Alcohol use disorder (AUD) is a serious form of problem drinking involving compulsive consumption of large amounts of alcohol, typically most days, or every day, of the week. The person’s body begins to rely on the presence of alcohol to feel normal, so they drink more to achieve their original level of intoxication. They also crave alcohol, and despite harming their close relationships with family and friends due to behavioral changes, they think they need alcohol to be happy or content.
When a person seeks help to overcome alcohol use disorder, there are several therapeutic approaches to changing the individual’s behaviors so they stay sober. One of the most important approaches involves healing family relationships. Spouses, children, siblings, parents, and other family members are all negatively impacted by a person struggling with addiction; at the same time, the person may be triggered by existing problems in family relationships, which need to be solved. Strong family support through addiction treatment helps those in recovery stay away from intoxicating substances. Family therapy can rebuild the family’s support structure, so everyone stays psychologically, emotionally, and behaviorally healthy.
Approaches to Alcohol Use Disorder Should Include Family Therapy
There are many forms of counseling provided to treat addictions. According to the National Institute on Drug Abuse (NIDA), types of therapy that work well for addiction treatment include:
- Cognitive Behavioral Therapy
- Contingency Management with Motivational Incentives
- Community Reinforcement Plus Vouchers
- Motivational Enhancement Therapy
- Peer Support or 12-Step Groups
- Multisystemic Therapy
- Family Behavioral Therapy
- Multidimensional Family Therapy
- Brief Strategic Family Therapy
- Functional family therapy
Typically, group therapy is a preferred approach during addiction treatment because the group dynamic and social support can show everyone that they are not alone in their struggles. Family therapy is a form of group therapy, although the focus is on healing relationships among those who have struggled for a long time with behavioral and psychological problems that both stem from and trigger AUD. There are many reasons to choose family therapy as part of an overall treatment plan.
- Family members can act as forces for positive change while supporting their loved one in recovery.
- Including family members increases the likelihood that the individual remains in therapy.
- Family members whose relationships have been harmed due to addiction can work together to heal those relationships.
Not all rehabilitation programs provide family therapy, but it can be a very important aspect of treatment, especially for people who have spouses and children, and for adolescents struggling with AUD.
Kinds of Family Therapy and Who Benefits Most
Most rehabilitation programs focus on group therapy, especially for those struggling with co-occurring disorders. Unfortunately, few programs currently offer family therapy as part of addiction treatment, although it is more likely to be part of the treatment plan for adolescents. Group therapy approaches in rehabilitation do, however, apply techniques similar to those used in family therapy, so bringing in family members when possible, or finding additional therapeutic treatments with a family therapy specialist, may be important.
Kinds of family therapy that may be part of alcohol use disorder treatment, especially for adolescents, include:
- Family Behavioral Therapy: This type of treatment is the foundational approach to family therapy for both adults and adolescents. Family Behavioral Therapy (FBT) not only addresses AUD, but it also addresses co-occurring disorders within the family structure. These may include other addictions, mood disorders, post-traumatic stress disorder (PTSD), and abuse. FBT mixes Contingency Management approaches with behavioral counseling, so everyone can begin to change their behaviors. For this approach to work, the individual recovering from AUD and at least one other family member must be present for therapy. These family members can include cohabitating or intimate partners, parents (especially for adolescents), or children.
- Multisystemic Therapy: This approach includes family therapy, along with individual, group, and community approaches to treatment. In this form of behavioral treatment, the adolescent’s behaviors are viewed as characteristics of the child; for example, the child may have a favorable view of substance abuse, which led them to try alcohol, and later develop a dependence on it. Family attitudes toward substance abuse may exacerbate the child’s attitudes; for example, the family may have a strict “no drugs” approach, which could cause stress for the child and lead them to try alcohol due to peer pressure. Other attitudes in the surrounding community, at school, in the neighborhood, or among friends are also considered.
- Multidimensional Family Therapy (MDFT): MDFT is a treatment approach that works best for adolescents and teenagers who are attending outpatient treatment programs. The adolescent’s family is one part of a network of influences that can change the child’s behaviors in different settings. Other influences on the adolescent include peers, communities, and individual influences like genetics. Family sessions can take place in the clinic, at home, in a family court, in school, or at a community center. Parents are asked to examine their styles of parenting to support their child in developing better behaviors.
- Brief Strategic Family Therapy (BSFT): This approach targets family interactions that may trigger compulsive behaviors in adolescents, like alcohol abuse. There may be other co-occurring problem behaviors that increase the likelihood of these stressful interactions, including truancy, delinquency, aggression or violence, or spending time with antisocial peers. However, these behaviors in the adolescent are indicative, in this type of therapy, of a larger problem in the family structure. BSFT is also designed to be flexible, so families can participate in as many sessions as needed in various locations, including schools, homes, and courts.
- Functional Family Therapy (FFT): Using the Family Systems approach, FFT considers the adolescent’s behaviors to be created and maintained by negative family interactions and structures. The therapist will work with the adolescent and their family to develop better approaches to communicating, solving problems, and resolving conflicts as well as help parents to develop better approaches to parenting.
Because of parental influence on their children, most of these approaches were developed for adolescents and work best in that treatment setting. However, even during therapy focused on teenagers, the adults’ struggles with substance abuse, including AUD, may come into play. Therapy for their child or sibling may help the adult seek treatment for their own struggles with alcohol or drugs.
Effectiveness and Necessity of Family Therapy
Adolescents who are enrolled in family therapy as part of their overall alcohol or drug treatment plan maintain abstinence longer than those who do not receive family therapy. In one study, 54.6 percent in family therapy maintained abstinence after treatment compared to 37.5 percent. Adolescents who participated in family therapy were also found to have greater overall improvement.
Another study examining three types of adolescent drug addiction treatment – Family Systems Therapy, peer group therapy, and family drug education – found that Family Systems Therapy led to more adolescents abstaining from alcohol and drugs after completion of treatment: 54 percent compared to 28 percent in group therapy and 16 percent in family drug education.
Family therapy is important for adults, too. Attachment disorders are common in children whose parents struggled with alcohol or drugs even when child abuse and neglect are not present. Adults struggling with substance use disorders, including alcohol use disorder, can heal these co-occurring family issues by attending family therapy with their spouses and/or children. With adults, engaging one adult – a worried significant other, for example – using a family therapy approach can strengthen the entire family system and support the person overcoming AUD.
Strengthening the family system also prevents substance use disorders and mental illnesses from harming children’s lives as they grow. A family history of alcohol abuse increases the risk of future substance abuse and mental health struggles for children.