Alcoholism as a Family Disease: Family Therapy and Treatment Outcomes

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The United States Census defines a family as two or more people related by birth, marriage, or adoption.¹ This definition has not changed in nearly a century when counting how many people live in a home. However, the definition of family and family structures has evolved regarding family therapy and alcoholism—one of the most common types of alcohol therapy used in rehab and other types of treatment.

Who Is Involved in Alcohol Therapy for Families?

Family can include anyone with an emotional connection to a person with a substance use disorder—the clinical diagnosis that measures the behaviors associated with addiction, including the behaviors that would commonly be called “alcoholism.” In treatment, a family can include:²

Married couples with children
Nonmarried couples with children
Single-parent families
Adopted families
Friends or those living with peers
Best friends
Foster care families
Blended families
Grandparents raising grandchildren
Stepfamilies
Godparents
Heterosexual couples with or without children
Gay, lesbian, transgender couples with or without children
Military families

Couples therapy is different than family therapy, but can also help a family unit of two people work through the challenges of alcohol addiction.

What Is Family Therapy?

Alcohol abuse impairs both your ability to perform daily living activities and fulfill responsibilities, as well as inhibits growth in your relationships. Often, the entire family needs intervention and healing as part of alcohol addiction treatment. In family therapy, the whole family is the client. The goal of family therapy is to use the strengths of the family to promote recovery for everyone affected by alcohol use disorder (AUD).²

Family therapy encompasses a several treatment methods that promote positive changes among the entire group. A primary goal of family therapy is to intervene, meeting the family where it is now. This intervention is intended to identify, stop, and prevent the patterns and behaviors that contribute to substance misuse and other dysfunction. Ideally, the intervention also reduces the potential effect that alcohol abuse has on children and future generations.²

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Who Answers?

Typically, you can choose who you want to include in your alcohol use disorder treatment. You decide who you feel closest to, who has been impacted by your alcohol abuse, and who can help you the most in recovery.²Your care team may make recommendations based on work your have done one-on-one. For example, if you speak often with your therapist about childhood interactions with a grandparent or regrets about an argument with a sibling, your therapist may suggest that you invite that family member to group sessions.

Are There Barriers to Family Engagement?

Some family members cannot attend these sessions, even if they could benefit from treatment, played an integral role in the dynamics surrounding your alcohol abuse, or sincerely want to support you. Reasons may include when or if family members:³

Are deceased
Are estranged and are not currently interested in reconciling
Have work conflicts
Have cultural differences
Have financial problems
Live far away
Refuse to participate
Are afraid or reluctant to discuss personal, private, secrete, or embarrassing details in a group setting
Try to protect the person with the alcohol use disorder from perceived threats in a group setting, such as being ganged up on or being blamed for family problems

One of the most common barriers to family alcohol therapy is the power a person with an alcohol use disorder has in choosing who they want to include. Sometimes, they do not want to include anyone and refuse to ask family to attend alcohol therapy.³

If you feel reluctant to have family therapy sessions despite recommendations or program guidelines to do so, discuss this with your counselor or therapist. You may talk about:

The feelings that come up when thinking about family therapy
What you fear may happen in family therapy sessions
What you fear may happen after family therapy sessions
The reactions you anticipate from certain family members if they are confronted about their own behavior
The reactions you anticipate when revealing the reality of your experiences

Talking about your fears, expectations, and boundaries you would like to set can help you make decisions about when and how to conduct family therapy and who should be involved. Remember that the facilitating therapist works as a guide and mediator in the sessions, setting boundaries and bringing up relevant topics of conversation. Family therapy and alcoholism interventions or confrontations are not the same thing, nor to they have the same accusatory tone.

Some family members may think therapy is only for the person with the alcohol use disorder. Others may have tried other treatments without success and question if it’s worth putting forth the effort. They may choose not to participate even if you express that doing so would be meaningful to you.

Is Family Therapy Effective in Addiction Treatment?

