There’s a little-known fact about recovery from mental health and substance use disorders: the person in treatment is not the only one who changes. A growing body of research shows that achieving and maintaining long-term, sustainable mental health and sobriety is far more likely when members of the immediate family engage in the therapeutic process alongside the person in recovery. Immediate family doesn’t necessarily mean the traditional nuclear family: it includes any person who functions as a primary caregiver or maintains a consistent presence in the day-to-day life of the teen in treatment. This can include extended family, friends, teachers, coaches, tutors, or neighbors – anyone close enough to know what’s going on and willing to help your teenager learn, grow, and take positive steps toward managing their mental health or substance use disorder.
When you engage in your teenager’s recovery, you learn you’re going to have to make some adjustments to how you live your life, as well. The idea that families are a crucial piece of the treatment puzzle is based on research conducted by mental health professionals and evidence collected by practicing clinicians over decades, but it’s also an idea that, once you think about it for more than a moment or two, falls into the category of common sense. No teenager grows up in a vacuum, and the sum total of their life experience contributes to the circumstances that led them to treatment. This is true for everyone, whether they grow up in a “Leave it to Beaver” household, a non-traditional family, as a ward of the state, or with a foster family: each individual is part of a complex group of humans who have a direct impact on their development, whether that impact is positive, negative, or somewhere in between.
What this means – and there’s no easy way to say this – is that if your teenager is struggling with a mental health or substance use disorder, then you’ve played a role in how they got there. This doesn’t mean you caused the problem. This doesn’t mean it’s your fault. This doesn’t mean you’re a bad parent or a bad person. It’s simple logic. We’ll construct a classic, three-step syllogism to describe what we mean, in order to mitigate your emotional reaction to this claim:
- Each individual is part of a complex system of relationships, which, for the sake of efficiency, we’ll call a family.
- The dynamics of the family contribute to the development of the individual.
- Therefore, the behavioral patterns the individual develops – including substance use or mental health issues – are influenced by the relationship dynamics of the family in which the individual grew up.
That’s why family engagement in the therapeutic process is so important. Family members are the foundation of the web of relationships that shape the choices and behavior of everyone involved – and that’s why, when your teenager embarks on their recovery journey, it’s critical for you to learn as much as you can about the behavioral, emotional, and practical life changes they need to make to achieve sustainable mental health and sobriety. The changes they make will require you to make changes along with them. In some cases this may mean a wholesale renovation of how you interact with your teen, and in others, it may simply mean supporting them as both of you make minor adjustments to the contours of your relationship.
Either way, the chances of restoring balance and harmony to your family increase dramatically when you accept the notion that the process requires teamwork, compromise, and the willingness to replace old modes of behavior with new ones. When your family engages in the recovery process, evidence suggests you increase the likelihood of the following positive outcomes:
- Decreased rates substance use
- Decreased rates of relapse
- Increased time spent in treatment
- Reduced behavioral issues such as aggression and opposition
- Reduced symptoms of co-occurring emotional issues such as depression and anxiety
- Improved school performance measures such as grade point averages and attendance
- Improved family relationships
- Decreased family discord
We’ll go out on a limb and assume those are all outcomes you’d like for yourself, your teenager, and your family. Next, we’ll offer a brief description of the common approaches to family engagement in the treatment of adolescent mental health and substance use disorders.
Types of Family Engagement: Therapeutic Modes
The National Institute on Drug Abuse (NIDA) describes the following five evidence-based modes of family involvement known to have a positive effect on adolescent treatment outcomes:
Family Behavioral Therapy (FBT). This mode of therapy typically involves the teen in treatment and one or more parent. Parents, counselors, and teens collaborate on choosing approaches to behavior management that resonate with the specific family. Therapists help families practice and implement behavioral strategies, contingency management systems – i.e. mutually agreed upon goals and rewards designed to modify target behaviors – and coping skills that improve family functioning.
Brief Strategic Family Therapy (BSFT). BSFT focuses on the nature of interactions between family members, with the underlying assumption that problem behaviors are often the result of maladaptive family patterns. A BSFT counselor spends time first observing families in relationship and then offering suggestions and strategies for transforming maladaptive patterns – which may exacerbate mental health disorders or lead to substance use disorders – to patterns that are supportive and life-affirming. BSFT is considered a subcategory of Family Systems Therapy.
Multidimensional Family Therapy (MDFT). This mode of therapy is typically reserved for adolescents who display pronounced behavioral problems such as delinquency and conduct issues that often accompany substance use disorders. MFDT simultaneously engages as many elements of the teen’s life as possible, including schools, the court system, and any available community resource. MDFT is most common and effective in cases of severe substance use, extremely challenging behaviors, and teenagers entering treatment or returning home after time in juvenile detention.
Multisystemic Therapy (MST). Like MDFT, MST benefits teens with a history of severe substance abuse, delinquency, or violent behavior resulting from or related to substance use or mental health disorders. The MST approach considers maladaptive adolescent behavior in the context of their personal attitudes toward substance use, family norms related to substance use, conflict, and discipline, peer attitudes toward substance use, school atmosphere, and immediate environmental factors such as living conditions and rates of neighborhood crime and substance use.
Functional Family Therapy (FFT). An easy way to think of FFT is that it’s a combination of Family Behavioral Therapy (FBT) and Brief Strategic Family Therapy (BSFT). FFT focuses on encouraging family members to commit to their role in treatment, helping them recognize their need to change along with the teen in treatment, and securing their participation in creating new and effective communication, conflict resolution, and contingency management strategies.
The Collaborative Nature of Treatment and Recovery
A landmark study published in 2009 described – with quantifiable facts and figures – an aspect of recovery that most people find intuitive:
“Those who added at least one non-drinking member to their social network showed 27 percent increase at 12 months post-treatment in the likelihood of treatment success, and sustaining abstinence.”
Though this study focused on adults struggling with alcohol use disorders, the implications for family involvement in adolescent substance use and mental health treatment are clear: if only one abstinent peer can dramatically increase the chances an adult can stay sober, then it stands to reason that the full and willing participation of a teenager’s family can exponentially increase that teenager’s chance of attaining long-term health, wellness, and sobriety. Combine this fact with the notion that family relationship dynamics contribute to the development of substance use and mental health disorders, and the importance of family engagement in the recovery process shifts from a novel therapeutic concept to an essential element in sustainable, successful treatment.
As a parent, it may not be easy to recognize your role in creating, reinforcing, and enabling addictive behaviors in your teenager. It may also be equally disconcerting to understand your contribution to their mental health disorders and emotional challenges, such anxiety, depression, or other co-occurring conditions. Before you beat yourself up about these insights, though – because playing the blame game won’t help anyone – we’ll take a moment to reiterate what we mentioned at the outset:
This doesn’t mean you caused the problem, this doesn’t mean it’s your fault, and this most certainly doesn’t mean you’re a bad parent or a bad person.
What it does mean, however, is that you, your teen, and your family arrived where you are together. You collaborated on creating the conditions that led to this moment in time. Which, in turn, means that in order to right the ship, you need to do it together – along with anyone else who plays a primary role in the their life. Your teenager needs both your individual help and the full support of the collective. They need you to make changes as they make changes. They need you to collaborate on establishing a new normal, returning balance and harmony to your family, and moving forward to a life where it’s possible to successfully manage the disruptive symptoms of substance use and mental health disorders.