationship and dynamically interacting with other members of the family system. The person abusing substances is regarded as a subsystem within the family system, whose behaviours have serious implications for the wider system. So, this approach involves a collection of therapeutic approaches that share a belief in the effectiveness of family level assessment and intervention. The familial relationships within this context are the points of therapeutic interest and intervention for the therapist.

The effectiveness of this approach in both treatment and prevention of addiction disorders has been proven. Controlled studies and reviews have shown that therapy engagement and retention rates for systems based treatments were superior to those achieved in standard forms of therapy. With regards to the preventive aspect, the systems approach has been found to be practical and beneficial. This involves early identification and prompt management of dysfunctional, ineffective family behaviours, which could be potential causes or triggers for an individual to develop addiction problems.

Recently, more contemporary models of this systems approach are being studied and advocated. These models view individuals with addiction problems as members of various groups in the social system as a whole. So, providing services and supports across a wide range of social systems, not only helps in the effective management of addiction disorders, but also prevents / reduces substance use problems and improves a wide range of outcomes related to health and social functioning.

While there are many styles or schools of thought and practice in the systems approach, practitioners should use the method that best benefit the client. Clinicians should also consider their comfort level and expertise in choosing a particular method.


Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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The family systems approach is inherently more complex more than non-family approaches because more people are involved.

While on some issues, therapists have an clear direction from professional codes of ethics, many issues fall under gray areas and ethical dilemas commonly arise.

Often unwilling clients are mandated to treatment by the family. In such cases, ethical issues arise involving the individuality or rights of the client.

Confidentiality is one of the most challenging issues when adopting the systems approach. To what extent do the client's problems need to be disclosed, to what level should other family members be involved in the decision-making process are all gray areas. Such delicate issues are not articulated within accessible guidelines, leaving therapists to work things out on their own. It is not uncommon for well-intentioned therapists to find themselves in breach of confidentiality by juggling too many agendas and finding themselves in a fix.

Individual family members may have their own goals and issues, which may or may not be entirely in the patients interest. So, identifying, focussing on and addressing the client's specific needs sometimes takes a backfoot when family dynamics comes into play.

A systems approach presumes that all family members have roughly equal contributions to the process and have equity in terms of power and control. But this may not be the case always. There are different levels of power and opportunity in families. One member can decide for the group, while others can be unfairly excluded from key decision making. Often there may be "power figures" in the family who may unduly tilt this balance, thereby jeopardizing the outcome of therapy, leading to ethical concerns.

Another important ethical issue is the therapists own values and personal beliefs regarding relationships and family. An inflexible view of belief or a cultural mismatch / incompetence may put at risk the very basic principles of this form of therapy.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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