Family Therapy in Addiction Treatment

Addictions are personal, but they produce far-reaching consequences. People caught in obsessive, drug-seeking behaviors destroy their relationships and bring chaos to those closest to them. The families of people struggling with addiction take the most direct hit, which is why family therapy is such a crucial component of addiction treatment and recovery.

What is Family Therapy?

Family therapy gives family members a voice about the destruction of addiction. When someone with an addiction seeks treatment, he participates in individual and group therapy sessions that focus on helping him with substance use. While it’s crucial for these people to get treatment, family members also suffer with the fallout from addiction. Spouses of those in the grip of addiction often feel angry, neglected, and ashamed about the situation. When children have an addicted parent, they feel responsible for the parent’s substance use and are at greater risk for cognitive and emotional problems.¹

A major goal of family therapy is to help family members understand how addiction affects them and give them tools for improving their relationships. Addictions sometimes occur because of dysfunction at home and therapy gives family members a way to understand risk factors and do what they can to prevent them.

Children are especially vulnerable when addiction in present in the home. Growing up in a home with addicted parents increases a child’s risk of mental health disorders like depression, anxiety, and bipolar disorder. Physical abuse, sexual abuse, emotional abuse, and neglect are all harmful to the psychological health of children. As adults, they often struggle with low self-esteem, and they have higher rates of alcoholism, divorce, and domestic violence.²

How Does Family Therapy Work?

A healthy family takes work, especially when a household deals with addiction. Family therapy focuses on dynamics that contribute to addictive behavior, helps members overcome resistance to change, destroys barriers to communication, and helps family members interact in a positive way. Therapists also have an obligation to make sure members of a household, especially children and teens, are safe from harm and neglect.³

Family sessions take a variety of forms, including the following:

• Private family sessions involving a therapist and one or more family members
• Group sessions with patients and their loved ones
• Intensive family education sessions (family weekends or activities)
• Individual counseling for spouses and children of recovering addicts
• 12-Step meetings for the families of addicts, such as Al-Anon and Alateen

There are several popular treatment models in family addiction treatment. Some of the most effective use the following widely used therapeutic strategies:

• Structural or strategic therapy: focuses on identifying and transforming the structural dynamics that promote addiction; structural therapy places a strong emphasis on improving communication and helping family members set boundaries with the addict
• Multidimensional family therapy: frequently used to help recovering teenagers; multidimensional therapy works with children and adolescents to build strong, stable identities; parents are counseled on communication, parent-child relationships, and setting limits
• Behavioral family therapy: uses Cognitive Behavioral Therapy (CBT) principles; identifies destructive thought patterns and behaviors within the family system; family members then learn how to replace those patterns with positive actions that support sobriety⁴

No matter which treatment model a therapist uses, therapy focuses on how the family functions as a system, creating both positive and negative outcomes through interactions. Creating positive interactions is the ultimate goal of family sessions.

Goals for Families in Treatment

One of the first goals of family treatment is to overcome obstacles to recovery. An addict may feel scrutinized, criticized, or judged in a counseling session. Sober family members may be reluctant to admit they’ve played a role in the addict’s behavior by enabling his or her destructive habits.

It may be even harder to admit that addiction provides certain benefits to the family. Providing drugs to an addicted mother may temporarily prevent violent, abusive behavior. Helping an alcoholic stay drunk may help him be more agreeable. Enabling a teenager’s addiction may seem to help a parent maintain emotional control. No one wants to admit addiction is ever a positive thing, but many families unconsciously perpetuate the behavior.⁵

Conscious or unconscious enabling takes place in a number of ways:

• Lying to friends or employers about a family member’s drug use
• Purchasing drugs or alcohol for someone in your home
• Paying bills for a family member who is in financial trouble
• Excusing a family member’s violent or manipulative behavior, even if it has a direct impact on your psychological or physical health

Another critical objective is to restore a healthy group structure. In families that have been devastated by addiction, the structure of the home breaks down completely. Family life may be chaotic and disorganized. Parents may have lost their authority and may be unable to set limits with addicted teens. Therapy sessions must focus on improving communication and restoring appropriate family roles. Creating a safe, sober home environment is one of the primary objectives of therapy.⁴

Education is one of the most important goals of family treatment. At counseling sessions or intensive family weekends, household members learn to identify the behaviors and thoughts that foster an addictive home environment. They learn new coping strategies and conflict resolution skills to help them deal with the stressful situations that come up daily in every home.⁴

Families who engage in addiction treatment therapy have the opportunity to explore their strengths as well as their weaknesses. Through intensive group sessions and activities, members rebuild trust and develop a new sense of empathy.

¹ “Substance Abuse Treatment and Family Therapy.” Center for Substance Abuse Treatment.  Treatment Improvement Protocol (TIP) Series, No. 39, 2004. Accessed 19 June 2017.

² Solis, Jessica M. et al. “Understanding the Diverse Needs of Children Whose Parents Abuse Substances.” Current Drug Abuse Reviews, vol. 5, no. 2, 2012, pp. 135–147. Accessed 19 June 2017.

³ “Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.” National Institute on Drug Abuse (NIDA), 14 January 2014. Accessed 19 June 2017.

⁴ “Quick Guide for Clinicians, Based on Tip 39 Substance Abuse Treatment and Family Therapy.” SAMHSA. 2005. Accessed 19 June 2017.

⁵ “Module 10J: Alcohol and the Family.” National Institute on Alcohol Abuse and Alcoholism. March 2005. Accessed 19 June 2017.