Family therapy is of critical importance when treating an adolescent or young adult with a substance use disorder.
Frequently, the development of a substance use disorder within the family is symptomatic of other problems within the family system. To fully understand, however, the importance of family therapy as it relates to a son or daughter with addiction, we would be remiss to not first take a step back and examine the broader topic of family systems. This examination will allow us to view the son or daughter within the context of the family system and not in isolation. This is a far more accurate and constructive lens when considering the best treatment approach.
A system is defined as a collection of inter-related and / or inter-dependent parts that comprise a more complex whole.
As we all know, there are numerous examples of systems. Many of these systems we interact with in our day to day lives. The school that your child attends is likely a part of a broader school system. The music that you listen to perhaps originates from a stereo system. Our environment is comprised of various fragile eco-systems. And we know that the human body is comprised of various systems. These systems, such as the respiratory system, the digestive system and the immune system play a vital role in our overall health. A breakdown or malfunction in one part of these systems can have a significant impact on our overall health. The family system functions, in most respects, no differently than other examples of systems.
When there is malfunction in one or more parts of the family system, the malfunction is not isolated to that one part or parts of the family. The shockwave reverberates throughout the entire family system.
Devon is single, white male in his early twenties who was admitted into treatment with the diagnosis of alcohol use disorder, severe, and cocaine use disorder, severe. Devon reported that he drank his first beer at eight years old and would sneak drinks at family parties. By the age of thirteen, Devon reported that he was drinking alcohol and smoking marijuana several nights per week. By the age of twenty he was using cocaine and alcohol daily.
As a family counselor, I began to examine Devon’s family system. I needed to determine how I could both support his family and to determine if there were changes that needed to occur within the system to support Devon’s recovery. Devon was the only son in a family of three daughters. The family was high functioning but knew very little about the illness of addiction. Devon’s parents assumed that this was just a phase that Devon was going through and that he would emerge relatively unscathed on the other side. It also became clear that Devon had far less structure than his sisters and, as the only son, was given far greater leeway than his siblings. Devon himself reported that he got away with far more than he should have been able to and any consequences that he received from his parents were light and often short lived. Devon reported that feelings were avoided in his family and that his family avoided having difficult conversations about his drug and alcohol use. As Devon’s addiction progressed, his parents began to feel a great deal of guilt that they had failed him in some way and caused his addiction.
During family counseling, I was able to educate the family on the disease model of addiction.
This alleviated much of the parent’s guilt as it related to self-blame regarding his addiction. Devon’s family also learned that Devon would need to take ownership of his own recovery. Devon’s parents were recommended to attend Al-anon and to focus on changes that they needed to make in their own lives. Devon reported, however, that the most important part of family counseling was a structured exercise called the knee to knee exercise. This is a communication exercise that focuses on expression of emotion. Devon was able to witness, for the first time, how his actions had truly impacted his family. Devon shared that he had no idea that his drug and alcohol use had caused so much pain and fear in his family. As family counseling concluded, each family member left with a much clearer understanding of the process of recovery, both in their individual lives and the life of Devon.
Robert was also a single, white male in his early twenties who admitted into treatment with a primary diagnosis of alcohol use disorder, severe, and cocaine use disorder, severe. Robert shared that he drank his first beer at age six and that he had begun to use marijuana, cocaine and alcohol by age twelve.
Robert is an only child and shared that his parents were extremely high functioning. His father is an attorney and his mother a successful business woman. Ryan shared that his family was very goal driven and that he frequently had a difficult time living up to their standards of perfection. This caused Robert to feel a great deal of shame. Robert shared that expression of feelings, other than anger and maybe sadness, was not allowed within his family (unspoken rule) and so he learned to stuff his feelings. Robert shared that he grew up not being able to identify his emotions. Robert also shared that his Mother was a huge enabler and that he manipulated her in this respect. Robert shared that his Mother would always take his side, mistakes were never his fault, and that he rarely if ever suffered consequences for the choices he made. Robert’s mother would always co-sign his behavior, whether the behavior was appropriate or inappropriate. Robert also had deep seated resentments towards his Father. Robert’s father would often be at a favorite bar instead of attending Robert’s hockey games, and Robert could never get the validation that he so desperately craved from his Father. This emotional distance between Father and son also reinforced the enmeshment and enabling that Robert experienced with his Mother.
The goals for family counseling were many. Unspoken family rules within the family system that created dysfunction had to be examined and replaced.
All family members needed to learn how to identify their emotions. Furthermore, an open line of communication, particularly on an emotional level, had to be established. This allowed Robert to express what his emotional needs were and to work through the resentments that he had with his Father. Robert’s Mother also had to look at her enabling behavior and recognize that it was helping to keep her son sick. It emerged in counseling that Robert’s Mother grew up with an alcoholic Father and that this fueled her rescuing with her son. She was attempting to heal wounds from her childhood in her relationship with Robert. As the family system began to operate in a healthier manner, Robert began to get his emotional needs met in a way that he never had previously. Robert also was allowed to take ownership of the choices that he made and to experience the natural consequence of poor decisions without being rescued or shamed. This eventually led to Robert making healthier choices and his recovery from his substance use disorder began to thrive.
Family counseling is an absolutely vital link in the treatment of an adolescent or young adult with a substance use disorder.
I have highlighted two examples of the benefits of this process. Unfortunately, I could give other examples of outcome failures when families were unwilling to engage in this journey with their loved one. The son or daughter with the addiction often becomes the scapegoat that distracts the family from looking at other problems within the family system. When families, however, are courageous enough to engage in the difficult task of family counseling, the changes can be extensive and beneficial. Family counseling can not only breathe new life into the family system, it also significantly impacts the recovery process for the adolescent or young adult struggling with the substance use disorder.