Article / Literature Review

Executive Director, Recovery Consulting, USA

Jessica Swan,
Executive Director,
Recovery Consulting,
USA.
Submitted : 6 February 2025 ; Published : 4 March 2025

Substance Use Disorders (SUDs) significantly impact the person who has it and their families, frequently leading to relational strain, psychological stress, financial challenges, and a host of other negative consequences. Recent data from SAMHSA (2023) shows that SUDs impact at least 66% of U.S. families, which makes providing families with practical, inclusive, family-centered interventions critical. More than simply addressing addiction through treatment for the person with the SUD, a family treatment framework is necessary (SAMHSA, 2020). It should include treatment for the relational trauma experienced in the family.

Reframing concepts such as codependency as normative responses to high-stress and high-strain relationships helps reduce stigma and encourage healing. Building on the recommendations and extensive research from SAMHSA (2020), The Family-Centered Relational Recovery Model (FACE Recovery ™) fills a gap in treatment support for primary SUD clients and families and improves outcomes for SUDs and their families. By creating a new framework based on extant literature that supports evidence-based treatment processes, families can transform alongside their loved ones with SUD. Currently, explicitly designed models are not available to support families in the treatment and recovery phases of SUD treatment. Treatment for the families of loved ones with SUD during these phases should include several components, using evidence-based practices to help families and integrating them throughout the process.

Substance Use Disorders (SUDs) are not isolated issues affecting only individuals, but rather, are pervasive, chronic health conditions that disrupt the entire family system. Emotional distress, strained relationships, and financial burdens can and do impact families with SUDs (Weisner et al., 2010). Strain and disruption to regular family functioning are evidenced by the deterioration of family cohesion, communication, and mutual trust, often leading to long-term consequences for all members involved (Kelly, 2022; Bull et al., 2024).

Families that have a person with an SUD within them may result in members experiencing role reversals, where children can become parentified, assuming caregiving responsibilities to parents with SUDs. Partners or spouses can take on enabling roles to maintain household functioning, similar to when someone within the system lives with another form of chronic illness. The family system role changes can lead to feelings of resentment, anxiety, and depression among family members (Klostermann & O’Farrell, 2013). Moreover, the fear of stigma or societal judgment can compel families to maintain secrecy, exacerbating isolation and delaying help-seeking behaviors (Daley & Douaihy, 2010).

Families dealing with SUDs frequently experience financial instability due to the costs associated with treatment, legal issues, and lost income. Weisner et al. (2010) found that healthcare expenditures for families with a member in treatment for addiction were substantially higher than those for families without such challenges. Economic strain can intensify familial stress, creating tension and conflict that hinder recovery efforts. In addition to the healthcare costs that families experience for their stress-related conditions, families also experience financial negative consequences of the person with SUDs and their poor decision-making that can lead to high spending on alcohol, drugs and over-shopping, lower-level work or lack of work, and lack of financial contribution to the family system.

The intergenerational transmission of trauma and substance use disorders further compound the impact of SUDs on families. Early-life trauma, such as childhood maltreatment, has been consistently linked to the development of SUDs and maladaptive coping mechanisms like codependency in adulthood (Bull et al., 2024; Bacon et al., 2018). Children exposed to parental substance use are more likely to develop behavioral and emotional issues, including increased risks for anxiety, depression, and substance use (Comiskey, 2019; Kelly, 2022). Extensive research in this area emphasizes the importance of early interventions in family systems for prevention and trauma-informed approaches for treatment to break these cycles. (Patrick & Noor, 2024; Covington, 2008; Lamb & Kougliali, 2024).

