One person’s drug use can affect their whole community. That includes family, friends, colleagues, and anyone close to you. Whether you or someone you love is in treatment for addiction, understanding family roles in addiction can help you heal.
Addiction and Family Systems
Addiction always has a context. Most people turn to drugs and alcohol as coping mechanisms. You might be dealing with mental health symptoms, trauma, or just the stress of daily life. Any of these issues—including addiction itself—can relate to your family dynamic.
To heal a dysfunctional family system, it might help to think about family roles. Family therapist Sharon Wegscheider-Cruse introduced this framework in her 1989 book Another Chance: Hope and Health for the Alcoholic Family. In it, she describes common ways that family members interact when one person has addiction.
This model isn’t universal, and it might not describe your experience perfectly. But learning about these different roles can give you insight into your own behavior. That newfound understanding can empower you to communicate your needs, set clear boundaries, and build stronger relationships within your family.
The 6 Family Roles
Wegscheider-Cruse describes 6 different family roles that support addiction.1 Each one has specific emotions, needs, and patterns of behavior.
The Person With Addiction
The person actively using drugs or drinking is at the center of this dynamic. Even if you feel isolated, your addiction can influence everyone around you. That doesn’t mean you’re responsible for everything that happens in your family. Sometimes, it’s just the opposite.
Successful addiction treatment addresses the underlying cause of your behavior. For example, your addiction might stem from childhood trauma. Your family may be the cause of that trauma or they may have survived it alongside you—or both. Sometimes, you’ll need to let go of these relationships to move forward. In other cases, rebuilding them can be vital to your recovery.
The Caretaker
The caretaker, or enabler, tries to protect their loved one with addiction. Because addiction and codependency go hand in hand, that can be counterproductive. It might feel like you’re keeping them safe. But in reality, you’re shielding them from the consequences of their own actions. And that makes it harder for them to realize they need help.
Enabling someone with addiction also puts the caretaker in harm’s way. You can find yourself bearing the brunt of someone else’s behavior. For example, imagine your loved one can’t pay their bills because they’re spending too much money on drugs. By lending them money, you risk your own financial security.
The Hero
This person, often the oldest child, sets out to save the family’s reputation. They put on a brave face and work hard to achieve their goals. To outsiders, they appear stable and successful. While that’s sometimes accurate, it’s not always the hero’s primary goal.
The hero feels responsible for their family’s safety and security. They may experience parentification,2 in which a child takes on the role of a parent. Sometimes that means caring for their siblings or earning money at a young age. Heroes might also provide emotional support to adults in the family. People in this role tend to feel overwhelmed, anxious, and depressed.
The Mascot
The mascot is like a class clown. This person tries to distract their family from the impacts of addiction. They use humor and kindness to keep everyone happy. In the short term, their behavior lightens the mood. But in the long term, it can lead to serious problems.
As a child, the mascot resolves conflict with jokes or distractions. As an adult, this can prevent them from building strong relationships. They may not know how to face communication issues or power struggles. And if humor is their primary coping mechanism, other people might not take them seriously.
The Lost Child
Caught up in the whirlwind of addiction, family members ignore the lost child. This person might be “the quiet one,” or seem like they live in their own world. Perhaps they love reading, video games, or another kind of escapism. Without the emotional support they need, they look for other ways to cope.
Like the mascot, the scapegoat distracts their family from the person with addiction. But instead of using humor, they act out. This person might start using drugs themselves, or spending time with friends who do. They also take unnecessary risks, requiring other family members to solve their problems.
This behavior can interfere with a child or teen’s social development. Scapegoats are at higher risk for educational, interpersonal and even legal problems as they get older.
Finding Help for Families
These Family roles in substance abuse describe patterns of behavior, not permanent parts of your identity. Think of them as a tool for recovery, and not a way of justifying harmful dynamics. Understanding your relationships can help you improve them.
Most rehabs offer some form of family therapy. Depending on your program, this could mean anything from virtual sessions to an intensive family program. Treatment can help each person understand their family role in the context of addiction recovery.
Family therapy is available for families of every structure. You can look for a program that treats teens and their parents, married couples, or entire chosen families. Some providers have even more specific areas of expertise. For example, you can easily find a rehab program for LGBTQ+ clients.
