The Critical Role of Family Therapy in the Treatment of Chemical Dependence – A Systemic Approach

The Critical Role of Family Therapy in the Treatment of Chemical Dependence – A Systemic Approach

In a previous post on the value and efficacy of Marital and Family Therapy in the Treatment of Alcoholism, I addressed the multigenerational relational trauma of alcohol abuse and dependence. It is equally valid that “Family–based models are now consistently recognized as among the most effective approaches for treating both adults and adolescents with drug problems” (Rowe, C. L. Family Therapy for Drug Abuse: Review and Updates 2003-2010. JMFT, 2012.).

Chemical Dependence and Substance Abuse are defined by the problems they cause and the company they keep. These include physical health, legal, occupational, and psychiatric/dual diagnosis issues. The relational traumas of Chemical Dependence include:

  • Chaos and unpredictability

  • Marital discord, infidelity and divorce

  • Abuse, neglect, incest and sexual acting out

  • Blame, bitterness, alienation and cutoffs

  • Interruption of family life cycle stages

Substance abuse and chemical dependence can have a devastating effect on the individual and the family. Family therapy can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another. Family conflicts, low family support, drug use among other family members and parenting stress have all been shown to contribute to relapse.

The goals of Family Therapy in the treatment of Chemical Dependence include:

(1) “Utilize the support and leverage of the family to reduce the individual’s drug use and implement other important lifestyle changes”

(2) “Alter problematic aspects of the family environment to maintain positive changes in the individual and other family members and promote long-term recovery”.

It is crucial to work with family members on their resistance to change in their own roles. This necessitates a re-organization of the family in order to establish healthy relationships, adapt to new roles, address other family issues and help achieve desired levels of intimacy. The Substance Abuse and Mental Health Services Administration (SAMHSA) has published a Treatment Improvement Protocol titled “Substance Abuse Treatment and Family Therapy” which discusses integrative treatment models.

Family involvement in substance abuse treatment also has value to the professionals who work with these clients. Integrated models focus on the whole family and lead to reduced resistance to treatment. One very important benefit of the integrated model of treatment is a reduction in cost. A family therapist and a substance abuse counselor can work together with the same group of patients, thereby decreasing the number of treatment sessions and reducing cost.

Family therapy increases treatment entry rates and decreases dropout rates. Benefits of working with the whole family also include more rapid recovery and improved life satisfaction for the patient and family. The intergenerational impact may be the most significant reason for addressing family dynamics in treating individuals with chemical dependence. Reorganizing the family to stabilize and rebalance the system has long term benefits. Healing family relationships helps reduce the impact of addictions on future generations.

Family therapy is a crucial component of a holistic approach to the treatment of chemical dependence.

Please feel free to ask any questions or to comment in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here . If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks.

Ronald B Cohen, MD, PC www.familyfocusedsolutions.com Ronald B. Cohen, MD
Psychiatrist / Family Therapist
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
RBCohenMD@FamilyFocusedSolutions.com

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14 comments

  1. Sandra Brown on April 14, 2013 at 4:30 pm said:

    This is so very, very true. I wish the professional my husband saw when he started therapy would have given us more information. It was indeed a very sad outcome.

    • Ronald B Cohen, MD on April 14, 2013 at 8:06 pm said:

      Hi Sandra,

      First and foremost be kind and empathic with yourself. This is an incredibly stressful and anxiety producing situation. It is unfortunately true that many psychiatric practitioners can’t see the forest from the trees and fail to work within the context of the family including the within (intrapsychic) and the between (interpersonal). Individual therapy makes sense until you realize that everybody is a member of a family. Unlike traditional therapy and psychiatry, which has its limits and often zooms in too fast on the identified problem individual, I work with the entire family so that it comes out whole in a manner that is less costly and more effective in a shorter period of time. Individual problems occur in a social context. When one member of a family is sick, the entire family is destabilized. Emotional adjustments are necessary for all. If I can be of help in the future please do not hesitate to contact me.

