Family Therapy for Alcohol Addiction

Alcohol use disorder (AUD) is a chronic, relapsing disease involving compulsive consumption of alcohol despite the harms it causes to your health and relationships.

When seeking help to recover from alcohol use disorder, there are several therapeutic approaches to changing the individual’s behaviors so they stay sober. One approach involves healing family relationships. Spouses, children, siblings, parents, and other family members can all be negatively impacted by a person struggling with addiction; at the same time, the person with AUD may be triggered by existing problems in family relationships, which need to be solved. Strong family support through addiction treatment helps those in recovery stay away from intoxicating substances. Family therapy can rebuild the family’s support structure, so everyone stays psychologically, emotionally, and behaviorally healthy. Read on to learn more about family therapy for addiction and how it is beneficial during the alcohol treatment process.

Types of Therapy for Alcohol Addiction

There are many forms of counseling that treat addictions. According to the National Institute on Drug Abuse (NIDA), types of therapy that work well for addiction treatment include:

• Cognitive behavioral therapy
• Contingency management with motivational incentives
• Community reinforcement plus vouchers
• Motivational enhancement therapy
• Peer support or 12-step groups
• Multisystemic therapy
• Family behavioral therapy
• Multidimensional family therapy
• Brief strategic family therapy
• Functional family therapy

Typically, group therapy is a preferred approach during addiction treatment because the group dynamic and social support can show everyone that they are not alone in their struggles. Family therapy is a form of group therapy, although the focus is on healing relationships among those who have struggled for a long time with behavioral and psychological problems that both stem from and trigger AUD. There are many reasons to choose family therapy as part of an overall treatment plan.

• Family members can act as forces for positive change while supporting their loved one in recovery.
• Including family members increases the likelihood that the individual remains in therapy.
• Family members whose relationships have been harmed due to addiction can work together to heal those relationships.

Not all rehabilitation programs provide family therapy, but it can be a very important aspect of treatment, especially for people who have spouses and children, and for adolescents struggling with AUD.

What Is Family Therapy?

Family therapy is a collection of interventions that use family strengths to enact change. It views the family as a complex system, where any change that impacts one part of the system impact all other parts. AUD harms not only the person with the disorder, but often their family members as well. Family therapy can help reduce this harm and start to heal all members by addressing how:

• AUD affects each family member.
• To change thoughts, feelings, and behaviors related to alcohol use.

Types of Family Therapy

Most rehabilitation programs focus on group therapy, especially for those struggling with co-occurring disorders. Unfortunately, few programs currently offer family therapy as part of addiction treatment, although it is more likely to be part of the treatment plan for adolescents. Group therapy approaches in rehabilitation do, however, apply techniques similar to those used in family therapy, so bringing in family members when possible, or finding additional therapeutic treatments with a family therapy specialist, may be important.

Types of family therapy that may be part of alcohol use disorder treatment, especially for adolescents, include:

