Couple/marriage and family therapist extent of training for working with families impacted by substance use

• Published date: 01 October 2022
• Author: Jessica L. Chou,Laura Lynch,Stephanie Brooks,E. Stephanie Krauthamer Ewing,Christian Jordal,Dara McDowell,Voulda A. Bluteau‐James
• Date: 01 October 2022
• DOI: http://doi.org/10.1111/fare.12690

RESEARCH

Couple/marriage and family therapist extent of

training for working with families impacted by

substance use

JessicaL.Chou | LauraLynch | StephanieBrooks |

E.StephanieKrauthamerEwing | ChristianJordal | DaraMcDowell |

Voulda A. Bluteau-James

Department of Counseling and Family

Therapy, Drexel University, Philadelphia,

Pennsylvania, United States

Correspondence

Jessica L. Chou, 1601 Cherry Street,

Philadelphia, PA 19103, USA.

Email: jlc563@drexel.edu

Abstract

Objective: The goal of this study was to explore substance

misuse training exposure and preparedness among couple/

marriage and family therapists (C/MFTs) who graduated

from Commission on Accreditation for Marriage and

Family Therapy Education (COAMFTE) programs.

Background: In 2018, approximately 53.2 million individ-

ualsaged12 yearsandolderreportedusingillegalsub-

stances. Substance misuse has a significant family impact,

and family system patterns can contribute to the develop-

ment or maintenance of substance misuse issues. Couple/

marriage and family therapists (C/MFTs) are well posi-

tioned to work with families impacted by substance mis-

use, as their standard training focuses on the interplay of

relationships and systems in the development and mainte-

nance of individual and family functioning. However, the

extent of substance misuse–specific training within

accredited C/MFT graduate programs is still unclear.

Method: The present study used a mixed-methods conver-

gent design to explore substance misuse training exposure

and preparedness among C/MFTs who graduated from

COAMFTE programs. A total of N=109 individuals

participated in online assessments, and n=8 completed

interviews. Quantitative and qualitative data were col-

lected during the same phase, analyzed separately, and

then integrated and interpreted to gain a comprehensive

understanding of substance misuse training and workforce

experiences among C/MFTs.

Results: Ninety-three percent of respondents (n=101)

reported very little to no substance misuse training in their

programs (no course to one course in their COAMFTE-

Received: 10 September 2020Revised: 23 September 2021Accepted: 15 January 2022

DOI: 10.1111/fare.12690

© 2022 National Council on Family Relations.

1658 Family Relations. 2022;71:1658–1678.wileyonlinelibrary.com/journal/fare

accredited programs), despite consensus among respon-

dents that such training and related supervision would be

valuable.

Conclusion: Training recommendations are provided for

the inclusion of substance misuse coursework among

graduate-level training programs.

Implications: A C/MFT educational program pursuing

curriculum changes to include more substance misuse–

related content may encounter several challenges. Implica-

tions for addressing challenges are discussed.

KEYWORDS

couple and family therapy, families, substance use, training

Over 53 million individuals aged 12 and older report using illegal substances (Substance Abuse

and Mental Health Services Administration [SAMHSA], 2019). In 2018, approximately 41 indi-

viduals died every day from prescription drug overdose (Wilson et al., 2020). Substance misuse

in the United States is a public health concern. Noteworthy, many terms for substance misuse

(e.g., substance abuse) are no longer endorsed, as they perpetuate stigma (NIDAMed, n.d.).

Thus, we use substance misuse, defined as improper or unhealthy use of illicit drugs or alcohol

that can cause harm to individuals as well as their family and friends (National Institute on

Drug Abuse, 2020).

Family context can play a role in the development and maintenance of substance misuse as

well as treatment and recovery outcomes (Lander et al., 2013). The presence of substance mis-

use among a family reverberates throughout the family system and across multiple generations

(Center for Substance Abuse Treatment, 2004). When substance misuse enters a family system,

rules and roles often change, creating family dysfunction (Reiter, 2019). For example, families

impacted by substance misuse tend to display rigid boundaries between the family and external

systems, emphasizing the need to keep the substance misuse a secret (Reiter, 2019); this secrecy

can prohibit families from discussing the substance misuse and its impact on family

relationships.

Substance misuse can result in role shifts within a family system, such as children becoming

parentified or grandparents parenting grandchildren (Chou et al., 2019). These changes can in

turn result in permeable system boundaries (Lander et al., 2013). Ultimately, “the family’s

homeostasis changes over time to where dysfunction and distressing interactions become the

family’s primary way of engaging with each other”(Reiter, 2019, p. 57).

Substance misuse programs have increasingly focused on the importance of including fami-

lies in treatment as part of the response to the alarming number of individuals and families

impacted by substance use disorders (SUDs; Reiter, 2019; Werner et al., 2007). Family-centered

treatment and the inclusion of multiple systems in the treatment process have been prioritized

as crucial elements of recovery (Reiter, 2019; Werner et al., 2007). Couple/marriage and family

therapists (C/MFTs) are well positioned to work with families impacted by substance misuse, as

their standard training focuses on the interplay of relationships and systems in the development

and maintenance of individual and family functioning. Couple/marriage and family therapists

are trained to understand family rules, roles, and boundaries that create and maintain conflict.

The high prevalence rates of substance misuse increase the likelihood that C/MFTs will

encounter families impacted by substance misuse (Chou et al., 2021); however, Corless

et al. (2009) highlighted that, compared with other treatment issues, family therapists remain

hesitant to claim their own importance for families impacted by substance misuse (Chou

et al., 2021).

C/MFT TRAINING EXPERIENCES1659