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How Family Therapy Improves Addiction Treatment Outcomes

Supporting Recovery throughout Life

How Family Therapy Improves Addiction Treatment Outcomes

Supporting Recovery throughout Life

Addiction is a family disease, according to the National Council on Alcoholism and Drug Dependence.​​​1 It affects every member of the family, and it can cause deep dysfunction in the family system. The relationship between addiction and family problems is well-established, and family therapy is an integral part of a high quality addiction treatment program.

The Definition of a Family

The definition of “family” has changed over the decades. Today, family is generally defined as the group of people to whom an individual is bound by powerful emotional ties. This is the group of people who are considered “family” for the purposes of family therapy in treatment.

Family Categories

The Substance Abuse and Mental Health Services Administration identifies three general categories that describe most families.

Traditional Families

Which encompass heterosexual couples and their children; blood relatives; adoptive families; foster families; grandparents rearing their grandchildren; and step-families.

Extended Families

Which include grandparents, aunts, uncles, cousins, and other relatives.

Elected Families

Which are non-biologically related people you choose as your family. Elected families include godparents, LGBT couples with or without children and emancipated youth and their close ties.

However you define your own family, it’s a system made up of individuals who interact in certain ways and function accordingly. The primary goal of family therapy is to improve the functioning of this system by addressing issues that affect its members.

How Addiction Affects the Family System

Addiction can cause uncertainty and chaos in the family system. It puts stress on the entire family and affects the way it functions. It can impact household finances, family stability and unity, and the physical and mental health of the family members.

Routine Interruptions

When someone in the family has an addiction, it can be difficult to create and maintain healthy routines, which may be constantly interrupted by negative experiences, especially if the person with the addiction is abusive or unpredictable.

Unhealthy Coping Behaviors

As family members work to maintain a sense of safety and normalcy despite the uncertainties of living with an addicted individual, they commonly develop unhealthy coping behaviors that further erode the stability of the family system. Children in particular who live with a person with a substance use disorder may feel overwhelmed and respond by withdrawing, acting out or even turning to drugs or alcohol themselves to self-medicate their confusion and pain.

Other Impacts

A review published in the journal Current Drug Abuse Reviews points out that 11 percent of all children live in a household where one or both parents abuse drugs or alcohol.2 These children are more than twice as likely as their counterparts who don’t live with an addicted parent to develop a substance use disorder by the time they reach young adulthood. They’re also more likely to have cognitive and behavioral problems that lead to poor academic performance and mental health problems down the road, including anxiety, depression and anger and trust issues.

When a family member becomes sober, the whole family enters recovery. Family therapy helps to stabilize the family system and improve communication and coping skills among family members.

Codependence, Enabling and Stinkin' Thinkin'

The overarching focus of family therapy is to foster a healthy family system that supports and facilitates long-term recovery. This requires delving into the unconscious patterns of thought and behavior that can perpetuate addiction and contribute to relapse.

Codependence and enabling behaviors are extremely common in families struggling with addiction, and these contribute to the dysfunction of the household. Cognitive distortions, also known as “stinkin’ thinkin'” by psychologists, play an important role in problematic relationships and communication breakdowns.

Codependence

Some family members of a person with a substance use disorder may become codependent, which leads to being so consumed with the loved one’s problems with addiction that they neglect their own self-care.

If you’re codependent, you may obsessively worry about the substance abuse and its consequences, or you may be in denial, lying to yourself and other people about the extent of your loved one’s substance abuse.

Codependence leads to low self-esteem; avoidance behaviors; and unhealthy coping behaviors like binge eating or compulsive shopping. It can damage your relationship with other family members and lower your quality of life even apart from the addiction.

Enabling:

Enabling occurs when you directly or indirectly and consciously or unconsciously make it easier for your loved one to continue abusing drugs or alcohol without consequence.

Family members may engage in enabling behavior in order to maintain peace, keep the loved one safe or increase a sense of control in an out-of-control situation.

Enabling behaviors include:

  • Using with your loved one so you can keep an eye on things
  • Suppressing your feelings to avoid upsetting your loved one
  • Accepting your loved one’s excuses and apologies
  • Minimizing the consequences of the addiction, such as covering for your loved one at home or excusing unacceptable behaviors
  • Lying to others about the situation at home
  • Making excuses for your loved one

Stinkin' Thinkin'

Cognitive distortions make healthy communication with others very difficult. The most common cognitive distortions include:

  • Jumping to conclusions: You interpret things negatively even when you don’t have facts to back it up. You may accuse a family member of reacting negatively to you even though there’s no evidence of it
  • Overgeneralizing: You make “always” and “never” statements that simply aren’t true, such as “you always yell” or “you never listen.”
  • All-or-nothing thinking: Everything is black and white. If things aren’t completely perfect, they’re terrible. 
  • Always being Right: You prioritize being right over the feelings of another person. You actively try to prove your actions or thoughts are correct.
  • Catastrophizing: You make gigantic mountains out of molehills, often expecting the worst and turning every minor negative event into a disaster.

Codependent and enabling behaviors and cognitive distortions can be hard to identify and even harder to break. Family therapy helps family members identify and change behavior and thought patterns for better communication and improved family functioning.

Stages of Change

Problems at home are major relapse triggers. Family therapy aims to create a stable and calm home environment that will support the recovery of the addicted family member. The objectives of family therapy, according to the Substance Abuse and Mental Health Services Administration, are to move the family from:

  • Distrust to reconciliation
  • Guilt to forgiveness
  • Stress to strength
  • Frustration to understanding
  • Despair to hope
  • Sadness to support
  • Anger to peace
  • Conflict to agreement
  • Crisis to resolution

The Three Stages of Change:

Through family therapy, a family in recovery moves through three stages of change:

Attainment of Sobriety

Before the loved one becomes sober, the family is in a state of dysfunction or crisis. The first stage of change is achieving sobriety and the family realizing that healthy change is possible.

