The Role of Family in Addiction Treatment
Family therapy is used in a number of substance abuse treatment settings, and it has been shown to be effective for both adults and adolescents. 1, 2 Therapy that involves a person’s support network can be important for recovery, especially for teens.
What Is Family Therapy?
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Additional issues may also be addressed in treatment, such as parenting skills, abuse, depression, family conflict and unemployment.2
In addiction treatment, family therapy often takes the form of education. Allowing family members to ask questions and begin a dialogue can in itself be healing.
Additionally, therapeutic interventions may include:
- Discussing family roles.
- Identifying ways to improve communication and rebuild trust.
- Learning what helps and what is harmful.
- Identifying ways to interact that respect the needs of everyone involved.
The Family Systems Model
Most family therapists have adopted a family systems model, which views substance abuse as a symptom of dysfunction in the family. Family therapy is based on the view that a family is a distinct system, and each person in the system affects how it functions.
The entire system suffers when one person (in this case a person receiving substance abuse treatment), is functioning at an impaired level. Those who are not addicted to substances may discover that their behavior is also dysfunctional because of the efforts required to support a system that is flawed.
Addiction affects the entire family, and some family members may take on certain roles (enabler, overachiever) as a way to cope. Family therapy can help to repair damaged relationships and teach family members healthy coping skills.
Benefits of Family Therapy for Addiction
Some benefits gained by people in treatment and their families are:
- Better understanding of the nature of addiction and how it affects behavior: This is accomplished through education. Just as the person has been assessed, the family has an opportunity for self-assessment and insight from a therapist.
- Becoming aware of family dynamics: Maladaptive family patterns will contribute to continued substance use. Everyone in the system should be treated to obtain the most positive outcome.
- Improving communication: In a system where there may have been no communication or limited emotional involvement, improved communication is essential and will require an investment by those interested in the most successful recovery outcomes.
- Regaining trust: Dishonesty and substance abuse sometimes go hand in hand. Family members may not want to open their hearts (or their wallets) to help a loved one who has betrayed their trust. Improved communication, honest interaction and witnessing positive changes can help mend this breach.
- Sharing feelings: During active addiction, bridges can be burned. Family members may be angry but unable to express it, they may fear relapse or they may be excited at the possibility of reconciliation. It takes time to learn how to recognize, balance and express these feelings.
- Setting boundaries: This applies to everyone involved. Clarifying boundaries is not easy. But it is a necessary step toward healthy recovery for the family. This may include detaching from any family member is in active addiction.
- Learning self-care: In addiction treatment, the focus is on the person with the addiction. During family therapy, a parent or spouse may learn that they need help, too. They may be directed to try Al-Anon, Nar-Anon or other mutual help groups in addition to finding an individual therapist.
Types of Therapies
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It is important to determine the appropriateness and level of involvement of family members. Everyone must feel safe and able to voice their feelings and opinions without fear of retribution.
Some types of family therapy that might be used in substance abuse treatment include: 1
- Behavioral contracting: The therapist helps the family to develop a written contract focused on maintaining a substance-free home. The therapist may also help the family identify triggers for substance abuse, predict potential problems and develop strategies to avoid them.
- Behavioral marital therapy: The therapist helps the couple to create a drug-free environment. He or she may work with the couple on coping skills, communication skills, relapse prevention skills and reinforcements for abstinence.
- Multidimensional family therapy: This type of therapy is commonly used with adolescents and focuses on substance abuse as well as behavioral problems. The therapist meets individually with the teen and his or her family. Adolescents work on coping skills, and peer and family relationships. Parents work on any addiction or mental health uses they may be struggling with as well as parenting skills.
- Solution-focused therapy: This approach focuses on solving the problems identified in the family and not on how they developed. The substance user, the family and the therapist try to come up with ways to help the user stop using drugs and alcohol and determine what a home without drugs or alcohol would look like.
- Multifamily groups: These groups might meet every week, and they give families insight into their own behaviors and let them know that they are not alone. Very often, family members may feel that they are “the only ones” dealing with substance use, and it can be helpful to learn that others have and are experiencing the same thing. They often help one another.
Most inpatient treatment centers offer a family component.
Treatment settings where family therapy may occur include:
- Residential or inpatient treatmentL: Most inpatient treatment centers offer a family component. This may consist of appointments or multiple weekends and is determined and negotiated by staff with the user’s involvement. Therapists will usually meet with family members alone and then with the user and his or her family for multiple sessions. The focus can be on couples and/or entire families.
- Outpatient recovery programs: are offered for both adults and adolescents who are either stepping down from residential treatment or for whom residential treatment may not be immediately necessary. Group sessions focus on the user and also have a regular family group component where all group members and their families meet together with a facilitator. When working with adolescents, it is best to find an age-appropriate group. These groups are primarily educational but can provide insight into areas where the family may want to work more deeply with an individual therapist.
- Individual marriage and family therapy – In a private setting, a user may choose to work with a marriage and family therapist who also has experience with substance abuse. These providers have different styles and focuses, and it is important to ask questions up front and determine if they offer what you want. Develop a list of questions about the things that are important to discuss in addition to the substance abuse. These may include saving a marriage; helping a child deal with divorce; physical abuse; financial issues; blended families; incest; and grief.
Whatever you decide, remember to educate yourself and ask questions. Dealing with addiction is upsetting, and people frequently make important decisions when they are stressed and feeling that something needs to be done in a hurry. While this is true, you owe it to yourself and your loved ones to investigate your options and find the treatment that is right for you.
How It Works
- Goals: The primary goal of family therapy is to improve or initiate communication. Once this process begins, it is up to each member to decide how much they are willing to continue working on it. Another goal is to improve the home environment so it is a safe place for the user and his or her family.
- Setting, frequency, and duration: Therapy may be held at a treatment center, in an outpatient setting or in a therapist’s private office. The frequency and length of sessions will be determined by the program and your schedule. A therapy session usually lasts an hour. Outpatient sessions typically last 3 hours and will meet over a set period of weeks. Family components in treatment centers often include group sessions as well as shorter therapy sessions and beneficial leisure activities.
- Therapists: A therapist or facilitator will generally solicit input from everyone involved and keep things focused. It is important to have a trained and neutral moderator.
- Participants: Anyone deemed beneficial or essential to a person’s recovery may participate. This can include a spouse, children, parents, extended family members or even close friends who are like family.
- Typical session: All sessions will vary. In a group setting, where other people and their families are present, there is usually a check-in when everyone will be introduced. In a therapist’s office, the family group with meet with one another and the therapist. These sessions may be more focused on individuals in the group with the therapist setting the tone.
Effectiveness of Family Therapy
Research about the effectiveness of family therapy is ongoing. However, several studies suggest that it may be a useful component of addiction treatment.
- One study found that different forms of family therapy can help keep substance abusers and their families in treatment, reduce substance use and other harmful behaviors, and improve social functioning. 1
- Another study found that behavioral couples therapy can lead to abstinence, better relationships, reduced occurrence of separation and divorce, and reduced domestic violence. 3
- A study that reviewed advancements in family-based treatment research found that family therapy treatments can be helpful for a variety of adolescent problems, including substance abuse, schizophrenia and conduct disorder. 1
Find a Family Therapy Program
If you or a family member is in need of a family therapy program for substance abuse, call 1-888-319-2606 Who Answers? to speak to a trained treatment support representative. This person can address your concerns and answer questions about treatment options. They can also provide information on ways to pay for services.
. Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (SAMHSA) (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.)
. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Family Behavior Therapy.
. O’Farrell, T.J. and Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment 18(1): 51-54.