      Regards,

      —Ron

  2. Adam Holstein, L.P. on April 18, 2013 at 10:42 am said:

    Ron,

    The article is very rich with information and food for thought. The intergenerational aspect I have always thought of as key to effecting change internally as well as with the family system. There is often times an unrecognized biological or unmet emotional need and the “patient self-medicates”. The problem also is that often times the family, immediate or past, do not understand or see the complexity of the problem and how to help. The underlying and often unconscious and non-conflicting ways they interact with the identified patient has to be addressed in some manner. We as well as the family needs to understand the ontological recapitulation from generation to generation. How do you frame or present to the family the need to make adjustments to their roles or interactions?

    • Ronald B Cohen, MD on April 18, 2013 at 5:59 pm said:

      Hi Adam,

      Recovery from chemical dependence involves healing the emotional illnesses of all members of the family. Family members must first learn to cope with their own problems before any beneficial effects can reach the individual with chemical dependence. One of the paramount problems for families is being recognized as individuals in need of assistance. Therapeutic tasks include;

      1. Establishing an understanding of chemical dependence and co-occurring family dysregulation.
      2. Developing self-focus/differentiation in all family members to address the “responsibility trap
      3. Adjust to a change in lifestyle that supports both abstinence and a stable family system
      4. Learn new behavioral skills for coping with stress and conflict
      5. Develop healthy interdependence
      6. Family Reorganization – Stabilize/Rebalance the System

      Hope that is helpful.

      Regards,

      —Ron

  3. Jeffrey L Miller MS,LMHC,CAP on April 18, 2013 at 1:51 pm said:

    Treating the family of the substance abuser is critical to overall success. Addiction and Abuse both impact the family in negative ways and no one in the family is spared. It has been my experience that support from the family is one of the best indicators of long term success. With the family in therapy, trying to get better, the user sees the level of importance the family puts on managing the AOD use. Addiction is a lonely disease and family participation and support help eliminate loneliness. Lonely is one of the critical four of HALT.

    • Ronald B Cohen, MD on April 18, 2013 at 5:06 pm said:

      Hi Jeffrey,

      Spot on! Alcoholism and chemical addictions affect the psychology of entire families. Intergenerational patterns of power, loss and control (“overfunctioning” or “overresponsibility”), transmit poisonous attitudes from parent to child. Family Systems Therapy treats the individual with a chemical dependency as part of a family unit that has a multigenerational history that led to addictive behavior. These unresolved problems often remain, even after sustained sobriety.

      Children are molded by the alcoholic family to be overreponsible (calm, efficient, but lonely and filled with self doubt) or underresponsible (filled with rage, demanding constant care and praise, but filled with violent resentment towards anyone that helps them). Because over- and under-functioning in families and relationships provides a welcome mat into people’s homes for alcohol and addictive chemicals, therapeutic interventions are aimed at modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. The goal is to solve problems in current relationships so as not to leave a damaging legacy for the next generation.

      Regards,

      —Ron

      PS If I remember correctly HALT is hungry, angry, lonely, tired. I seem to remember that as a suicide quartet. AOD I’m not familiar with. What say you?

  4. Josephine Reyes, Accredited Mediator on April 26, 2013 at 8:44 pm said:

    Dear Dr. Cohen,

    I am a practicing mediator for 28 years and yet, when it came to being exposed to the violence that my 36 year old stepson did, I could not handle it. He was on methadone and other drugs, combined with vodka and Red Bull.

    Your article opened my eyes, but the pain, the grieving and the disappointment is still there and I don’t know when I can accept the behavior. I have since asked this extended member of the family to move somewhere else. He has joined his mother in his fight and flight!

    I am studying for the Diploma in Child, Youth and Family Intervention and jointly completing my Family Dispute Resolution Practitioner course to include Family Mediations in my practice. Thank you for such a wonderful website and Family Focused Solutions practice.

    Josephine Reyes
    Sydney, Australia

    • Ronald B Cohen, MD on April 29, 2013 at 2:43 pm said:

      Hi Josephine,

      It sounds like you speak from a place of great personal pain and disappointment. First and foremost be kind and empathic with yourself. This is an incredibly stressful and anxiety producing situation. Alcoholism and chemical addictions affect the psychology of entire families. Add to this the responsibility trap, grief, loss, reactivity, turbulence, low credibility and angry projection and we have a recipe for true disaster. The first task is to insure safety. All other considerations are secondary.