Research shows that when family members get involved in therapy, individuals experience more positive outcomes in recovery. Family therapy can reduce rates of alcohol relapse. It is also effective in influencing someone to enter treatment, stay in treatment, and maintain stability in recovery.⁴

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Family therapy is most effective after screening the family to eliminate factors leading to ineffective treatment. Family therapy is not advisable:⁴

With family members who have extreme anger or pose a threat of verbal abuse or physical violence
With family members who are currently in an abusive relationship of any kind with anyone, including individuals who are not part of the family sessions
For someone currently experiencing substance withdrawal symptoms
For any family members who are not willing to agree to or who cannot be reasonably expected to abide by any ground rules set by the facilitating therapist, such as confidentiality about what happens in the sessions

Family therapy should take place in appropriate environments to be effective. Clinical settings, like the office of a licensed therapist, are where most therapies occur. Other environments may include schools, hospitals, residential addiction treatment facilities, outpatient centers, and the home of the person with alcohol use disorder.⁵

What Are the Primary Principles of Family Therapy?

Therapists who work with families recognize that changing one part of the family system can change the whole system. Each family member is valuable in one family member’s recovery from an alcohol use disorder. This is one core principle of family therapy and alcoholism treatment.²

Other principles include:²

Working with the family, not above them; therapists avoid trying to control the family with authority or as the expert
Focusing on harm reduction when abstinence is not immediately possible
Redefining what it means to be successful in treatment to include all family members and not just those with a history of alcohol abuse
Recognizing the value of positive relationships with family and extended social networks
Choosing the right family counseling approaches based on family needs, values, backgrounds, and other relevant factors
Teaching families that management of alcohol use disorders is like managing other chronic illnesses within the family

Along with principles of family therapy, goal setting with different approaches helps families reach their goals. The primary purpose of family therapy is to help all members make positive changes in thinking and behaviors related to substance use disorders that can lead to better well-being, closer relationships, and improved quality of life for the whole family.²

What Types of Family Therapy Are Used in Addiction Treatment?

Approaches used in family therapy and alcoholism include the following.

Multi-Systemic Family Therapy

Multi-systemic family therapy (MSFT) aims to help adolescents ages 12-18 overcome a substance use disorder and other behavioral problems. Therapists intervene with both the family and other social networks.

Social networks can include friends, teachers, and officers in the criminal justice system. MSFT helps the person misusing alcohol identify and accept responsibility for their choices and consequences instead of relying on parents or caregivers to enforce changes.⁶

Functional Family Therapy

The goal of functional family therapy (FFT), similar to that of MSFT, is to reduce negative behaviors like the misuse of alcohol and drugs. FFT works with the family to enhance communication and make the family more functional. Families learn to identify and stop behaviors that enable or lead to substance use and replace them with life skills like problem-solving and conflict resolution.⁶

Systemic Motivational Therapy

Systemic motivational therapy (SMT) aims to help families develop and implement strategies that deter substance use disorders with all family members. It incorporates motivational interviewing to help families see the benefits of abstinence and become eager to make changes.⁷

Multidimensional Family Therapy

Multidimensional family therapy (MDFT) and alcohol use disorder treatment combine treatments that address the person misusing alcohol, parents, extended family, friends, and other social influences. The goal is to encourage change in stages using multiple services, including individual counseling, motivational interviewing, and other interventions based on the family’s needs. This technique is effective for people with co-occurring disorders.⁸

Behavioral Family Therapy

The goal of behavioral family therapy (BFT) is to reduce negative behaviors and increase positive behaviors related to substance misuse. BFT aligns with the theory of positive and negative reinforcement. This technique uses rewards, or contingency management, to motivate family members to encourage abstinence.⁹

Behavioral couples therapy (BCT) or integrative behavioral couples therapy (IBCT) are forms of therapy complementary to BFT. These approaches specifically help the intimate partner of a person with alcohol use disorder. The goal is to enhance relationship skills while encouraging a reduction in alcohol misuse.¹⁰

Brief Strategic Family Therapy

Brief strategic family therapy (BSFT) is a method for therapists who believe the family of a person with an alcohol use disorder is dysfunctional, with that dysfunction directly leading to one or more family members misusing substances. The goal of BSFT is to change family interactions that encourage the poor decision-making that leads to substance misuse and behavioral problems.¹¹

Solution Focused Brief Family Therapy

With solution-focused brief family therapy (SFBFT), resolving specific problems is the goal. The therapist uses multiple techniques to help families and those misusing substances recognize areas of life affected by drugs and alcohol to empower them to make positive changes.¹²

Your therapist may choose one or multiple types of family therapies to address the alcohol abuse in your family. Therapists must do a thorough assessment with you before determining which treatments may be best suited to your needs.