In 2023, the NIH published a global piece from the human genome project, offering insight into the extent of traits and genetic factors that inform SUDs (NIH, 2023). The work by over 150 researchers scientifically solidifies the historical, anecdotal research and insights that SUD is genetic and environmental. Not only is the process of developing addiction largely influenced by pre-existing genetic information, but it is also closely linked to the structural maturation of the brain and its neural connections. Additionally, research from NIDA (2024) elucidates explicitly that human brain development has a significant influence on substance use initiation and continuation, as well as the likelihood of developing an SUD. The aggregated results of these studies reinforce the critical role of a family system in shaping its members’ outcomes by directly providing DNA and influencing genetic expression through environmental influence. Families transmit genetic material and create environmental conditions shaped by genetic and environmental influences. Intergenerational trauma and SUD transmission are, then, the direct result of the biological and environmental family systems.

Families with SUDs can experience significant psychological stress and injury. Family members often exhibit symptoms that can contribute to the development of anxiety disorders or depression, such as chronic stress, hypervigilance, fatigue, and emotional dysregulation (Bacon et al., 2018). Dayton (2012) noted that unresolved trauma in family systems continues family dysfunction, and this can lead to recurring patterns of unhealthy behavior and relational distress. By recognizing the significant and interconnected effects that SUDs can have on families, treatment models can adopt a systemic approach that prioritizes family involvement and the healing of relational trauma. Addressing the multifaceted challenges families face is essential for their well-being and enhances the effectiveness of individual recovery efforts.

Codependency has long been understood as a set of maladaptive behaviors characterized by enabling tendencies, emotional over-dependence, and attempts to control a loved one’s behavior. Early definitions, such as those by Subby and Friel (1984), described codependency as an emotional and behavioral condition rooted in exposure to dysfunctional family dynamics. Beattie (1992) expanded this definition to emphasize the internal struggles of individuals who seek validation and self-worth through caretaking roles, often at the expense of their needs.
As the understanding of trauma and relational dynamics has evolved, however, contemporary scholars argue that it may be more effective to conceptualize codependency as a response to relational trauma rather than a set of pathological behaviors. Bradshaw (2005) relates codependency with cycles of shame and abandonment, noting that these behaviors can originate from early attachment disruptions and attempts to navigate unsafe family and relationship environments. Similarly, Dayton (2012) highlights that many codependent behaviors, such as over-monitoring or caretaking, emerge as adaptive responses to the chronic stress associated with loving someone who struggles with addiction.

Modern practices and language can redefine codependency by framing it within a trauma-informed lens and recognizing it as a set of protective strategies rather than inherently dysfunctional behaviors. Bacon et al. (2018) underscore that codependent individuals often respond to inherent needs for connection and security. Researchers and clinicians can redefine hyper-vigilance or over-involvement behaviors to achieve relational stability in unpredictable environments. Shame can be a common consequence of complex trauma (Courtois, 2004; Herman, 1997) and frequently links trauma with SUD (Lamb & Kougliali, 2024; Wiechelt, 2007).

Hyper-vigilance, often criticized as excessive control, may develop where addiction is exhibited, used as a survival mechanism for members of families living in an unstable, uncertain, and chaotic environment. Tipsword et al. (2022) suggest that being controlling, hypervigilant, or overly worried are frequently stress-induced adaptations designed to mitigate potential harm. People in such an environment typically respond to abnormal circumstances perceived as dangerous and unpredictable. A shift in perspective here may help reduce stigma and further the understanding of relational dynamics involved in families impacted by addiction.

Reframing codependency as a response to relational trauma carries significant implications for family addiction treatment. Traditional approaches have often focused on identifying and eliminating behaviors labeled as codependent, potentially (and inadvertently) reinforcing feelings of shame and inadequacy among family members. Instead, trauma-informed interventions advocate for validating the emotional experiences of family members and recognizing their behaviors as rooted in efforts to cope with chronic stress (Daley & Douaihy, 2010).
Such approaches prioritize education on relational trauma, helping family members understand the origins of their behaviors and providing new skills and learning for healthier coping (Gilbert et al., 2020). Boundary-setting, emotional regulation, and new communication skills can empower families to negotiate their relationships through treatment and recovery without sacrificing their well-being (Miller et al., 1991; Dearing & Tangney, 2011; Meyers, Roozen, & Smith, 2011). Additionally, cultivating trust and collaboration within the family system is essential and can encourage empathy while reducing shame (Bradshaw, 2005; Bacon et al., 2018; Dearing & Tangney, 2011).