      The emotional question I hear you asking is how best to take care of yourself in the face of traumatic and disruptive circumstances. The beginning of a way out remains focusing on self and differentiation. Attending to your own emotional health and well being necessitates maintaining appropriate limits and boundaries, and avoiding being over-responsible. The family can heal even if the individual with the chemical dependence does not. Best of luck.

      Regards,

      —Ron

  5. Maggie Allen on February 7, 2017 at 12:54 pm said:

    It’s really great that family involvement is a really important part of helping a teen get through their issues. In my opinion, there is nothing stronger than familial bonds, so it is good that they are utilized for something like this. I think that it would help lead to better long term abstinence from the substances as well.

    • Ronald B Cohen, MD on March 17, 2017 at 10:03 am said:

      Hi Maggie,

      The Bowen Family Systems Theory approach posits that alcoholism and chemical addictions affect the psychology of entire families. Intergenerational patterns of power, loss and control (imbalances in responsibility, functioning and adequacy) transmit poisonous attitudes from parent to child.

      These unresolved problems often remain even after sustained sobriety. And because over- and under-functioning in families and relationships provides a welcome mat for alcoholism, substance abuse and chemical dependence, therapeutic interventions are aimed at modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. The goal is to solve problems in current relationships so as not to leave a damaging legacy for the next generation.

      Regards,

      — Ron

  6. Tomas Killington on March 16, 2017 at 10:58 am said:

    My brother has struggled with addiction for the majority of his life. The family dynamic has struggled right along with him. We have been looking for ways we can improve the relationships within the family. I didn’t realize family therapy can help re-establish family order that can help reduce the individual’s drug use. That’s something we can all use right now.

    • Ronald B Cohen, MD on March 17, 2017 at 10:05 am said:

      Hi Tomas,

      Right you are. Modification of family relationship patterns starts with inquiries about developing increasing levels of functional differentiation and solid self, working to diminish levels of fusion and/or emotional cut-off, i.e. helping all interested and committed family members to become more productively responsible for their own behavior.

      The good news is it only takes one motivated family member, committed to change his or her behavior in the context of family relationship dynamics, to improve the entire family’s functioning. A change in functioning of one family member is automatically followed by compensatory changes in other family members.

      Regards,

      — Ron

  7. Ridley Fitzgerald on March 28, 2017 at 3:29 pm said:

    I can definitely see the benefit of family therapy. From what I have heard about chemical addiction, family environment can be pretty influential for the good, or for the bad. If I was struggling with this, I would definitely want my whole family’s support.

    • Ronald B Cohen, MD on March 31, 2017 at 10:16 am said:

      Hi Ridley,

      Thank you for your observations. Bowen Family Systems Theory (BFST) coaching addresses the individual with a chemical dependency as part of a family unit that has a multigenerational history that led to addictive behavior. These unresolved problems often remain, even after sustained sobriety. Over- and under-functioning in families and relationships provides a welcome mat into people’s homes for alcohol and addictive chemicals. Therapeutic interventions are aimed at modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. The goal is to solve problems in current relationships so as not to leave a damaging legacy for the next generation.

      Recovery from chemical dependence involves healing the emotional illnesses of all members of the family. Family members must first learn to cope with their own problems before any beneficial effects can reach the individual with chemical dependence. One of the paramount problems for families is being recognized as individuals in need of assistance. Therapeutic tasks include:

      1. Establishing an understanding of chemical dependence and co-occurring family dysregulation.
      2. Developing self-focus/differentiation in all family members to address the “responsibility trap”
      3. Adjusting to a change in lifestyle that supports both abstinence and a stable family system
      4. Learning new behavioral skills for coping with stress and conflict
      5. Developing healthy interdependence
      6. Family Reorganization – Stabilize/Rebalance the System

      Regards,

      Ron

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