The Family System Therapy Approach to Addiction Treatment

There are various types of treatment geared toward successful drug and alcohol rehabilitation. One very effective approach, particularly when used with young adults in recovery, is the family system model. A Family System Approach to treatment keeps in mind that addiction is typically a family disease.

One family member’s addiction can cause the entire family unit a lot of stress and disruption, causing negative and unsettling experiences. There are many reasons why family therapy is so important to those undergoing treatment for addiction.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 11.8 million young adults over the age of 12 in the United States abuse opioids1. The National Institute on Drug Abuse reported that 21.5 million adults who are aged 12 and over have a substance abuse disorder2. This statistic includes the abuse and misuse of drugs such as:

  • alcohol
  • marijuana
  • cocaine
  • heroin
  • hallucinogens
  • inhalants
  • non-medical use of prescription drugs

Addiction’s Impact on Families

Addiction has an impact on not only the person abusing substances, but it also has a powerful effect upon his or her entire family. A family can take on many different structures.

There are traditional two-parent, single parent, step, foster and multigenerational families. Everyone, however, in any type of family structure is touched in some way or another as a result of a one loved one’s struggle with addiction.

Whether they are of an economic, psychological or other nature, the effects of substance abuse often have a great impact upon the family. Therefore using a family system approach to substance abuse treatment can be vital to recovery.

Family System Therapy For Substance Abuse

A family system model in therapy focuses on the need to involve family members in the recovery counseling process3. The theory behind a family system approach is that a person cannot be completely understood or successfully treated for substance use disorder without first comprehending how that person functions within his or her own family system4.

Addiction: A Symptom of Dysfunction

Substance abuse can be a symptom of dysfunction within a family, making it important to focus on the family system, which can vary in size depending upon the makeup of the family and whether extended family members can or should be involved.

An individual, especially an adolescent seeking recovery from substance abuse, usually lives at home with at least one parent or guardian. That parental role model sets the rules and regulations of the household and provides support to the young person.

The repercussions of substance addiction can even reach beyond the immediate nuclear family, having an effect upon extended family members who feel a gamut of emotions, including anger and fear, toward the person with substance addiction5.

Dysfunction of Communication

Family communication, including direct conflict with one another, can bring forth many of the issues that have led to addiction. The interactions that occur during family therapy actually help in dealing with unhealthy family interactions. A dysfunctional family that can learn to become more unified and communicative will often be extremely helpful with successful recovery.

Dysfunction by Enabling

Enabling of substance abuse can take place within a family, either consciously or unconsciously. For example, you may lie to friends about a family member’s drug use. You might even buy drugs or alcohol for an addicted family member. Perhaps one of your loved ones pays your bills for you if you are having financial issues due to substance use. Others may excuse violent and disturbing types of behavior even if that behavior is negatively impacting your emotional or physical health.

Substance Abuse Results in Isolation

People who are abusing substances often find they are becoming more isolated from family members. They will tend to spend more and more of their time with others who are also using drugs, consequentially reinforcing this type of behavior. This can lead to a breakdown of family communication and understanding. Learning ways to talk to and understand one another within the family structure can be elemental in achieving lasting sobriety.

Types of Family System Therapies

Getting families together to sit down with a counselor during therapy sessions while in recovery is often one of the main keys to success. There are different types of family system approaches used in addiction treatment. The general idea is to understand the effect of the substance use disorder on the family to achieve homeostasis, or a healthy balance, within that family.

The child of a father who is addicted to alcohol, for instance, may cover up the adult’s drinking symptoms by cleaning up after him when he gets sick. He may also help his father into bed after he passes out, or otherwise adapt to the problem by helping maintain it. Boundaries and secrets may exist within a family that can compound and help perpetuate drug use.

