Family Adjustment

Family organization and quality of interaction among its members impact on the risk for and maintenance of substance abuse. Indeed, the transmission of alcoholism across generations is to some degree influenced by attitudes and rituals of the family pertaining to consumption (Steinglass, Bennett, Wolin, & Reiss, 1987). Inasmuch as the family is the primary influence shaping the values and behavioral patterns of children, parenting style and family environment exercise a profound influence on the child's development until at least adolescence, when psychoactive substance use may first become problematic.

From the standpoint of psychological evaluation, a number of issues must be addressed. First, it is essential to characterize the contribution of psychiatric disorder, including substance abuse, in the family. The greater the family density of substance use disorder and pervasiveness of psychiatric disorder in family members of the client undergoing evaluation, the more severe the psychological problems. Among young substance-abusing clients, it is especially important to record the presence and history of physical and sexual abuse as an etiological factor on any manifest psychological disturbances. Second, the causal relationship between family dysfunction and drug use behavior needs to be ascertained.

How substance abuse precipitated the family problems or, conversely, how family problems triggered substance abuse needs to be investigated in the course of the evaluation. Third, the reinforcement contingencies, if any, exercised by the family on the member with the substance abuse problem need to be analyzed. It thus needs to be determined whether substance abuse is ignored, punished, or positively reinforced. Fourth, the roles and status of each family member must be understood to the extent that individual maladjustment, conflict, and instability contribute to overall family dysfunction that in turn propels one member to consume alcohol or other psychoactive drugs.

Five self-report instruments are commonly used to quantify family functioning. The Family Environment Scale (FES; Moos, 1974; Moos & Moos, 1981) was the first instrument developed to evaluate family system functioning. The FES evaluates three major dimensions: (1) Relationships, (2) Personal Growth, and (3) Systems Maintenance. Each major dimension consists of several scales. The Relationship dimension encompasses scales that measure family conflict, cohesion, and expressiveness. The Personal Growth dimension includes scales that evaluate the family's emphasis on independence and achievement, as well as intellectual, religious, and recreational pursuits. The Systems Maintenance dimension contains scales that measure the family's success at organization and control. The Self-Report Family Inventory (SFI) is based on the theoretical orientation of the Beavers Systems Model of Family Functioning (Beavers & Hampson, 1990). It measures health/competence, level and type of conflict, communication patterns, cohesiveness, leadership, and emotional expression.

Epstein, Baldwin, and Bishop (1983) developed the Family Assessment Device (FAD) to evaluate current level of family functioning. The FAD can be administered to children as young as 12 years of age. In addition to providing a general functioning score, the FAD provides useful information pertaining to affective involvement, behavior control, family roles, problem solving, communication patterns, and affective responsiveness.

The Family Assessment Measure (FAM) focuses on the individual perceptions of each family member (Skinner, Steinhauer, & Santa Barbara, 1983; Steinhauer, Santa Barbara, & Skinner, 1984). The family system characteristics assessed by the FAM include affective involvement, control, role performance, task accomplishment, communication patterns, affective expression, and values and norms.

The Family Adaptability and Cohesion Evaluation Scales (FACES), developed by Olson, Russell, and Sprenkle (1980, 1983) and Olson and colleagues (1989) for both research and clinical applications, is another frequently used measure of family functioning. It takes only 10-15 minutes to administer and is appropriate for children (ages 10-12). It assesses three dimensions of family functioning: cohesion (degree of emotional bonding), adaptability (family power/roles/rules), and communication (dyadic patterns/styles).

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