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Family intervention for the treatment and rehabilitation of drug addiction: An

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Article  in  Journal of Substance Use · July 2013

DOI: 10.3109/14659891.2013.799239

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ISSN: 1465-9891 (print), 1475-9942 (electronic)

J Subst Use, Early Online: 1–6

! 2013 Informa UK Ltd. DOI: 10.3109/14659891.2013.799239

ORIGINAL ARTICLE

Family intervention for the treatment and rehabilitation of drug

addiction: an exploratory study
Dini Farhana Baharudin1, Abdul Halim Mohd Hussin1, Melati Sumari2, Sarina Mohamed3, Mohd Zaliridzal Zakaria1,
and Rezki Perdani Sawai1
1
Asian Center for Research in Drug Abuse, University Sains Islam Malaysia, Nilai, Malaysia, 2Faculty of Education and 3Faculty of Law, University of
Malaya, Kuala Lumpur, Malaysia

Abstract Keywords
J Subst Use Downloaded from informahealthcare.com by 175.136.6.11 on 07/14/13

Objective: To explore the experiences of families who undergone a family intervention program Drug addiction, family, intervention, recovery,
at a drug treatment and rehabilitation agency located in the city of Kuala Lumpur, Malaysia. treatment
Specifically, families were asked to comment on their experience in attending the program and
how much of their improvement was due to the program and other factors. History
Methods: Data were collected through use of a semi-structured interview with eight family
members who underwent the family intervention program at the agency which consists of Received 3 January 2013
family psycho-education, family support group and family retreat. Observations were also Revised 6 April 2013
conducted. Accepted 15 April 2013
Results: Five themes emerged from the analysis: therapeutic alliance between counselor and Published online 8 July 2013
participants; helpful things participants received from the program; helpful things participants
For personal use only.

did themselves during the time they were involved in treatment; helpful things participants
learned in the program that they are continuing to use; and unhelpful elements in the program.
Conclusion: Findings support that the family intervention program has positive potential in
supporting family members in the treatment and rehabilitation of drug addiction.

