How healthcare practitioners provide meaningful support for families of alcoholics

Alcohol addiction is a pervasive issue in the UK, with recent data indicating that approximately 608,000 adults are dependent on alcohol1, yet only about half receive treatment annually for alcohol or drug addiction2. 

Alcohol-related harm is responsible for over 10,000 deaths each year3, with significant economic and social costs. While the devastating effects of alcohol addiction on individuals are widely acknowledged, its impact on families often remains unseen and under-discussed.

For every individual living with alcoholism, there are often multiple family members – partners, children, parents – who endure emotional distress, instability, and profound psychological consequences4. Children of alcoholics are four times as likely to engage in excessive drinking, and at significantly greater risk of developing substance use disorders themselves5, as well as mental health issues including depression and anxiety. The toll on partners and spouses can manifest as emotional trauma, codependency, and financial hardship.

For clinicians and healthcare professionals, the challenge extends beyond treating the individual with alcohol dependency. Providing whole person, yet family-centered care, is crucial in mitigating the ripple effects of alcohol addiction. 

Worried about your own alcohol use, or that of someone you know? Get in touch → 

What defines ‘an alcoholic’? 

From a clinical perspective, alcoholism – also known as alcohol use disorder (AUD) – is characterised by compulsive alcohol consumption, impaired control over drinking, and negative emotional states when not drinking. 

“…a problematic pattern of alcohol use leading to clinically significant impairment or distress.”

• Diagnostic and Statistical Manual of Mental Disorders

According to the DSM-5, a diagnosis of AUD is made when an individual meets at least two of the eleven following criteria over a 12-month period.

The neurochemical mechanisms

The neurobiological underpinnings of alcoholism involve dopamine dysregulation, which reinforces alcohol-seeking behaviours. Chronic alcohol use alters brain function in several key ways:

• Dopamine release: alcohol stimulates excessive dopamine release7, creating a cycle of craving and reward.
• GABAergic inhibition: increased GABA activity leads to the sedative and calming effects of alcohol, but chronic use reduces natural GABA production8.
• Glutamate suppression: alcohol inhibits glutamate9, impairing cognitive function and executive control.
• Cortisol activation: prolonged alcohol consumption increases stress hormone levels10, perpetuating anxiety and withdrawal symptoms.

This cycle of craving, dependence, and withdrawal can make cessation extremely difficult, often necessitating structured interventions and medical support.

How this affects the family unit

The impact of alcoholism on a family may extend far beyond the individual struggling with addiction. The effects are often insidious, shaping family dynamics in ways that can persist for years11, even after recovery. Alcohol dependence can create an environment of instability, fear, and dysfunction, affecting relationships, emotional wellbeing, and even long-term behavioural patterns in children.

One of the most immediate consequences is emotional distress. Spouses, children, and other family members often experience chronic stress, anxiety, and depression due to the unpredictable nature of living with an alcoholic. The mood swings, aggressive behaviour, or withdrawal associated with excessive drinking can create a home environment marked by tension and fear. 

Certain legal difficulties might be another significant burden. Alcohol addiction frequently leads to job loss, neglect of responsibilities, and asset mismanagement. Families may struggle with reputational damage or hindered succession planning, for instance.

In households where a parent struggles with alcoholism, parental dysfunction can be common12. A parent who is frequently intoxicated may be emotionally unavailable, neglectful, or inconsistent in their caregiving. This can manifest as missed school events, forgotten responsibilities, or even outright neglect of a child’s basic needs. 

Over time, children in these environments may develop a deep-seated need for control or hyper-independence as a response to their upbringing.

A particularly insidious consequence is codependency, where family members – often a spouse or an older child – begin to sacrifice their own wellbeing in an attempt to manage or control the addicted individual’s behaviour13; possibly making excuses for their drinking, covering up their mistakes, or taking on additional responsibilities to compensate for their absence. Codependency can become a deeply ingrained pattern that hinders both recovery and the family’s ability to heal.

Perhaps one of the most alarming consequences is the increased risk of abuse. Studies have consistently shown a strong correlation between alcohol dependence and domestic violence14 – one report from the BBC claims that men addicted to alcohol are up to six times as likely to abuse their partner15. 

Family members, particularly spouses and children, may be subjected to physical, emotional, or psychological abuse – leading to lasting trauma that requires intervention from both medical and mental health professionals.

How healthcare professionals can provide support & engender lasting change

To effectively support families affected by alcohol addiction, healthcare professionals must move beyond treating the individual and adopt a whole-family approach. Alcohol addiction rarely exists in isolation. Recognising this and addressing the broader consequences can lead to more sustainable recovery outcomes and stronger family resilience.

As writer Johann Hari famously said, “the opposite of addiction is not sobriety – it’s connection.” 16

This helps illuminate the role of family involvement in the recovery process. Healthcare practitioners, from GPs to mental health professionals, play a crucial part in fostering these connections and equipping families with the tools they need to heal alongside their loved one.

Here are key ways clinicians can provide support:

1. Screening for family impact

When assessing a patient with Alcohol Use Disorder (AUD), it’s critical to look beyond the individual. Asking direct but sensitive questions can help unearth hidden struggles within the family.

• “How has your drinking affected your relationships at home?”

