Family Involvement and Sustained Recovery in Substance Abuse

Abstract

Purpose

Adolescent substance use is an ongoing issue in the world around us. Based on the literature reviewed for this research proposal, it would appear that family involvement can have implications on whether patients are successful after treatment has been completed (Bertrand, Bertrand, Richer, Brunelle, Beaudoin, Lemieux, & Menard, 2013; Liddle, Dakof, Turner, Henderson, & Greenbaum, 2013; Doumas, King, Stallworth, Peterson, & Lundquist, 2015; Mason, Haggerty, Fleming, et al., 2012; Rulison, Feinberg, Gest, & Osgood, 2015; Ryzin & Dishion, 2012; Henderson, Wevodau, Henderson, Colbourn, Gharagozloo, North, & Lotts, 2016). Various interventions have been used to study this including inpatient (Liddle, et al, 2013; Robbins, Feaster, Horigian, Rohrbaugh, Shoham, Bachrach, … Szapocznik, 2011) and outpatient programs (Doumas, King, Stallworth, Peterson, & Lundquist, 2015; Mason, et al., 2012; Henderson, et al., 2016; Ryzin & Dishion, 2012; Rulison, Feinberg, Gest, & Osgood, 2015).

Method

This research study will take place in working with the Area Substance Abuse Council (ASAC) in Cedar Rapids, Iowa. They have an inpatient program for substance use with adolescents age 13 to 17. Currently, they do not have a specific requirement for family involvement in their treatment (CD+ Youth Residential, 2016). This study would implement family therapy to a group of patients and their families to see if there are any significant changes in the ability for patients to maintain their sobriety after treatment versus treatment as usual and a control group waiting for therapy.

The major limitations to this study are with attrition and generalization. There is no certainty how long people will remain in treatment, who may leave before others and what impact the differences in treatment may have. Also, it will be difficult to generalize this information to a particular population as it takes place in a small agency in Iowa, limiting the populations that may be generalizable.

The ethical issues for this study revolve around the population that is being worked with. The population contains two special groups in adolescents as well as substance use. This need to be taken into consideration and looked upon carefully. There are particular steps that will need to be put into place to make sure that the special populations are taken care of and managed appropriately.

Implications

If this study at ASAC adds to the literature that has already been produced, it is possible that it could be built off to help other programs that are like ASAC. They can then build requirements for family involvement in treatment by potentially helping more patients maintain recovery with changes in their environmental and family systems.

Introduction

Adolescent substance use is becoming more widespread throughout the nation. There are a number of adolescents that are seeking out drugs to get “high” or not feel the effects of situations in their lives. Some of these adolescents are receiving treatment in random facilities throughout the nation. It does seem that these facilities are not focused on the same actions in their treatment. Some of them share various evidence-based practices, while others have their own thread of treatment and actions. It seems that there are agencies that take into account the family factor in treatment, whereas others chose not to make this an area of focus. With these differences, it would be beneficial if they worked together to form a set of treatment that works across the board as advances that are made can have an impact on all of those that are involved.

It has been questioned whether or not family involvement in treatment can cause a difference in recovery for adolescents and can impact them to make the changes that they need to make. This research proposal would allow for the research to be done to see what the difference is in recovery for those that have family involved in their treatment, and those that continue with business as usual. If it is determined that family involvement creates a significant change for adolescents and substance use, then it may be a factor that can be added to substance abuse treatment across the board to allow for them to make successful changes. More specifically, this will be evaluated with a specific agency in Iowa. This agency currently requires little involvement from the family in their treatment actions. If this study concludes the positive outcome of family involvement, it could change the way that the agency completes their program overall.

While there has been research completed on this topic, it has not been done in this region or within this agency. This study will evaluate a program and the impact that family involvement can bring into it. This will create more backing for the studies that have already been produced and examine it with this treatment program. The combination of both of these allows for changes to made to present more possible success with adolescents and their recovery. If this study is fulfilled as expected, it would be the potential for big advances in adolescent substance abuse treatment as it could prevent them from continuing to be addicts in society, allowing them to live to their full potential.