Background that communication and caregiving duties break down to the

extent that the well-being of the children and the family as a
Families are important in both the etiology of addiction and
whole are in jeopardy (Brown & Hohman, 2006).
its recovery (Gruber & Taylor, 2006). In relapse prevention,
According to van Wormer (2008), the family therapy field
success in establishing a social support network raises the
has devoted little effort to addiction-focused treatment and
chances of long-term treatment success. Family therapy, even
has tended to refer drug-afflicted members to specialized
in only a few sessions, can be invaluable in reducing the
services or self-help groups. And because of the difficulty that
feelings of guilt or confusion in significant others. Family
substance abuse treatment centers face in working with the
counseling, moreover, can be invaluable in preparing the
whole family, often little more than lip service is given to
family for changes that are needed to enhance and maintain
the addicted person’s recovery.
family members’ needs by these treatment centers. 13
20
Family members can suffer through a lack of, or poor quality
To treat an individual member who is addicted in isolation is
of, support available to them (Copello et al., 2010;
to ignore the context in which much of that behavior takes
Templeton, 2009).
place. To know the context, an understanding of the systemic
This is also true in the Malaysian context. From the
intergenerational nature of addiction is essential. Even more
literature reviewed, it was evident that there is lack of
than ordinary illness, addiction is a source of major stress that
utilization of family-based approaches. Although there is
resonates through the family system and affects the family’s
evidence that the family has a role in influencing the addictive
interactions with every other system in the community. The
or relapse process and its remediation (Mahmood Nazar et al.,
emotional and financial resources of the family may be almost
1996; Ghani et al., 2008), family-based treatment is less
entirely depleted by the stress of the addict’s illness. The havoc
popular perhaps due to difficulty in gaining commitment of
wrecked on the family by alcohol misuse is even more dramatic
family members and lack of training for counselors delivering
and progresses more rapidly when a drug enters the picture.
the service. Because there is very minimal usage of the
Qualitative data based on interviews with former addicts reveal
family-based approaches in Malaysia, the research on family-
based treatment modality in Malaysia has also been scarce.
Correspondence: Dini Farhana Baharudin, Asian Center for Research in
As family-based approach has been proven to be successful
Drug Abuse, University Sains Islam Malaysia, Nilai, Malaysia. Tel:
+606 798 8000. Fax: +606 798 8244. E-mail: dini@usim.edu.my in the West in the treatment of drug users, there is a need to
 2 D. F. Baharudin et al.
look at the experience that the family undergo in drug
addiction treatment in the Malaysian context as well as to
devise possible alternate recommendations for counselors
who are interested in the augmentation of family techniques
in the treatment of drug addiction. Therefore, this study aims
to do so.
Method
Counseling research that explores clients’ perspective and
inner views are still lacking (Bowman & Fine, 2000; Gaddis,
2004; McLeod, 1998), but recently there is a move from the
dominant positivist view to a more humanistic/qualitative
approach (Ribner & Knei-Paz, 2002). According to Howe
(1996), merely observing and measuring what clients do falls
short of actually understanding their inner experience of the
process.
The purpose of this study was to explore family interven-
tion in the treatment and rehabilitation of drug addiction.
J Subst Use Downloaded from informahealthcare.com by 175.136.6.11 on 07/14/13
Therefore, a qualitative design was chosen as the most
appropriate choice for this study based on the notion that
naturalistic inquiry is most applicable for discovery oriented
research into unstudied phenomena (Creswell, 1994; Denzin
& Lincoln, 2000).
The setting
This study was conducted at a drug addiction treatment and
For personal use only.
rehabilitation agency in the city of Kuala Lumpur. The agency
was set up to provide drug prevention, intervention and
rehabilitation. It later became a registered Malaysian NGO in
1991. Most of the staff here are former drug users and
volunteers. There are two counselors at the agency.
Besides treatment and rehabilitation program for the drug
users, families are encouraged to be involved in treatment and
rehabilitation program provided by the agency. The family
intervention program consists of three main components:
the family psycho-education; the family support group; and
the family retreat. Both the family psycho-education and the
family support group are conducted once every month,
usually during weekends, while the family retreat is con-
ducted twice a year. In contrast to traditional family therapy,
the family treatment interventions utilized at this agency were
designed to elicit resilience and healing in the family
members rather than to uncover the family’s presumed role
in causing and perpetuating the addiction.
Participants
The participants were family members of clients at the agency
who are willing to participate in the study. Families were
encouraged to be involved in the family intervention program
that was organized by the agency. Some families show
commitment to join the program but others did not.
Interviews were conducted with only eight family members
who follow the program (n ¼ 8: two male and six females).
The age range was 46–62 years, except for one participant
who is 28 years old. The eight participants include two
fathers, four mothers, one single-mother and one sibling. Most
of the participants’ family members in treatment are adoles-
cents or young adults between the ages of 15–26 years.
J Subst Use, Early Online: 1–6
Procedure
Ethical approval was gained from the agency. A key part of
the procedure was allowing families to voluntarily consent to
participate in the study. The counselor for the families was
also consulted about the family’s suitability to be involved.
All of the three main components of the family interven-
tion program, that is, the family psycho-education, the family
support group and the family retreat were involved to explore
participants’ experiences. Data were collected from
November 2011 to December 2012. Data collection proced-
ures involved interviews and observations. Interviews lasted
40–60 min and were recorded and transcribed. All interviews
were conducted face-to-face. All participants were provided
with a written verbatim transcription of their interviews and
were asked to check the accuracy and parts that they may not
feel comfortable with. Observations were also conducted
where one of the researchers became observer during the
period of one year, joining every intervention program that
was held concerning families.
Data collected from the interviews and observations were
analyzed. Common themes as they emerged were identified.
Once themes are identified from participants’ responses,
initial categories were classified and questions formulated to
narrow the focus of the study, initial findings confirmed and
new or additional information were probed.
Results
The data is presented based on the themes that emerged from
the responses. Quotes from participants’ own words were
thought to be the best vehicle for presenting the data because
of the clarity and authenticity they offered on the participants’
experiences. Five themes were found as follows:
Therapeutic alliance between counselor and family
members
All participants in the study (n ¼ 8) appeared to have a
constructive working relationship with the counselors at the
agency. In the family intervention program, family members
have a close relationship with the drug user’s counselor and
would be given information and report on their progress. Even
though the counselor is not using family therapy per se, the
combination of components in the program utilized by the
agency seems to work in the Malaysian setting to provide
‘‘therapy’’ for the families. The existence of the counselor in
some way met the families’ needs. Some statements from the
participants are:
I feel comfortable, listened to and heard, especially as this
(having my son in treatment) is very hard on me and my
wife. He explained about everything in a way that makes us
feel accepted and supported. (P5; father)
I thought we got on reasonably well. Just the way she talked
to me . . . she didn’t look down on me, thinking negative
things and just made me feel welcome. (P2; mother)
We (me and my daughters) have a very good relationship
with the counselor . . . we can call him whenever . . . it is
good to know we have someone to refer to. (P1; single-
mother)
 DOI: 10.3109/14659891.2013.799239 Family intervention 3

