Strength in Unity: Family Therapy – a Biopsychosocial Approach

There is a profound truth in the African proverb, “It takes a village to raise a child.” This sentiment is especially significant when it comes to substance misuse treatment.

Substance use disorder affects not only individuals but also their loved ones and family members. A strong and supportive family can be a beacon of hope when someone is going through recovery and has been shown to “significantly reduce drug use and other related problem behaviors, and enhance particular domains of prosocial functioning.”[1]

At Crossroads Centre Antigua, family therapy (FT) plays a vital role in our program and is a cornerstone of our holistic approach to recovery. In this blog, we’ll look at the benefits of this form of treatment. Recovery doesn’t have to be a solitary journey; it can reap enormous benefits when the whole family has the opportunity to heal.

[1] Resource: Bolton D, Gillett G. The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments [Internet]. Cham (CH): Palgrave Pivot; 2019. Chapter 1, The Biopsychosocial Model 40 Years On. 2019 Mar 29. Available from: doi: 10.1007/978-3-030-11899-0_1

Understanding Family Therapy: A Cornerstone of Addiction Treatment

The relevance of FT becomes clear when we consider biopsychosocial theory, a crucial piece of the puzzle in our understanding of addiction. This theory, which was first outlined by George Engel in 1977, takes into account the intertwined nature of our social experiences and psychological health. Our mental well-being is not an isolated component of our existence; but interwoven with our interactions, relationships, experiences, and biological makeup.[2]

This model recognizes that substance use disorder (SUD) and alcohol use disorder (AUD) are influenced by a combination of these factors rather than solely attributed to personal choices or weaknesses. It isn’t just a physiological issue; it’s a complex tapestry of a person’s social interactions, mental state, and emotional well-being, with each thread playing its part, contributing to the multifaceted nature of addiction.

  • Biological factors – refers to genetic predispositions, physiological aspects, and biochemical imbalances that can contribute to addiction. Family therapy recognizes that individuals may have a biological vulnerability to substance use due to their genetic makeup or neurochemical processes.
  • Psychological factors – encompass thoughts, emotions, and mental health. These factors include underlying psychological conditions, coping mechanisms, self-esteem, and cognitive patterns that influence substance use or hinder recovery.
  • Social factors – play a significant role in SUD and involve the influence of relationships, cultural norms, peer pressure, and environmental contexts. Family therapy acknowledges the impact of family dynamics, socioeconomic status, and the availability of substances in shaping the development and maintenance of substance use.

FT offers a structured space to address these interlinking issues, providing the opportunity for healing the individual and their family. It ensures that no one’s issues are viewed or treated in isolation but rather in the context of their familial relationships and social networks.

Imagine a nest woven carefully, strand by strand, with each strand representing an aspect of an individual’s life – their relationships, experiences, mental health, emotions, and the addiction they are struggling with. Now imagine that nest being fortified, strand by strand, in a process that seeks to heal, strengthen, and reconcile. That’s the essence of family therapy in addiction treatment – it’s a process that ensures the healing of the person and their ‘village’ as well.

[2] Resource: Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological bulletin, 122(2), 170-191.)

The Synergy of Family Therapy and The 12-Steps

The 12-steps are a highly effective, community-based method of helping people achieve long-term abstinence through altruism and spiritual development.[3] Family therapy and the 12-step recovery process can happen in synergy. In step 8, we make “a list of all persons we have harmed, and become willing to make amends to them all,” and in step 9, we make direct amends (except where to do so would cause harm).

SUD and AUD can leave family relationships fraught, and there are often many elephants in the room that people try to avoid, either through fear of conflict or just not wishing to upset the other person. FT arms us with the communication skills and coping mechanisms to make this process smoother – it makes us better at speaking, listening, and empathizing as a family unit.

[3] Resource: Donovan, Dennis M et al. “12-step interventions and mutual support programs for substance use disorders: an overview.” Social work in public health vol. 28,3-4 (2013): 313-32. doi:10.1080/19371918.2013.774663

Healing from Within: How Family Therapy Helps

Family therapy isn’t simply about addressing the addiction – it goes beyond this, tackling the underlying emotional, psychological, and relational aspects often intertwined with substance use. Studies show it produces “superior and stable outcomes with significant decreases on target symptoms of alcohol and drug use.”[4][5] Other ways FT can benefit families include:

  • Allowing families to dissect and understand how their interpersonal dynamics may influence substance use and addiction patterns.[6]
  • Helping to improve communication within the family, ensuring that members feel heard, understood, and valued.
  • Imparting crucial coping strategies to family members, enabling them to better manage the stressors associated with a loved one’s addiction and triggering situations.[8]
  • Emphasizing the role of personal accountability in recovery and encouraging individuals to take responsibility for their actions and healing.
  • Helping to find and address co-occurring mental health conditions that may be underlying causes of substance or alcohol misuse or may be exacerbating use.
  • Psychoeducation about the biological, psychological, and social factors involved in SUD can help families understand the complexities of addiction, the effects on the individual and the family system, and the importance of a holistic approach to treatment.
  • Identifying triggers and high-risk situations, creating strategies for coping with cravings and stress, and establishing a supportive and recovery-oriented environment within the family with relapse prevention planning.
  • Helping the family feel involved when setting treatment goals, exploring different treatment options, and discussing strategies for ongoing support and collaboration throughout the recovery journey.

Family therapy plays a vital role in positive change and building a robust foundation for long-term recovery. The lessons learned during FT – from effective communication strategies to emotional coping mechanisms – equip individuals with the tools needed to maintain sobriety and ensure healthier family dynamics.