Family involvement also empowers each person to heal on their own. In addition to group sessions, family members with and without addiction can benefit from individual therapy. This treatment offers you a safe, private space to explore your own feelings. You can also learn practical ways to improve your behavior, both for your family’s sake and your own.
Search our list of luxury rehabs to find programs with family therapy, treatment for loved ones, and other types of specialized care.
Substance use disorders don’t develop in a vacuum. They often develop due to genetics, trauma, or social pressures. Any of these factors may be caused by difficult family dynamics. Because of this, many people in rehab benefit from attending family therapy in rehab.
“Family” is a complex idea. For some people, it means only their family of origin, such as parents and siblings. Others use the term to refer to their spouses and children. Many people also have chosen families, which may include friends, collaborators, and even more complex relationships. And whomever you consider to be your family, you can be sure that your group dynamic is unique.
Depending on each specific family’s interpersonal relationships, commitment to healing, and availability, this type of therapy may or may not be a good fit. However, many people in recovery find it to be extremely beneficial.
Who Benefits From Family Therapy
When you first enter treatment, it may be difficult to disentangle your own behaviors from the behaviors of those around you. Many people benefit from traveling to rehab, putting both physical and emotional space between themselves and their loved ones while they begin recovery. Over time, you’ll likely reach a nuanced understanding of what caused your past behaviors. Through this process, many people with substance use disorders learn how to be accountable for their own behavior, without blaming themselves for the actions of those around them.
No matter what led you to misuse substances, it can be extremely helpful to examine the external and interpersonal circumstances of your life. This process empowers clients to make sustainable changes, with the goal of living a healthy lifestyle even when faced with challenging situations. By focusing on yourself, and staying in your lane, you can consistently make choices that support your own values.
The Person in Recovery
For many clients, family therapy is an essential component of recovery. As you learn more about the dynamics that enabled your past behavior, you’ll become better equipped to create more sustainable interpersonal relationships. This process can also help you come to terms with past traumas, such as growing up with an alcoholic parent, especially if those traumas were either shared with or caused by family members.
“Family work helps people achieve and maintain long-term emotional resolve and resilience.”
Set on a lush campus in Vélez-Málaga, Spain, Camino Recovery‘s robust family program runs 4 to 5 days.
Significant data supports the idea that healthy family dynamics can help you commit to long-term recovery. Specifically, “Involving family members in substance use disorder (SUD) treatment1 can positively affect client engagement, retention, and outcomes. Positive social/family support is related to long-term abstinence and recovery, whereas negative social/family support (e.g., interpersonal conflict, social pressure to use) is related to increased risk for relapse”.
This modality not only helps clients do inner, emotional work; it can also be the first step in building a support network to help you navigate life after rehab. That network may ultimately include your family, friends, loved ones, and even work colleagues. Family therapy can help you bolster your closest relationships, giving you a strong base from which to cultivate a wider community.
One study on the effects of family therapy in addiction treatment2 found that “Family therapy enhanced family resilience, structure, and strong ties; the program improved problem-solving skills, coping skills, and family resiliency levels” of people with substance use disorders. Although this particular research focused on adolescents in recovery, the same theory may apply to adults in recovery. And these same skills may also improve the lives of the other people in your family.
Family of Origin
In most families, members play multiple roles at once. You might be a parent, a grandchild, and a spouse, all at the same time. These dynamics are always complex, even in the easiest and healthiest of circumstances. Family therapy is not only intended to help you heal; it’s also designed to help the people around you heal, and to heal the ways in which you relate to each other.
“Family members assume certain roles, which often relate to…cultural attitudes, family beliefs, gender, and overall family functioning. Some roles develop in response to stress or the underfunctioning of a family member.” When you attend rehab and begin recovery, the roles of your family members may begin to shift. Although this process can be extremely healthy, it can also be stressful and confusing. For example, if your spouse has learned to care for you in a certain way, you may no longer benefit from that specific kind of care. Family therapy creates a safe space in which you and your loved ones can process these changing relationships.