Helpful things participants received from the program after they had undergone the program. Some statements
include:
All participants (n ¼ 8) were positive in terms of benefiting
from the family intervention program. They reported
I learnt that we (husband and wife) need to continue
experiencing some improvement in their life from attending
working as a team. We tend to compete with each other
the program. They began to get new insights of looking at
causing our child to manipulate the situation . . . I may say
their situation and themselves, they learn different ways and
no at one point and then my husband would soften it and in
means of handling their problems, gather more knowledge
some ways changed it to a yes . . . now we see that and we
and understanding about addiction and strategies that they
try our best to have collaboration with each other . . . sup-
find useful. Comments include:
port instead of sabotage . . . very important so as not to
confuse the child with contradicting and perhaps confusing
The family weekend program where they give talks about
messages. (P7; mother)
addiction was helpful in increasing my knowledge and
Now when I feel myself getting into a situation where
understanding of addiction. I want to know more to help
you’re feeling let down because things are not working out
my son. (P5; father)
according to plan, I sit down and think . . . my son’s in good
I was shocked to know that I was contributing to her
hands at the center and I need to take care of myself and be
behavior, an enabler, that’s what she (the speaker)
strong for my other children. (P1; single-mother)
said . . . I know now that only she can change herself
Communication techniques, sharing, more open . . . give
when she is ready . . . there are things that I must change
him (son) more acknowledgment of his strengths and
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also in order for her to change such as not so controlling

achievements, accepting him as my son, telling him that I
. . . and we are all ‘‘work in progress’’!! (laughing) (P4;
love him regardless of his failures . . . that might be what he
mother)
was looking for . . . I realized that I have to take on the role
I have less emotional outbursts . . . before, I was depressed,
as the head of the family for it to function well . . . (crying)
afraid and angry . . . I still do but not too much . . . I will try
(P8; father)
to find support whenever I started to feel that I need
someone to talk to, maybe call someone from the group or
the counselor . . . just to get it off your chest . . . it helped.
(P3; mother) Unhelpful elements in the program
For personal use only.