Community Reinforcement and Family Training (CRAFT) integrates a trauma-informed approach and has demonstrated effectiveness in improving family dynamics and enhancing the outcomes of individuals in recovery (Miller et al., 1999; Meyers, Miller, & Toniganm, 1999; Meyers, Roozen, & Smith, 2011). CRAFT provides families with practical skills, validating the individual experience and offering a supportive environment for healing and growth. The tools provided in this evidence-based model can be adapted to the treatment model and enhanced for acute care settings to encourage healing during this phase of care for the person with SUD. Validating the family member experience, providing support and reflection, and offering tools for communication as suggested through CRAFT have the potential to serve the family system and enhance change for both the family and the person with SUD.

Family participation in substance use disorder (SUD) treatment is critical to improving patient outcomes, especially for improving treatment engagement and recovery rates. Studies demonstrate that patients with active family involvement are significantly more likely to complete their treatment programs than those without family support (Polcin et al., 2008; Stanton & Shadish, 1997; Kelly, 2022). Stanton and Shadish (1997) found that treatment completion rates increased from 63% to 87% when family members were involved in the recovery process, and Polcin et al. (2008) highlight that trauma-informed treatment models lead to higher success rates in recovery by treating individuals holistically and including family.

Similarly, family engagement has been shown to enhance abstinence rates, with patients achieving more extended periods of sobriety in family-inclusive programs (Arriss & Fairborne, 2020). Tambling, Russell, and D’Aniello (2021) emphasize that family involvement in treatment is crucial in improving outcomes, particularly among young adults with SUDs, and McCrady and Flanagan (2021) show that family involvement in treatment leads to higher retention rates and better long-term recovery outcomes.

Behavioral Couples Therapy (BCT) and the 5-Step Method (also called SSICS)(Copello, Templeton, Orford, Velleman, 2010) have proven effective in reducing substance use and improving relational dynamics (Meyers et al., 2011). These models integrate family members as active participants in the treatment process, encouraging collaboration and shared responsibility for recovery (Klostermann & O’Farrell, 2013). Family involvement in the SUD treatment process shows improved psychological well-being for both patients and their families by addressing relational conflict and expanding coping mechanisms (McCrady & Epstein, 2009).

Community Reinforcement and Family Training (CRAFT) programs emphasize family education and skill-building. They equip family members with strategies to support recovery while maintaining healthy boundaries. Using CRAFT helps patients to engage and enter treatment and empowers families to navigate addiction challenges with greater resilience and confidence (Miller et al., 1999). Of importance, CRAFT was developed and is evidence-based for families to help their loved ones enter treatment. This model engages families and patients, benefiting both, but it does not integrate loved ones into the treatment continuum.

The economic benefits of family involvement in SUD treatment underscore the significance of integrating the family into the SUD treatment team and supporting them. Families engaged in the treatment process with their loved one with SUD can see reduced healthcare costs, improved health, and fewer emergency interventions (Weisner et al., 2010). As people with SUDs remain abstinent over time, the family members see reduced medical bills, reduced psychiatric conditions, and reduced medical conditions. The health of the person with SUD can act as a proxy for the health of the family members. Relationship impacts such as this emphasize the need for all family members to heal. Encouraging both family and SUD patients to engage in the treatment process likely improves financial outcomes for both parties.

Family involvement cultivates healthier dynamics by reducing manipulation, enabling behaviors, and communication breakdowns. Programs that incorporate trauma-informed care address underlying relational trauma, promoting trust and emotional safety within the family system (Polcin et al., 2008; Daley & Douaihy, 2010). Weisner et al. (2010) emphasize that families engaged in treatment report higher levels of relational satisfaction, characterized by increased empathy, understanding, and mutual respect. Relationship improvements can extend beyond the immediate family and have the potential to influence broader social networks and enhance community support for recovery.

