Addiction tends to cause rifts in the families it appears in. Some even call it a family disease. Family therapy can make a difference and help couples, children, or members of an extended family learn to communicate better and work through conflicts.
Family counseling had its origins in the 1950s, adding a systemic focus to previous understandings of the family's influence on an individual's physical health, behavioral health, and well-being. The models of family counseling that have developed over the years are diverse. They generally focus on either long-term treatment emphasizing intergenerational family dynamics and the family's growth and well-being over time or brief counseling emphasizing current family issues and cognitive-behavioral changes of family members that influence the way the family system operates.
Family-based counseling in SUD treatment refects the latter family systems model. For example, in SUD treatment, family counseling focuses on how the family influences one member's substance use behaviors and how the family can learn to respond differently to that person's substance misuse.
When family members change their thinking about and responses to substance misuse, the entire family system changes. These systems-level changes lead to positive outcomes for the family member who is misusing substances and improved health and well-being for the entire family.
Family counseling in SUD treatment also differs from more general family systems approaches because it shifts the primary focus from being on the process of family interactions to planning the content of family sessions. The counselor primarily emphasizes substance use behaviors and their effects on family functioning. For example, in a couples session in which the couple discusses the husband's return to drinking after a period of abstinence, the counselor would note the interactions between the husband and wife but zero in on the return to use. In doing so, the counselor can develop strategies the couple can use as a team to learn from the experience and prevent another return to use.
Although the specific family-based methods this chapter describes refect different strategies and techniques for addressing substance use behaviors, they share the same core principles of working with family systems. These core principles include (Corless, Mirza & Steinglass, 2009):
- Recognizing the therapeutic value of working with family members, not just the individual with SUD, as they deal with SUDs.
- Incorporating a nonblaming, collaborative approach instead of an authoritative, confrontational approach in which the counselor is the expert.
- Having harm reduction goals other than abstinence, which can bring positive physical and behavioral health benefits to the individual and entire family.
- Expanding outcome measures of “successful” treatment to include the health and well-being of the entire family, as well as the individual with the SUD.
- Acknowledging the value of relationships within the family and extrafamilial social networks as critical sources of support and positive reinforcement.
- Appreciating the importance of adapting family counseling methods to ft family values and the cultural beliefs and practices of the family's larger community.
- Understanding the complexity of SUDs and the importance of working with families to manage SUDs, as with any chronic illness that affects family functioning, physical and behavioral health, and well-being.
Some family-based interventions in the following sections are SUD-specific adaptations of general family systems approaches. Others were developed specifically to address SUDs from a family perspective. Each description includes an overview and goals of the approach, supporting research specific to SUD treatment, and relevant techniques and counseling strategies.