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    Understanding addiction as a family disease with David Gulden, LMFT, LMHC

    Addiction: A Family Disease

    When addiction enters a family, it never affects just one person. Like a stone dropped in water, its ripples touch everyone, changing relationships, roles, and the very structure of family life. This is why a family systems approach to intervention isn’t just helpful—it’s essential for lasting recovery.

    “Recovery is not an individual disease. I’m sorry, addiction is not an individual disease. It affects every member of the family.”

    Furthermore, as a dual-licensed therapist (LMFT, LMHC) with extensive treatment center experience progressing from primary therapist to clinical director, I approach interventions through a family systems lens, recognizing that treating only the person with substance use disorder addresses just one part of a complex, interconnected system.

    For Families: Download my Family’s Guide to Understanding Professional Interventions to learn how family systems thinking can transform your approach to your loved one’s addiction.

    Understanding the Addicted Family System

    Family systems theory views the family as an emotional unit where members are intensely connected. In families affected by addiction, the entire system gradually adapts to accommodate the substance use.

    “The way I conceptualize interventions is based on the addicted family system—everyone around the impaired person is kind of playing a role in that system.”

    These adaptations include:

    Role Shifts: Family members take on specific roles:

    • The Enabler: Makes excuses and shields from consequences
    • The Hero: Tries to make the family look good
    • The Scapegoat: Acts out to draw attention away
    • The Lost Child: Withdraws and becomes invisible
    • The Mascot: Uses humor to deflect tension

    Communication Changes:

    • Open discussion becomes limited
    • Secrets develop around the addiction
    • “Don’t talk, don’t trust, don’t feel” becomes normal
    • Everyone “walks on eggshells”

    Emotional Reorganization:

    • Family’s emotional life revolves around managing addiction
    • Everyone’s mood depends on whether the person is using
    • Crisis becomes the new normal
    • Celebrations revolve around substance use patterns

    Here’s the critical insight: These adaptations happen gradually, and families often don’t recognize how much they’ve changed. This is why intervention focused only on the individual often fails.

    Why Traditional Approaches Fall Short

    Unfortunately, traditional intervention models focused solely on getting the impaired person into treatment often fail because they don’t address the family system changes that developed around the addiction.

    Unsustainable Change

    When only the individual receives treatment while the family system remains unchanged, old patterns quickly pull the person back into addiction.

    Unaddressed Trauma

    Family members have their own trauma and coping mechanisms that need healing.

    Continued Enabling

    Without guidance, families often continue behaviors that unintentionally support addiction.

    Resistance Reinforcement

    Family dynamics can actually strengthen the person’s resistance to change.

    “What we would want to do with the intervention is give that person help. But to do that, you’d have to affect systemic change—change the way everybody operates around the use or behavior to promote overall system health.”

    The missing piece: Everyone in the family needs recovery, not just the person using substances.

    For Professionals: If you have clients who would benefit from a family systems approach to intervention, I welcome professional consultation to discuss specific cases and family dynamics assessment.

    The Family Systems Approach Difference

    A family systems-oriented intervention treats the entire family as the client, recognizing that:

    • Everyone needs healing – Each member has been affected
    • Patterns perpetuate problems – Family interactions can maintain addiction
    • Change anywhere creates change everywhere – System adjustments affect the whole
    • Recovery is a family journey – Sustainable recovery involves everyone

    Key Elements:

    Comprehensive Assessment

    Beyond substance use, we examine family history and multigenerational patterns, current roles and relationships, communication styles and boundaries, previous attempts at change

    Systemic Preparation

    All family members receive education on understanding addiction as a brain disease, recognizing their roles in the family system, learning new communication skills, identifying enabling behaviors, preparing to change regardless of the person’s choice

    Systemic Intervention Design

    Create safe emotional environment for honest communication, allow each member to express concerns and love, present treatment options including family involvement, set clear, united boundaries regardless of outcome, introduce concept of family recovery

    Whole-Family Recovery Plan

    Whether or not treatment is accepted: specific support resources for each member, new communication guidelines, clear boundaries and consequences, family sessions during treatment when possible, post-treatment reintegration planning

    The Power of Systems Change

    The most powerful aspect of a family systems approach is that it creates change regardless of whether the impaired person initially accepts help:

    “I tell families, the minute we intervene on your loved one, everything is going to change. They may not go to treatment that day, but systemic change will happen because the family system is taking action regardless.”

    What Happens When Systems Change:

    1. Enabling Stops
    Natural consequences return

    2. Reality Becomes Clearer
    True impact becomes apparent

    3. Leverage Increases
    United family stance motivates change

    4. Healing Begins
    Family recovers from trauma and codependency

    5. Sustainable Environment Develops
    Healthier system supports recovery

    Success Stories: The Systems Difference

    Traditional Approach:

    The Jones family intervened on their son after a DUI. He went to 30-day treatment while the family waited at home. Upon return, nothing had changed—mom still checked his room, dad avoided conflict, tensions remained. He relapsed within weeks.

    Family Systems Approach:

    The Smith family worked with a dual-licensed therapist after their daughter’s third overdose. During preparation, parents recognized enabling patterns, siblings acknowledged resentment, all committed to recovery work. She initially refused treatment, but the family maintained new boundaries. Three weeks later, experiencing natural consequences without family rescue, she called asking for help. Today, the entire family continues recovery work together.

    The difference: Family systems approach created lasting change for everyone, not just crisis management.

    The Research Support

    Evidence consistently supports family involvement in addiction treatment:

    • 73% improved outcomes with systems-focused intervention
    • Higher completion rates with family therapy involvement
    • 50% reduced relapse rates when family issues are addressed

    Studies show:

    • Treatment outcomes improve significantly when families participate
    • Family therapy correlates with higher completion rates
    • Relapse rates decrease when family issues are addressed
    • Family recovery reduces addiction risk in future generations

    For Treatment Professionals: Implementation Guidelines

    When considering intervention referrals, look for providers who:

    Assessment Criteria

    • Evaluate entire family system, not just individual
    • Understand multigenerational addiction patterns
    • Assess family roles and communication styles
    • Plan for whole-family recovery

    Clinical Qualifications

    • Licensed in family therapy (LMFT particularly valuable)
    • Experienced in family systems theory
    • Trained in addiction and family dynamics
    • Competent in group and family facilitation

    Begin Your Family’s Healing Journey

    Whether your loved one is ready for help or not, your family can begin healing now. A family systems approach offers hope for everyone affected by addiction.

    “The family is the one really asking for help for them and for themselves. The families around the addict—they’re the ones suffering.”

    What Family Systems Recovery Looks Like:

    1. Immediate
    Stop enabling, set boundaries, begin support groups, learn healthy communication

    2. Medium-term
    Process grief and trauma, rebuild trust, develop new traditions, create accountability

    3. Long-term
    Sustain healthy dynamics, support ongoing recovery, prevent future addiction patterns, thrive as individuals and family

    Taking Action:

    For Families: Download my comprehensive Family’s Guide to Understanding Professional Interventions for specific strategies on implementing healthy boundaries and beginning your recovery journey.

    For Professionals: If you have clients who would benefit from a family systems approach, contact me directly to discuss specific cases and determine appropriate intervention strategies.

    For Everyone: If you’re ready to explore family systems intervention, I offer confidential consultations to assess your family’s specific needs.

    Schedule Your Confidential Consultation

    Family-focused • Evidence-based • Compassionate guidance for everyone affected by addiction

    About David Gulden: Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), with extensive treatment center experience progressing from primary therapist to clinical director. Specializing in family systems approaches to intervention, recognizing that recovery is a family journey, not an individual endeavor.