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
Addiction is a Family Disease
The National Council on Alcoholism and Drug Dependence calls addiction a family disease. That’s because addiction affects the entire family system and the individuals who comprise it. Addiction puts family members under a great deal of stress, disrupting routines and causing unsettling or even frightening experiences.
As a result, family members develop unhealthy coping strategies as they strive to maintain equilibrium in the household. The family unit becomes a fragile and dysfunctional system, and this often unwittingly contributes to the addiction as the family adopts destructive behaviors as a result of it.
Children in the household are particularly affected by addiction. Substance abuse in the home interrupts a child’s normal development and leads to a higher risk for physical, mental and emotional health problems.7 Children of an addicted parent often have difficulties in school and are more likely than their peers to have a learning disability, skip school or be expelled. They’re also four times more likely than their counterparts to become addicted to alcohol or drugs themselves.
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. Parents and siblings may also adopt enabling behaviors that contribute to their loved one’s substance abuse.
- Denial – In many cases, when a child has a substance abuse problem, parents will deny that there is an 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.
Coping with Addiction in the Family: Unhealthy Behaviors
Families often cope with addiction in unhealthy ways, such as by living in denial about the addiction or by following behind their loved one, picking up pieces. Their lives may revolve around the addiction, whether it’s at the root of endless arguments or it’s an elephant in the room.
Codependent and enabling behaviors are common among families living with addiction. These types of behaviors can foster the addiction as well as make recovery very difficult for both the addicted loved one and the family members.
Codependency often results when someone has to adapt to dysfunction in the family system. Codependent behaviors are learned thoughts, attitudes and behaviors that lead to neglecting your own needs and desires in favor of being obsessively concerned with a loved one’s problems.
Codependent behaviors include:
- Worrying constantly about your loved one’s drug abuse and the consequences of the addiction
- Living in denial about the addiction, such as by lying to others about a loved one’s substance abuse or avoiding contact with others because you don’t want to have to make excuses
- Reacting violently or irrationally to events related to the addiction
- Having very low self-esteem as a result of neglecting your own physical, spiritual and emotional needs as you focus solely on your loved one
- Aiming misplaced anger at others, such as the kids or pets
- Engaging in your own unhealthy behaviors that help you cope with reality, such as over-eating, excessive shopping or obsessive Internet use
- Basing your mood on that of your loved one
Enabling behaviors support a loved one’s substance abuse by removing consequences, either out of love or fear. This makes it easy for a loved one to keep using, and it’s unhealthy for the enabler, the addicted individual and the family system.
Enabling behaviors include:
- Using drugs or alcohol with a loved one to help keep trouble at bay
- Keeping your feelings inside in order to keep the peace with your loved one
- Accepting your loved one’s justifications for substance abuse
- Working to protect your loved one’s image by minimizing the consequences of the addiction, such as by making excuses for them or taking care of their responsibilities
- Going out of your way to make everything at home appear normal to others
- Feeling guilty when you’re unable to prevent natural consequences from affecting your addicted loved one
How Children May Cope with Addiction in the Family
Children may develop their own set of unhealthy coping skills in response to addiction in the household and the chaos and uncertainty it inevitably brings. Many children blame themselves for a parent’s substance abuse and may strive for perfection to avoid upsetting the delicate balance in the household. Conversely, they may withdraw for the same reason.
Children who witness or fall victim to physical, emotional or sexual abuse may develop post-traumatic stress disorder and suffer from related nightmares, insomnia and flashbacks. They may withdraw socially due to a lack of social skills or the fear that someone may find out the truth, and they may suffer from anxiety born from an unstable living environment or from a deep-seated fear of losing their parent to the addiction.
What Is Family Therapy?
There are many benefits of family therapy, especially when it’s used in an addiction treatment setting. 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.
Benefits of Family Therapy
A large body of research demonstrates the positive impact the family can have on a loved one’s recovery from addiction. The National Institute on Drug Abuse highlights the many benefits of family involvement in recovery, including:
- Keeping your loved one engaged and motivated during treatment
- Learning about addiction and its effects on the family as well as understanding how treatment works and what to expect when it’s complete
- Enabling family members to voice feelings and concerns and ask questions about a loved one’s addiction
- Offering a loved one a high level of appropriate support after treatment
- Easing feelings of fear, anger, stress and confusion related to the addiction
- The chance for family members to develop skills and strategies to help a loved one stay on the path to recovery
- Improvements in family communication skills
- The opportunity to address any mental health issues within the family system, such as depression or anxiety, which can hamper family communication and contribute to relapse
Getting involved in a loved one’s recovery improves the chances of long-term success while improving household function and family members’ own mental health.
Objectives of Family Therapy for Addiction
According to the Substance Abuse and Mental Health Services Administration, there are two main goals of family therapy for addiction.1
- Provide helpful support for the individual in drug treatment. Family therapy decreases an individual’s chances of 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 involvement. Family therapy for addiction 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.
- Life skills. 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.
- Behavioral changes. 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.
- Goal-setting. 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. Some may also worry about the following things:
- That they’ll be ganged up on in therapy.
- That they’ll have to confront difficult issues that they’d rather not face.
- That they’ll have to reveal family secrets like abuse or illegal activities.
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.
While it can be very difficult to get reluctant family members involved in treatment, psychoeducational workshops and motivational interviewing are two interventions that can help weaken resistance. Psychoeducational workshops impart the importance and far-reaching benefits of family involvement in recovery. Motivational interviewing can help a family member work through ambivalence toward recovery and help them identify their own motivation for change.
Relapse Is Possible
Recovery is all about relapse prevention. Health, home, purpose and community are the cornerstones of a life in recovery, but it’s important to understand that setbacks—which are any behaviors that can lead to relapse—are a normal part of recovery. Relapse rates for addiction are similar to those for other chronic diseases like heart disease and diabetes.6 Between 40 and 60 percent of people in recovery will relapse at some point.
It’s important for the individual in recovery and family members to understand that relapse and other setbacks are not he catastrophe they were once considered to be. Relapse is now widely regarded as an opportunity to evaluate the recovery plan and determine what went wrong, then take steps to develop the missing skills that led to the relapse.
How you approach setbacks can make a big difference in continued recovery. People who regard setbacks as a personal failure are likely to disregard all of the positive gains made in recovery and may feel that sobriety is too difficult to achieve and give up altogether. Conversely, those who view setbacks as a catalyst for re-evaluating the recovery plan, identifying the missing skills that led to the setback and developing those missing skills will likely get back on the road to recovery stronger than before, with more resolve and motivation to achieve long-term sobriety.
Family involvement in treatment and recovery has been shown to help prevent relapse, but relapse is always possible. Knowing the stages of relapse and the signs associated with each stage can help family members recognize an impending setback and help their loved one avoid relapse by intervening and ensuring the loved one gets the support needed to get back on track.
Get Addiction Help for the Whole Family at Nova Recovery Center
At Nova Recovery Center, we understand that addiction is a disease that affects the entire family unit. Even more importantly, we emphasize the importance of treating the entire family, not just the addicted person.
Our Family Program is designed to address the specific issues family members and loved ones of the addicted person face and we also provide Family Behavior Therapy throughout each client’s program to facilitate the healing process and address problematic behaviors caused by the addiction.
Call Nova today to learn more about family addiction treatment and recovery.