Helping Families Cope With Substance Dependence

Research Update

The following is a Research Update excerpt from the Butler Center for Research. Download the PDF to read the entire Update.

The negative consequences associated with alcohol and drug dependence are well documented; however, less attention is given to the consequences that are experienced by the family members and friends of substance abusing individuals. Without proper coping mechanisms, the stress of caring for a loved one who is struggling with addiction can result in chronic medical and psychological health problems, significant financial burden, and an overall reduction in quality of life.1, 2, 3 Thankfully, a number of resources and care models have emerged to empower family members affected by substance dependence, offering strategies that allow these family members to better care for themselves, and, as a result, better support their loved ones.

Emphasizing Healthy Coping Over Labeling and Blame

Historically, researchers and practitioners have sometimes treated those who loved or supported substance abusing individuals insensitively, which has turned many people away from seeking the help they need. Women supporting individuals with alcohol or drug use disorders have been unfairly generalized as suffering from codependency, accused of enabling addiction behavior, and/or assumed to have a history filled with neglect or abuse.4 Male supporters are less often assumed to be codependent, but their unique struggles have been largely ignored in the literature.4 Social tendencies toward blaming parents of substance abusing children have led to recurring themes of isolation and stigma among mothers, fathers, and grandparents of adolescents and adults who have substance dependence issues.5 While it is not to say that psychopathology is nonexistent among families affected by substance dependence, the vastness and diversity of families affected have shown that many people do not meet preconceived stereotypes (it is estimated that 90–100 million adult family members are impacted by substance use disorders worldwide3).1, 4 This awareness has led to a call for therapeutic and supportive interventions that do not focus on trying to pathologize (or diagnose) family and friends of substance abusing individuals but instead offer healthy coping strategies for anyone dealing with the stress and grief that accompany addiction. As a result, today's families have multiple options for compassionate support services that rely upon evidence-based strategies for motivation and education.

Support Resources for Families

Families have access to a wide array of support services to learn coping strategies for the stress of caring for a substance abusing person, as well sharing and communicating with others who are going through similar experiences. Perhaps one of the simplest and most cost-effective strategies is attending community-based support groups (sometimes called "mutual aid") specifically geared toward friends and family members of people suffering from addiction. Twelve Step support groups such as Al-Anon, Nar-Anon, and Adult Children of Alcoholics (ACoA) are open at no cost to anyone who wishes to attend. Meeting locations and times can easily be found on each organization's website (see "Questions and Controversies" section), and instructions are provided to anyone who wishes to start a new group in an underserved area.7, 8 Special support groups are available for teenagers who have been impacted by someone else's substance dependence, and these programs often include online meetings and chat options, in addition to traditional in-person meetings.9

For family members who wish to work with a professional counselor or a primary care physician in a one-on-one setting, a number of intervention models that focus on educational strategies for healthy coping have been specifically developed for people with loved ones who are chemically dependent. There are three main foci of family member treatment interventions: (1) programs that aim to help substance abusing individuals by working directly with their loved ones (e.g. Pressures to Change and Community Reinforcement and Family Training), (2) programs that combine family members and substance abusing individuals in joint therapy sessions (e.g. Behavioral Couples Therapy and Social Behavior and Network Therapy), and (3) programs that offer therapeutic assistance solely to loved ones who have been directly affected by addiction (e.g. Behavioral Exchange Systems Training).10 Modern therapeutic interventions specifically for family members are based on the stress-strain-coping-support model, which assists family members with healthy coping strategies, rather than focusing on the diagnosis and/or treatment of any psychological disorders that may be present among loved ones affected by another person’s chemical dependence.1

Reductions in Ill-Health Symptoms and Maladaptive Coping After Interventions Based on the Stress-Strain-Coping-Support Model

Even if time or financial resources are scarce, brief interventions can be extremely helpful; research has found that families who participate in even brief, one-session interventions with a professional counselor or trained primary care physician can experience significantly lower stress.10


Friends and family members of substance abusing individuals often experience significant stress related to the addictions of their loved ones. Whether by participating in community groups with others affected by addiction, by attending one-on-one therapeutic sessions to learn healthy coping strategies, or by a combination of both, many friends and family members can reduce their stress and improve their daily lives.

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