Family Therapy with Addictions

Addiction affects the whole family. Because of this, it is understandable why some would suggest that treatment should involve the whole family. It is often the case that addicted individuals seek treatment in response to a form of external pressure exerted by family members. Many therapists adopting family therapy to treat substance abuse today have broadened what constitutes family to include other members of the substance user’s social networks including employers, friends and concerned others in the intervention (Fals-Stewart, O’ Farrell & Birchler; 2006).

The level of involvement with the family in treatment is regulated by the therapist ranging from family members offering support, to them being full partners in the treatment process with the user and the therapist. Treatment can be provided separately or jointly with family members. However, it is structured a major emphasis of treatment is to educate family members about co-dependence. Co-dependency is an unconscious addiction to another person’s abnormal behaviour (Wekesser, 1994). Specifically, co-dependent members of the family often forget about their own needs and desires as they devote their lives to control and cure the substance abuser (Parsons, 2003).

Each member of the family may be affected by substance dependence/abuse differently. Parental substance abuse/dependence may have severe effects on normal children of alcoholics. Children of the substance dependent/abuser may hold themselves responsible for their parents’ dependency and may think they may have caused it. Feelings of guilt, depression, loneliness and fears of abandonment are common with children of substance dependants/abusers. Such children may also have problems in school and have their school performance affected (Parsons, 2003). Crime, violence, incest and battering are common in substance abuse families. Relationship issues such as loss of intimacy have also been associated with substance dependence/abuse.

Partners of substance dependants/abusers are also affected negatively by the addiction. Feelings of self-pity, hatred, avoidance of social contacts and embarrassment have been said to be common in such relationships (Berger, 1993). The role of the therapist is to gain understanding of these functions of substance use in the broader family system in order to explain to the family the development of the behaviour and the function it serves.

Problem solving skills, coping skills, positive interactions and communication skills training are some of the interventions provided (Fals-Stewart, O’ Farrell & Birchler; 2006).

Family Therapy with Alcohol Addiction

Family intervention is considered to be an effective treatment for alcohol use disorders (Fals-Stewart, O’ Farrell & Birchler, 2006). The level of involvement of the family in treatment is regulated by the therapist ranging from offering support to being a full partner in treatment. The focus is to offer the support of the user’s entry into treatment. The three main approaches of family therapy are:

1. Family disease approach that view alcohol use as an illness suffered not only by the alcohol user but by the whole family. The emphasis of treatment is to educate family members about co-dependency behaviour that enables the user to continue with the behaviour. The family members are made aware that their acts of “love” and “caring” may only serve to enable the substance user to continue with their alcohol abuse or dependence.

For example:

A wife who drives to the bar to go pick up her drunk husband at night as an effort to insure his safety enables him to continue the use of alcohol; A child assumes the parent role and makes dinner because mum is too intoxicated to prepare dinner; A wife covers up for her husband for not going to work because he was too drunk.

Family members are encouraged to emotionally separate themselves from the substance by detaching themselves from the problem to minimise distress and maximise coping skills.  With this style of therapy, the family members are taught that there is nothing that they can do to stop their loved one from using the substance other than to stop enabling them through doing things that actually help the family member keep the alcohol abuse or dependency active. It is important for the therapist to conduct separate treatment for the family members and the alcohol user (Fals-Stewart, O’ Farrell & Birchler; 2006).

2. The family systems approach assumes that there is a reciprocal relationship that exists between the family functioning and the alcohol use. The approach believes that the development of substance use occurs when an individual member of the family is having challenges managing important developmental issues within the context of their family environment (Fals-Stewart, O’ Farrell & Birchler, 2006).

It is important for the therapist to gain understanding of the function of alcohol use in order to explain to the family the development of the behaviour and the function it serves. Techniques that are used to achieve this include joining to promote rapport with the family by making a connection with each member of the family and increase reception to therapy by promoting areas of strength in the family.

For example:

A family of four; mum, dad, Sophia and Tia have presented for treatment because dad is an alcohol abuser. The therapist may facilitate joining in the following:

Therapist: “Mum thank you for being here today. It is important that we all take part in this treatment. And you Sophia, your father must be proud of you for being such a good girl. Tia, your mum has told me that you help her a lot around the house. That is wonderful. Dad, you have such a great family”

Restructuring involves modification of the family’s dynamics such as bonding and power positions within family members. For example:

Therapist: “So Tia should you be the one to make sure Sophia is in bed on time? Or is that something mum and dad should do? What do you think mum and dad?”

Contracting refers to an agreement between the family, the alcohol abuser and the therapist to work together on agreed issues. For example:

The alcohol abuser can make a promise that he will not use alcohol in the day of the interview and the wife and children make a promise to support the substance abuser to stay sober and also not to use enabling behaviours.

Reframing involves the therapist helping the family understand their interconnectedness and how the alcohol use serves an important function in their family. For example:

“Do you think that your drinking interferes with your marriage and stops you from being the father that you would like to be?”

Marking boundaries means limits between the individual, the alcohol use and the family are defined (Fals-Stewart, O’ Farrell & Birchler, 2006). For example:

The alcohol abuser is prohibited to have contact with his drinking friends for all the duration of the treatment.

3. The behavioural approach follows operant and social learning principles. The approach assumes that substance use is a behaviour that is learnt in the context of social interactions. The treatment emphasis is on; rewarding sobriety (for example: praise and recognition when a partner goes a day without drinking), reducing negative reinforcement of drinking alcohol (for example, encouraging your spouse to drink water after heavy drinking to prevent hangover) and increasing desirable behaviours that are unrelated to drinking (for example planning a family activity like going to art exhibition instead of attending a party).

The therapist’s focus is to increase problem solving skills including problem identification coping skills, positive interactions and communication skills (Fals-Stewart, O’ Farrell & Birchler, 2006).


  1. Fals-Stewart, W., O’Farrell, T.J., & Birchler, G.R. (2006) Family therapies techniques in Rodgers, F., Morgenstern, J., & Walters, S.T. (2006). Treating Substance Abuse: Theory and Technique (2nd ed.). NY, NY: The Guilford Press.
  2. Parsons, T (2003). Alcoholism and its effects on the family. All Psych Journal retrieved from World Wide Web on the 5th of October 2009.