Loved Ones and Chosen Family
Not everyone considers their family of origin to be their family. And not everyone should. If your relationships with your original family were particularly traumatic or harmful, it can be healthy to surround yourself with people of your own choosing. Many rehab centers define this word much more broadly, inviting clients to focus only on loving and supportive relationships.
“‘Family’ means a group of two or more people with close and enduring emotional ties. Using this definition, each person in treatment for a behavioral health disorder has a unique set of family members. Therapists don’t decide who should be in family therapy. Instead, they ask, ‘Who is most important to you?’” By answering this question, clients can start to regain agency in their own lives. You have both the ability and the right to choose which relationships are healthy for you. Even before your loved ones start attending therapy, defining “family” for yourself may help you understand your core values and your deepest needs. “It is up to clients to identify whom they would like to include in family counseling.”3
Some rehab centers have a special focus on providing therapy for chosen families. In the LGBTQ+ affirming program at Caron Ocean Drive, for example, some clients may be estranged from their families of origin. The team at this rehab strongly believes that “family members, including people you identify as your family of choice, should be part of the treatment process. If you are dealing with rejection from your family because of your sexuality, our therapists can provide counseling for you and any family members you wish to include.”
Caron Ocean Drive in Boca Raton, Florida offers a warm, nurturing environment for family therapy.
However you define family, it’s likely that you can find a rehab program that can support you and your loved ones. Some rehab centers—especially those that offer personalized treatment—may work with you to create a specialized program that meets your exact needs, making family therapy as accessible as possible.
Making Family Therapy Accessible
Even if family therapy is the right fit for you, as an individual, it may or may not be accessible for your loved ones. This is especially true for clients who attend destination rehabs. When you’re located in a different city or country from your family, you may need certain accommodations in order to schedule group conversations. Fortunately, in this technological era, there are many options available.
Phone Calls
If family therapy sessions aren’t the right fit for you or your loved ones, you may still benefit from staying in touch. Some rehabs allow clients to use cell phones and other electronics to contact far-away family members.
Every program has its own regulations. In some facilities, you may have free access to your personal cell phone or computer throughout treatment. Others may allow you to schedule phone calls in advance. You may also be required to spend some time in therapy before you’re allowed to reach out to family, or to begin focused family therapy.
Virtual Family Therapy Sessions
Thanks to the growing popularity and accessibility of online medicine, you may be able to try family therapy even if your loved ones are far away. There are a number of HIPAA-compliant telehealth platforms4 that allow clients to safely meet with therapists, trusting that their conversations will remain private and protected.
Research suggests that virtual therapy may be just as effective as in-person therapy.5 David Mohr, Ph.D., director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, asserts that “telehealth is essentially just as effective as face-to-face psychotherapy—and retention rates are higher.” However, since the popularity of this format has grown so quickly, there is still much we don’t know about its efficacy.
Known for their cutting-edge facilities, All Points North Lodge in Vail Valley, Colorado, includes telehealth options specifically for families.
In-Person Family Therapy
If you attend rehab locally, you and your family may prefer to attend therapy together in person. This is an important option for people whose loved ones may not be comfortable using technology to discuss personal information, and those whose families include small children.
Many programs offer various versions of this modality, ranging from regular meetings to occasional visits. Aurora Recovery Centre offers a wide variety of robust programming for families, which people can attend either with a loved one in recovery or on their own. While these programs are therapeutic, they also share practical skills, teaching attendees “how family and community systems are affected by substance use disorder.” PROMIS London takes a different approach, hosting a family week during which your loved ones come together as a group for several days in a row.
Benefits of Family Therapy
Because every family is unique, every family is affected by substance use disorders6 in a slightly different way. These conditions can easily influence “breakdown in the ways in which family members get along, communicate, and bond with each other. A family is a system consisting of different ‘parts’ (the family members), so a change in one part can cause changes throughout the system.”
Family therapy is intended to heal not just the involved individuals, but the whole system. This process may teach you and your loved ones how to better support each other through hardships, encourage each other to use healthy coping mechanisms, and engage in activities you all find meaningful. Rehab is, among other things, a time for you to get to know yourself again. And you may find that you’ve changed. Family therapy invites your loved ones to get to know you again, too.