Adjustment to Sobriety

During the second stage of change, the family develops a new system to help them adjust to a new way of life. The relationships within the family system are stabilized, and the family becomes more stable as a whole.

Maintenance of Sobriety

The third stage of change occurs as the family develops healthier ways of communicating and makes important lifestyle changes that support a life of sobriety.

Four Models of Family Therapy

There are a number of approaches to family therapy that may be used in a treatment program. The Substance Abuse and Mental Health Services Administration identifies four general models of family therapy that are commonly used in treatment settings.

Family Disease Model

The family disease model of family therapy views addiction as a disease that impacts the family as a whole and affects each family member in a unique way. In order to cope with the problems addiction brings to the family system, family members often develop enabling and codependent behaviors. Under the family disease model, these unhealthy behaviors must be addressed in order to treat the addiction.

Family Systems Model

According to the family systems model of family therapy, families organize themselves based on their interactions related to the substance abuse. Maladaptive patterns of communication cause a breakdown in the functioning of the family system as family members adapt to the substance abuse in an attempt to maintain balance.

According to the family systems model, identifying and changing dysfunctional communication patterns and identifying the role of each family member in the addicted household leads to better family functioning and meaningful healing through healthier family interactions.

Cognitive-Behavioral Model

The cognitive-behavioral model of family therapy draws on the understanding that unhealthy thought patterns lead to dysfunctional behaviors, and these are reinforced through unhealthy family interactions. The cognitive-behavioral approach involves helping family members identify and change faulty thought and behavior patterns through improved communication and problem solving as well as developing healthy coping skills.

Multidimensional Family Therapy

Multidimensional family therapy is typically used to treat adolescent substance abuse. It emphasizes the complex relationships between cognitive, emotional, behavioral and environmental factors and improves coping, problem-solving and decision-making skills while restoring function to the family system.

The type of family therapy used in a treatment program depends on a number of factors, including who is addicted, how the addiction has affected the family and the preferences and expertise of the therapist. Many therapists use aspects of many different models in order to address the unique needs of each family.

What to Expect in Family Therapy

Prior to Therapy

A family therapy session typically lasts an hour. Prior to beginning therapy, the family may be asked to sign a contract agreeing to certain standards of behavior, such as not interrupting or shouting. 

Understanding Family Dynamics

Initially, the whole family meets together, and the therapist asks questions, listens and observes while family members interact. The therapist keeps the conversation productive, and through observation begins to understand the dynamics of the family system and identify the family’s strengths and challenges.

Family Therapy Topics

The therapist helps family members develop skills and strategies for changing the way they think and behave in the family system. They learn to better communicate their needs and listen to the needs of other family members. Topics in family therapy are wide-ranging and may include: 3

  • Setting healthy boundaries
  • Handling crises
  • Coping with negative emotions
  • Positive communication and listening skills
  • Adjusting to change
  • Codependence and enabling behaviors
  • How to best support a loved one in recovery

Assignments

The family may be given homework assignments to complete between sessions, such as engaging in a fun activity together or giving one another compliments. These types of assignments help family members practice new skills and stay mindful of how they interact one-on-one and as a unit.

Developing Skills

The family therapist may choose to meet with family members individually or in smaller groups. He or she may recommend individual therapy for some or all of the members of the family. Individual therapy can help family members–particularly children and adolescents -work through a variety of issues and develop essential coping skills.

Why Some Family Members Decline to Participate

Some family members may be reluctant to participate in family therapy, for a variety of reasons. These include:

Fear:

Some people may fear change, preferring things to stay the way they are rather than take a risk on the unknown. They may be afraid of embarrassment or judgment. 

Fatigue:

Family members who are exhausted by the addiction and the issues that underlie it may opt out of family therapy.

Distrust:

A family member may distrust other family members, or he may distrust therapists and be unwilling to speak openly.

Power Concerns:

Powerless family members may feel like family therapy won’t produce any benefits, while family members in positions of power may fear losing the power advantage through therapy.

Cynicism:

Some family members may be cynical about the benefits of family therapy and believe that it won’t do any good.

Sometimes, an unwilling family member will have a change of heart as recovery progresses. In any case, the therapist may try to meet with reluctant family members to try to address their concerns and convince them to give family therapy a try.

Family Support Benefits Recovery

According to the National Institute on Drug Abuse, the benefits of family involvement in treatment are far-reaching and improve the chances of successful long-term recovery.4 Family therapy:

  • Improves family members’ understanding of addiction and how it affects their loved one’s brain function and behaviors
  • Reduces conflict and improves the quality of life at home
  • Fosters motivation for change in the addicted loved one
  • Helps family members support their loved one without enabling
  • Improves family members’ mental health
  • Imparts families with skills and strategies for reducing conflict and increasing tolerance and understanding

Family therapy can make a huge difference in recovery for everyone involved. Through improvements in the functioning of the family system come fuller healing, greater happiness and a higher quality of life for all members of the family.

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Resources

  1. https://www.facingaddiction.org/audience/family-friends
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676900/
  3. https://www.ncbi.nlm.nih.gov/books/NBK64269/
  4. https://archives.drugabuse.gov/news-events/nida-notes/2010/12/multidimensional-family-therapy-adolescent-drug-abuse-offers-broad-lasting-benefits