Hi XXXXXXX

The systems perspective is very relevant with regards to the pre-adolescent and adolescent stages of development. There are two important client groups to focus when adopting a systems approach:

1)     One group includes adolescent and pre-adolescent clients with addiction problems.
2)     The other group involves children of parents who have addiction problems.

Focussing on both these groups is equally important in the treatment and prevention of addiction disorders in young people.

When it comes to the first group, it is essential to realize that there is a recent trend of an alarming increase in the number of adolescents and pre-adolescents with substance abuse problems. So, it is high time intervention strategies are designed to specifically target this young age group.

Secondly, like we have discussed earlier, it has been proven beyond doubt that children of parents with addictions are at a significantly higher risk of developing addiction problems in the future. So, it becomes all the more important to give special attention to these young people when planning family-based interventions in the systems approach.

When designing interventions to help the first group, the following principles have to be kept in mind (I have mentioned only the ones which are relevant to this special age group; the basic principles of treatment in the systems approach to addictions have already been discussed):

-     Adolescent and pre-adolescent drug abuse should be viewed as a complex phenomenon in which personal issues, interpersonal relationships, overall family functioning, and social forces must all be addressed to effect enduring change.

-     It is also very important to understand the key role of the parents and other family members while planning treatment strategies for young people with addiction problems. It is essential to consider young people within their system of relationships, including peers, family, community and others. The family can play a key role in supporting and helping the youth achieve his or her goals.

-     The developmental perspective is another useful principle in understanding addictive behaviours in young children better. Adolescent substance abuse is conceptualized as a problem of development, a deviation from the normal developmental pathway. Substance abuse is a failure to XXXXXXX developmental challenges and a set of behaviours that compromises hope to achieve future development. So, this concept moves beyond considerations of symptoms only to understand a youth’s ability to cope with the developmental challenges at hand, and considers the implications of stressful experiences and developmental failures in the pathogenisis of addictive behaviours.

-     We should realize and recognize that youth are not a homogeneous group. There are variations due to their developmental stage, gender, culture, race, class, religion, sexual orientation, disability, etc. So, the therapist has to be flexible in understanding the young person’s behaviour with the background of such diverse factors.

-     While using a systems-based approach, it is best that the “family system” is identified by the young person, that is, the young person can define the nature and extent of involvement of the family. This may or may not include the young person’s biological family, but whomever the youth defines as “family” will influence the kind of involvement that “family” has in the treatment. It has been shown that the outcome is much better in cases where the young person voluntarily chooses the degree of involvement of the family members in therapy.

-     Multiple therapeutic alliances may be required to create a foundation for change. Therapists should strive to create individual working relationships with the adolescent, individual parents or caregivers, and individuals outside of the family who are or should be involved with the youth.

-     The aim of interventions in the systems approach should be not only to treat the substance abusing problem, but to build healthy and useful relationships between the teens and their parents. In other words the outcome of therapy should not just be reduced drug use, but there should be lasting benefits that extend beyond that.

-     Interventions should be youth-centred and welcoming. We should ensure that all aspects of our services are youth-friendly (for example accessible locations, flexible timings, appealing and attractive packages to enhance motivation and improve engagement in therapy, etc.)

-     Finally, the therapist attitude is fundamental to success. Therapists should promote participation and enhance motivation of all relevant persons; create a workable agenda and clinical focus; provide unconditional support and consistency throughout treatment.

Now, let’s discuss the other group which needs special attention and focus – the young children of parents with addictions. I have already discussed in my previous answer how these children are at a higher risk for not only developing addiction problems in the future, but also at risk for developing a wide variety of psychological problems also. So, early professional help is important in preventing more serious problems for the child, including reducing risk for future alcoholism.

Typically, from the systems perspective, these children assume one or more of these roles:
-     Hero: These responsible children try to ensure that the family looks “normal” to the rest of the world. They tend to be academically or professionally very successful, but the cost of such success is often denial of their own feelings.
-     Adjuster: These children learn never to expect or to plan anything, and tend to follow without question. They often strive to be invisible but as a result, they often come to feel that they are drifting through life and are out of control
-     Placater: These children learn early to smooth over potentially upsetting situations in the family and please others, but often at the expense of their own feelings.
-     Mascot: These children are “entertainers,” relying on their sense of humor to distract from or take away the family’s upset. They tend to have difficulty focusing and making decisions, and have a low tolerance for distress.
-     Scapegoat: These people are identified as the “family problem.” They are likely to get into various kinds of trouble, including drug and alcohol abuse, as a way of expressing their anger at the family.

Now, it is important to identify these complex roles, correct any maladaptive roles and teach such children better coping skills. Strengthening available alternatives for social and emotional support will help decrease the stress and emotional burden, and thereby prevent maladaptive behaviours like addictive behaviours in the future. Ensuring healthy family functioning is instrumental in creating developmentally adaptive lifestyle alternatives for young children. The child’s relationships with parents, siblings, and other family members are fundamental areas of assessment and change in the systems perspective.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

---