Family is the single most important aspect of most people’s lives. Family ties make and break addictions. Most psychological research suggests that social support, especially from family, is one of the single most important aspects of recovery. Yet, substance use disorders actively harm relationships, harm family ties, and destroy family hierarchy. Family therapy is one approach to helping families to recover from substance abuse in the family. And, while most family therapy is entirely about family and not addiction, that’s often exactly the support that someone in recovery needs.
Family therapy helps you to rebuild relationships, helps family members to recover from the damage of substance abuse, and gives the family tools to establish new roles and hierarchy by breaking negative patterns and habits. This approach gives you the tools to rebuild the foundations of a happy life – rather than just getting clean – which is essential to staying clean and sober. The goal is to help families recover, so that the person in recovery has a stable social support, and also so that their family members can recover.
What is Family Therapy?
Family therapy normally uses a behavioral therapy approach to intervene in family interactions and relationships – usually with the intent of identifying negative behavior patterns and replacing them with healthy ones. This can take many forms, with the most common including the “Family System”. If you’re specifically seeking out family therapy for recovery, you’re also highly likely to encounter the “Family Disease Model”. Different models use different approaches and often attempt to figure out different problems – meaning the therapy is tailored to the problem at hand.
Family System – Family System is the most common family therapy method used in recovery treatment. Here, the treatment provider makes the assumption that the rest of the family has organized behaviors, thoughts, and emotions around the individual dependent on a substance. That’s natural and normal, especially if the individual with an addiction is temperamental, likely to be violent, or frequently requires considerable help. The result, in most families, is that the entire family hierarchy revolves around one person, responsibilities change hands, and even small kids take on massive amounts of responsibility. The therapy takes the approach of identifying how those behaviors and patterns can be corrected, to identifying maladaptive behaviors, and to introduce new behaviors to restore the family structure to a healthy one.
Family Disease Model – The Family Disease model is the second most common behavioral therapy used to treat families in recovery. Here, the substance abuse is viewed as a disease that spreads from the addict to the rest of the family – building negative behavior patterns as it goes. This model is especially beneficial in that it works to root out undiagnosed problems in other family members, such as trauma, codependence, and anxiety – because it assumes those problems are there.
These two main therapies may be supplemented or replaced by other therapies. For example:
Brief Strategic Family Therapy – Family members attend 12-16 sessions designed to investigate and improve negative interaction patterns with the goal of improving them. This is ideal for families with light issues.
Family Behavioral Therapy – Family behavioral therapy takes a full behavioral therapy approach to every member of the family, treating each person as though they have negative behavior patterns they want to be rid of.
Functional Family Therapy – Functional Family Therapy approaches families with the idea that they have trauma and want to work through it. Functional Therapy treats the family as a unit rather than as individuals, under the assumption that traumas are largely interpersonal and dependent on others.
Multi-systemic and Multi-Dimensional Family Therapy– These two therapies are often used in tandem and often with other therapies. The goal is to specifically treat enabling behavior patterns or patterns which contribute to substance use and relapse. Unlike other forms of family therapy, these two forms are primarily only used to prevent relapse, rather than to improve the health of the family as a whole.
Importantly, the treatment type you receive will heavily depend on where you go, how you seek out treatment, and how you and the family are assessed.
When someone in your family is addicted to a substance, suffers from a mental illness, or is otherwise unwell, it leaves marks on the whole family. Stress, trauma, changes in patterns, lapses in judgement, increases in negative emotions, and similar abound. When you go into recovery, those scars don’t just go away. They stay and they negatively impact the family, how the family interacts, and how the family support each other. This not only negatively affects the addicted person’s ability to recover but also puts everyone else at a greater risk of mental illness and developing a substance use disorder themselves. Timely family therapy can help to root out those issues, preventing significant and long-lasting damage.
Understanding – Family therapy, especially that delivered during treatment, helps families to understand addiction. That obviously results in a better understanding of what happened, a better ability to forgive, and a better way to move forward.
Improved Relationships – Family therapy works to help families recognize and move past barriers, to set boundaries, and to therefore improve the full family dynamic. That might be identifying enabling behaviors. It might also be identifying points of stress or tension, of identifying negative behavior patterns that lead to arguments, or to help each person understand the other’s communication methods. The idea is to ensure that everyone understands what the other has gone through and how they feel about it, how the other communicates and from what basis, and which behaviors of their own are contributing to hurt and unhappiness.
Parenting – Family therapy is especially important if you have young kids. That’s important even if you have a spouse who has had no issues. Having one member of the family addicted to a substance greatly increases levels of stress, which reduces quality of parenting from both parents. Family therapy can help kids to understand problems and to come to terms with them, can improve parenting, and can improve parental management – so that everyone involved is happier and less stressed. In one study, family therapy was also shown to catch co-occurring disorders and developing anxiety in children significantly earlier than in families that did not seek it – allowing those children to get treatment.
Most families are resistant to family therapy, especially parents. “It’s not me with the problem”. But, likely, it is. Substance use disorder builds stress, trauma, and maladaptive patterns. If your loved one stopped taking care of their responsibilities and you had to pick them up, you have behavioral problems to work through and recover from. If your spouse was violent or frequently blacked out, you have trauma to work through. If your parent suddenly became distant and more interested in drugs or alcohol, you have trauma to work through. And, many families respond to substance abuse by withdrawing, by becoming antagonistic, and by arguing with the person with a substance use disorder. That’s fair, even though you can’t argue with someone who is irrational, but those patterns extend well past when the addiction stops.
Rebuilding Family Ties
Organizations like SAMHSA list family therapy as one of the single most important steps you can take following an addiction. That recommendation is based on data that shows families that get therapy are more stable, less likely to develop their own disorders, and less likely to become addicted themselves. That’s especially true when children are involved, because children are extremely vulnerable to substance use disorders. Getting help can move a child out of the path of early substance abuse, emotional management problems, and self-esteem issues by resolving dysfunctional patterns.
While no family therapy can ever rebuild your family as it was, it will help you to recover. It will help your family to recover. And, that’s an essential part of recovery in the modern sense of “building a life where you can be happy without drugs or alcohol”.
Substance abuse is incredibly harmful to everyone around the abuser. Family therapy helps you to tackle that harm and to take steps to recover from it, so that you and your family can be happy.