Addressing relational trauma through family-focused interventions can break intergenerational cycles of addiction and dysfunction. Studies indicate that children in families where SUD treatment includes family participation are less likely to develop substance use issues themselves, highlighting the preventive potential of these approaches (Kelly, 2022; SAMHSA, 2020). Family SUD treatment contributes to a more stable and supportive environment for long-term recovery by supporting healthier relational patterns and promoting emotional regulation.

Shame and guilt are emotions consistently noted among family members affected by a loved one’s substance use disorder (SUD), often allowing for continued dysfunctional patterns and hampering recovery efforts for those with SUD and the family. Bradshaw (2005) emphasizes that shame binds individuals to negative self-perceptions, reinforcing maladaptive behaviors within family systems. It can bind people to their trauma and thereby to their SUD, creating a significant hurdle in entering recovery from SUD and preventing people from seeing it at all (denial) (Lamb & Kougliali, 2024; Baumeister et al., 1995; Treeby et al., 2020). Addressing shame and guilt is a critical component for healing trauma and breaking repetitive, systemic, intergenerational behaviors (Covington, 2008; Hernandez & Mendoza, 2011).

Cook (1991) explores the relationship between shame, attachment, and addictions, highlighting that internalized shame, often stemming from attachment-related issues, contributes significantly to the development and maintenance of addictive behaviors. O’Flanigan (2013) normalizes the pity that a person experiences in SUD and suggests that shame can exist without blame. Moreover, the research by Lamb and Kougliali (2024) emphasizes that SUD frequently develops out of an inability to cope with shameful emotions, and the recovery from SUD comes from healing a shame-based narrative that grows from developing the SUD and related behaviors.

Sustained recovery is possible by identifying and creating a new non-shame-based recovering identity. Addressing shame in therapeutic settings is linked to improved treatment adherence and reduced risk of relapse (Zhang et al., 2018) for people with SUD. People with SUDs can develop healthier behaviors and improve their overall quality of life by confronting and processing shame, thereby improving their chances of sustained recovery from SUD (Hernandez & Mendoza, 2011).

The research provides insight into the need to heal shame without emphasizing blame and the need to heal attachment to break old relationship patterns. Family treatment for SUD can help people validate their experiences and change their family narratives using non-shame-based narratives. Family system changes and healing exists within this context, where clinicians can reduce retraumatization by acknowledging the history of each individual in the system and each individual’s impact on those relationships.

In trauma-informed care, creating a therapeutic environment that facilitates safety, trust, and empathy is essential for addressing shame. Dearing and Tangney (2011) discuss the importance of therapists being attuned to their clients’ shame and implementing clinical strategies that promote self-compassion and resilience. Validation is critical to healing shame and learning to reframe and rewrite internal narratives regarding family behaviors and SUD, generally.

Effective trauma-informed family treatment integrates evidence-based models and peer support systems to address the complex needs of families dealing with SUDs (SAMHSA, 2020). The Community Reinforcement and Family Training (CRAFT) approach has successfully engaged treatment-resistant individuals by empowering family members with communication and reinforcement strategies (Smith et al., 2009). Meyers et al. (1999) found that CRAFT engaged 64% of resistant individuals in treatment, significantly higher than traditional interventions.

Supportive Skills for Interpersonal Coping with Stress (SSICS) (Miller, Meyers, & Tonigan, 1999) also focuses on enhancing family members’ abilities to manage stress and improve communication, centering the family in the model to help improve the likelihood of their loved ones receiving treatment for SUD. The model encourages family change to improve outcomes for those with SUD. CRAFT and SSICS both emphasize the importance of family involvement in treatment, recognizing that family dynamics play a critical role in recovery.