Literature Review

Family Involvement in Treatment

Adolescents face various struggles every day. Some of these struggles, such as substance use and behavioral struggles, lead them to being placed in a treatment setting. Today’s youth are living in a world where illegal substances are more accessible. Therefore, experimentation of these substances is also becoming more common. These substances include marijuana, alcohol, opiates, psychedelic mushrooms, prescription medications, and methamphetamines to name a few (Schlauch, et al., 2013). When an adolescent finds themselves addicted and losing themselves within the addiction, they often find themselves in some form of treatment, outpatient or inpatient. Both of these often require individual counseling and groups for the patient. However, family involvement is not a consistent requirement for substance use treatment. It has been proven that family factors have an impact on adolescent behaviors as well as continues to be an active system for patient’s before, during and after treatment (Schlauch, et al., 2013; Bertrand, et al., 2013; Liddle, et al., 2008). Since the family system is one that continues while the patient works to recreate the rest of their systems, it can be of great importance for the family to work on their own interactions to assist the adolescent (Winters, et al., 2011). Overall, it seems that family involvement could potentially increase the rate of successful discharge from treatment and sustained abstinence after treatment (Bertrand, et al., 2013; Liddle, et al., 2008). Since family involvement may vary depending on the treatment requested, the intensity of their involvement as well as the consistency, it would be essential to evaluate what has worked in various studies.

Services at ASAC

When adolescents enter substance abuse treatment at the Area Substance Abuse Council, they can enter at either the outpatient or the inpatient levels. Each of them has a different set of requirements that need to be met. At the outpatient level, a patient is expected to attend group once a week and individual sessions as requested by their counselor. However, at inpatient, the interactions are much more intense. The patient is expected to live on the Area Substance Abuse Council campus with other adolescents for a period of 90 days, on average. During this time, they engage in substance abuse treatment groups, behavior treatment groups, school, and one family treatment group a week. The family is not obligated to attend this group. They are often only obligated to come and take their children for appointments and occasionally take their child on day passes or visits (CD+ Youth Residential, 2016). The current lack of requirements for family involvement makes one ponder if there would be an increase in sustained recovery rates after treatment with more family involvement.

An area of treatment that is often a requirement for the patient is individual counseling. Often times, the counselor meets with their patient on a regular basis to talk about their use, their relationships, setting boundaries, and relapse prevention. Another area of focus is on the patient’s cognitive thoughts. Cognitive Behavioral Therapy (CBT) is a form of counseling that is often used to evaluate one’s mind frame. When working with addiction, CBT is how one works to fight the thoughts that their addiction might give as they work on sobriety as well as their own thoughts about why they need to use (Liddle, et al., 2013). Through this evaluation, one learns how to continue without the use of substances. In the study by Liddle, et al. (2013), they evaluated CBT therapy and found that often the therapy is good for the person while they are in treatment. However, the results are not sustained for a period of time after treatment. While CBT is essential for adolescents to use while in treatment, it is also important for the family to learn about how the adolescent thinks, what their triggers are and the steps that they can take to work with the adolescent on relapse prevention. This is where the Area Substance Abuse Council incorporates their family group. The topics of these groups revolve around the way the adolescent thinks, identifying triggers and high risk situations and how addiction works overall (CD+ Youth Residential, 2016).  With both the individual and the family learning about cognitive thoughts of the adolescent, it allows them to have the support to work on their struggles when they are home as the family would be familiar with the process.

