Family Well-Being in the Context of Addiction

Background and Purpose:  While substance use treatment providers often supplement the treatment process by involving their clients’ family members to address enabling behaviors and to facilitate and restore healthy family communication, the family members’ own well-being needs often go unmet despite the distress associated with having a member with a substance use disorder.  This study is a systematic review of the literature to address the following research questions: 

1. What are the effects of a substance use disorder on the family?
2. What do we know about addressing the needs of a substance use client's family members?
3. How can we improve our approach to addressing the needs of a substance use client's family members?

Methods:  We searched five databases— PsychINFO, Social Work Abstracts, Social Services Abstracts, Family and Society Studies Worldwide, and MEDLINE— to locate published scholarship on substance use disorders and the family.  We used the following inclusion criteria: 

1. The article was published in English between 2006 and mid-2016.
2. The article focused on the family (or significant others) of members with an active substance use disorder.
3. The article focused primarily on the effect of the substance use disorder on the family, treating secondarily, if at all, the effect of other co-occurring disorders (e.g., mental health) on the family.
4. The article focused on psychosocial concepts related to the effect of a member's substance use disorder on the family.

We retrieved 1,180 articles from the databases and evaluated their titles and abstracts for fit with our criteria, settling on 60 articles to retain for this study.  We prepared brief summaries of each article to identify topics to categorize the articles, then coded them and analyzed coded content using framework matrices.

Results:  The effects of a substance use disorder on family members include internalized (e.g., health) and externalized (e.g., relationships) symptoms, and patterns of family system functioning and culture that maintains substance use and maladaptive behaviors.  Approaches for addressing the needs of family members include formal psychosocial models (e.g., Al-Anon), informal supports (e.g., extended family), and formal support (e.g., child welfare systems). 

The ways in which substance use affects the family system calls for an approach to understanding and addressing family well-being that is separate from the recovery of the member in substance use treatment.  Based on the results of our review, this study presents a framework for approaching family well-being in the context of substance use treatment that both addresses factors unique to the well-being of the family system and enhances the recovery process of the member in treatment.

Conclusions and Implications:  Family members of people with a substance use disorder need their own, separate recovery process to enhance their well-being.  Although involving the family in the client’s treatment experience is valuable, specific efforts to understand and address the unique needs of the client’s family system are warranted.  The framework presented here offers an approach to both addressing family well-being and recovery from addiction in a way that is accessible to everyday substance use treatment providers.