This book is authored by an experienced Professor of Family Therapy and licensed marriage and family therapist. Mainly comprised of his own writing but with some contributions from others, its overall aim is to “view addiction through a systems lens”. This is done with 15 chapters organised around two main areas. Part 1 covers assessment, with chapters about the conceptualisation of addiction; neurobiology and genetics; the addicted family; diversity; roles in the addicted family; the family life cycle; and issues in substance-using families. Part 2 covers treatment, introducing the main approaches to family therapy and their application to addiction, alongside chapters on working with partial systems, recovery and the self of the therapist. The book aims to reach a wide target audience including students and practitioners. It is written for the American market – readers elsewhere may need to consider the nuances of application to their own countries and practices.
I liked the summary, key terms and reflection questions at the end of each chapter. A case study is presented in Chapter 1 and while this is helpfully referred to a number of times in later chapters, additional opportunities could have been taken to relate the ideas presented to the specifics of a case study. Key terms and concepts are highlighted throughout, but a separate glossary might have been a useful addition. Similarly, some chapters might have benefitted from the addition of a table – for example, to summarise key protective factors and evidence of resilience; the characteristics of the typologies of adult children presented in Chapter 6; and the main elements of the theories of family therapy discussed in Chapters 11 and 12. While I was unconvinced of the added value of Chapters 2 and 3 on neurobiology and genetics, they do provide useful context, and I liked the chapters which covered resilience (although only one model of resilience is covered in detail) and diversity. Ideas from these chapters could have been threaded through a number of later chapters, particularly when considering treatment.
Throughout, there is a focus on typologies and staged models. For some this may not sit easily alongside the concepts of diversity introduced in Chapter 5, as there is a risk of practitioners making judgements or assumptions about, or even pigeon-holing, clients. Chapter 8 provides useful coverage of a number of issues which commonly co-exist alongside substance misuse, including domestic violence, child abuse and dual diagnosis, though I would question the assertion that “addiction is one of the causal agents of violence in the family”.
A strength of the book is that, particularly for a reviewer who subscribes to a very different view of addiction and the family, and of how to help families, it is challenging and offers much food for thought and reflection. Some questions I am left with relate to whether other popular theories and ideas about addiction and the family could have been included and used to offer a critique of family therapy; the perception of loaded terms like “dysfunctional” and whether they can be counter-productive to families (I wonder how such terms would be received if used to explain other illnesses and troubles which families face); and what the evidence is about the specific outcomes of family therapy for the wider family and for other “non-addicted” family members in their own right, as there is very little about this – the focus is largely towards substance misuse and treatment engagement.
The book is largely well written and researched, comprehensive and authoritative, containing a wealth of ideas and knowledge. Overall, this is a thought-provoking volume which makes a useful contribution to the “addiction and the family” library.
