Family Therapy: Substance Abuse and Family Dynamics
Davina Scott, MSW, draws on clinical experience in family therapy to examine how substance abuse disrupts family dynamics and routines. To illustrate these ideas, we follow a hypothetical family case: Alex, a 16-year-old whose parent, “Sam,” struggles with alcohol use. Although Alex’s story is fictional, it reflects patterns many families face. Throughout, Davina shows how families can move from chaos toward connection and resilience.
Family Therapy Foundations & Impact
Substance use disorder (SUD) arises when persistent substance use disrupts daily life and relationships. The DSM-5 names four key signs: impaired control, social impairment, risky use, and pharmacological changes.
In our hypothetical case, Sam often drinks late into the night (impaired control), misses work shifts and family dinners (social impairment), drives while intoxicated (risky use), and experiences tremors or anxiety during withdrawal (pharmacological changes). These clinical definitions matter in family therapy, where therapists guide families through education, assessment, and goal setting.
In clinical settings—especially during family therapy—professionals explore how substance abuse reshapes family dynamics at every level. They assess communication patterns; in Alex’s family, Sam’s drinking triggered arguments about money and safety that replaced honest dialogue with blame. They map evolving roles: Alex became the “hero,” excelling in school to distract from home chaos, while Pat (Sam’s partner) took on caretaker duties, covering bills and managing mood swings.
Therapists introduce systemic interventions—such as genograms to track substance-use patterns and reflecting teams to foster empathy—to help families replace reactive cycles with proactive strategies like “time-out” agreements.
To track progress, therapists set measurable goals: Sam might aim for 30 days of sobriety; Alex and Pat commit to weekly check-ins. Celebrating small victories—like a week without alcohol or a peaceful family meal—reinforces hope. By framing SUD definitions and examining substance abuse impacts in family therapy, clinicians help families transform unhealthy family dynamics into resilience-building opportunities.
Family Therapy Role Shifts & Homeostasis
Families adapt to substance abuse by assigning roles that preserve a familiar—but unhealthy—balance. Davina identifies seven roles:
- The User (Sam). Sam focuses nearly all attention on alcohol, anchoring daily disruption.
- The Caretaker (Pat). Pat juggles bills and calms Sam’s mood swings at personal cost.
- The Hero (Alex). Alex excels in school to distract from home chaos and earn external validation.
- The Scapegoat. A family member acts out through anger or rule-breaking to divert attention from Sam.
- The Mascot. Humor or antics lighten tense moments but can prevent honest conversations.
- The Lost Child. This person withdraws emotionally—spending time alone or shutting down—to avoid conflict.
- The Enabler. By covering up consequences—such as hiding empty bottles—the enabler unintentionally sustains substance use.
In Alex’s family, Sam embodies the User by focusing all attention on alcohol; Pat fills the Caretaker role by juggling household needs; Alex takes the Hero role by excelling academically; and other members might shift among Mascot, Lost Child, or Scapegoat as stress peaks.
Family systems theory calls this drive to preserve familiar patterns “homeostasis.” Even harmful dynamics feel “normal,” so when Pat suggested professional help, Sam resisted, accusing Pat of betrayal, and Alex feared losing the family as they knew it.
In family therapy, Davina addresses resistance by distinguishing predictable change (clear goals, structured routines) from unpredictable disruption. She adopts a neutral stance—neither blaming Sam nor siding with Pat—and fosters curiosity with questions like, “What would it feel like if family dinners were calm again?” She then encourages a trial period of boundary agreements, showing small adjustments can succeed without catastrophe.
Davina also normalizes anxiety about the unknown and teaches coping strategies—such as breathing exercises—so each member can manage discomfort when new patterns emerge. Through consistent support, role awareness, and incremental goals, families gradually loosen homeostatic grips. In this way, family therapy transforms resistance into an invitation for renewed connection and balanced family dynamics.
Family Therapy Boundaries & Pathways
In family therapy, setting boundaries emerges as a cornerstone of recovery from substance abuse. Davina guides families through the following structured four-step process.
- Members list harmful behaviors—such as Sam driving under the influence or missing curfews.
- Each crafts clear “I” statements: Pat says, “I will not cover your bar tabs anymore,” and Alex shares, “I feel unsafe when you drink and drive.”
- Davina leads role-play exercises: Pat rehearses calmly refusing money requests, and Alex practices expressing concern without anger.
- She integrates support offers—Pat adds, “I will help you research treatment options,” and Alex commits, “I will attend family sessions with you.” Through these rehearsals, boundaries shift from abstract concepts to lived practice.
Building on strong boundaries, family therapy outlines the following five pathways to healing:
- Acknowledge the Problem: Pat admits, “I feel overwhelmed when bills go unpaid,” and Alex confesses, “I worry I’m losing my parent.”
- Seek Professional Help: A therapist trained in Internal Family Systems guides members to address trauma, while Sam explores medication-assisted treatment.
- Build Support Networks: Joining Al-Anon or SMART Recovery helps Pat and Alex learn they’re not alone and practice vulnerability in a safe community.
- Practice Self-Care: Alex returns to soccer for stress relief; Pat resumes weekly yoga. Celebrating milestones—like a calm dinner or a week of sobriety—reinforces progress.
- Review & Adjust: In ongoing sessions, Davina facilitates regular check-ins to refine boundaries, update goals, and explore new coping skills.
By weaving boundary-setting exercises with clear recovery steps, family therapy provides families a comprehensive roadmap from crisis toward calm, strengthening bonds and fostering lasting resilience in their family dynamics.
Conclusion: Family Therapy for Substance Abuse & Family Dynamics
Ultimately, substance abuse affects every family member, but family therapy offers a transformative path. Through clear definitions, role awareness, boundary setting, and structured recovery steps, families like Alex’s can dismantle harmful patterns and rebuild trust. Therapists support measurable goals, normalize anxiety about change, and celebrate small victories. Families learn to replace reactive cycles with proactive strategies and to view setbacks as opportunities for adjustment rather than failure.
With professional guidance, self-care practices, and strong support networks, families move from chaos toward calm. Each intentional step—acknowledging challenges, seeking help, practicing boundaries, and reviewing progress—reinforces connection and fosters lasting resilience in their family dynamics.
Editor’s Note: The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of Council for Relationships.
Therapy & Psychiatry at Council for Relationships: Family Therapy and Psychiatry
Council for Relationships has over 80 therapists and psychiatrists offering integrated family therapy and psychiatric care across Pennsylvania and New Jersey since 1932. We support individuals, couples, families, and caregivers with collaborative, expert care—online and in person.
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About Philadelphia Therapist Davina Scott, MSW
Davina Scott, MSW, is a Staff Therapist at Council for Relationships. She sees clients virtually across Pennsylvania and in person at our Center City Philadelphia office. Davina specializes in helping clients who feel stuck in life, navigate trauma, or rebuild their sense of identity.
Her integrative approach includes IFS therapy, CBT, mindfulness, and somatic practices. She is a trauma-informed therapist committed to creating a space where clients feel safe, supported, and empowered.
Want to work with Davina? Request an appointment today.