• Family behavioral therapy: This type of treatment is the foundational approach to family therapy for both adults and adolescents. Family behavioral therapy (FBT) not only addresses AUD, but it also addresses co-occurring disorders within the family structure. These may include other addictions, mood disorders, post-traumatic stress disorder (PTSD), and abuse. FBT mixes contingency management approaches with behavioral counseling, so everyone can begin to change their behaviors. For this approach to work, the individual recovering from AUD and at least one other family member must be present for therapy. These family members can include cohabitating or intimate partners, parents (especially for adolescents), or children.
• Multisystemic therapy: This approach includes family therapy, along with individual, group, and community approaches to treatment. In this form of behavioral treatment, the adolescent’s behaviors are viewed as characteristics of the child; for example, the child may have a favorable view of substance abuse, which led them to try alcohol, and later develop a dependence on it. Family attitudes toward substance abuse may exacerbate the child’s attitudes; for example, the family may have a strict “no drugs” approach, which could cause stress for the child and lead them to try alcohol due to peer pressure. Other attitudes in the surrounding community, at school, in the neighborhood, or among friends are also considered.
• Multidimensional family therapy (MDFT): MDFT is a treatment approach that works best for adolescents and teenagers who are attending outpatient treatment programs. The adolescent’s family is one part of a network of influences that can change the child’s behaviors in different settings. Other influences on the adolescent include peers, communities, and individual influences like genetics. Family sessions can take place in the clinic, at home, in a family court, in school, or at a community center. Parents are asked to examine their styles of parenting to support their child in developing better behaviors.
• Brief strategic family therapy (BSFT): This approach targets family interactions that may trigger compulsive behaviors in adolescents, like alcohol abuse. There may be other co-occurring problem behaviors that increase the likelihood of these stressful interactions, including truancy, delinquency, aggression or violence, or spending time with antisocial peers. However, these behaviors in the adolescent are indicative, in this type of therapy, of a larger problem in the family structure. BSFT is also designed to be flexible, so families can participate in as many sessions as needed in various locations, including schools, homes, and courts.
• Functional family therapy (FFT): Using the family systems approach, FFT considers the adolescent’s behaviors to be created and maintained by negative family interactions and structures. The therapist will work with the adolescent and their family to develop better approaches to communicating, solving problems, and resolving conflicts as well as help parents to develop better approaches to parenting.
• Solution-focused brief therapy. This approach focuses on solving family problems rather than pinpointing the cause. Families work together with their counselor to envision what the world would look like without alcohol use and create treatment goals.
• Community reinforcement and family training (CRAFT). CRAFT teaches families positive reinforcement strategies to encourage their loved one to stop drinking and enter treatment.
• Family recovery support groups. This approach uses community-based peer support groups to help people understand and cope with addiction. It includes groups such as Al-Anon, Families Anonymous, and SMART Recovery Family and Friends.
• Behavioral couples and family counseling (BCT). This approach is for people with AUD and their intimate partners and promotes positive reinforcement to reduce relationship stress, improve communication, and reduce substance use.

Because of parental influence on their children, most of these approaches were developed for adolescents and work best in that treatment setting. However, even during therapy focused on teenagers, the adults’ struggles with substance abuse, including AUD, may come into play. Therapy for their child or sibling may help the adult seek treatment for their own struggles with alcohol or drugs.

How Effective Is Family Therapy for Addiction?

Adolescents who are enrolled in family therapy as part of their overall alcohol or drug treatment plan maintain abstinence longer than those who do not receive family therapy. In one study, 54.6 percent in family therapy maintained abstinence after treatment compared to 37.5 percent. Adolescents who participated in family therapy were also found to have greater overall improvement.

Another study examining three types of adolescent drug addiction treatment – Family Systems Therapy, peer group therapy, and family drug education – found that Family Systems Therapy led to more adolescents abstaining from alcohol and drugs after completion of treatment: 54 percent compared to 28 percent in group therapy and 16 percent in family drug education.

Family therapy is important for adults, too. Attachment disorders are common in children whose parents struggled with alcohol or drugs even when child abuse and neglect are not present. Adults struggling with substance use disorders, including alcohol use disorder, can heal these co-occurring family issues by attending family therapy with their spouses and/or children. With adults, engaging one adult – a worried significant other, for example – using a family therapy approach can strengthen the entire family system and support the person overcoming AUD.

Strengthening the family system also prevents substance use disorders and mental illnesses from harming children’s lives as they grow. A family history of alcohol abuse increases the risk of future substance abuse and mental health struggles for children.

Benefits of Family Therapy

Family therapy helps give each family member skills to cope with and start to heal from the impact of AUD. Benefits include:

• Increased likelihood of the person with AUD staying in treatment.
• Better treatment outcomes, including lower relapse rates.
• Lower cost than individual therapy or mixed therapy.
• Better understanding of how other family members’ thoughts, feelings, and perspectives.
• Improved family relationships.
• Better understanding of addiction and the recovery process.