December 6, 2017

Network Therapy

Recovery from opioid addiction often involves two dangerous tendencies: the risk of relapse and drop out from treatment, and the tendency to “lose control” over drug use once relapse has occurred.[1] Patients at risk for relapse and loss of control often benefit from the involvement of extra social support in their treatment.

Strong social support is well known to be an important positive factor in addiction recovery. It is sometimes helpful to involve people who are important in a patient’s life in the treatment, in an approach called “network therapy.” On average, patients’ chosen “networks” can have 2 or more members and can be made up of spouses, significant others, peers, parents, and/or siblings. Network members, chosen by the patient and therapist together, become part of the therapist’s working team in the common cause of an individual’s recovery. For example, if a patient’s spouse and sibling are included in his/her “network,” they will both be aware of his/her medication schedule and therapy appointments and encourage him/her to stick with treatment. A patient’s “network” may attend occasional therapy sessions together with the patient and therapist.Network therapy is often combined with a referral to a 12-step program for extra social support.[2]

Network Therapy and MAT

Network therapy is very compatible with MAT. Opioid-dependent patients often experience occasional relapses when starting to use buprenorphine. Studies have shown that patients who involve at least one other family member or close friend in their initial office visits and care have a lower chance of relapsing to heroin or other opioid use during and after treatment with buprenorphine.[3]

Family Therapy

For some patients, family therapy can be helpful in recovering from opioid addiction. Family therapy strengthens relationships and enlists the support of family members in the patient’s recovery. Family members can learn more about substance abuse and recovery when they accompany the patient to certain therapy sessions, and then can be able to help reinforce at home what the patient learns in therapy about how to prevent relapse. Behavioral family counseling may involve aspects of cognitive-behavioral therapy, such as practice learning new skills and “homework” assignments, while also including the accountability and social support provided by family members who attended certain therapy sessions.

Studies have found that men entering MAT programs with naltrexone therapy were less likely to relapse and less likely to have drug-related legal and family problems one year after treatment when they participated in family behavioral therapy than when they received only individual therapy. In this study, families helped participants monitor daily doses of medication (though naltrexone doses are now available in an easier-to-use, once monthly dose).[4] Involving family in at least the beginning stages of therapy may be especially helpful for adolescents struggling with substance abuse. [5]

When a family member won’t get help

Spouses and other close family members of an individual struggling with substance abuse often deal with a lot of stress and emotional difficulties. When a substance abuser refuses to get help, family members may seek help on their own. 12-step groups often have programs for family members of substance abusers (e.g. NarcAnon). Coping skills therapy has also been shown to help family members deal with drug-related situations at home.[6]

CRAFT

Community Reinforcement and Family Therapy (CRAFT)

Another helpful strategy for family members, CRAFT teaches an addicted individual’s family how to support healthy behaviors and encourage sobriety without being drawn into conflicts related to drug use or its consequences. Family members can seek support from a CRAFT-trained therapist, even if the addicted individual is not yet ready to enter into treatment. Participants in a CRAFT program learn how to use positive communication skills to improve interactions and maximize their influence in their loved one’s life.

CRAFT teaches skills such as:

  • Understanding a loved one’s triggers to use substances
  • Positive communication strategies
  • Positive reinforcement strategies – rewarding non-using behavior
  • Problem-solving
  • Self-care
  • Domestic violence precautions[7]

[1]American Psychiatric Association. (2013). Substance Use Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[2] Galanter, M. (2008). Network Therapy. In M. Galanter & H. Kleber (Eds.), Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.
[3]Galanter, M., Dermatis, H., Glickman, L., et al. (2004). Network therapy: decreased secondary opioid use during buprenorphine maintenance. J Subst Abuse Treat 26. 313–318.

[4]Fals-Stewart, W., O’Farrell, T.J. (2003.) Behavioral family counseling and naltrexone for male opioid dependent patients. J Consul Clin Psychol 71. 432–442.

[5]Szapocznik, J., Perez-Vidal, A., Brickman, A.L., et al. (1988). Engaging adolescent drug abusers and their families in treatment: a strategic structural systems approach. J Consult Clin Psychol 56.552–557.

[6] O’Farrell, T. J., & Fals-Stewart, W. (2008). Family Therapy. In M. Galanter & H. Kleber (Eds.),Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.

[7] What is CRAFT. The Center for Motivation and Change. From: http://motivationandchange.com/outpatient-treatment/for-families/craft-overview. Accessed 10-1/14.