“Although family counseling may temporarily shake up the family system and activate intense feelings, these feelings are a normal part of counseling.” This process isn’t easy. However, for many clients, it is an extremely important part of recovery.
Aurora Recovery Centre invites family members to their verdant campus in Manitoba, Canada.
Limitations of Family Therapy
There is no one-size-fits-all solution to healing from a substance use disorder. As helpful as family therapy can be, it may also be detrimental to certain clients. For example, some clients find that attending rehab—and especially traveling to rehab—is a helpful way to distance themselves from toxic interpersonal dynamics. In these cases, it may be better to take a break from communicating with loved ones until after you complete residential treatment.
In other cases, family therapy may be detrimental to a client’s loved ones. According to experts, “certain family members should not be included in SUD treatment and services. Such situations include when intimate partner violence has occurred, when child abuse or neglect has occurred, when individuals are currently withdrawing from substances, when clients with SUDs are also struggling with psychosis or are suicidal, and when clients have significant cognitive problems (like severe learning or memory problems).”
And even if you and your healthcare providers agree that family therapy would be beneficial for all involved, it may not be a realistic option. Your family may even be resistant to treatment,7 refusing to join you in the process of recovery. If this is the case, it’s best to focus on your own healing, and rely on your clinicians to provide you with more direct support. You may also benefit from attending support groups, and connecting with other members of your cohort.
Your Family and You
Family therapy is a way of healing not just your psyche, but also your relationships. By improving your communication skills, you’ll learn how to navigate stressful situations without losing much-needed interpersonal support.
It’s important to remember, though, that you are not your relationships. Working on your family dynamics can be extremely helpful. But regardless of their mental health, and regardless of their approval of your behavior, you have the right to be well. Whether or not you decide to attend family therapy, rehab is an opportunity for you to focus on your own personal healing process.
Frequently Asked Questions About Family Therapy in Rehab
What is the role of family therapy in rehab?
Family therapy plays a vital role in addressing the impact of addiction on the family system. It promotes healing, communication, and understanding among family members. This process can teach members how to better support each other, building a foundation for lasting recovery.
How does family therapy benefit the addiction recovery process?
Family therapy benefits the addiction recovery process by fostering a supportive and healthy family environment. It helps identify and address enabling behaviors, improves communication skills, rebuilds trust, and provides a strong foundation for sustained sobriety and emotional well-being.
Who participates in family therapy sessions during rehab?
Family therapy sessions in rehab typically involve the person in treatment and their family members. This can include parents, siblings, spouses, and chosen family. The goal is to address dynamics within the family system and strengthen relationships for long-term recovery.
Over the past few years, I’ve had the chance to visit a number (the current count is 19, I believe) of the luxury rehabs listed on our site.
I’ve enjoyed meeting the teams behind each one, but have come to particularly appreciate and recognize the unique benefit of family-owned and operated centers. Here are a few of the reasons that dynamic can be so special.
Financial Independence
There’s certainly nothing inherently wrong with institutional investors, but a key benefit communicated to me when visiting these centers is that without an institutional investor to answer to, family-owned rehabs find they are freer to make decisions that put client needs over profit when necessary.
Don Lavender (Programme Director) and his wife Meena (Family Therapist & EMDR Practitioner) run Camino Recovery in Malaga, Spain. Don and Meena spent many years working for institutional treatment centers in the US and UK, and Don was happy to share the benefits of operating a family-owned center.
Don (right) and Meena (front, 2nd from left) and their team at Camino Recovery.
“Meena and I wanted to do this on our own. Even though we’ve been approached a number of times, we haven’t gone with or worked with investors. Because when you have to pay more attention to the bottom line than paying attention to the welfare of the client, sometimes a good business decision can turn out to be a poor clinical decision.”
Jan Gerber, Managing Director of Paracelsus Recovery in Switzerland, who runs the company with his mom, the Clinical Coordinator, and dad, the Medical Director puts it this way, “I have a very strong belief that institutional money, institutional investments, and mental health don’t work together. Because when it comes to mental health treatment, be it addiction treatment, eating disorders, depression, or anything else, there is no objective decision. Does a person need more psychotherapy or less psychotherapy? More of that treatment or less of that treatment? It needs to be a clinical decision where the budget and financial side is completely cut off.”
