Addiction Treatment Works Best When Family Is Involved

Amy sits nervously in the center of a group circle made up of people in recovery and their family members. She is about to read a letter aloud, the first time she has shared a “Family Letter” in the weekly group sessions attended by her peers and their loved ones. Amy is protective of her mom. She was not close to her father when she was a child because he had a drinking problem, which made him short tempered and sometimes violent, so she avoided him. She stepped in to protect her mother a few times, which was traumatic, and that stress led her to start drinking to numb her pain. As Amy’s story unfolds, it becomes clear why addiction treatment works best when family involvement is part of the recovery process.

Amy’s letter

With her mother seated across from her, Amy takes a deep breath and begins in a shaky voice: “Mom, as a recovering alcoholic I need us to move away from a dysfunctional relationship where I feel like I am protecting you from Dad when he is drinking, or serving as the only person you can talk to about your dynamic with him,” says Amy, who is 20 days into a treatment program for alcohol use.

“I am willing to stop stepping into my co-dependent protective role if you are willing to consider moving away from Dad. Unless you move away from him, I am afraid he will keep hurting you. When he hurts you and you are in pain, it hurts me. I feel your pain. And I drink and use because I do not want to feel that pain and I do not want to feel so afraid for you. If nothing changes in your relationship with Dad or his drinking, then I will have to distance myself from both of you to protect my recovery. I will still love you no matter what.”

“Dad, I know you probably are not going to be here today to hear this, but I hope you can get the kind of help I am now getting. I feel so much better. I know you need treatment, too, and I know things would be better for you, and us, if you got it.” Amy’s mother silently nods, her eyes filled with tears.

Addiction treatment works best with family involved

The counselor who is facilitating the session commends Amy for her courage and the hope she shows by speaking up. He gently asks Amy’s mother to share the emotions she feels when Amy says these things. That invitation helps Amy and her mother discuss difficult topics openly without blaming each other.

Even though Amy’s father did not attend the family session, her mother’s support matters. Evidence suggests that involvement from one engaged relative can help strengthen family interactions, increase motivation for the person in treatment, and support long term recovery for the entire family.

All in the family

Addiction is often called a family disease. The health of the family system, the home environment, and family interactions can all contribute to substance use. For this reason, family work should be part of any treatment program, and including family in recovery programs has become a standard element at many centers, including The Right Step in Texas. Families who participate gain education, communication skills, and support, and they frequently report reduced stress as they learn to set healthy boundaries.

To see how clients and families describe their experiences, explore the Right Step testimonials. For information about outcomes, review our addiction treatment outcome study.

Family programs give family members firsthand insight

“We are very proud of our family program, which involves a full day every Saturday,” says Casey Arrillaga, MSW, LCDC, EAP Case Specialist, The Right Step. “Families get a slice of life by seeing firsthand the things our clients do every day in their treatment program, such as their own process group. Families also attend an educational session with their loved one, experiential groups such as family sculpting or a session where a family returns to The Right Step to talk after some time in recovery. The day culminates in the family letters and sharing group, which is one of our most powerful sessions all week.”

Through family therapy and sharing sessions, families work on past hurts and look toward the future. Loved ones practice problem-solving and communication skills, and they create a plan to heal relationships, set healthy boundaries, and provide support that encourages positive change.

Family sessions can uncover underlying issues

Families who share their letters sit in the center of the room, with other families and clients around them for support. After each family shares, the group offers reflection and feedback.

Arrillaga explains that surprising moments of insight can happen, which can be healing for all family members and enlightening for others attending. “One mother was able to admit that she was shocked to hear her daughter call herself an alcoholic,” he recounts. When he asked what that realization meant, she told the group, “Well if she is an alcoholic, then I guess I am, too.” After they spoke about their history of drinking together, the mother committed to attending a support group and seeking her own recovery.

A couple who had shared in the group were able to look each other in the eye and talk about how they had manipulated each other when active addiction was present. The spouse admitted that he had kept his partner drunk so that she would be easier to handle, while our client admitted to using sex so that he would get her alcohol. This led to a conversation where they moved beyond the family myth of “the terrible wife and the wronged husband,” and began a more honest and open marriage.

Family therapy prompts crucial communication

Why does addiction treatment work best when family involvement is encouraged? One key reason is communication. Counselors guide clients in writing letters to loved ones by using question prompts, many of which reflect concepts from the Positive Recovery and Daring Way programs used at The Right Step. Examples include:

• How would you like to see this relationship improve?
• What are you willing to do to move toward this?
• What are your fears around this relationship?
• How do my actions cause you pain in this relationship?
• What do you do when you feel the pain, and how can you improve these reactions?
• What strengths do you bring to the relationship, and what strengths do you see in your loved one?
• Is there anything you would like to say that has not yet been said?

