A Guide to Family Therapy in Substance Abuse Recovery

family therapy

Table of Contents

  1. What is Family Therapy?
  2. Family Therapy in Substance Abuse Treatment
  3. Complicating Factors
  4. Why Treatment Centers Should Understand Family Therapy

What is Family Therapy?

Family therapy is an important part of substance abuse recovery treatment because when one family member is ill with the disease of addiction, the whole family is ill as well. Since the family is a system of closely connected parts, when one part “breaks down,” it affects the entire system. That’s why it is key that therapy is given to help heal the family as well as to help the person struggling with addiction. There are different therapeutic approaches to family therapy.

Strategic School of Family Therapy

The strategic approach is a therapist-driven therapy rather than the more traditional way that is client-driven. It has a brief timeframe. The therapist takes the initiative by identifying conflicts within the family and designing solutions to resolve them.

Structural Family Therapy

Structural therapy is a therapeutic approach that looks at how family members interact with each other in ways that cause problems. When a family is dysfunctional, the aim of this type of therapy is changing the family structure rather than changing individual family members. The focus is to improve how family members communicate and interact with each other to develop a healthier family structure.

Solution-Focused Family Therapy

Unlike other forms of counseling that spend time analyzing problems and the family’s past, solution-focused therapy focuses on finding solutions in the “here and now.” The overall theme is to have family members taking what they need to know about improving their lives and finding quick resolutions to meet their goals. The therapist coaches family members to remember they are able to find their own solutions if they work at it.

Integrated Approaches

Currently, many family therapists take an integrated approach to family therapy within addiction recovery.1 A multidimensional approach takes something from many different techniques to help families grow healthier and stronger.

Family Therapy in Substance Abuse Treatment

The goal of family therapy is to heal and strengthen the family. Substance abuse treatment and therapy need an integrated therapy approach to do this. This means that the therapies focus on multiple issues.


  • Each family member’s issues as they relate to alcohol or drug abuse. For example, how a family member may enable a person’s drinking.
  • The effect of each family member’s issues has on the family system. This is examined as a way to turn around substance abuse. For example, a substance abuse problem exists in one person in the family, so therapy looks to change interactions within the family system that do not support substance abuse.



  • How the family wishes to intervene in the recovering person’s life.
  • Education or advice for the family about substance abuse and recovery.
  • Education on how substance abuse affects parenting, how to improve parenting skills, and supporting the parents as they make changes.
  • Counseling on defining and changing the interactions and behaviors surrounding substance abuse and developing ways to disrupt those patterns.
  • Help for the family in defining specific goals for change, some which may not be related to substance abuse. Then the counselor helps the family make those changes.



Integrated models are more effective and can cost less in the long run. Better treatment outcomes that result from a comprehensive approach more than compensate for the time and money invested.1

Complicating Factors

Dual Diagnosis

Those with a substance abuse problem and a form of a mental health disorder have what is called a co-occurring condition. A common example of this is someone with an alcohol use disorder and depression. Also called a dual diagnosis, this condition can complicate family therapy.

Research shows that millions of Americans are affected by a dual diagnosis. In 2014:

  • It was estimated that more than 20 million adult Americans had a substance use disorder.2
  • It was estimated that almost eight million adult Americans had a substance use disorder, along with another mental illness.2
  • More than half of adult Americans with a dual diagnosis were men.2
  • People with a dual diagnosis had higher rates of disease and death.3

Limited Skill and Information

Family members may want to provide the person support, but they have limited skills when it comes to dealing with mental health issues. Family members also may have limited knowledge when it comes to handling substance abuse and recovery. The dual diagnosis may add a lot of pressure to the family environment, resulting in higher levels of conflict, stress, and relapse.

Biological Factors

The biological aspects of addiction may also affect family therapy. The recovery process fluctuates due to what drugs were abused, how much was used, and the degree of its effects. Recovery may also depend on how closely drugs, antisocial behaviors, any any co-occurring conditions are related. Withdrawal symptoms may also interfere with sessions.

Money Issues

Socioeconomic factors of a family in therapy can have serious effects of the effectiveness of therapy. If the family is dealing with poverty, survival is the main focus. This makes it hard for a therapist to turn the focus from survival to the family system or the behaviors of family members. Also, if the family is being treated using agency funds, the agency determines the length of treatment, regardless of the client’s needs.

Cultural Issues

Cultural backgrounds play a significant part in possibly complicating family therapy. A therapist needs to understand the family’s cultural background and how it may divert from mainstream culture. It’s also key for the therapist to know the family hierarchy, how it functions, and what goals the family will find appropriate.

Why Treatment Centers Should Understand Family Therapy

Family therapy can help improve troubled relationships with family members. Specific issues such as substance abuse, conflicts, mental illness, as well as other problems, can be treated in therapy. It’s key that rehab centers know what approaches are best to improve treatment outcomes.

Family therapy, along with any needed mental health treatment, can help heal the person in recovery, as well as the family unit as a whole.

In dealing with addiction, the family can attend therapy while the recovering person is in a residential program. In some cases, the family may participate in family therapy, even if the individual with an addiction hasn’t sought treatment or is in relapse.

Family therapy helps its members deal with grief, stress, anger, and conflict. It can help bring family members closer, help them to better understand one another better, and learn coping skills to minimize dysfunction.

During the research of prospective treatment centers, be sure to check that they understand the value of family therapy.

Patients who participate in family therapy have a better understanding of family dynamics, improved problem solving, and better anger management skills.


  1. https://www.ncbi.nlm.nih.gov/books/NBK64266/
  2. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health/index.shtml
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367509/