Jan (center) and his mother Dr. Christine Merzeder (center right) meeting with their team.
Intimate Atmosphere
For the most part, family-run treatment centers tend to be smaller, more intimate environments. Of the four I mention in this post, Camino is the largest with a maximum of 8 clients, which is well below the norm for residential treatment centers.
Dr. David Nesenoff, of Tikvah Lake Recovery in Florida, provides an extremely personalized treatment experience with treatment taking place entirely in his home.
“Even though Tikvah Lake Recovery is a 15,000 square foot mansion on a 200-acre private lake, this is our home. My wife Nancy and I live here. There are no signs outside and if one were to poke their head in they would see a peaceful home with a few guests visiting. Our clients are considered guests in our home and they are treated as such. Discussions around our table can be anything from talking about the unbelievable food in front of us or about our day or just some fun stuff hosts and guests usually talk about around the family table. Our clinical director becomes part of the family as well as he often joins us around the lunch table and he and his staff are on-site working with our guests one-on-one every day.”
Dr. Nesenoff welcomes potential clients into his home in the short clip above.
David and his son Adam, who operate the center together, believe that the size of the facility (the program is limited to a maximum of 6 people) and the home-like atmosphere are key factors to their guests’ success.
Ameet Braich, Clinical Director of Camino Recovery (and the son of Meena Lavender) also sees great benefit in a more intimate setting. “We’ve all come from years in the field, working in larger institutions and have found that working in a clinical environment is detrimental to the therapeutic process. Having a small, intimate space where people can really get honest and open up about their issues, really works well in this setting.”
Addiction Is a Family Problem
My first exposure to a family-owned and operated treatment center was Duffy’s Napa Valley. From its founding in 1967 until it was acquired in 2015, Duffy’s operated as a family-run business, and frequently described themselves as “A family business for a family problem.” That slogan resonated with me, and I think its a key component to why family-owned centers are so special.
Addiction is a problem that affects the entire family and can also be a byproduct of problems within the family. So “it is natural for the solutions to these struggles and barriers to be learned within a family environment,” says Nesenoff.
Clients at a family-operated program get the chance to see family dynamics in action, which in itself can be helpful. Don says, “We’re imperfect just like every family. But when we mess up or make mistakes, we acknowledge it. And, in a way, it gives the clients the permission to learn.”
As a key part of their program, Camino invites the families of their clients to join them on site for a 5-day workshop, where according to Don, they teach them about the “disease concept and codependency” as well as a focus on enablement.
He doesn’t doubt that there is a connection between Camino’s family ownership and the effectiveness of their family program. “Camino is a family-owned and family-run business. … We pay attention to families seriously, not only our own family but the family systems of others. … Family is important. It is of value. And when people leave us, they return to family.”
A Dream Come True
“It’s a dream come true.” This is how Debby Berry, co-founder of Kembali Recovery described starting and running a treatment center with her son Clayton.
Clayton and Debby show us a nearby waterfall for our Bali Destinations episode.
As anyone who runs a family business knows, it has its challenges. But more often than not, the benefits are worth the effort, and felt not only throughout the organization but by the clients and their families in desperate need of help.
When considering treatment options, you should always investigate the quality of the program. Search our collection of rehabs and find key information such as licensing, accreditations, and pricing at a glance. Whenever possible, consult a trusted medical or mental health professional before a final decision is made.
Frequently Asked Questions About Family-Run Rehabs
What are the benefits of a family-run rehab?
Family-run rehabs may have more flexibility and tend to prioritize clinical care over profits. Most treat a few patients at a time in an intimate, home-like setting. This comfortable atmosphere helps patients open up in therapy.
What is the difference between a family-owned rehab and state-funded rehab?
The cost of treatment without insurance is a key difference between family-owned and state-funded rehabs. State-funded rehabs offer low- to no-cost treatment for uninsured people. However, it often takes longer to enter state programs compared to family-owned rehabs.
Do family-run rehabs have better family programs?
Family-run rehabs tend to pay special attention to their family program. Patients also get to see healthy family dynamics in action and can apply these to their own lives.