Most participants strongly valued the help they received from

the program but some (n ¼ 3) mentioned the need for further
Helpful things participants did themselves during the improvements. What appeared to be beneficial was the feeling
time they were involved in treatment of continued support from the family intervention program and
the staffs at the agency. Elements that were perceived as
There was plenty of evidence from the interviews that all the
unhelpful were language and therapy. Some of the program
participants (n ¼ 8) were very active and continued striving to
components were conducted fully in English and some par-
resolve their difficulties between sessions as mentioned
ticipants were unhappy that the agency was not sensitive to the
below. They stated things that were supportive, that they
fact that they may not be well-verse in that language. Although
were doing and how those things were helping them. They
there were translators, they still feel unsatisfied as the objective
seem to know what they needed and wanted and what would
of the program components may not be achieved as they do not
be helpful to them:
fully understand what was being said. In terms of therapy, some
participants wished there were more one-on-one therapy being
Every day there’s prayer. I go back to God (Allah) and
done for the families. Some illustrations of these concerns are:
pray for the well-being of my family, for support and
strength and for my son to get back on track . . . he is still
It is a waste of money and time to come . . . I did not get too
young, you know, only 15. (crying) (P3; mother)
many things from the program . . . I mentioned to the
I called my other children and we will have discussions
counselor/facilitator about this but he said it is already
together, I will convey to them about information I got from
good you are here . . . I feel angry, that is why I miss some
the program at the agency . . . I asked them time and again
of the session and went up (to my room). (P6; sister)
whether I put most of my energy and attention to their
The invited speaker was good. The group sharing activity
sister as I don’t want them to feel that I was neglecting
really helped me getting to know about what was
them . . . they all said no and were very supportive and
happening in my family . . . Although I talked to her and
understanding . . . . (P4; mother)
she did provide some sort of brief counseling or advising to
me after the presentation, it was not enough. I feel the need
to get more therapy for myself and my wife as a
Helpful things participants learned in the program
couple . . . we have a lot of unresolved issues and we still
that they are continuing to use
need to learn more on working together. I wonder if they
The participants in this study (n ¼ 8) indicated learning (counselor) can help us out on this. (P5; father)
ways and means of handling their problems, knowledge
about addiction, new ways of looking at their situation Observation data also shows the development and changes
and themselves and strategies that they continued to use in the participants. For example, some participants in the
 4 D. F. Baharudin et al.
earlier stage of the program were rather closed and unwilling
to participate but as they progress through the program, they
open up and shared more, expressing more emotions, making
connections with other families involved in the program and
even encouraging and supporting each other. Many seem to be
more active and empowered, giving ideas, tips and sugges-
tions to other family members based on what they had
experienced and learned.
Discussion
This study, in line with Bohart & Tallman’s (1999) recom-
mendations for more research on the client’s perceptions of
therapy, set out to discover in more depth how families in
treatment of drug addiction viewed their improvements from
the existing program and the ways they were proactive in the
process. These data fit well with Bohart & Tallman’s (1999)
premise that ‘‘research evidence converges to suggest that the
active efforts of clients are responsible for making psycho-
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therapy work’’ and Prochaska & DiClemente’s (1992)
readiness of client to change.
The stages of family needs, moreover, may or may not
directly correspond to the addict stage of recovery. Family
members may be far more ready for change in the positive
direction and their readiness to change contributes to the
success of the program, especially in terms of them initiating
proactive measures for themselves and other family members
For personal use only.
as well as creating solutions themselves of given time,
opportunity and ways to do so. Families giving commitment
to treatment itself signifies a positive step forward and a clear
indication of their motivation to change (Bohart & Tallman,
1999; Presley, 1987).
It is interesting to note that the participants involved in this
study are parents or siblings of drug-abusing clients who are
adolescents or young adults. Drug users are usually perceived
as loners or people cut-off from primary relationships.
However, studies have shown that 60% to 80% of people
who are drug dependent, especially below the age of 35,
either live with their parents or are in daily contact with at
least one parent (Bekir et al., 1993; Stanton & Shadish, 1997).
In the context of Malaysia, where the culture is more
collectivistic, drug users usually maintain their connection
with their families (Dini Farhana Baharudin et al., 2012).
Data also shows that participants, who are families of
adolescents and young adults, are giving commitment to
treatment by participating in the family intervention program.
This is contrary to the general perception about the feasibility
of engaging drug-abusing adolescents and their families in
treatment and supports the evidence that parents and families
play an important role in treatment and outcome (Liddle,
2004; Rowe & Liddle, 2003).
Therapeutic relationship or alliance has been amply
demonstrated to be central to successful therapy (Duncan
et al., 2002; Kothari et al., 2010; Maione & Chenail, 1999).
The client’s perception of that relationship is possible even
more important than the counselor’s because it has been
found that clients’ ratings are better predictors of outcome
(Bachelor & Horvah, 1999). Therefore, having a constructive
working relationship with the counselor is important, as it was
J Subst Use, Early Online: 1–6
to all the families interviewed. An implication for this is for
counselors to realize that they are closely being assessed by
clients in much the same way that they are assessing their
client, in this study, clients being the families in treatment.