What Can You Expect in Your First Family Therapy Session?

Alcohol therapy for families can occur at all levels of treatment, including:

At each level of care in alcohol addiction treatment, family members are offered chances to attend educational classes to learn more about the disease of addiction. They can also attend counseling sessions with and without their loved one who has an alcohol use disorder. Therapists teach family members strategies to help motivate a loved one to get and continue treatment, support them during treatment, and enhance their recovery.¹³

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The initial meeting with a family therapist is an assessment of needs, not a formal therapy session. Your therapist asks questions and uses your answers to formulate a treatment plan. This is also a time to measure how engaged you are in the process and how willingly you collaborate with the therapist.¹⁴

The therapist also explains how you can overcome a substance use disorder that affects the family. The process includes identifying family strengths, setting goals, and creating a list of positive supports. Finally, you tell your story of how substance use has affected your family. The therapist provides a safe, nonjudgmental environment for you to do so.¹⁴

What Are Other Recovery Activities for Families?

Your family therapist will also provide a list of other ways you can get involved in recovery as a family.

Recovery activities for your family include attending:¹⁵

Open Alcoholics Anonymous (AA) meetings
Family education groups that provide psychoeducation on various topics, such as:
- The disease of addiction
- Relapse prevention and early recovery expectations
- Communication skills
- The differences between enabling versus helping
Multi-family support groups
Sister groups of AA that are intended just for family members, such as:
- Alcoholics Anonymous Family Groups (Al-Anon)
- Alateen
- Families Anonymous
- Adult Children of Alcoholics
- Adult Children Anonymous
Alcohol-free family events, including events your family organizes and those organized by recovery-focused organizations, such as public AA events
Individual family therapy
Couples therapy
Child-focused therapy

Is your family affected by a loved one’s alcohol abuse? Call us at 800-948-8417 Who Answers? to find alcohol addiction treatment services.

Resources

Pemberton, D. (2015, January 28). Statistical definition of family unchanged since 1930. United States Census Bureau.
Center for Substance Abuse Treatment. (2004). Substance Use Disorder Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series, No. 39. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
Szapocznik, J., Zarate, M., Duff, J., & Muir, J. (2013). Brief strategic family therapy: engaging drug-using/problem behavior adolescents and their families in treatment. Social work in public health, 28(3-4), 206-223.
Substance Abuse and Mental Health Services Administration. (2013). Family therapy can help: for people in recovery from mental illness or addiction.
Slesnick, N., & Prestopnik, J. L. (2004). Office versus Home-Based Family Therapy for Runaway, Alcohol Abusing Adolescents: Examination of Factors Associated with Treatment Attendance. Alcoholism Treatment Quarterly, 22(2), 3-19.
Eeren, H. V., Goossens, L., Scholte, R., Busschbach, J., & van der Rijken, R. (2018). Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method. Journal of abnormal child psychology, 46(5), 1037-1050.
Williams, A. A., & Wright, K. S. (2014). Engaging families through motivational interviewing. Pediatric clinics of North America, 61(5), 907–921.
Rowe, C. L. (2010). Multidimensional Family Therapy: Addressing Co-Occurring Substance Abuse and Other Problems among Adolescents with Comprehensive Family-Based Treatment. Child and Adolescent Psychiatric Clinics of North America, 19(3), 563-576.
National Institute on Drug Abuse. (2020). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
Christensen, A., & Doss, B. D. (2017). Integrative Behavioral Couple Therapy. Current Opinion in Psychology, 13, 111-114.
Szapocznik, J., et al. (2015). Brief Strategic Family Therapy: Implementing evidence-based models in community settings. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25(1), 121-133.
Stermensky, G., 2nd, & Brown, K. S. (2014). The Perfect Marriage: Solution-Focused Therapy and Motivational Interviewing in Medical Family Therapy. Journal of family medicine and primary care, 3(4), 383-387.
McCrady, B. S., & Flanagan, J. C. (2021). The Role of the Family in Alcohol Use Disorder Recovery for Adults. Alcohol research: current reviews, 41(1), 06.
Tuerk, E. H., McCart, M. R., & Henggeler, S. W. (2012). Collaboration in Family Therapy. Journal of clinical psychology, 68(2), 168–178.
Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).