Families sometimes return a year later to share what life was like before, during, and after treatment, which provides social supports and hope for people struggling with substance use.

Family involvement improves outcomes

A growing body of research, including resources from the Substance Abuse and Mental Health Services Administration, indicates that family therapy and family programs can help people with substance use disorder start and stay in treatment, reduce stress in the household, improve communication, and increase participation in aftercare.

Family counseling approaches can improve engagement and retention, and they can support recovery for patients and families. Evidence suggests benefits for both adults and young adults, including children who are affected by a parent’s alcohol or drug use.

Families benefit, too. When parents, partners, or other caregivers receive education and training, they gain a better understanding of substance use, learn coping skills, and can set healthy boundaries that support their family member’s recovery while protecting their own well-being. These steps reduce stress and can help prevent patterns that perpetuate stigma.

What to expect in a family addiction program

Every addiction recovery program is different, but common components in family support include:

• Education about substance use disorder, mental health, and how the brain and behavior are affected
• Family training in communication skills, problem solving, and setting boundaries that support recovery
• Practice sessions that focus on specific family interactions and goals
• Support groups for family members and caregivers
• Planning for aftercare, social supports, and community resources that help the entire family

See SAMHSA’s resources for families.

Skills families practice together

Family therapy is a safe place to practice new skills. Common areas include:

• Communication skills, like listening fully, reflecting emotions, and making clear requests
• Problem-solving strategies that focus on one issue at a time
• Setting boundaries that protect safety and recovery for everyone
• Coping skills for stress, cravings in the household, and difficult emotions
• Planning for triggers in daily life, including holidays, phone calls, and family events

Clinicians often integrate approaches that have been reviewed by the mental health services administration and the national institute network that includes the National Center for Advancing Translational Sciences. The aim is to help the patient and family move together through the recovery process and strengthen resilience across the healthcare system.

Support groups and social supports for families

Many families benefit from peer support in addition to therapy. Options include:

• Al Anon Family Groups and Alateen for teens, which are 12-step style support groups for loved ones affected by alcohol use
• Groups focused on skills, such as SMART Recovery Family and Friends
• Faith-based or community-based groups that provide support in your local area
• Education series offered by treatment programs

See the NIAAA Alcohol Treatment Navigator’s support resources for family and friends.

How family therapy helps different ages and stages

Family support programs are helpful at any age:

• Children and teens: Family-based approaches can protect a child from harm and help parents respond to behavior concerns. Family therapy for adolescent substance use looks at school stress, peer influence, and mental health. It also helps families plan structure at home, including curfews and consequences, and adds social supports that improve well-being.
• Young adults: Family involvement can support transitions to college or work, help with housing decisions, and create structure for medication support or therapy appointments. Families can also help a young adult navigate the healthcare system and connect with community reinforcement practices that encourage positive choices.
• Adults and parents: Partners and parents often work on rebuilding trust, managing finances, and repairing communication patterns. Couples and parents may also learn new ways to share responsibilities and team up more productively to support each other.

Family training topics that make a difference

Education segments in family programs often cover:

• Substance use disorder 101 for families, including the science of craving and loss of control
• Substance use and co-occurring mental health disorders, and how to coordinate care
• Safety planning for active addiction, including overdose response and when to involve professionals
• How to set healthy boundaries and maintain them in daily life
• How to build and maintain a social network that provides support for the whole family

Families are encouraged to ask questions and to practice these skills so that loved ones experience consistent family support at home.

When families need extra help

Some situations require immediate professional support, such as intimate partner violence, a child or adult at risk of harm, threats of self harm, or medical emergencies related to substance use. In those moments, families should call 911 or seek emergency care right away. For nonemergency situations, families can connect with licensed clinicians in their community, then ask how to include family therapy and family training in the plan.

How we partner with families in Texas

At The Right Step, families are part of the work. Our team invites parents, caregivers, spouses, and other family members to participate in education, experiential exercises, and family letters. We listen to each person’s goals, and we help the entire family practice communication skills, problem-solving, and setting boundaries.

Families who want an overview of available materials can browse our Addiction Treatment Resources. If your family is exploring addiction treatment in Texas, we welcome you to reach out to our team to discuss next steps.