Different Types of Family Treatment

In the studies that were used for this literature review, Multidimensional Family Therapy (MDFT) (Liddle, et al, 2013), Brief Strategic Family Therapy (BSFT) (Robbins, Feaster, Horigian, Rohrbaugh, Shoham, Bachrach, … Szapocznik, 2011), and community projects such as Parent Project (Doumas, King, Stallworth, Peterson, & Lundquist, 2015), Project Hope (Mason, Haggerty, Fleming, et al., 2012), Adolescent Community Reinforcement Approach (Henderson, Wevodau, Henderson, Colbourn, Gharagozloo, North, & Lotts, 2016), Family Check-up (Ryzin & Dishion, 2012), and Strengthening Families (Rulison, Feinberg, Gest, & Osgood, 2015) were all various forms of family involvement used in treatment aspects. MDFT and BSFT required families meeting for a certain period of time to discuss and process areas of family relations, interactions, involvement, parental monitoring, and warmth in a therapeutic setting (Robbins, et al, 2011; Liddle, et al., 2013). The community resources of Parent Project (Doumas, et al., 2015), Project Hope (Mason, et al., 2012), Adolescent Community Reinforcement Approach (Henderson, et al., 2016), Family Check-up (Ryzin & Dishion, 2012), and Strengthening Families (Rulison, et al., 2015) are all interventions that are set up in the community to work on parent-children relationships in various ways.

Parental monitoring and parental warmth, have been highly recognized to impact patients that are in treatment. The Parent Project (Doumas, et al., 2015), MDFT (Liddle, et al., 2013), BFST (Robbins, et al., 2011), Project Hope (Mason, et al., 2012), and Family Check-up (Ryzin & Dishion, 2012) all focus on parental monitoring and warmth. Each of these studies also produced information regarding how the intervention led to a decrease in substance use with adolescents in all forms of treatment (Doumas, et al., 2015; Liddle, et al., 2013; Robbins, et al., 2011; Mason, et al., 2012; Ryzin & Dishion, 2012).  Both areas involve attention being paid to the child to let them know what is going on, setting boundaries and expectations for them, and allowing them to understand that you are there if they need you (Bertrand, et al., 2013). The above-mentioned progress all demonstrated works to increase positive interactions and guide the parents to better understand what changes can be made on their end to assist the adolescent in treatment, rather than enable their use (Doumas, et al., 2015; Liddle, et al., 2013; Robbins, et al., 2011; Mason, et al., 2012; Ryzin & Dishion, 2012).

From the articles in review, it is apparent that there are various ways that family involvement can provide benefits to the clients during treatment and show a decrease in the amount of substances that are used (Bertrand, et al., 2013; Liddle, et al., 2013; Doumas, et al., 2015; Mason, et al., 2012; Rulison, et al., 2015; Ryzin & Dishion, 2012; Henderson, et al., 2016). Through the studies that were read and focused on, Liddle et al (2013) produces the most information about sustained recovery and family involvement in treatment. This study produces information showing a decrease in substance use and long-term sustained recovery. The long-term effects of MDFT lead one to evaluate the involvement of family over time. Since MDFT showed a better capability to sustain lower substance use, it would be apparent that family receiving therapy at the same time as the patient allows for a change in the system as a whole, including the family system (Liddle, et al., 2013; Winters, Botzet, & Fahnhorst, 2011).

Negative Results of Family Treatment

While most of the articles that were reviewed presented positive effects on cutting down substance use with adolescents, there were also two articles that did not show this (Milburn, Iribarren, Rice, Lightfoot, Solorio, Rotheram-Borus,. . . Duan, 2012; Jalling, Bodin, Romelsjo, Kallmen, Durbeej, & Tengstrom, 2016). One of these studies evaluated a project known as STRIVE. This project worked with families in their home and their adolescent runaways to try to reunite them. They specifically focused on conflict resolution, problem-solving and expressing emotions. While the substance use overall appeared to go down, the results also show an increase in the use of marijuana (Milburn, et al., 2012).

