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.

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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.


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 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.