Family dynamics have changed drastically over the last several decades, impacting the way we view life as well as the behaviors and roles we take on. The modern family unit may include single-parent families, unmarried cohabiting couples and children, increased divorce rates, gay and lesbian marriages, in addition to shared childcare, household and employment duties.
Regardless of the various ways the family unit changes, family therapy is still a beneficial component of substance abuse treatment. In fact, research has found that behavioral health treatment that includes family therapy works better than treatment that does not, and when combined with individual treatment, can reduce rates of relapse, improve medication adherence, reduce psychiatric symptoms, and relieve stress.1
Impact of Substance Abuse on Families
Although the effects of substance abuse vary based on family structure, drug and alcohol-abusing behaviors impact family dynamics in several ways that are very unhealthy.2
- Negative emotions – As a result of the substance abuse, family members typically experience negative emotions such as anger, resentment, anxiety, concern, guilt, and embarrassment.
- Safety – In some cases, the safety of other family members may be put at risk by a person’s substance abuse. Children or spouses may also feel the need to obtain legal protection due to fear of their loved one’s actions.
- Responsibilities – Certain family members inherit too many responsibilities or responsibilities that are not age-appropriate. This can cause children or spouses to become overwhelmed, anxious and resentful.
- Communication – When a family member is abusing drugs, communication within the family unit is often negative and positive interaction is very limited. In addition, the needs, concerns, and wants of the family members other than the substance abuser may be overlooked.
- Structure and boundaries – Homes in which substance abuse exists often have a lack of structure with minimal parental involvement and loosely existing or non-existent boundaries. This results in confusion for children and negative/inappropriate behaviors.
- Denial – In many cases, when a child has a substance abuse problem, parents will deny that there is any issue. This may be because they don’t want to face the problem or they simply cannot see it clearly.
- Relationships – Substance abuse produces damaged relationships that can continue on through generations through negative behavioral modeling. Additionally, drug or alcohol abusers will often isolate themselves from other family members and spend the majority of their social time with other substance abusers.
What Is Family Therapy?
Family therapy helps the members of a family unit heal and recover as a group. The therapeutic setting provides a safe space for everyone to learn how to adjust to a loved one’s recovery from addiction and mental illness. Family therapy sessions are also designed to help family members make specific, positive changes to improve the home environment as well as heal relationships within the family unit.1
Family therapy typically involves the substance abuser and at least one other member of the family. This could be a spouse, parent, significant other, sibling or any other individual who has a close relationship with the person in treatment.
Objectives of Family Behavior Therapy
According to the Substance Abuse and Mental Health Services Administration, there are two main goals of family therapy.1
- Provide helpful support for the individual in drug treatment.
Family therapy decreases an individual’s chances for relapse, aids in the development and maintenance of positive behavioral and attitude changes, and promotes long-term recovery of the individual in substance abuse treatment.
- Improve the emotional health of the family as a whole.
Therapy helps family members establish trust and encourage forgiveness for past behaviors. It also can provide peace and resolve conflict or feelings of anger, frustration, and sadness. Additionally, family therapy extinguishes the sense of ongoing crisis and encourages participants to let go of negative emotions.
What to Expect
According to the National Institute on Drug Abuse, family therapy has shown positive results for substance use problems and coexisting disorders such as depression, child abuse/neglect, depression, unemployment and other types of family conflict.3 If you and your family are enrolled in family therapy while a spouse, parent or other loved one is in substance abuse rehab, here’s what you can expect.
Family therapy typically starts after the user has entered substance abuse treatment and has made progress. This may be a few weeks or a few months into the treatment. It usually involves the client in substance abuse treatment and at least one other family member. This may be a member of the immediate, extended, blended family, or another individual that is significantly close to the client.
During therapy, the counselor will assist family members as they acquire new skills and learn how to apply them. This helps create healthier interaction at home that improves the overall environment. Counselors also teach members of the family how to communicate more effectively and behave in ways that support the client’s recovery instead of hindering it.
Contingency management is also used within family therapy to assist the client as he or she develops behavioral goals that encourage abstinence from all substance use. This enhances progress and helps to resolve underlying issues and mend damaged relationships.
Family members are also asked to set goals related the roles they play within the family unit. For example, parents set goals that are related to their parental roles, siblings set goals that are related to being a brother or a sister, and so on. These goals are reviewed during each session and family members provide rewards when they are achieved.
What to Do If a Family Member Does Not Want to Participate
In some instances, a family member may not be willing to participate in family therapy. This is often due to fear, skepticism that the counseling won’t make a difference, or sheer exhaustion from ongoing efforts.
If this happens, it is beneficial to have the individual meet with the counselor on an individual basis to address his or her concerns, review the purpose and benefits of family counseling, as well as encourage participation. Ultimately, the decision to participate must be made willingly, but additional education and encouragement from an addiction treatment professional can help persuade unwilling family members.