The other study that was evaluated took place in Sweden and looked at two programs called Parent Steps and Comet 12-18 (Jalling, et al, 2016). Both of these programs were intervention programs to help stop adolescents and their antisocial behavior. However, neither study produced positive results or significant ones. They actually stated that the difference was an increase in drug use after the programs were put into place (Jalling, et al, 2016). Both studies gave reasoning to support these findings and why they may not have come out the way they expected including the implementation of the programs in Sweden (Jalling, et al, 2016) and the difficulty in recruitment for the study on STRIVE (Milburn, et al., 2012). Time is an area that both studies address as being a possible issue.

One study, (Jalling, et al., (2016) states that the research time period may not be long enough to see any changes progress in the study. The other study (Milburn, et al., 2012) defines that there might not be enough time working with the family and the clients in this intervention. In Jalling, et al, (2016), the intervention itself may be the reasoning for the lack of results as it is based on working with a different population than substance use. Whether it be time, the intervention, or another circumstance that lead to the lack of positive results, they still present that there may be other areas to address and change to see positive results.

There are other areas that are evaluated by the other studies that were researched. These areas include the difference in cost for family therapy versus individual counseling (Morgan, Crane, Moore, & Eggett, 2012), the barriers that those who have been in residential treatment feel that they had (Gogel, Cavaleri, Gardin, & Wisdom, 2011), and the idea of early intervention (Jalling, et al, 2016; Spoth, et al., 2014). It appears that the cost of family therapy is often less than that of individual therapy (Morgan, et al., 2012). With the information gathered from the majority of studies, it would be a good assumption that requiring more family therapy may actually lead to treatment costing less overall. This would be another added benefit for those that work with their adolescents in the treatment process (Morgan, et al., 2012). When adolescents who had previously been in residential treatment were interviewed about barriers, they identified that they often felt that their family didn’t realize how much impact they actually had on their recovery (Gogel, et al., 2011). If family involvement is not presented as a pertinent factor that the youth want for treatment, then the family may not feel the need to be involved as much in their child’s treatment (Gogel, et al., 2011).

Lastly, two of the studies that were reviewed identify the necessity for early intervention in situations to help children curb antisocial actions, delinquent behaviors, and the potential for substance use. (Jalling, et al, 2016) identifies that the program didn’t appear to work with adolescents, but it had previously shown beneficial to the younger children in the program. The same was found in (Spoth, et al., 2014) where they worked with middle schoolers on interventions in life skills and Strengthening Families. The middle schoolers were then less likely to get involved with substance use and delinquent behaviors (Spoth, et al., 2014). The lower cost of family therapy, combined with the barrier in treatment when they aren’t involved shows the desire for children to have them involved and the ability there is financially to do this (Morgan, et al., 2012; Gogel, et al., 2011). The early intervention shows that programs set up for this will help provide preventative measures for family and children as well (Jalling, et al, 2016; Spoth, et al., 2014).

The articles that were evaluated in this review do have their limitations and lack of generalizability to some situations. The articles that were used make it difficult to generalize the information that was given. The studies also took place in various areas: northwestern part of the United States (Doumas, et al., 2015; Mason, et al., 2012; Ryzin & Dishion, 2012), Iowa with one having additional information on Pennsylvania (Rulison, et al., 2015; Spoth, Trudeau, Redmond, & Shin, 2014), California (Milburn, et al., 2012), Texas (Henderson, et al., 2016), Sweden (Jalling, et al, 2016), various treatment sites throughout the nation (Gogel, et al., 2011; Robbins, et al., 2011; Winters, et al., 2011), Quebec, Canada (Bertrand, et al., 2013), and lastly the northeastern part of the United States (Liddle, et al, 2013).

The racial and ethnic backgrounds that were considered in each of the studies settled on three main groups Caucasian (Doumas, et al., 2015; Mason, et al., 2012; Robbins, et al., 2011; Henderson, et al., 2016), Hispanic (Doumas, et al., 2015; Mason, et al., 2012; Robbins, et al., 2011; Henderson, et al., 2016), and African American (Doumas, et al., 2015; Ryzin & Dishion, 2012; Robbins, et al., 2011; Henderson, et al., 2016; Liddle, et al., 2013). There were also studies that looked at Indians (Doumas, et al., 2015), Latinos (Ryzin & Dishion, 2012), and Asian Americans (Ryzin & Dishion, 2012; Henderson, et al., 2016). Overall, nine of the studies that were evaluated did not conclude what kind of racial and ethnic backgrounds their subjects had. Gender was not something that was studied in most of the articles. There were only three that evaluated one gender or the other and the differences (Rulison, et al., 2015; Henderson, et al., 2016; Liddle, et al., 2013).

