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Family Therapy in Alcohol Treatment

What Is Family Therapy?

Family therapy is a type of psychotherapy that focuses on ways family members can support one another and work through difficult life situations. It may be helpful to think of family therapy as a general term that describes several different models and approaches to family treatment. Some of the commonly used family therapy models include:2

  • Psychoeducation, which is helpful with people who have serious mental illness along with a substance use disorder. Psychoeducation can provide support groups, problem solving, and community resources.
  • Family behavior therapy (FBT) is an approach that addresses substance use disorders for both adults and adolescents. FBT uses therapy, along with contingency management. Contingency management is an approach which provides rewards for meeting such goals in therapy as having negative drug tests or going to self-help meetings. FBT encourages family members to agree on contracted goals and then providing the rewards for meeting these goals.
  • Behavioral couples therapy (BCT), which can be used in cases where only one member of the couple has a substance use disorder. This approach aims to improve relationship communication and increase abstinence from substances.
  • Multidimensional family therapy (MDFT), which utilizes an intensive approach to treating adolescents with substance use disorder and works with the family and the school system, juvenile justice, and other systems in which the child lives. Individual counseling is part of this approach, along with changing family functioning patterns in family therapy.
  • Solution-focused brief therapy, which focuses not on the underlying causes of the issues in the family, but rather how to problem solve and move forward. This approach helps families break down the problem and create solutions at each step to change the outcome, while helping the family envision goals and outcomes where things are different in the future. The process takes a collaborative approach in which the family is seen as a partner with the therapist to create their own solutions.
  • Functional family therapy, which is widely used with adolescents and focused on motivation for change, as well as problem solving and changing dysfunctional family patterns of interaction.

How Does a Loved One’s Substance Abuse Affect Family Members?

If you are in an intimate relationship with someone who misuses alcohol or drugs, you may experience higher levels of relationship dissatisfaction and greater interpersonal conflict than people in relationships where drugs or alcohol are not an issue. Furthermore, when conflict erupts over the use of substances, people will often then use substances to relieve the stress from the conflict. The cycle of substance use, conflict, stress, and more substance use is hard to break.3 Studies show that substance use affects family members in many areas, including:4

  • financial hardships.
  • interpersonal violence.
  • legal issues.

Additionally, children who live in families with people who have substance use disorders may develop issues with attachment and overall development, as well as being at a higher risk of developing a substance use disorder themselves. 4

Family therapy can be an effective intervention to help cope with these disorders. Studies show positive results from intervention and therapy. For example, BCT has been shown to reduce drinking and improve relationship quality as well. Other approaches such as solution-focused brief therapy have also shown effective outcomes in working with families with substance use disorders.2

Who Can Attend Family Therapy?

When deciding who should participate in family therapy, remember there are many definitions of family. Essentially, a family is a group of people who care about one another and describe themselves as family. Your family may reach beyond your immediate family, which can include friends, extended family members, or other people close to someone, such as a coach, or a coworker.2

Regardless of which approach is taken, or who attends a family therapy session, the goals of family therapy generally include5

  • To help each person in the family support the person with the substance use disorder, and in doing this, help the person avoid relapse and maintain recovery.
  • To improve the overall emotional wellbeing of each family member.
  • Increasing the problem-solving ability of the family.
  • Improving and changing the ineffective patterns of communication.

When Is the Best Time to Begin Family Therapy?

In general, it is best to start family therapy after the person in recovery has had time to begin their own treatment and is fully committed to the process of recovery. When a person has engaged in individual treatment and has begun to work on their initial recovery, understanding their triggers and how to cope with these, as well as showing stable patterns of behavior, they may be ready to start family therapy. However, it is best to consult with you or your loved one’s counselor to determine the timing for family therapy.5

What to expect in Family Therapy

Various elements in family therapy change based upon the approach or particular model that a therapist uses. The general approach to family therapy involves7

  • Individual assessment for the person who has the substance use disorder, to understand the overall situation with the person’s family and who should be involved with family therapy.
  • Family interviews to discover patterns of interaction, family problems, and how each person views the substance use issues with the individual. In addition, the therapist will assess for issues of violence or abuse.
  • Assessing strengths of the family and who can support the person with a substance use disorder and how they can do so. Furthermore, the therapist will explore family patterns of substance use and how this has contributed to the person’s experiences with substances.

The first sessions are also spent explaining the process of therapy, assuring each person is heard in terms of how the substance use has affected them, and continuing to assess the family interactions. The identified person should be part of these sessions unless there are unusual circumstances, such as threats of violence or being intoxicated.

The content of sessions may vary. In some sessions, the focus may be on solving a particular problem or perhaps reinforcing coping skills. In other sessions, the content may be about communicating effectively.5

Is it Effective?

Numerous studies on different models of family therapy indicate that it is effective.5,7 The meaning of effective may vary from one person to another, but, overall well-being, communication, and longer periods of recovery from substance use are generally the indicators that the treatment approach is working effectively.5,7

In some cases, family members may refuse to participate in therapy. Sometimes people are afraid of what therapy entails or may not understand or believe in the process. In these cases, the therapists can try reaching out over the phone during sessions to ask for their input.

Alcoholism and addiction may affect each member of the family in a different way. Family therapy in addiction treatment can provide resources to navigate those relationships and be successful in recovery.


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