Addiction is sometimes referred to as a family disease. Even though only one person can have an official substance use disorder at a time, it tends to radiate toward the people that are closest. Family members and spouses play a huge role in the success and failure of a person’s pursuit of recovery. They also face enormous pressure in dealing with a loved one who is addicted. When do I help? When does helping become enabling? It’s unimaginably difficult to watch an addicted family member’s life start to deteriorate because of addiction.
Family members often have a lot to learn when it comes to dealing with addiction. In some cases, even family members are hesitant to send the addicted person to treatment because they themselves have issues with co-dependency. In other cases, family members and spouses can attend treatment and therapy sessions with the addicted person. But is this always the best option? It’s important to realize that, in addiction treatment, the client’s needs come first. Sometimes that means family therapy sessions and family involvement in treatment.
But there is a lot to consider before families can attend addiction treatment.
Addiction studies have begun to show some evidence that supports the involvement of family in addiction treatment. There are several benefits to family therapy, and more and more treatment centers are exploring new ways to involve spouses and family members in the treatment process. Family addiction therapy has shown to be helpful in several different endeavors:
● Family involvement helps the clinical team and therapist gain more information about the client that can be helpful in treatment.
● Family involvement can encourage the person in treatment’s readiness to change.
● Family members have a chance to voice feelings about the addiction, the situation, and the addict.
● The person in treatment can learn exactly how their addiction has affected others.
● Pent up frustrations, resentments, and anger can be voiced and resolved.
● Family members can be encouraged to join support groups for families of addicted people.
● Family members can learn the difference between helping and enabling behaviors.
Family therapy is a variety of therapeutic modalities that offers assessment and intervention at the family level. It comes with the understanding that each part of the family must come together to create a whole. Rather than operating as a collection of individuals, a cohesive family has to operate as a single unit, which means seeing from other points of view and, in some cases, sacrificing your desires for the betterment of the family. For instance, if you enjoy an occasional beer but your brother has an alcohol use disorder, pursuing the good of your family as a whole may be to avoid drinking in front of him.
Family therapy leverages the family’s strengths to address the family’s weak points. These strengths can be especially helpful in developing ways to cope with issues and live without using addictive substances. Family therapy also seeks to improve and recovery from the impact of chemical dependency. Addiction can take its toll on multiple aspects of life including health and finances. In treatment, these issues need to be addressed by meeting some basic needs (i.e. helping a displaced family find housing).
Family therapy can focus on treating the family as a unit, or it can focus on treating an individual as a part of a family group. Because addiction treatment is typically focused on helping an individual achieve lasting sobriety, family members may be invited to therapy sessions or included in the individual’s treatment goals.
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While family therapy has shown to be a helpful tool in some cases and more and more treatment modalities are seeking to involve family members, is family therapy always a good idea? There are many challenges to family therapy and in some cases, it might not be beneficial. Here are some things to consider when you are thinking about the possibility of family therapy:
It’s an important pillar of addiction treatment to realize that every individual is unique and there are no one-size-fits-all addiction treatment methods. A therapy option that is good for one person may not be effective for someone else. A family is the same way. Every family has its own dynamic and has gone through unique challenges. Every individual in recovery has their own thoughts, resentments, and feelings of guilt when it comes to their family. In many cases, resolving those issues can be of great benefit to treatment, but sometimes it can serve as a painful stumbling block.
It’s important for your therapist to sit down with you and learn more about your family and how they have handled your addiction. If there is a possibility that involving your family in the treatment will not be helpful in your pursuit of recovery, then your needs will come first. In a case where family involvement might hurt your treatment, family therapy can be avoided or deferred until after treatment or later in the treatment process.
Families are unique and the addicted individual is unique. But it’s important to realize that each member of your family will also have their own personal issues that need addressing. Some family members are hostile towards one another, hypercritical of the addicted person, or even in active addiction themselves. Family members who are unsupportive or uncommitted to therapy can slow down or hurt progress for the person who is in treatment. On the other hand, it may be worth it if deep anxieties and feelings of guilt or anger are resolved.
Studies show that couples who seek rehabilitation together can have a huge impact on the success of treatment. It seems that couples who are both addicted are more likely to relapse together, possibly because one person who is headed toward relapse is likely to bring the other with them. Plus, couples are threatened by twice as many triggers and potential high-risk situations.
However, studies show that people in cohesive relationships with good communication are more likely to avoid relapse. If only one spouse is going through a treatment program, both can benefit from behavioral couples therapy. BCT helps bolster your support system and helps both partners learn relapse prevention strategies.
If your family is involved in your treatment program it can help to increase your level of accountability, which will stay with you even after treatment. After treatment ends, you will need to seek an ongoing commitment to recovery (with the help of an aftercare program). This can be in the form of a 12-step program or other support groups. However, if your family is able to be a source of positive support, you will also have help and accountability at home. Studies also show that positive family involvement can encourage clients to remain in treatment for the duration of their therapies.
Supporting your spouse in recovery is challenging. Most couples, especially young couples experience normal hardships and relationship issues that often are pushed out of the way by addiction. Sometimes, after completing treatment other issues come quickly to the forefront. In family therapy, spouses can learn to avoid these post-treatment pitfalls and work through issues constructively.
If not, tumultuous marital issues can lead to relapse for the person in recovery. In fact, studies show that an overly critical spouse was a major cause of relapse, shortened periods of abstinence, and led to more frequent drinking in people with alcohol use disorders.
Spouses can also benefit from psychoeducation, classes that are designed to increase your knowledge and understanding of addiction. This can help you better understand how addiction works and how you can help without enabling.
Families have different ways of interacting with one another and discussing addiction and the person who is addicted. The family environment is an important element in addiction recovery.
Therapists use the term “expressed emotion” to describe the nature of this environment.
Expressed emotion doesn’t mean simply talking about your feelings, instead, it has to do with how family members spontaneously talk about the person who’s addicted.
High expressed emotion is characterized by hostile, overly critical, and intolerant behavior.
Sometimes they believe this is the most helpful stance, especially when they believe they are showing “tough love.”
High expressed emotion also refers to emotional over-involvement, which means they are overprotective, excessively praise or blame the addict, or are intrusive.
If you or a loved one is struggling with addiction or substance abuse, there is help available. Learn more about addiction treatment, recovery, and opportunities for family involvement by speaking with an addiction specialist at Delphi Behavioral Health Group at 844-899-5777. Dealing with addiction in your own life or the life of a family member can be a serious challenge, but you don’t have to do it alone.
Butzlaff, R. L. (1998, June 01). Expressed Emotion and Psychiatric Relapse. from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/203937
O’Farrell, T. J., & Schein, A. Z. (2000, January). Behavioral Couples Therapy for Alcoholism and Drug Abuse. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215582/
O’Farrell, T. J., Hooley, J., Fals-Stewart, W., & Cutter, H. S. G. (1998). Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology, 66(5), 744-752 from http://dx.doi.org/10.1037/0022-006X.66.5.744
Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family–couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122(2), 170-191 from http://dx.doi.org/10.1037/0033-2909.122.2.170
National Institute on Drug Abuse. "How can family and friends make a difference in the life of someone needing treatment?" from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-can-family-friends-make-difference-in-life-someone