Why family therapy for substance use disorders is so effective

Studies into relapse rates in substance misuse and the role of the family have shown that a lack of family support is an effective predictor of SUD relapse. When involved in the recovery process and cared for and supported through family therapy for substance use disorders, the patient’s loved ones can provide consistent support and feedback, encouraging patients to remain focused on their recovery goals.

Family therapy for substance use disorders is not new, but many clinical centers have struggled to manage the increased costs of developing specific family treatments, so have not tended to include them in treatment significantly. But some treatment programs have found some new and innovative ways of incorporating families into therapy and increasing success and program completion. 

Community Reinforcement and Family Training is an approach that focuses on the family members of those who are misusing drugs or alcohol.. Family behavior therapy teaches the family skills to change unhealthy behaviors, and motivational interviewing to help families encourage their loved one with SUD at certain stages of recovery. The use of online support groups and telehealth family therapy also helps overcome geographical boundaries and can be a way to manage costs. 

By providing family therapy for substance use disorders, alongside treatment, clinicians can help both the individual suffering from the SUD and support the family by treating them as an emotional unit. 

Intergenerational trauma

Intergenerational trauma

Research in recent years has shown that interpersonal trauma during childhood can lead to increased susceptibility to SUDs, especially for girls and women. In the treatment of SUDs, we often see intergenerational patterns of SUD where, for example, three generations in a family have alcohol use disorder.  While there is a genetic component to this, newer studies on epigenetics have shown that the effects of childhood trauma can be passed to future generations, putting them at higher risk of SUDs.  

In a study of Black women in the criminal justice system, increases in the number of parents/grandparents with SUD, increased the risks of developing an SUD in their children. This also increased the risks of having Child Protective Services involvement in the family. These findings document the generational effects of substance use disorders and their link to trauma, which are pervasive and deserve early intervention.

Studies in females with SUD have also shown that having a spouse or significant other using substances will increase the risk of relapse for someone presenting for SUD treatment. Positive family activities, on the other hand, can lower risk of relapse.

Family function, self-esteem, and resilience 

Family function, self-esteem, and resilience

Family function refers to family members recognizing their roles, and relationships and problem-solving within the family unit. Studies show it can affect both substance dependence and addiction relapse. Family function is closely associated with substance dependence, but in a positive family environment with support and encouragement, it can help reduce the risk of relapse, mediated by improvement in self-esteem and resilience.  

Self-esteem and resilience are the key factors in the relationship between family function and relapse tendency of SUD patients.

Effective family therapy can help unwind problematic coping strategies, analyze family dynamics and break unhelpful behaviors to help families embrace a new reality and continue to move forward with more supportive behaviors.

Racial and gender patterns in families with SUDs

Racial and gender patterns in families with SUDs

Cultural gender roles are an important factor in understanding family dynamics in SUDs. The extent to which traditional gender roles are enforced can have an influence on substance misuse. One study showed that strict adherence to gender norms within the family may increase SUD risk in young people. 

According to research, LGBTQ+ individuals who reported higher levels of family rejection during adolescence are 3.4 times more likely to use illegal drugs. A study conducted with The Trevor Project also showed that experiencing “conversion therapy” or other efforts to change their identity was associated with greater odds of alcohol or marijuana misuse or prescription drug misuse. 

A SAMHSA study into racial and ethnic differences in SUDs also found that substance use disorders were five percent higher for people reporting being multi-racial and 4.8 percent higher for American Indian or Alaska Native people. Further research has found that White individuals are more likely than Latinx or African Americans to receive treatment for SUDs (37.6 percent compared to 22.4 percent and 25 percent respectively).

It is important for treatment centers to identify and address toxic family patterns that could affect all clients, including minoritized individuals, creating a psychologically safe and supportive environment where patients can open up. Family therapy can create a space to help individuals feel loved and accepted, while trauma-informed care can help address past experiences. 

Families from minoritized groups often have a high dropout rate after the first therapy session, potentially due to a lack of understanding of how cultural differences can affect the therapeutic approach. For minoritized individuals, creating outreach programs that are culturally sensitive and partnering with community organizations can encourage more people to access treatment. Therapists who share the same racial or ethnic background can also help, as can offer treatment in different languages.

By providing compassionate, culturally competent family therapy, clinics can help break the cycle of substance use within families and empower individuals from all backgrounds to achieve lasting recovery.

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