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Family Alcohol Counseling

Updated on June 30, 2009

Family Alcohol Counseling is a fairly uncommon topic, because you will frequently hear about addictions counseling and family therapy, but these two treatment modalities do not go together as often as they probably should. In this hub I will describe some of the different ways that a family-oriented approach can be taken to treatment alcohol addiction. There is little established research in this area and likely a lot of strong opinions from people who are involved in these types of recovery programs in various ways, so I will try to remain as neutral as possible.

The first thing you will need to know about is the methods that are used to treat alcoholism itself. The main approaches in use are the 12-step recovery programs, harm-reduction programs, and traditional psychotherapy. There are additional types of psychotherapy treatments that could be incorporated, such as hypnosis for alcohol addiction, but these are likely beyond the scope of this hub and so I will do my best to eventually address them elsewhere if there is interest.

The next major piece of understanding family therapy for alcoholics is going to be understanding what marriage and family therapy is, some of the theories behind it, and how it can generally be expected to work. Again, this is an area where lots of different theories are involved, although I think the field of family counseling is somewhat less heated than the addictions field. Again this hub should be limited in its exploration of the different models of family therapy so that it can be easily understood, so for the time being I will limit our discussion to the 12-step model, structural family therapy, and emotion focused family therapy.

Types of treatment for alcohol addiction

The three most prominent ways of treating alcoholism today are through 12-step programs, harm-reduction programs, and traditional psychotherapy. It is important to recognize that the lines between these types of programs are not rigid. Many harm-reduction programs are based off of twelve-step models, and traditional psychotherapy methods are often recommended for individuals taking part in either of the two types of programs.

The nature of a twelve-step program, such as Alcoholics Anonymous, is that it is entirely led by alcoholics in recovery. No mental health professionals are typically directly involved in any AA meeting unless they are attending as addicts who have come for their own benefit. However, many therapists will recommend 12-step program involvement in addition to therapy, and can help their clients to engage more effectively in the program. There has also been some research results suggesting that 12-step involvement can enhance the benefits of psychotherapy, so this is becoming a pretty widely accepted practice among therapists.

The only requirement to take part in Alcoholics Anonymous is a desire to stop drinking, which means that AA is an abstinence-only program, as are all 12-step programs. Twelve-step devotees maintain that a true addict is an addict for life, and that they will never be able to consume alcohol in a normal fashion. Therefore, the goal of a 12-step program is always to completely quit drinking or using drugs.

Harm reduction is a model of addiction treatment that believes that it is better to reduce the amount that alcoholics drink. Under this model, it is not necessary to require complete abstention from drinking. Instead, alcoholics are encouraged to reflect on the nature of their addiction and to take responsibility for reducing the amount that they drink down to normal and healthy levels. Many people feel that this model is more encouraging than the twelve-step model because there is less failure associated with a "relapse." Instead, participants recognize that their behavior has been unhealthy and work to bring it within normal range.

Traditional psychotherapy can complement either of these approaches. The aim of therapy may differ widely depending on the individual psychotherapist and their theoretical orientation. Typically some cognitive and behavioral aspects will be incorporated into any addiction therapy, in order to help the client begin to monitor their addictive thoughts and behaviors more closely. There are also many emotional and relational components to addiction that can be explored in therapy that can help to improve the client's insight and commitment to improving their lives.

Photo by Erik Charlton -
Photo by Erik Charlton -

Approaches to Family Alcohol Counseling

The first major approach to counseling an alcoholic family is the 12-step approach. This approach sees the alcoholic as the main identified patient, but also includes the rest of the family as an enabling system for the addictive behaviors. For this reason, family members are typically encouraged to attend Codependents Anonymous (CODA) meetings, which are part of the 12-step program for becoming less enabling and codependent in your relationships.

Codependency is a concept that is difficult to operationalize because it is a part of the 12-step pop-psychology model which has been developed largely as a type of public discourse among addicts rather than through scientific study and clinical research. As a result, the term "codependency" has become a kind of a catch-all for unhealthy relationship patterns. The 12-step model of family counseling is a very behavioral model, because it focuses on reducing addictive behaviors in the addict and reducing enabling behaviors in the rest of the family.

The structural model of family therapy looks at addiction in the individual as a problem that actually involves every part of the family system. In other words, the family is a kind of entity unto itself, and the addiction serves some purpose for the family as a whole. Therefore, the symptom will be safeguarded until the structure of the family is adjusted so that it is no longer necessary.

A structurally-oriented family alcohol counselor will therefore pay attention not only to behaviors, but to ingrained family beliefs and assumptions that support the continuation of the alcoholism and any consequences that it might produce. The therapist will attempt to reconfigure the family's private mythology, power hierarchy, and characteristic ways of relating to one another. Once the foundations of the addictive behavior have been changed, the structural model holds that the behavior itself will also change.

Finally, an emotionally focused family alcohol counselor will pay more attention to the emotional experiences involved in both the addiction and the family experience of the addiction. More than this, they will look at the relationships between individuals in the family and the ways that they reflect the lifelong patterns of relationships that each individual has engaged in. By promoting each individuals' insight into their own relational functioning and that of their family members, the emotion-focused model aims to help family members' gain better control over the ways that they are triggeredd by one another, thereby allowing for greater control over addictive patterns.


There is no "correct" method for treating an alcoholic or helping a family to afflicted by alcoholism. The theoretical model used depends on the preferences of the counselor and the needs of the individual family. Most therapists have preferred models of working with families, but many will adapt their own ideas to the unique presentation of the family being treated. Also, an approach that works for one family may not be as effective for another family. Therefore, families that have received treatment and are still struggling to manage alcoholism should not rule out the idea that another therapist or treatment model might be more helpful to them.


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