A few of the family system therapies in use today in some rehab facilities include the following:

Brief Strategic Family Therapy (BSFT)

This therapy highlights the contribution of negative family interactions to problematic behaviors. BSFT counseling sessions help families change their unhealthy interactions with one another over the course of a dozen or more meetings. This family system treatment modality can be used successfully during either residential or day treatment, and it is also very useful in aftercare treatment.

Family Behavior Therapy (FBT)

This therapy involves at least one parent in the planning of treatment together with the family member who is in recovery. As a team, the family chooses from treatment options, learns behavioral strategies during counseling sessions, and then applies these newly learned skills at home. This family system therapy is very appropriate for aftercare, as the goals set are aimed at preventing future substance use.

Functional Family Therapy (FFT)

Functional Family Therapy uses behavioral strategies to improve communication and problem-solving issues among family members. Conflict resolution and parenting skills are also touched upon.

Contingency Management (CM)

Contingency management interventions are also effectively used during Functional Family Therapy to promote abstinence during treatment for substance disorders6. Contingency management treatments reward or reinforce certain behaviors to help that behavior continue in the future. The rewards for continued sobriety can take the form of vouchers for certain retail items or services, such as clothing, eating out at a restaurant or gift certificates. When used during substance addiction treatment, CM interventions help reinforce sobriety.


Multidimensional Family Therapy (MDFT)

Multidimensional Family Therapy involves both family members and the community. School and justice system authorities work with families and those with severe substance abuse issues to more easily re-enter living at home and functioning well in society after recovery.

Effectiveness of Family System Therapy for Addiction Treatment

Often, treating just the individual is not effective enough as the person in recovery does not live in a bubble, but rather has a family, perhaps even children, to consider as part of the big picture.

MDFT and Youth Effectiveness

With a family systems approach to addiction therapy, family members learn how to build new patterns of interacting and behaving that are less destructive. They learn alternative ways to function rather than by reinforcing substance use. Family therapy models have been shown to be among the most effective and powerful approaches in addiction treatment for young people.

Specifically, MDFT works to develop alliances between young adults, their parents and community members. Eighty-seven percent of young adults undergoing MDFT retained their sobriety for at least three months after leaving a treatment center. Those who underwent Functional Family Therapy, the treatment aimed at changing negative interactions and family patterns, was found to be even more effective, with sobriety lasting up to 15 months post-recovery on average7.

 How Family System Therapy Works

Keeping in mind that the family is an emotional unit, the relationships, behaviors and patterns of interacting often become stagnant and resistant to change. Utilizing a family systems approach to addiction treatment helps defuse anxiety, stress and sensitivities that may have been ongoing for years. In fact, these themes for interaction may have been put into place generations ago.

At a recovery center for addiction recovery, family system therapy can take several different forms. There may be private sessions between one or more family members and a therapist. Group sessions between the person with substance addiction and their loved ones can occur together.

Identifying Family Functions

One of the first things a therapist must determine is how a family functions together as a system via their interactions with one another. Once an approach is decided upon, the goal is to create positive family interactions that support a cohesive family unit, which in turn will support long-term sobriety.

Family Therapy Sessions

During family therapy sessions, each member of the family unit that is involved will have a chance to express their thoughts and feelings concerning the ways in which addiction has affected them. As a team, the family works to help each person relieve their anxiety and stress, which in turn relieves the strain on the family.

Members look at their individual roles within the family and play reversal games to learn how to support one another. These techniques help restore relationships and rebuild a healthier family system.

Frequency of Family Therapy

Family therapy sessions can be conducted on a weekly basis, either in person or over the phone if family members live too far away. Although the family system approach is very effective, it is not usually the only type of treatment used in recovery.

Family Therapy: One Part in Holistic Treatment

Taking a holistic approach to substance use treatment helps you learn more about the triggers involved in the disease of addiction. Stress-relieving techniques, like exercise and art therapy, are helpful, particularly during the recovery healing process.

Individual counseling in combination with a family system approach and holistic therapies are effective routes towards successful, lasting sobriety.