Peer support systems, such as Al-Anon and Adult Children of Alcoholics (ACOA), provide invaluable spaces for collective learning and mutual support. Member participation is associated with improved coping skills and emotional well-being among family members. ACOA (2024) highlights that sharing experiences within a supportive community reduces feelings of isolation and promotes healing.

Moreover, integrating trauma-informed care within substance use treatment settings has been shown to improve engagement and outcomes (SAMHSA, 2020). Mahon (2024) conducted a systematic review indicating that trauma-informed care as an organizational intervention enhances service user engagement and satisfaction in substance use settings.
In summary, addressing shame and implementing best practices in trauma-informed care are essential components of effective family treatment for the loved ones of people with SUDs. Family treatment integrated into SUD treatment models facilitates healing and promotes sustained recovery for individuals with SUD and their families by teaching strategies and encouraging empathy, validation, and support.

Recognizing codependency as a normal response to relational trauma is critical in reframing family behaviors and interactions in addiction treatment. Historically, clinicians have pathologized codependency, but emerging research emphasizes that chronic stress and attachment disruptions often drive these behaviors (Bradshaw, 2005; Dayton, 2012). By embedding relational trauma frameworks into family treatment for SUD, clinicians can validate family members’ experiences and teach healthier coping mechanisms. Trauma-informed care models prioritize empathy, safety, and the normalization of stress responses, which can foster trust and enhance therapeutic engagement (Dayton, 2012; Bacon et al., 2018; Covington, 2008 ).

Integrating trauma-informed frameworks also encourages a more holistic approach to treatment, addressing both the individual with an SUD and the family system as a whole. Family-focused interventions that incorporate relational trauma frameworks improve recovery outcomes and reduce relational conflict, as they address the root causes of maladaptive behaviors rather than merely treating symptoms (Kelly, 2022).

Shifting the narrative from pathologizing to validating the family experience is essential for fostering resilience and collaboration in the family system. Families impacted by SUD often employ coping strategies, such as enabling or hyper-vigilance, to maintain stability in an unpredictable environment. Reframing these responses as typical adaptations to relational trauma can reduce shame and empower families to engage more effectively in treatment (Tipsword et al., 2022; Bradshaw, 2005; Snoek et al., 2021; Lamb & Kougliani, 2024).

Educational initiatives that teach families about trauma responses and stress-induced behaviors are vital components of this normalization process. Psychoeducation sessions that explain the neurobiological and psychological impacts of trauma can enhance families’ understanding and reduce self-blame (Daley & Douaihy, 2010). Additionally, helping families understand that behaviors like control or denial are protective strategies rather than failures can help families approach recovery with greater compassion and confidence.

Understanding cultural differences and applying cultural humility (SAMHSA, 2020) within this normalizing process is critical to incorporating all types of families in treating SUD. There is no one-size-fits-all to families; therefore, clinicians must stay open, affirming each family’s experience and makeup. Being flexible and responsive means compassionate work and supportive of the change process in treating SUD.” to “Being flexible and responsive means providing compassionate work and being supportive of the change process in treating SUD. It aligns nicely with the relational trauma incorporation as well and is a part of the holistic approach to treating SUD and family.

To effectively address relational trauma, clinicians require specialized training in trauma-informed care and family-focused intervention models like Community Reinforcement and Family Training (CRAFT). CRAFT, for instance, has demonstrated efficacy in engaging individuals resistant to treatment by leveraging family dynamics and reinforcing positive behaviors (Miller et al., 1999). Providing clinicians with tools to recognize and address trauma responses enables them to better support families.

Training in cultural competence and intersectionality is crucial to addressing the diverse experiences of families affected by addiction. Cultural contexts shape family dynamics and trauma responses in diverse ways, and clinicians must be equipped to navigate these nuances effectively (Klostermann & O’Farrell, 2013). Professional development programs and continuing education workshops are important for keeping clinicians up-to-date on the latest research and best practices in trauma-informed family care.