The general age of the population is the one factor that is clear across all studies and relies on a group of adolescents age thirteen to eighteen and their families. While the articles limitations do make it difficult to generalize them to various populations due to some lack of detail, the important factor that remains the same is that family interventions appear to have a positive impact on client’s ability to have a positive recovery and potentially maintain sobriety. This conclusion enhances the reasoning to do another study to see if it would be successful for this group as well.

The articles chosen for this review were ones that focused on family intervention basics in treatment. The articles provided information about parental impact through various areas including externalizing and internalizing problems (Schlauch, et al., 2008), parental monitoring, parental warmth (Bertrand, et al., 2013; Doumas, et al., 2015; Liddle, et al., 2013; Robbins, et al., 2011; Mason, et al., 2012; Ryzin & Dishion, 2012), and therapy options provided by treatment (Liddle, et al., 2013; Robbins, et al., 2011). The majority of articles had a similar result in the idea that family interventions can help impact adolescent thoughts on substance use when the parents play a more volatile role in the adolescent’s life and are more aware of what is going on (Bertrand, et al., 2013; Liddle, et al., 2013; Doumas, et al., 2015;  Mason, et al., 2012; Rulison, et al., 2015; Ryzin & Dishion, 2012; Henderson, et al., 2016). Once an adolescent is in treatment, the articles demonstrate that the family assistance sustains long-term changes in the patient and their substance use (Liddle, et al., 2013).

The other articles back up and provide the reasoning for why these areas work and how family changes can change the way that adolescent substance use can also be changed as a result.  From this information, it would seem that adding requirements for family involvement in treatment could lead to more patients with sustained recovery after treatment. Based on the literature review, the hypothesis to be tested during this study is that the addition of family involvement in adolescent substance abuse treatment will lead to a more sustained recovery process.

Methodology – Sample

This study will work with a population of adolescents that are headed into or on a wait list for residential treatment for substance abuse at the Area Substance Abuse Council (ASAC) in Cedar Rapids, Iowa. The program is referred to as CD plus. The program houses up to 24 adolescents between the ages of 13 and 18. After 18, they can be aged out of the program, unless they are currently enrolled in school. The general population that makes up this program consists of adolescents that are on probation for charges that were pressed, coming from the hospital where chemical dependency issues were found, or voluntarily admitted by the families out of concern for their children’s.

The recruitment process will start by gathering information from ASAC regarding clients that will be attending the residential treatment. These clients may be on the wait list or preparing to do an intake soon. After intake, they will be asked if they would like to participate a study. If so, they will then ask if they would like to participate in family therapy as well. This information will be compiled and given to the person in charge of the study. From there, they will be assigned numbers to identify who will participate in the study, who will be on the wait list for family therapy and what group will be in the business as usual area. As there are only 24 clients in their program at a time, the goal will be to have thirty members over a period of time that participate in the study.

This design was chosen as it was the best way to work with the program. The sample is within a program that doesn’t have family therapy in place. This will allow for something new to be conducted and the ability for business to be continued as usual otherwise. The sample is an availability sample that is based off a group of people that are readily available to work with. Since the clients are already planning on going into treatment, they do not have to be sought after or found. The sample size of thirty clients will take a period of time, but it will allow for the elimination for possible external validity areas.  The study is also designed where family therapy is an option that they can add to treatment if they desire, without requiring them to be in the study. Therefore, they will be asked if they would like to be part of the study, and then they will be asked if they would like to participate in family therapy as part of the study as well. This way information can be gathered about all clientele in all areas of treatment and allows for several groups to be study as well as their differences. If the family and the client desire to be in family therapy, they will then be put on a list. From there, a random sample would be chosen to receive family therapy, while others desiring to do family therapy would be placed in the control group.