This process of mutual appraisal is common in any social
interaction but it is sometimes easy for counselors to forget
that it also happens in therapy sessions and consultations. The
data suggests that a counselor with a positive view of the
client’s potential to grow and self-heal and autonomy as well
as being a constant support may be in harmony with clients’
own ideas of what is needed and effective for them in the
helping relationship.
Participants in this study appeared to have had a generally
positive experience of the family intervention program. The
findings also show the benefits and areas for further
improvement of the program. The program allows participants
to gain new insights of looking at their situation and
themselves, they learn different ways and means of handling
their problems, gather more knowledge and understanding
about addiction and strategies that they find useful. However,
data also show participants are active in their quest and have
their own resources in handling their difficulties during the
time they were involved in treatment.
Many counselors believe that what clients do between
sessions is at least as important, and probably more so than
what happens during therapy. The value of this out-of-session
activity is well documented in the literature (Bohart &
Tallman, 1999; Bowman & Fine, 2000; Manthei, 1996; Sheel,
2004). In fact, Lambert (1992) estimated that, clients’
resources and what they do outside their session is the largest
contributor to success in counseling. These activities include
formal homework tasks and client initiated self-help effort
(Bohart & Tallman, 1999). During this non-counseling time,
usually the other 28–29 days of the month, it is reasonable to
expect that families will be actively engaged with their
problems and their solutions, and it would be useful for
counselors to know what occurred during that time. In this
way, the families’ strengths, successes and competencies can
be highlighted and reinforced. As implication, counselors
should expect this self-healing to happen, predict it and
encourage it. It builds on and supplements what is happening
in therapy and supports the families’ inclination to be
active, effective, self-help agent (Bohart & Tallman, 1999;
Manthei, 2007). Counselors may also expect that families will
discover ways in which they can make improvements for
themselves. These improvements will often be triggered by
things that have been learned or discussed in their treatment
program.
In discovery-oriented approaches to counseling, the aim is
to help clients use their own capabilities to change and if need
to be, to teach them new skills and ideas (Bohart & Tallman,
1999). The ultimate aim is to boost clients’ capabilities to
solve any problems that might occur in the future. The
participants’ comments illustrate the value of teaching and
encouraging clients during their program to be self-reliant
when future problems arise. This outcome is almost a
universal goal to therapy, a process of psycho-education and
support whereby families facing with addiction gain confi-
dence and competence needed to overcome their future
 DOI: 10.3109/14659891.2013.799239
problems. Counselor may stress the long-term value of the
program by pointing out that once they discover how to
handle their problems effectively, they can repeat the process
again in the future by using their new insight, skill and
confidence or by adapting their learning to fit slightly
different circumstances and challenges in the future. This
sort of suggestion will reinforce the families’ view of
themselves as an effective, capable problem-solver.
Literature on unhelpful interactions in therapy is consid-
erably less extensive than it is for helpful factors (Bowman &
Fine, 2000). In previous studies, findings include counselors’
behaviors such as repetition and misdirection (Llewelyn,
1988), unclear goals, talking too much (Bowman & Fine,
2000) and inappropriate or confusing self-disclosures (Hill &
Knox, 2002). In this specific study, aspects that were not
mentioned by the literature that the participants were less than
satisfied with were language and therapy. This may be due to
the differences in cultural context and the family intervention
program itself. Other contributing factors include time
J Subst Use Downloaded from informahealthcare.com by 175.136.6.11 on 07/14/13
constraints and counselors’ lack of training in family therapy.
Family therapy itself is not in the program component but
may be added by request by the families themselves or the
drug user in treatment.
There are several limitations to this research. First is the
small sample size of eight participants. As the number of
participants who were involved is small, the results are
certainly not definitive and are interpreted with caution. There
For personal use only.
are some concerns about the time lapse between families
attending the program and being interviewed. Gaps in their
memories regarding the program could have compromised the
fullness and accuracy of the data obtained. This is always a
concern in retrospective reporting although there were
suggestions from previous study that clients can recall
events that happened in therapy up to six months previously
(Martin & Stemaczonek, 1988). Finally, the interviews were
conducted in participants’ native language, which is the
Malay language. In this article, quotes from participants were
translated into English, whereas the original quotations were
in Malay language. Although the translation was done through
a proper procedure, the fact remains that they were translated
version and not the original quotations.
Despite the limitations, this study supports previous
studies on the involvement of family members and substance
using clients in treatment (Liddle, 2004; Velleman et al.,
2005) and interventions aimed at supporting family members
affected by the drug addiction (Copello et al., 2010). The
study also provides some interesting results that are worth
consideration by agencies and counselors in the treatment and
rehabilitation of drug addiction to help families in need.
Finally, the findings also indicate the need to hire more
counselors who are trained in family therapy in drug
rehabilitation agencies so that more drug addicts can be
helped with the support of their families.
Declaration of interest
The authors report no conflicts of interest. The authors alone
are responsible for the content and writing of this article.
This research was funded by a research grant scheme from
the University Sains Islam Malaysia PPP/FKP-1-15511.
Family intervention 5
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