The Role of Family in Addiction and Mental Health Treatment

Seeing your child or loved one enter addiction or mental health treatment can be harrowing. Not only have you had to watch your child suffer through the stages of addiction, but when they enter rehab, you are cut off from them for several weeks at a minimum. As a parent or family member, it can be difficult to know what to do during that time. Your family may feel fractured and broken, and communication can break down among the other family members.

Seeing a loved one enter treatment is a huge paradigm shift. Family members must change their worldview and consider how they can heal themselves to help heal their loved ones.

Family Systems

Psychoanalyst Murray Bowen developed the concept of the Family System in the 1950s and 60s. Bowen theorized that families were affected by eight overlapping concepts:

  1. Triangles – A three-person relationship on which other emotional systems are built.
  2. Differentiation of the self – Those able to differentiate between themselves and their family can act independently, whereas those with a low level of differentiation rely more on validation from others.
  3. Nuclear family emotional process – The emotional process is how the family interacts emotionally. This is affected by marital conflict, emotional distance, and dysfunction in both spouses and children.
  4. Family projection process – Parents may project their anxieties and emotions onto their children, which can, in turn, affect how children develop and create emotional problems for others.
  5. Multigenerational transmission process – Those with a similar level of differentiation tend to be well suited to one another. Therefore, children and future generations in families with low differentiation will likely have lower levels of differentiation.
  6. Emotional cut-off – Some family members may deal with conflict or uncomfortable emotions by cutting themselves off from the rest of the family unit, which increases stress and compromises future relationships.
  7. Sibling position – Birth order may impact the family in key areas, including parental expectations and discipline.
  8. Societal emotional process – Many things that impact families can also affect societies, and vice versa. Cultural conflicts and shifts can also often affect families.

Family Systems are naturally connected emotionally, often very strongly. For example, when one member of the family unit feels anxious, this anxiety can spread until the emotional connection becomes a source of pain and discomfort.

The spreading of pain and negative emotions is often seen when one member of the family enters addiction treatment. When one member is sick or removed from the family, the entire system can falter and damage all members. However, by understanding these relationships and systems, individual problems can be addressed and the positive family system dynamic can be restored.

Family Systems also help members of the family become more independent and allow many people to break free from intergenerational patterns that may be contributing to patterns of addiction, substance abuse, and poor mental health within the family. There is also evidence to show that Family Systems Therapy is effective in treating substance abuse disorders, attachment problems, eating disorders, and relationship distress.[1] [2]

Family Therapy

Therapy is an incredibly valuable tool to improve communication and relationships among family members. Family therapy is often cited as a useful tool, especially when supporting a loved one in treatment. Research suggests that family therapy in substance abuse recovery programs can be more effective than group and individual therapy approaches.[3]

Family members can take time to work on themselves and their relationships when their loved one is in treatment for their substance abuse disorder. Family dynamics can be particularly toxic when one member is struggling with substance abuse, and other family members can harbor a lot of resentment and anger toward the one struggling.

Family therapy incorporated in substance abuse and mental health treatment can address relationships among family members that may be unhealthy. For example, one family member may be used as a scapegoat and blamed for all the family’s problems. Another family member may take the role of the hero, someone who attempts to solve all of the family’s problems. Family therapy can address why people fall into these roles and how these roles may enable the person with a substance abuse or mental health disorder.

Practices incorporated within Family Therapy include:

  • Cognitive-behavioral therapy (CBT)
  • Journaling
  • Communication techniques
  • Writing letters to other people or yourself

With work and time, families can learn how to reframe their negative emotions and improve their relationships within the family unit. By increasing their self-awareness, family members can transform how they relate to others and address long-standing issues.

Many parents can also believe that they have damaged their child who is suffering from a substance use disorder or a mental health condition. In some cases, this can thwart treatment, with some parents refusing treatment due to not wanting to retraumatize their child. Part of family therapy can help educate parents and family members about substance abuse and help them establish a new mindset and learn how they can best support their child.

When receiving family therapy, some families may experience their relationships getting worse before getting better. It may initially seem as though therapy is not working, but this perception is normal because many grievances and complaints may be brought up, which temporarily increases tensions and emotions as therapy starts to work.


In families, firm but healthy boundaries are vital for the normal development of the family and children.[4] However, in a family in which one member struggles with substance abuse, boundaries can become porous and fail to protect you or your child.

Family therapy can assist with the development of healthy boundaries that can protect everyone within the family unit. Boundaries that you may choose to set include:

  • Refusing to cover for your loved one if their substance abuse affects their job or education
  • Not allowing any harmful substances, such as alcohol, in the house
  • Refusing to allow or participate in insults or ridicule of your family members even in jest
  • Asking permission to share ideas or advice about personal matters

However, some people may attempt to push boundaries or disregard them completely. In families unused to concrete boundaries, these limits may initially be tested and violated. Family members must hold their loved ones accountable for their actions to allow them to reap the benefits of having healthy boundaries.

Some of the major benefits of establishing boundaries within a family include:

  • Reducing conflict – Boundaries can help reduce the conflict within a family system. Conflict is natural but can be exacerbated when a loved one or a child has a substance use disorder.
  • Protecting your emotions – Helping a loved one with a substance abuse disorder can take a toll on your emotions and the emotions of the rest of the family. You may feel hurt by their actions or lash out in response to some of their behavior. Placing healthy boundaries can protect you and your loved one from constantly getting hurt.
  • Creating respect – Before, during, and after treatment for substance abuse, many people feel they have lost the respect of their family and peers. Boundaries can help build more respect among family members.


A child or family member entering treatment for their substance abuse disorder or mental health can heavily impact the rest of the family. Family members can feel as though they have failed their loved ones, and conflict can arise among other family members as they blame themselves and others for what has happened.

Families are linked closely by emotions, and when one person is unwell and in treatment, the rest of the family system can feel unbalanced and off kilter. However, by utilizing family therapy and setting healthy boundaries, family members can work on themselves and offer more support to their loved one in treatment.

If you or anyone you know is struggling, please do not suffer alone. Please contact Heather R. Hayes & Associates.  Call 800-335-0316 or email today.


[1] Rowe CL. Family therapy for drug abuse: review and updates 2003-2010. J Marital Fam Ther. 2012;38(1):59-81. doi:10.1111/j.1752-0606.2011.00280.x

[2] Carr A. Evidence for the efficacy and effectiveness of systemic family therapy. In: Wampler KS, McWey LM, eds. The Handbook of Systemic Family Therapy. 1st ed. Wiley; 2020:119-146. doi:10.1002/9781119438519.ch6

[3] Hogue, A.; and Liddle, H.A. Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research. Journal of Family Therapy 31(2):126–154, 2009.

[4] Lander, Laura et al. “The impact of substance use disorders on families and children: from theory to practice.” Social work in public health vol. 28,3-4 (2013): 194-205. doi:10.1080/19371918.2013.759005

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