Methodology – Research Design

The study will be a qualitative and experimental longitudinal study that is focused on finding out the details between the differences in treatment, with the independent variable being treatment and the dependent variable sustained recovery, emotional changes, environmental changes and family interventions. The study is based on an available sample that is presented from the ASAC youth residential program. The study is an experimental one where there will be three categories of groups. There will be a set that continues with business as usual in treatment. This consists of weekly family groups, daily treatment groups, class with Cedar Rapids Community School District, anger management group, connection groups and individual counseling. Another group will be offered business as usual with the addition of family therapy every week, via in-person, phone, or video counseling. The family counseling will entail working on relationships, setting boundaries, evaluating triggers, relapse prevention, and environmental awareness for parents including monitoring and parental warmth. The last group will be a wait list control group. This group will be on the wait list for the family therapy option. As described before, the group that they are in will be based on what they state in their interview with study members.

Methodology – Measurement

The information gathered in this study will be gathered at the beginning of treatment and the end of treatment. There will be an evaluation of what the pattern of use, environmental factors and emotional factors are as well as basic identifiers about the individuals. As the information is gathered, each person will be assigned a number to eliminate the likelihood of identifying who is in the study. At the end of treatment, the information about patterns of use, environmental factors and emotional factors in use will be evaluated. The environmental factors that will be evaluated include their family situation, what their peers are like and the differences in places they may go or atmospheres they like to be in. Emotional factors that will be evaluated include changes in mood individually as well as in interactions with family members.

All of these will be evaluated through a list of questions in an interview over the phone or in person with both the patient and family members. The interviews will occur separately to prepare for bias that may otherwise come. If the family was interviewed altogether, there is a chance that they will not want to be honest about how they feel. The questions will be asked from a sheet that is prepared beforehand. The same open-ended questions will be asked to each family and patient. The information gathered will be put into categories to help process the reasoning for the sustained recovery, if there is one. It will then be evaluated to see if there is a substantial change due to family involvement in the group that received family therapy versus those in the control group or the business as usual group. The study team will check in the with the families every six months after treatment for up to three years to see if recovery is sustained.

Limitations

Attrition is the only area that could be a threat to internal validity in this study. The length of stay in the treatment center combined with the desire of the family to have them there may cause people to leave the study in various time frames and areas of their treatment. With this being the case, it may be hard to identify what the time frame looks like for the treatment as well as how effective the treatment is when some may leave earlier in some areas than in others. Also, the time frame may change depending on which group they fall into for the study. A way to control for this would be to maintain a minimum amount of days necessary to participate in the study, identifying that it may take at least 90 days to see results from the treatment given.

There are also threats to external validity. These threats occur with generalization of this information. It is apparent that this study is taking place within the state of Iowa. Therefore, it would be most generalizable to this state and area as they may be dealing with similar populations as well as substances. Another factor that makes it less generalizable is the uncertainty of the population’s race and gender that will be evaluated. Depending on what comes out of the study, it may be more generalizable or less generalizable to the general population. With the sample size of thirty, the hope would be that it is the perfect amount to get the correct look at what the general population for adolescents and substance use looks like. There is no clear way to prepare for this, as it is uncertain what the outcome will be and what the population will look like.

The study has several strengths that can come from it as it is conducted. The study is being produced to present a new and potentially better treatment alternative for adolescents in residential treatment. This study will most likely be able to be generalized to populations within Iowa as the clientele for this study will be from all areas of the state. The study could also make advancements in the research to sustained recovery. If this study completes as hypothesized, it would allow for a better understanding of what can help people stay in recovery once they are out of treatment. This could allow for more addicts to make life changes to stop addiction and for less drugs to potentially be on the streets in that area. Lastly, the clients are already heading to treatment for substance use, which means that they don’t have to be sought out. The clients are completing treatment, regardless of being in the study, which can make them more willing to participate.