[4] Resource: Liddle, Howard A. “Family-based therapies for adolescent alcohol and drug use: research contributions and future research needs.” Addiction (Abingdon, England) vol. 99 Suppl 2 (2004): 76-92. doi:10.1111/j.1360-0443.2004.00856.x
[5] Resource: Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social work in public health, 28(3-4), 194-205.
[6] Resource: Tip 39 Substance Use Disorder Treatment and Family Therapy.” SAMHSA.GOV, Accessed 31 May 2023.
[7] Resource: Stanton, M D, and W R Shadish. “Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies.” Psychological bulletin vol. 122,2 (1997): 170-91. doi:10.1037/0033-2909.122.2.170
[8] Resource: Waldron, Holly Barrett, and Charles W Turner. “Evidence-based psychosocial treatments for adolescent substance abuse.” Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 vol. 37,1 (2008): 238-61.

Exploring The Different Kinds of Family Therapy

Family therapy is an umbrella term used to describe a multitude of approaches that offer unique insights and methods to address the varied challenges that families face. From delving into the influences of past generations to developing specific, tailored strategies for change and using storytelling as a therapeutic tool to enhancing emotional connections within the family, each modality sheds light on a different aspect of the family dynamic and offers its own pathway to healing and growth. Some different types of FT include:

  • Family Therapy – an evidence-based approach that involves the entire family in the treatment process. It aims to improve family dynamics, enhance communication, and address dysfunctional patterns contributing to or resulting from SUD. Therapists work collaboratively with family members to identify and modify maladaptive behaviors, improve problem-solving skills, and strengthen family support systems.
  • Multi-family therapy – brings together multiple families in a therapeutic setting. This approach allows families to connect with others going through similar challenges, share experiences, and learn from each other. It provides a supportive environment for mutual understanding, empathy, and shared growth. Multi-family therapy can be particularly helpful in reducing isolation and stigma and creating a sense of community and has been shown to be effective in a clinical setting.[9]
  • Brief strategic family therapy (BSFT) – is a family-based intervention that focuses on improving family interactions and addressing specific patterns contributing to SUD. It aims to restructure family dynamics, enhance communication, and strengthen parenting skills. This therapy is typically brief and targeted, focusing on key areas that impact substance use and recovery.[10]
  • Community reinforcement and family training (CRAFT) – a body of evidence supports using CRAFT for SUDs. CRAFT is an evidence-based intervention that involves the family in motivating and supporting the individual with SUD to seek treatment. It emphasizes positive reinforcement, communication skills, and self-care strategies for family members. One study found it to be more effective than the Johnson intervention model and Al-Anon in engaging resistant substance users in treatment.[11]
  • Functional family therapy (FFT) – is a family-based intervention that focuses on improving family functioning and reducing risk factors associated with SUD. It addresses specific family dynamics, such as communication patterns, conflict resolution, and boundary setting. FFT also emphasises problem-solving skills, coping strategies, and behavioral changes within the family system. A meta-analysis by Waldron and Turner (2008) suggested that FFT has a significant impact on reducing drug use and associated behavioral problems in adolescents.[12]
  • Strategic family therapy – conceptualised by Jay Haley and Cloe Madanes, devises bespoke interventions to disrupt recurring dysfunctional patterns and spur positive change.[13]
  • Narrative therapy – a brainchild of Michael White and David Epston, positions problems as separate from the person. This modality harnesses the power of storytelling, allowing families to reframe their experiences and gain fresh perspectives.[14]
  • Steve de Shazer and Insoo Kim Berg’s solution-focused brief therapy (SFBT) – prioritizes finding solutions and capitalizing on family strengths and resources.[15]
  • Emotional synchronisation – Sue Johnson’s emotionally focused therapy (EFT) centers on adult relationships and attachment, often utilized in couples and family therapy to amplify emotional connectivity.[16]

[9] Resource: Garrido-Fernández, Miguel et al. “Multi-Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment.” Journal of marital and family therapy vol. 43,2 (2017): 338-351. doi:10.1111/jmft.12195
[10] Resource: Robbins, M. S., Feaster, D. J., Horigian, V. E., Puccinelli, M. J., Henderson, C., & Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713-727.
[11] Resource: Meyers, R. J., Miller, W. R., Hill, D. E., & Tonigan, J. S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10(3), 291-308.
[12] Resource: Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child & Adolescent Psychology, 37(1), 238-261.[^8^]
[13] Resource: Haley, J. (1976). Problem-solving therapy. Jossey-Bass.
[14] Resource: White, M., & Epston, D. (1990). Narrative means to therapeutic ends. Norton.
[15] Resource: De Shazer, S., & Berg, I. K. (1997). ‘What works?’ Remarks on research aspects of solution-focused brief therapy. Journal of Family Therapy, 19(2), 121-124.
[16] Resource: Johnson, S. M., & Greenberg, L. S. (1985). Emotionally focused couples therapy: An outcome study. Journal of Marital and Family Therapy, 11(3), 313-317.

Embracing Long-Term Change

Recovery isn’t a solitary endeavour – it’s a collective journey in which families can evolve together, fostering understanding, compassion, and resilience that lasts long after the treatment has finished. FT empowers families and gives them the tools and skills to support their loved ones effectively while simultaneously addressing their emotional needs – a testament to its comprehensive approach.

If you or a loved one are struggling with substance misuse, consider embracing the power of family therapy. At Crossroads Centre Antigua, we are here to guide you on this path of healing and recovery. We welcome family visits and enjoy witnessing the entire family unit heal together, become more resilient, and, ultimately, grow closer.

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