Family Systems

Every member of the family unit is impacted by substance use. The family system is a key structure that helps clinicians understand and treat substance use disorder and prevent relapse. The family has intimate information about the individual’s relationship to substance use, to which no one else is privy. They might know how the relationship to alcohol developed, how it is maintained, what the main triggers are, and what positively and negatively influences substance use. The family system has the power to influence both the positive and negative contributing factors to alcohol use. By determining the family’s developmental stage, it is possible to target appropriate intervention and address the emotional and behavioral patterns of the family unit. A family systems interventional approach is useful because it identifies the impact of the environment on the individual and vice versa. This intervention works on building the framework of the family with each member acting as a pillar and with their own set of responsibilities.

Let’s take a look at the family system with an example. 

Gary has been married to Linda for 28 years. They have two grown children, Elise and David. Gary started drinking heavily after losing his job and endured a long and challenging search for a new job. He felt demoralized and as if he couldn’t provide for his family. Alcohol numbed his painful feelings. When Gary entered treatment, Linda assumed things would improve quickly. Gary’s goal was to bring his drinking down from 25 units per week to 18 units, but Linda assumed that his work with the therapist would result in abstinence within a month. Linda knew that sports games were a significant trigger for Gary, but instead of finding ways to support him to meet his goals, she nagged at him as he drank beer. 

Linda and Gary’s situation is typical of families managing substance use challenges. That said, struggles differ between each family based on factors like financial situations, culture, dynamics, and values.  Let’s look at how Linda could define her role and how she might support Gary with his alcohol use. 

  1. Communicating on the definition of appropriate alcohol.

A good place to begin is defining what it means to have an appropriate amount of alcohol. Linda may think that having one beer a week was suitable whereas Gary’s definition was to have one every other day. Communicating these definitions can be helpful in working together to create tangible goals at home. This is a conversation that can happen with the guidance of the therapist or medical doctor and between family members. In Gary’s case, he was engaging in gradual reduction. It would have been helpful for him to state his goals with Linda, and keep in mind that change doesn’t happen overnight. In this way, Linda could celebrate small successes, change her perception around milestones and progress, and leave room for ambiguity and challenges. 

2. Creating a safe environment with triggers in mind.

Families can play an essential role in identifying triggers. One of Gary’s biggest triggers was sports games. He tended to drink heavily. Planning is where success begins and Linda and Gary could have worked together to ensure that they only stocked the fridge with the alcohol they intended to drink. Linda and the kids might have made special snacks and mocktails for the game and worked to create a safe and comfortable, non-judgmental environment for Gary. 

Now, what if Gary drank too much?

Since Linda and the kids can’t change how much Gary has consumed, it’s best to focus on what they can do at the moment. Rather than egg him on with belittling comments, they can be a strong pillar of support until he sobers up. The next day, they can have a candid and caring conversation about Gary’s goals, and help him get back on track. When you take shame out of the equation, you make room for vulnerability and change can occur at the level of substance use, and within the family system. It is also vital for Linda to remember to take time for herself and engage in self-care. That way, she can continue to support Gary and won’t experience resentment or burnout. 

Linda could connect empathetically with Gary. She might say:

“I noticed that yesterday was a hard day for you. How can I support you best?”

“A game is coming up, how can we plan as a family to support you?”

“How was your day?”

Since they are a family of four with unique personalities and attributes, it is helpful to assign different roles. Gary’s daughter Elise might be more patient when Gary has had too much to drink. At this time David, a good moderator, can support his Mom and later help to facilitate a conversation as a family. When you know your role in a family system, it is easier to take a step back if you feel out of your depths to make room for someone else who can navigate the situation better. If Linda gets heated, she can practice handing the reins to Elise and focusing on taking space in the moment so that she doesn’t further provoke Gary’s drinking. 

Understanding the nuances and roles within a family system takes time, observation, and patience. When it comes to substance use, family systems can be the key to understanding the pattern of drinking and moderating the role that environment plays.

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