By Anna Ciulla, LMHC, RD, LD


The case for family therapy during recovery is a strong one, based on decades of research into how the intervention improves drug and alcohol treatment outcomes. As a clinician in the field, I’ve also seen firsthand how family therapy can effectively address the systemic dynamics of substance abuse. In this third and final installation of a series devoted to “clinical excellence,” I’ll share that experience, along with findings from leading experts in the field. The aim will be to show why family therapy is critical to recovery.

How Addiction Is a Family Disease

An October 1 NBC Nightly News report told the heartbreaking story of 9-year-old Stetson and his three younger siblings— each an innocent victim of the devastating fallout of their mother and stepfather’s addiction to heroin. They were now in the care of other family members, who had also been impacted by the enormous strain of heroin abuse.

Sadly, such stories abound in this country. They help to illustrate the physical, emotional and financial toll that addiction takes on families, and why we clinicians have come to treat addiction as a “family disease.” The reality is that one person’s substance use disorder (SUD) impacts the entire family system— but especially the parents, spouses and children of that loved one. If left untreated, these family dynamics can pose a serious obstacle to successful long-term recovery.

Family Dynamics of Addiction

What are the family dynamics of addiction, then, and how does family therapy help to heal and redress them? Research has revealed the following commonly occurring patterns of dysfunction in SUD-affected families:

• Impaired parent-child attachment and a higher rate of attachment disorders
• Unmet developmental needs
• Higher rates of domestic violence and abuse
• Parent-child role reversals
• Disrupted family rituals and routines
• Impaired communication
• Financial problems
• Emotional chaos, fear, and a high-stress family environment characterized by shame and secrecy, loss and conflict
• Higher propensity for addiction and other risky behaviors in children of parents with a SUD

If left untreated, these dynamics don’t just disable the recovery of the loved one with the SUD. They can also leave a devastating long-term impact that compromises the health and well-being of future generations, according to studies.

The Essential Benefits to Working with a Licensed Family Therapist

The destructive and potentially long-term impact of substance abuse on the family is only one reason why family therapy is critical to recovery. Another has to do with the therapeutic benefits unique to working with a licensed family therapist. From my experience, these include:

• A trained and emotionally neutral observer who is better able to identify unhealthy family dynamics and ways of relating
• An emotionally safe and accepting environment in which to air needs and feelings
• Improved communication and mutual understanding

Family Therapy for Codependency

Another reality is that the family dynamics of addiction can be hard to address without the help of a licensed therapist. Take the commonly occurring dynamic of “codependency,” for example. Codependency is characterized by an unhealthy need to please others. Those who suffer from it are constantly seeking self-validation by putting themselves out in order to rescue the person with the SUD.

At its root, though, codependency stems from an inability to set healthy emotional boundaries. And what I’ve found (from working with SUD-affected families) is that family therapy is one of the most direct and effective ways to help families establish these healthier boundaries. (12-step recovery groups like Co-dependents Anonymous can also be supportive in this pursuit, but to a more limited extent because they focus almost exclusively on the codependent person.) My own experience has been that when clients and their families start practicing these healthier boundaries with the help of a family therapist, they really can begin to heal from codependency and other dysfunctional dynamics that feed addiction.

How Family Therapy Improves Treatment Outcomes

Additionally, there is now a large body of evidence that testifies to how family therapy improves treatment outcomes for SUDs, by:

Additionally, there is now a large body of evidence that testifies to how family therapy improves treatment outcomes for SUDs, by:

• halting the progression of substance abuse
• preventing relapse
• increasing abstinence rates
• and boosting motivation for recovery
Still, other research has turned up the following outcomesrelated findings:

As an intervention for teen substance abuse

… family therapy significantly decreased teen drug use, improved family functioning, and reduced conflict, strengthening family cohesion, according to findings in the Journal of Family Therapy. In another study at the University of Miami, family therapy boosted adolescent engagement in recovery, leading the researchers to conclude “family-based models for therapy” are “among the most effective approaches for treating both adults and adolescents with drug problems.”

As an intervention for alcoholism

… the participation in therapy of just one “supportive significant other” (a spouse or other close family member) reportedly improved both retention in treatment and treatment outcome. Another study found that alcoholics who received communication skills training with family participation (a form of family therapy) drank significantly less alcohol per day during a six-month follow-up. They also exhibited better communication skills and lower levels of anxiety— measures that correlated closely with treatment outcomes.

As a treatment for co-occurring disorders (CODs)

… CODs like anxiety, depression and schizophrenia (among other mental disorders) often coexist with drug or alcohol addiction, but family therapy has been a promising intervention for many of these disorders. As one example among many, in findings published in the journal, Advances in Psychiatric Treatment, depressed clients who received couple’s therapy “did significantly better” than those who received an antidepressant alone. Similarly, a 2010 study found that schizophrenic clients with relatives receiving family intervention were more likely to comply with their medication regimen and had lower rates of relapse.

In summary, family therapy is critical to recovery from drug and alcohol addiction. The family dynamics of addiction are one reason. These dynamics are hard to address without the help of a family therapist— another reason. Then there are the essential therapeutic benefits that only a licensed family therapist can provide, based on my experience working with clients and families (a third reason). The overwhelming evidence that family therapy improves treatment outcomes is a fourth and final reason. Together, these four factors help to fill in the contours of what constitutes “clinical excellence” in treating addiction, by revealing how family therapy is a gold standard in substance abuse care.