Health promotion and prevention of substance abuse

Subtance abuse is a family systems problem (Berenson 1976; Steinglass et al., 1987). Like a Calder mobile, the family has its own stability and equilibrium - touch any part of the mobile and all parts swing to a new position in the overall sculpture. Substance abuse, when present, may become the central and organizing aspect of the mobile. The family organizes itself and establishes equilibrium around the substance abuse. Substance abuse compromises the health of the individual and has reverberations through all aspects of the patien t’s life, including the family and work setting. The healthcare provider is touched by the substance-abusing patient’s compromised health status and has the potential of touching the patient in health-promoting ways so that the mobile swings in positive directions. Generations past and future as well as the extended family are often affected by the problem of alcoholism and substance abuse and can be resources to help effect change in the pattern of alcohol and drug use. The case of Juan Espinosa illustrates how one touch to the mobile creates a new sculpture. The genogram of Juan’s family shows the pervasiveness of the problem of alcoholism throughout the family system.