Peer-led support groups, such as Al-Anon and Adult Children of Alcoholics (ACOA), play a vital role in reducing isolation and enhancing emotional resilience among family members. Mutual aid support groups offer a safe space for families to share their experiences, learn from others, and develop healthier coping strategies. Research shows that participation in peer support groups improves psychological well-being, promotes mutual understanding, and strengthens families’ abilities to navigate addiction behaviors in their loved ones (Daley & Douaihy, 2010; ACOA, 2024).

Providing peer support in treatment programs also bridges the gap in clinical care by offering ongoing, community-based support across the continuum of care. The development of family peers has emerged as a helpful community support option, helping families help each other in the community (SAMHSA, 2020). Telehealth and online peer support platforms have expanded access to mutual aid support groups, making them more accessible to families in underserved or remote areas (Weisner et al., 2010). Encouraging the integration of peer-led initiatives into clinical settings can complement formal treatment approaches and provide families with continuous support throughout the recovery journey.

Designed by Jessica Swan, based on existing literature and recommendations
The Family-Centered Relational Recovery Model (FACE Recovery™) integrates core components of family sharing, psychoeducation, skill-building opportunities, and clinical feedback to address relational trauma and support recovery from SUD. FACE Recovery™ emphasizes a trauma-informed approach and highlights normalizing family coping mechanisms, improving resiliency, and facilitating relational repair where appropriate.

Objective: Build trust, reduce isolation, and create space for open dialogue among family members.

• Guided sharing sessions facilitated by a clinician allow family members to discuss their experiences, emotions, and perceptions of the addiction and its impacts.
• Safe, non-judgmental environments where participants can express their feelings and hear others’ perspectives.

• Family sharing reduces isolation, fosters empathy, and enhances mutual understanding (Daley & Douaihy, 2010; ACOA, 2024).
• Sharing personal narratives helps family members recognize their common responses to loving someone with SUD and validates their lived experience (Bradshaw, 2005).

• Structured “Circle of Stories” sessions where each family member has time to share their experiences uninterrupted, followed by reflective discussions to promote understanding and connection.

Objective: Equip families with knowledge about addiction, trauma responses, and recovery strategies.

Modular educational sessions covering:

• The neurobiology of addiction and trauma (Kelly, 2022).
• Understanding relational trauma and codependency as stress-induced responses (Bradshaw, 2005; Dayton, 2012).
• Skills for managing stress and enhancing communication.
• Delivered via in-person workshops, online platforms, or self-paced materials.

• Psychoeducation reduces stigma, enhances understanding, and empowers families to engage meaningfully in recovery (Daley & Douaihy, 2010; Tipsword et al., 2022).
• Providing a framework for understanding trauma normalizes responses and encourages self-compassion.

• Interactive workshops incorporating visual aids (Power Points, worksheets, videos, etc.), storytelling, and other evidence-based materials to teach families about addiction and relational trauma.

Objective: Translate learned skills into actionable behaviors through experiential exercises and real-life applications.

• Role-playing exercises to practice communication, boundary-setting, and conflict resolution (Miller et al., 1999).
• Group-based activities where families work collaboratively to problem-solve common challenges in addiction recovery.
• Real-world assignments, such as practicing new communication techniques at home, with follow-up discussions in therapy sessions.

• Practicing skills in a controlled, supportive environment builds confidence and facilitates behavioral change (Daley & Douaihy, 2010; Klostermann & O’Farrell, 2013).
• Experiential learning enhances retention and helps families integrate new strategies into their daily lives.

Weekly family workshops where members simulate challenging scenarios (e.g., refusal to enable substance use) with clinician guidance.

Objective: Provide constructive, individualized feedback to guide family progress and ensure alignment with recovery goals.

• Regular check-ins where clinicians assess family progress, provide tailored recommendations, and track outcomes.
• Evaluation tools, such as family functioning assessments, can measure changes in communication, conflict resolution abilities, and emotional regulation strategies.

