COUC 691 Week 8 DB Forum 4 (Al-Anon) Example

Discussion Board Forum 4 (Al-Anon): Thread and Two Replies

COUC 691 Substance Abuse: Diagnosis, Treatment and Prevention, Discussion Board Forum 4, Al-Anon (thread and two replies)

Thread by [Student Name]

The prompt, the meetings, the members and the classmates' posts are composites standing in for the course's own forum, and no Al-Anon member is described in identifying detail; the textbooks, Scripture and published studies are real; COUC 691 shares its course guide with CEFS 691, and the requirements follow that public guide.

Thread

At the Wednesday evening Al-Anon meeting I attended, a mother said that for two years she had searched her adult son's room every morning for bottles, and that the day she stopped was the first day she felt like a person again. At the Saturday morning meeting, a wife said she had repeated one phrase to herself in the car for a month: "I didn't cause it, I can't control it, I can't cure it." Neither woman had stopped loving the person who drank. Both had stopped organizing their lives around the drinking.

Members called this detachment with love. As I understood it, detachment does not mean leaving or not caring; it means refusing to make the loved one's drinking the center of one's own life, no longer covering for the person or trying to manage every drink. The meetings had no talk of getting anyone sober. They were about members' own sleep, jobs, children and faith. One man said that for the first time in years he had gone fishing on a Saturday instead of driving around town looking for his wife's car. Another member laughed and said the hardest step for her was letting a phone call go to voicemail.

Research on family members suggests why such a fellowship is needed: their suffering is real, and it is often unseen. Orford et al. (2010) summarized two decades of qualitative studies in several countries with partners, parents, siblings and adult children of people who drink or use drugs heavily. Family members described a relationship that had turned unpleasant and sometimes aggressive, conflict over money and possessions, constant uncertainty and worry, and a home life under threat. They coped by putting up with the problem, standing up to it or withdrawing and gaining independence, and good social support was often missing. The authors stress how disempowered family members usually feel.

For counselors, that means families deserve attention for their own sake, not only as helpers in the client's treatment. Capuzzi and Stauffer (2016) describe family involvement as part of comprehensive addiction care, and Al-Anon is one place where families can find the support Orford and colleagues found lacking. In my own work at a recovery residence, I have spoken with residents' mothers and wives only to arrange visits; after these meetings, I want to ask them how they are doing.

Galatians 6:2 tells believers to carry one another's burdens, while verse 5 says each will carry his own load (English Standard Version Bible, 2001/2016). Al-Anon seems to hold both truths together.

Classmates: did your meetings change how you think about the families of your future clients?

Reply to Brittany

Brittany, you wrote that the Al-Anon meetings moved you, but that you also felt frustrated, because your own brother refuses treatment and you wondered whether Al-Anon simply teaches families to give up on getting a loved one help. That is an important question, and one I asked myself on the drive home. One study tested it directly.

Miller et al. (1999) randomly assigned 130 concerned significant others of unmotivated problem drinkers to one of three 12-hour counseling approaches: Al-Anon facilitation therapy, a Johnson Institute intervention preparing for a family confrontation, or community reinforcement and family training (CRAFT), which teaches family members behavior change skills to use at home. CRAFT engaged 64% of the drinkers in treatment, compared with 30% for the Johnson approach and 13% for Al-Anon facilitation. Most families in the Johnson condition decided not to go through with the confrontation. Yet all three approaches produced similar improvement in family members' own functioning and relationship quality.

So the two goals are different. Al-Anon helps family members cope and heal, whatever the drinker does; CRAFT also helps them influence the drinker toward treatment. For your brother, a family member might benefit from both: Al-Anon for the long road and CRAFT for the specific skills of rewarding sober behavior, allowing natural consequences and choosing the right moment to suggest treatment. Would you feel comfortable recommending CRAFT to clients' families alongside Al-Anon, and do you know whether anyone in our area offers it?

Reply to Andre

Andre, you described a client at your practicum site whose mother attends Al-Anon and Nar-Anon while her son uses opioids and refuses help, and you asked whether there is anything more the counseling center could offer her. A trial with families of drug users speaks directly to her situation, and it adds to what we read about alcohol.

Meyers et al. (2002) randomly assigned 90 concerned significant others of treatment-refusing drug users to CRAFT, CRAFT with added group aftercare sessions, or Al-Anon and Nar-Anon facilitation therapy, each with 12 hours of manual-guided individual treatment. CRAFT alone engaged 58.6% of the drug users in treatment, CRAFT with aftercare engaged 76.7%, and the facilitation condition engaged 29.0%. One detail stood out to me: no family member succeeded in engaging a loved one once the individual sessions had ended.

That finding suggests that the help needs to happen while the family member is actively working with a counselor. For your client's mother, the counseling center might offer a series of CRAFT sessions while she continues Nar-Anon for support. The aftercare result also suggests that a group of parents meeting after the individual sessions could keep the gains going, since the combined condition engaged the most users of all. How might your site make room for family members who are not themselves the identified client, given that insurance rarely pays for their sessions?

References

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). Pearson.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Meyers, R. J., Miller, W. R., Smith, J. E., & Tonigan, J. S. (2002). A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others. Journal of Consulting and Clinical Psychology, 70(5), 1182-1185. https://doi.org/10.1037/0022-006X.70.5.1182

Miller, W. R., Meyers, R. J., & 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 Psychology, 67(5), 688-697. https://doi.org/10.1037/0022-006X.67.5.688

Orford, J., Velleman, R., Copello, A., Templeton, L., & Ibanga, A. (2010). The experiences of affected family members: A summary of two decades of qualitative research. Drugs: Education, Prevention and Policy, 17(sup1), 44-62. https://doi.org/10.3109/09687637.2010.514192