Family Dynamics & Addiction: Are We Helping?

When it comes to the treatment of a substance use disorder (SUD), the family unit is increasingly being considered as a critical component of recovery. Depending on its structure and dynamics, the home environment can be a source of either support or instability for a recovering patient. SUDs develop from repeated and heavy use of legal and illegal drugs or alcohol. SAMHSA explains the condition is characterized by “clinically significant impairment, including health problems, disability and failure to meet major responsibilities at work, school, or home.” There are many challenges of living with a loved one with an alcohol or drug problem but understanding the role of family dynamics and how to care for yourself can lead to better outcomes for everyone involved. 


A Role You Didn’t Know You Play

As a member of a household trying to manage a loved one with an addiction, there are generally six family roles that are unconsciously assumed.

  1. First, there is the focal point of the family: the member addicted to the substance. By the very nature of a SUD, this person’s behavior interferes with not only their own daily functioning and emotional load, but the entire household’s. A lot of time, energy and even money are diverted to their needs. 
  2. The caretaker – also known as the “martyr” of the family – takes up the role of providing for those needs. This person wants to keep the peace but ends up enabling their loved one as they are not held accountable for their actions. The caretaker might try to defend poor behavior or take up extra responsibilities to cover for them.
  3. Similar to the caretaker is the hero or “golden child.” This person tends to over-achieve, pursue perfection and seem extra responsible in attempts to restore stability, trying to make it appear as though the family is not dysfunctional. For example, they might keep the house clean and enforce a strict schedule so that things appear to be in order. 
  4. The scapegoat, also known as the problem child, is the opposite of the hero. This member tries to get attention by acting out through defiance and hostility. 
  5. The mascot or comic does as the name suggests: they try to make light of the situation through jokes and silliness to reduce the stress caused by the addicted member. 
  6. Finally, the lost child – or the quiet one – typically limits their interactions altogether. They might avoid getting emotionally involved, withdrawing entirely to cope. 


Family Therapy in Addiction Recovery

All these roles can have negative consequences, not only for the member with the SUD but for each individual in the home. Unhealthy patterns of emotional expression and communication may develop, and individuals may begin to suffer from their own mental health conditions, such as depression. The stress of it all can encourage new or continued instances of alcohol and drug use as members try to cope. This is why the success of the addicted member may be contingent on the success of the family establishing healthier dynamics. Family therapy can be a useful tool to address these concerns. 

According to the Treatment Improvement Protocol (TIP) Series, substance use treatment and family therapy are two different disciplines that, when jointly used, offer different perspectives that can improve treatment effectiveness. While the former focuses on the individual with the SUD, the latter has the goal of specifically treating family needs: 

“Family therapy addresses the interdependent nature of family relationships and how these relationships serve the [individual] and other family members for good or ill. The focus… is to intervene in these complex relational patterns and to alter them in ways that bring about productive change for the entire family.”


Resources for Family Members

If you find yourself feeling guilty for having taken on a dysfunctional family role, the important thing to do is address it as soon as possible. Find out how your family can get involved in your loved one’s recovery process through family therapy. You may also be struggling with your own emotional or mental health concerns, which is understandable and more common than you might have guessed. In that case, individual or group therapy can help you develop healthy management skills. 

There are also groups like Al-Anon, Alateen and Nar-Anon that are designed to support family and friends of a loved one with a drug or alcohol use disorder. A quick internet search will tell you if a group meeting is happening in your community. There are other groups, too, like Co-Dependents Anonymous, that focus on overcoming issues of codependency that occur in homes of addiction. Whatever you decide, remember that it’s OK to reach out for help. 


Treating substance use disorders is complicated by the fact that the family unit plays an important role in either supporting recovery or enabling the addiction. Family members may assume different roles in their attempt to cope, including the caretaker, hero, scapegoat, mascot or the lost child. These roles can have negative consequences for the addicted member and the entire family unit. At Casa Palmera in Los Angeles, California, we understand how hard this situation can be and that’s why we focus on the family unit when someone needs help to overcome addiction. Contact us today if your loved one and your family finally need help.


This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.