• Clinical feedback reinforces positive changes, identifies areas needing adjustment, and maintains family engagement (Dayton, 2012; Weisner et al., 2010).
• Monitoring ensures that interventions are responsive to the changing needs of each family over time.

• Bi-weekly feedback sessions where clinicians conduct family assessments and provide feedback to the family based on their needs.

The FACE Recovery™ model outlines a structured, evidence-based approach for integrating family involvement into treatment for SUD, focusing on relational trauma and systemic family healing.

• Conduct a small-scale study with 5 – 10 families participating in the FACE Recovery™ program over 12 weeks.
• Collect qualitative and quantitative data on family satisfaction, improvements in relational dynamics, and individual recovery outcome measures.

• Use pilot study findings to refine program content and delivery methods, incorporating feedback from families and clinicians.

• Expand the FACE Recovery™ model to additional clinical settings, integrating telehealth options to increase accessibility.
• Develop training programs for clinicians to ensure consistency and fidelity in program delivery.

• Conduct long-term follow-up studies to assess the sustainability of program outcomes.
• Share findings through publications, conferences, and training workshops to promote broader adoption of the model.

1. ACOA. (2024). The Laundry List. Retrieved from https://adultchildren.org/literature/laundry-list/
2. Anxiety, How Can Anxiety be Treated? https://corespirit.com/articles/anxiety-how-can-anxiety-be-treated-6piwwt
3. Arriss, T., & Fairborne, C. E. (2020). The effect of significant other involvement in treatment for substance use disorders: A meta-analysis. Journal of Consulting and Clinical Psychology, 88(6), 526.
4. Bacon, I., McKay, E., Reynolds, F., & McIntyre, A. (2018). The lived experience of codependency: An interpretative phenomenological analysis. International Journal of Mental Health and Addiction, 18, 754–771. https://doi.org/10.1007/s11469-017-9824-8
5. Baumeister, R. F., Stillwell, A. M., & Heatherton, T. F. (1995). Personal narratives about guilt: Role in action control and interpersonal relationships. Basic and Applied Social Psychology, 17(1–2), 173–198. https://doi.org/10.1207/s15324834basp1701&2_10
6. Beattie, M. (1992). Codependent no more: How to stop controlling others and start caring for yourself. Hazelden Publishing.
7. Bradshaw, J. (2005). Healing the shame that binds you: Recovery classics edition. Health Communications, Inc.
8. Bull, C., Trott, M., Najman, J. M., Arnautovska, U., Siskind, D., Warren, N., & Kisely, S. (2024). Associations between child maltreatment and hospital admissions for alcohol and other substance use‐related disorders up to 40 years of age: Results from the Childhood Adversity and Lifetime Morbidity study. Addiction. https://doi.org/10.1111/add.15762
9. Comiskey, C. (2019). Responses to the needs of children of people who use drugs. European Monitoring Centre for Drugs and Drug Addiction.
10. Cook, D. R. (1991). Shame, attachment, and addictions: Implications for family therapists. Contemporary Family Therapy, 13(5), 405–419. https://doi.org/10.1007/BF00890495
11. Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-step method: Principles and practice. Drugs: education, prevention and policy, 17(sup1), 86-99.
12. Covington, S. S. (2008). Women and addiction: A trauma-informed approach. Journal of psychoactive drugs, 40(sup5), 377–385.
13. Daley, D., & Douaihy, A. (2010). A family guide to addiction and recovery. Murrysville, PA: Daley Publication.
14. Dayton, T. (2012). Trauma and addiction: Ending the cycle of pain through emotional literacy. Health Communications, Inc.
15. Dearing, R. L., & Tangney, J. P. (2011). Shame uncovered: Its psychotherapy and transformation. In R. L. Dearing & J. P. Tangney (Eds.), Shame in the therapy hour (pp. 1–22). Washington, DC: American Psychological Association. https://doi.org/10.1037/12326-000
