The fact of the matter is that family dynamics will play a role in most of our lives at some point. Sometimes, these dynamics will be minute, like petty bickering over something that will be forgotten by tomorrow. Other times, these dynamics will play a more significant role. Sometimes, they even change the dynamic of the family forever moving forward. Addiction in the family is one of these dynamic contributors that can change the trajectory of a family. This is where the family systems model can help explain how addiction negatively affects the family, as well as start to mend the wounds that it often inflicts.

Understanding the Prevalence of Children of Parents Struggling With Addiction

The pioneer and champion of the family systems model (which is based on his “family systems theory”) was the 20th-century psychologist Dr. Murray Bowen. Dr. Bowen once said, “That which is created in a relationship can be fixed in a relationship.” He determined that the family is a complex unit, and due to that complexity, each member of the family influences the other in one way or another. Understanding this is where the “fix” comes in. One can see how bringing addiction into this equation could make for a very disrupted family system model.

Addiction in the family is happening a lot more than many people may think. According to the National Institute on Drug Abuse (NIDA), “20.4 million people in the United States were diagnosed with SUD in the past year [2022].” That statistic represents the subsequent reverberations that substance use disorder (SUD) then has on the home 

Based on the 2020 survey conducted by the National Center on Substance Abuse and Child Welfare, there has been a significant rise in negative addiction-related issues in the home. According to the survey, “[Data indicates] that the prevalence of parental alcohol or other drug (AOD) abuse as an identified condition of removal of children and placement in out-of-home care has increased from 2000 to 2020. Data from 2000 show a prevalence rate of 18.5%. This increased to 39.0% in 2020, an increase of 20.5%.” 

A significant increase and one many people believe to still be on the rise. This is especially true due to the aftermath effects of the COVID-19 pandemic, such as increased adolescent isolation, increased parental addiction, and decreased community involvement.

A Precursor to Understanding the Family Systems Model: Addiction as a Chronic “Family Disease”

There is little doubt that addiction affects more than just the individual who is struggling. Sometimes, a helpful way to think about someone’s active addiction is to think of them as a tornado, and everyone and everything in their path gets affected by the wreckage that they cause.

This is true in the way that addiction negatively affects the family. It is why addiction is also referred to as a chronic “family disease.” Addiction is corrosive, and there is only so much that a family unit can take. This is why addiction requires an effective family solution.

There is a chapter in the “Big Book” of Alcoholics Anonymous (AA) dedicated to this topic entitled The Family Afterward. This chapter states, “A doctor said to us, ‘Years of living with an alcoholic is almost sure to make any wife or child neurotic. The entire family is, to some extent, ill.’ Let families realize, as they start their journey, that all will not be fair weather. Each in his turn may be footsore and may struggle.” 

While, yes, there may be some “struggle,” as the chapter (with admittedly antiquated language at times) alluded to, the key is to find a system of recovery that allows for as little as possible. After all, addiction has caused enough pain in the family; now it is time to heal. It is time to heal safely, securely, soundly, and successfully. This is where the concept of the family solution and the family systems model comes into play.

Addiction Requires an Effective Family Solution: Understanding the Family Systems Model

Dr. Bowen explains how families struggling with addiction issues have taken on a situation that affects everyone in the family. Yet, it is up to each individual to heal first before coming together. Dr. Bowen writes, “You have inherited a lifetime of tribulation. Everybody has inherited it. Take it over, make the most of it, and when you have decided you know the right way, do the best you can with it.” This is an oversimplification of what the family systems model offers, but it does set up the basic concept.

The family systems model utilizes the complex connections between family members to better understand family dynamics. This understanding can be the bridge and help bridge the gap between family addiction struggles and unified family healing.

The peer-reviewed clinical journal BMC Palliative Care offers an essential and comprehensive breakdown of the family system model. It states that “Family Systems Theory [also known as the family system model] focuses primarily on the interaction between members of the family and between the family and other systems. A system can be defined as a set of interacting elements. The family is seen as a group of interdependent individuals, making the family a system, and a change in one family member, e.g., when someone in the family becomes critically ill, will influence the whole system.” When it comes to the family systems model that Dr. Bowen is discussing that ”critical illness” is parental addiction.

How Do the Family Systems Model and Family Systems Therapy Work?

Now that the family systems model is defined, it is time to understand how it can be utilized to help the family heal. This is where family systems therapy can be utilized.

Family systems therapy is a type of therapy that focuses on the relationships between family members rather than the individual family members themselves. It utilizes these relationships and the dynamics present to begin to problem-solve the issues at hand: the issue of addiction in the home and its subsequent fallout.

The first part of family systems therapy comes from educating the family on what their current status is. Doctors Varghese, Kirpekar, and Loganathan discuss this in their article, Family Interventions: Basic Principles and Techniques. 

The doctors discuss how “Working with families involves education, counseling, and coping skills with families of different psychiatric disorders. Various interventions exist for different disorders such as depression, psychoses, child, and adolescent related problems, and alcohol use disorders. Such families require psychoeducation about the illness in question, and in addition, will require information about how to deal with the index person with the psychiatric illness.” This information is a lead-in to the next steps of family systems therapy.

How Do the Family Systems Model and Family Systems Therapy Work With Addiction?

One of the biggest aspects to remember about the family systems model is that whatever happens to one family member will affect the other family members in one way or another. These effects can be both positive and negative. In the context of addiction, these effects are consistently negative.

