Supporting a family member in recovery from alcohol or drug problems

When someone in a family has a problem with alcohol or drugs, the people around them are affected too, and they often wonder what helps and what makes things worse. This page summarizes what public health agencies and published studies say about the family's role. It is general education, not advice for any one family, and it does not replace guidance from a qualified clinician.

How families are affected

The Substance Abuse and Mental Health Services Administration (SAMHSA) says the challenges of helping a loved one with a mental or substance use disorder can be taxing, and that caregivers should take steps to prioritize their own health as well. Research on family members who seek help shows the same picture in numbers. In a 2017 study of concerned family members in Psychology of Addictive Behaviors, participants reported emotional, relationship and family problems, and depression, anxiety and anger scores that fell over the course of the study.

This page does not assign blame to anyone in the family. The condition is described by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as chronic and relapsing, which is part of why recovery involves a long stretch of support rather than a single decision.

Learning about the condition

Understanding what to expect can reduce some of the confusion. Two points from federal sources are worth knowing. The National Institute on Drug Abuse (NIDA) says relapse rates for drug use are similar to those for other chronic illnesses, and that relapse does not mean treatment has failed. NIAAA says it is rare for someone to go to treatment once and never drink again, and that people more often try to quit or cut back over time, have recurrences, learn from them, and continue.

For a longer discussion, see relapse prevention strategies and psychoeducation, which covers learning about the condition as part of treatment.

Supportive communication and CRAFT

Community Reinforcement and Family Training (CRAFT) is a structured program for family members or other concerned people. According to the 2017 study by Kirby and colleagues, it has three goals: engaging a person who is resistant to treatment, reducing that person's substance use, and improving the family member's own mood and functioning. Its components include:

• a functional analysis of what role the substance use plays;
• training in reinforcing the person's positive, sober behavior and in not interfering with the natural negative consequences of drug use;
• communication skills training, to reduce conflict and unproductive interactions;
• training in recognizing suitable times and ways to suggest treatment;
• self-care, including enriching the family member's own relationships and activities;
• safety training, so family members can recognize precursors to physical violence and take protective measures.

The evidence is encouraging but limited. In that trial, treatment entry was 62 percent when families received CRAFT and 63 percent for a variant focused only on treatment entry training, compared with 37 percent in a third comparison group. The difference between CRAFT and the comparison group was statistically significant. But the trial was small, CRAFT did no better than the shorter variant, and family members' depression, anxiety and anger decreased in all three groups, so those improvements cannot be credited to CRAFT specifically. A clinician can say whether a CRAFT program is available locally.

Setting boundaries

Boundaries mean deciding what a family member is and is not able to do, and saying so calmly. The sources opened for this page do not set out rules for boundaries, so none are offered here. One related point from CRAFT is that it teaches family members to avoid interfering with the natural consequences of substance use while still reinforcing positive behavior. CRAFT includes safety training for situations with a risk of violence. Questions about what is workable for a particular family are best taken to a clinician or family counselor.

Family involvement in treatment

NIDA describes family therapy as helping people, especially young people, with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning. SAMHSA says families should be open to support groups or family therapy and counseling, which it says can improve treatment effectiveness by supporting the whole family. For peer groups in general, see mutual-help groups.

Looking after yourself

SAMHSA's advice that caregivers prioritize their own health is echoed in CRAFT's self-care component, which focuses on the family member and on activities and relationships that do not depend on the other person's recovery. A family member's own doctor or counselor can help with stress, low mood or anxiety.

Naloxone awareness and urgent help

NIDA's DrugFacts page on naloxone (January 2022) states that naloxone is a medicine that rapidly reverses an opioid overdose. It says families with loved ones who struggle with opioid addiction should have naloxone nearby, ask their family member to carry it, and let friends know where it is. It adds that in most states people at risk, or who know someone at risk, can be trained to give naloxone, that it will not reverse overdoses from other drugs such as cocaine or methamphetamine, and that people should still call 911 immediately in the event of an overdose. This page gives no emergency instructions.

For emotional crises, the 988 Suicide & Crisis Lifeline's website says it is available 24 hours a day, every day, by call, text or chat, and has a section on finding support for a friend or loved one. It presents itself as a US service. In the United States, SAMHSA's National Helpline is 1-800-662-HELP (4357). Some situations, such as an overdose, a threat of violence or a medical emergency, need emergency services immediately. A broader first-step overview is in what happens when you ask for help.

Questions to ask a clinician

• Can family members take part in treatment, and in what way?
• Is a program like CRAFT or family therapy available, and what does the evidence say about it?
• What should we expect if a return to use happens, and who should we contact?
• Is naloxone relevant to our situation, and where can we get training?