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Should We Use Family Therapy for Treating Addiction in Afghanistan?

Esmael Darman

M.S., Clinical & Counseling Psychology

I would like to start this piece by this question: Can Family Systems Therapy be a good way of helping and treating drug and alcohol addicts? Evidence (Evidence for Family Therapy, Textbook of Substance Abuse Treatment, Chapter 30, p5) shows that yes, it can. Therefore, there should be something about this approach that has been found effective.

Biologically speaking, some groups of genes have been implicated in cocaine, opiate, alcohol, and nicotine addiction, and according to some experts (Drug Addiction Genes Identified, Reuters, 2008), “genetic factors account for up to 60 percent of a person’s vulnerability to drug addiction, with environmental factors accounting for the remainder.” Although some other data may not necessarily agree with this percentage, researchers agree on the fact that there are molecular pathways that contribute to drug/alcohol addiction. As a result, it obviously makes sense to study drug addiction within the family.

Developmentally speaking, the family’s behaviors, characteristics, level of knowledge, education, beliefs, identity, socio-economic status, and in a nut shell its dynamics obviously have an impact on shaping an individual’s personality. There are numerous theories focused both on individuals (Freud on psychosexual stages; Mahler on attachment; Klein and Fairbairn on splitting and projective identification; Nathan on failure of complementarity, etc) and families (Bowen on triangulation and differentiation; Bateson and Haley on interaction and communication; Minuchin on hierarchies, boundaries and identified patient; Bandura on social cognitive learning, etc). Today we have a huge amount of data thanks to these theories and other studies conducted on the subject of human development.

Culturally and socially speaking, acculturation and immigration (Psychiatric Times, 2008, Vol. 25, No.1), as well as displacement (Harm Reduction Journal, 2005, Vol. 2:13), have been implicated in addiction. It is worth noting that although there are some overlaps or disagreements among these theories, almost all of these theories have appropriately highlighted the importance of family as a system and the significance of this system in alleviating or worsening symptoms, problems, and challenges that have caused or have been caused by drug and alcohol addiction. Thus, the complexity of drug/alcohol addiction requires a systemic approach, preferably an integrative one.

The issue gets more interesting when one tries to address the problem in a traditional, collectivist society with extended families, with every member of the family having a defined role, and a sense of mutual obligation, with children obey their parents and elders/ parents being responsible for the support. The tricky thing in these families is the powerful message for children not to bring embarrassment and shame to the family. That is why in some of these societies, including Afghan society, addiction is viewed a disgrace and in some cases even a crime. On the other hand, in a patriarchal family, with father being the authority figure, it is hard not to get the family’s support and it is obviously challenging to act individually as there is the risk of becoming ostracized and losing the family support.

However, one of the strengths of family systems therapy is that many ethnic and cultural groups place great value on the extended family and include grandparents, aunts, and uncles in the treatment, which may have a distinct advantage over individual therapy (Theories and Techniques of Counseling, Gerald Corey, p 433). Nevertheless, these families need to be desensitized to addiction and its stigma and be given some good information in order to provide better support for their addicted member. Having the largest drug addicted population in the world in a collectivist society (U.N. World Drug Report for 2005,, Iran has already tried family therapy with some adjustments as a measure to cope with increasing number of drug addicts and it has proved effective compared to many other treatment plans. And since there are many commonalities between Iranian and Afghan societies in terms of culture and lifestyle, it may be particularly helpful if these experiences are also shared with Afghan medical/mental centers in the future.

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