There are also potential weaknesses to this situation as well. There is a limited population due to using only one agency. This may make the study take a period of time longer than what is expected to get the appropriate sample size to generalize the results of the study. The other factor that makes it uncertain about generalization is not knowing what the population will look like, as it is not pre-determined what the gender and races will be for those that are in the study. This could be a perfect representation of the population or it could only show part of the population that enters treatment. It is also apparent that there are far more adolescents involved in substance use than what will be in the study. The generalizability for this study may be limited to the Midwestern area for generalizing as it will be representing various communities and members of the state.  Most of these weaknesses may be cleared up as the study is completed and the population is evaluated. The biggest one that will be considered is time, and it may be one that doesn’t go away. However, the time needs to be taken to find appropriate results.

Ethical Issues

This study works with special populations of clients as they are youth and they have been diagnosed with some area of substance use struggle. To work through this ethical issue, there will be restrictions put into place for the adolescents. It will be required that they have parental permission before being a member of the study, that they are informed and understand what the expectations are in the study, that they can decide whether they want to be a part of the study as well, and the study team will be trained in the areas of boundaries for asking clientele questions and processing with them. The substance use area of this ethical issue will be considered through talking with the adolescents separately from the parents and clarifying what they are willing to process and talk about with them. Youth that have substance use issues are not required to tell their parents everything that they bring forth during treatment. Therefore, it will be important to talk with them and clarify what family therapy will be discussing and what information they do not want to be shared.

Confidentiality and anonymity will be considered in this study in various ways. There will be forms for consent from the client as well as the family members. The parent or guardian will be asked to sign accepting the client into the study. The client will then be asked to sign to consent to be part of the study as well. ASAC will know who is doing family therapy due to billing purposes. However, they will not be informed of who is in the study that is being conducted. This information will be saved on a personal computer where they are assigned particular numbers to identify who they are and record data. Once the data has been analyzed and one year has passed, all documentation will be deleted and removed to allow for continuous confidentiality of those involved in the study. When the information is reported, there will not be individual identifiers, just general group information that is released including continuation of use, change in use, race, and gender to allow for generalization of information.

The risks of this study are low, but they are ones to take note of. There is a level of stress and discomfort that may come with this study. Family therapy generally brings out situations of stress, problem-solving, sometimes trauma, and sometimes confronting issues that can be uncomfortable. Due to this, there will need to be stipulations put into place with the therapy. These stipulations would be that clientele and family don’t leave if there is an apparent change in emotion or emotional struggle that occurs from the session. If the family seems settled and okay, but the patient doesn’t, the family may be asked to leave to allow the patient to process. If the family and the child are both struggling, they will continue to process the situation until there appears to be an emotional balance. There will also be check-ins set up with the family and the child for a period of time after the therapy session by the therapist. Another area of risk is that some may find out the study is occurring, which can lead to comments or ridicule. In this situation, the study members would need to step in and take effect by processing with the client about the situation and what can be done for them as well as maintaining the positives of their situation.

Implications

If the study produces the results of positive sustained recovery with added family involvement in treatment, then it would provide serious implications to the treatment process. The study would allow for new requirements to be made in treatment, asking the family members to be more willing to participate. This will provide backing for that conversation to help inform them of the benefits of their participation. When they understand the impact and the results of previous studies, the agencies working with adolescent substance use may want to require more attention from the family to render more positive results from the overall treatment. When more adolescents can have sustained recovery, this means the less likely it would be to have them in and out of treatment for years of their life, it could break the cycle of addiction in their family and life, as well as allow them to break the pattern of addiction that they started. This can allow for them to prevent some addicts of the future and allow them to get started on their goals in a safe environment that can be maintained with their recovery.

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