16. Efficient Extraction of Deep Image Features Using a Convolutional Neural Network (CNN) for Detecting Ventricular Fibrillation and Tachycardia. https://www.mdpi.com/2313-433X/9/9/190
17. Hernandez, V. R., & Mendoza, C. T. (2011). Shame resilience: A strategy for empowering women in treatment for substance abuse. Journal of Social Work Practice in the Addictions, 11(4), 375-393.
18. Gilbert, J. M., Oliff, H., Sutton, D., Bartlett, C., & Henderson, R. (2020). Substance Abuse Treatment And Family Therapy. A Treatment Improvement Protocol (TIP) Series 39. Substance Abuse and Mental Health Services Administration.
19. Kelly, J. F. (2022). The importance of family recovery in addiction treatment. Journal of Substance Abuse Treatment, 137, 108699. https://doi.org/10.1016/j.jsat.2022.108699
20. Klostermann, K., & O’Farrell, T. J. (2013). Treating substance abuse: Partner and family approaches. Social Work in Public Health, 28(3-4), 234–247.
21. Lamb, R., & Kougiali, Z. G. (2024). Women and shame: Narratives of recovery from alcohol dependence. Psychology & Health, 1-38.
22. Mahon, D. (2024). A systematic review of trauma-informed care in substance use settings. Community Mental Health Journal. https://doi.org/10.1007/s10597-024-01395-z
23. Meyers, R. J., Miller, W. R., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67(5), 688–697. https://doi.org/10.1037/0022-006X.67.5.688
24. Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The Community Reinforcement Approach: An update of the evidence. Alcohol Research & Health, 33(4).
25. McCrady, B. S., & Epstein, E. E. (2009). Addictions: A comprehensive guidebook. Oxford University Press.
26. Patrick, J., & Noor, A. (2024). Impact of Adverse Childhood Experiences on Adolescent Identity Development and Mental Health Outcomes. Deleted Journal. https://doi.org/10.62345/jads.2024.13.2.130
27. SAMHSA. (2023). National Survey on Drug Use and Health: Highlights for the 2022 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
28. Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol (TIP) Series, No. 39; SAMHSA Publication No. PEP20-02-02-012). Substance Abuse and Mental Health Services Administration.
29. Smith, J. E., Campos-Melady, M., & Meyers, R. J. (2011). Community reinforcement and family training (CRAFT): Engaging unmotivated individuals in treatment. Journal of Behavior Analysis in Health, Sports, Fitness and Medicine, 4(1), 19–27.
30. Snoek, A., McGeer, V., Brandenburg, D., & Kennett, J. (2021). Managing shame and guilt in addiction: A pathway to recovery. Addictive behaviors, 120, 106954.
31. Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled comparative studies. Psychological Bulletin, 122(2), 170–191.
32. Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122(2), 170–191.
33. Tian, D. (2012). Family trauma recovery stages. Journal of Family Therapy, 34(2), 141–159. https://doi.org/10.1002/joft.1302
34. Tipsword, J. M., Brown-Iannuzzi, J. L., Jones, A. C., Flores, J., & Badour, C. L. (2022). Avoidance coping partially accounts for the relationship between trauma-related shame and PTSD symptoms following interpersonal trauma. Violence Against Women, 28(1), 107–125. https://doi.org/10.1177/1077801221998356
35. Weisner, C., Parthasarathy, S., Moore, C., & Mertens, J. R. (2010). Individuals receiving addiction treatment: Are medical costs of their family members reduced? Addiction, 105(7), 1226–1234. https://doi.org/10.1111/j.1360-0443.2010.02936.x
36. Zhang, W., Amos, T. B., Gutkin, S. W., Lodowski, N., Giegerich, E., & Joshi, K. (2018). A systematic literature review of the clinical and health economic burden of schizophrenia in privately insured patients in the United States. ClinicoEconomics and Outcomes Research. https://doi.org/10.2147/ceor.s156308