When dealing with addiction and family systems therapy, it is important that everyone in the family’s voice is heard and that they feel seen. It is only when each member can express themself openly, honestly, and safely that the family can then come together and begin to solve their problems in a unified way. 

But what happens when a family member is not ready and refuses addiction care? This is when the family must come together as a social unit and determine the next steps. These steps may include setting boundaries, such as the individual is not allowed in the home if they continue to use alcohol and/or other substances. The key is to come together as a family to make these decisions and, ultimately, to follow through with them.

Who Is the Family Systems Model and Family Systems Therapy For?

It is important to note that family systems therapy is not just for families that are struggling with a member in active addiction. This type of therapy is for families who have members who are currently in treatment, are out of treatment, are in early recovery, and even those with family members who have long-term sobriety and recovery. 

Family systems therapy is meant to be effective for all family dynamics and situations, including during the stages of addiction and recovery. Its benefits can also be felt during all of these stages of addiction and recovery as well.

What Are the Benefits of the Family Systems Model and Family Systems Therapy?

Just as with any other form of therapy, there are benefits and limitations to family systems therapy. The benefits tend to outweigh the limitations in the model because there is rarely any potential for long-term side effects, as opposed to some forms of pharmacological or psychotherapeutic treatments. Following are some of the benefits of the family systems model and family systems therapy:

• Helps establish boundaries, which in turn will ultimately help the person struggling with sobriety and recovery
• It strengthens the support systems between family members, which includes how one family member supports another when they are forced to confront the person struggling
• Helps build communication skills within the family
• Addresses issues of “codependency,” which can be a significant problem in households that are “taken hostage” by addiction
• Family systems therapy can help foster empathy and compassion for one another because, before this therapy, family members are often unaware of what the others are going through

What Are Some Limitations of the Family Systems Model and Family Systems Therapy?

There are some limitations to family therapy as well. The following are just a few of those limitations:

• Not all family members are willing or able to participate, which makes healing the whole family system very difficult
• Communication is required, and if family members are unwilling to do so, the process cannot work
• Family systems therapy works on goal setting and certain boundaries that may not work based on certain socio-economic, cultural, and generational factors (though many psychotherapists are amending their process to better avoid this)
• Regarding addiction, if the person struggling is unwilling to get help and continues to be disruptive, the process may have to be delayed until their addictive behaviors are better under control

Making Sure to Directly Address a Child of a Parent Struggling With Addiction’s Needs

The individuals most affected by addiction in the home are also often the ones most in need of attention during the family systems therapy process. These are the children in the home.

Children often lose their voice when they are dealing with a parent (or older sibling or caretaker figure) struggling with addiction. That is why it is important to let them open up in family systems therapy. They must be able to vent all of the feelings they have regarding the situation, lest these emotions bottle up and manifest into a type of disorder such as post-traumatic stress disorder (PTSD) or other type of anxiety or mood disorder. A concept known as the “7 Cs” can help with this.

The 7 Cs are an ideal way to directly address the needs of a child struggling to be heard within the family. These are “I didn’t CAUSE it; I can’t CONTROL it; I can’t CURE it, but I can help take CARE of myself by COMMUNICATING my feelings, making healthy CHOICES, and CELEBRATING me.” When these concepts are explained to a child of addiction in a safe and supportive manner, they can better understand their place within the family as an equal member rather than as an observer.

Integrating the Family Systems Therapy With Other Concepts: Addressing the “Three Rules” and the Family Roles That Exist Within a Family Affected by Addiction

In her book, It Will Never Happen to Me, an expert on codependency and addiction, Dr. Claudia Black, explains the three major rules that manifest when addiction manifests within the home. These rules are “don’t talk, don’t trust, and don’t feel.”

Dr. Black’s rules represent a breakdown in the family. They represent a lack of communication, a lack of reliability, and a lack of emotional connection. Family systems therapy can address all of these lacking components. When the family structure is viewed and treated as the social system that it is, these rules dissipate. This is because family systems therapy cannot work without communicating with each other, trusting one another, and respecting each other’s feelings.

Dr. Black also discusses the roles that children often take on in an unhealthy family system. These roles are often taken out of fear and can cause emotional damage if not addressed. The roles are “the responsible child, the adjuster, the placater, and the acting-out child.” Family systems therapy offers a healthy and safe way to address each of these roles. The responsible child role can be addressed by offering additional praise when they are not taking on a leadership role; the adjuster role can be addressed by including the child in more of the decision-making processes within the family; the placater role needs more validation and emotional identification; and, the act-out role requires the setting of limits and boundaries.

NACoA: Helping the Entire Family Heal

Dr. Bowen explained that “The overall goal [of counseling] is to help family members become ‘systems experts’ who could know [their] family system so well that the family could readjust itself without the help of an expert.” This embodies our goals of healing the family at NACoA as well. 

Here at NACoA, we aim to heal children of addiction and the entire family. We do so by offering support and resources to those who can utilize them both in the field and the professional sphere. Though sometimes challenged, family can be a bond like no other. We deliver the resources to prove it.

Substance use disorder (SUD) does not only affect the person who uses substances; it can affect and influence the entire family. A parent’s substance use has also been shown to lead a child to develop an addiction of their own. The family systems model breaks down the behaviors and patterns often handed down by family members and looks at how family dynamics play a role in active addiction and addiction recovery. If you are interested in adding the family systems model to your practice, we have the resources to help. For more information on helping children of parents struggling with addiction and the family systems model, please reach out to NACoA today at (301) 468-0985.