• “Do you have family members who feel stressed or overwhelmed by your alcohol use?”
• “Is there someone in your household who has taken on additional responsibilities because of your drinking?”

Additionally, clinicians should screen for secondary trauma in spouses and children, who may experience symptoms of anxiety, depression, or even PTSD as a result of living with an alcoholic. A PHQ-9 (for depression) or GAD-7 (for anxiety) assessment for family members can provide insight into their mental wellbeing.

2. Integrating family into treatment plans

Family participation in treatment improves engagement and long-term recovery success. Involving loved ones in the care plan fosters a sense of shared responsibility and support.

• Family therapy: where appropriate, encouraging family members to engage in therapy alongside their loved ones can help process emotions and develop coping mechanisms.
• Education: providing family members with clear, evidence-based information about addiction can dispel myths, reduce stigma, and help them understand that alcoholism is a medical condition – not a moral failing.
• Setting boundaries: teaching families healthy boundary-setting techniques prevents codependency and enables them to support recovery without enabling destructive behaviours.

For example, a mother struggling to support her son’s addiction may feel guilty for enforcing boundaries. A clinician can guide her through this by saying:

• “Loving someone doesn’t mean tolerating harmful behaviour. What small changes can we make that protect your wellbeing while supporting your son’s recovery?”

3. Implementing trauma-informed care

Many families of alcoholics experience chronic stress, neglect, or even abuse. Healthcare professionals must recognise the emotional wounds left by addiction and adjust their approach accordingly.

This means:

• Avoiding judgmental language – instead of saying, “Why did you stay in that situation?”, a more compassionate approach might be, “It must have been incredibly difficult for you. How can we help you move forward?”
• Recognising survival mechanisms – some family members may exhibit hypervigilance17, avoidance, or emotional numbness as coping mechanisms. Understanding these responses through a trauma-informed lens prevents re-traumatization.
• Fostering a sense of safety – creating a non-judgmental, validating space allows family members to express their fears and frustrations without shame.

A trauma-informed approach acknowledges that healing is not just about the alcoholic achieving sobriety, but also about repairing family relationships that may have been fractured.

4. Encouraging interdisciplinary collaboration

Alcohol addiction affects multiple aspects of a person’s life: mental health, relationships, and even legal standing. No single healthcare professional can address all these issues alone. Collaborating with other specialists ensures a more comprehensive support system.

Clinicians should:

• Work closely with mental health professionals to provide family therapy and counseling.
• Refer patients and families to social workers who can assist with housing, financial aid, or child welfare concerns.
• Engage addiction specialists and rehab centers for more structured intervention plans.
• Provide information on mutual aid groups like Alcoholics Anonymous (AA) and Al-Anon for ongoing peer support.

5. Advocating for policy changes

Beyond individual interventions, healthcare professionals can be powerful advocates for systemic change18. In general, clinicians can:

• Push for better funding for alcohol treatment programs and family support initiatives.
• Educate policymakers on the long-term societal costs of untreated alcohol addiction.
• Raise awareness about the need for more affordable inpatient and outpatient treatment options.

A clinician who frequently sees families struggling to access services might write to local MPs, collaborate with advocacy groups, or speak at public health conferences to highlight these issues.

Healthcare practitioners, alcohol addiction, & families: the last word

Alcohol addiction does not usually exist in isolation. Often, it affects entire families, shaping emotional and psychological wellbeing. As healthcare practitioners, our role extends beyond treating the individual to supporting the wider family unit, fostering resilience, and breaking cycles of addiction.

At Harbor London, we champion a whole-person approach to care. Our services integrate medical treatment, mental health support, and social interventions to ensure that individuals and their families receive the guidance, resources, and interventions they need. 

Addiction is not a moral failing. It is a complex medical condition requiring compassionate, evidence-based intervention. By equipping families with the right tools, we empower them to rebuild their lives, establish healthy relationships, and support their loved ones on the path to recovery. 

Make a referral today → 

References 

1. https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england/estimates-of-alcohol-dependent-adults-in-england-summary#:~:text=National%20estimates,-These%20estimates%20of&text=There%20were%20an%20estimated%20608%2C416,than%20in%202018%20to%202019.
2. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report
3. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/alcoholrelateddeathsintheunitedkingdom/registeredin2022
4. https://americanaddictioncenters.org/alcohol/support-recovery/family
5. https://www.addictioncenter.com/alcohol/growing-up-alcoholic-parents-affects-children/
6. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-use-disorder-risk-diagnosis-recovery
7. https://www.nature.com/articles/s41386-020-00938-8#:~:text=Drugs%20of%20abuse%2C%20including%20alcohol,than%20in%20alcohol%20naive%20states.
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC165791/
9. https://academic.oup.com/alcalc/article/53/3/209/4796882
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC2266962/
11. https://www.verywellmind.com/what-happens-to-the-familys-compassion-for-alcoholics-3862542
12. https://post.parliament.uk/research-briefings/post-pn-0570/#:~:text=Parental%20Alcohol%20Misuse%20(PAM)%20can,%2C%20marital%20conflict%2C%20and%20deprivation.
13. https://pubmed.ncbi.nlm.nih.gov/3384506/
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC8729263/
15. https://www.bbc.co.uk/news/uk-50887893
16. https://amiquebec.org/opposite-of-addiction/
17. https://pmc.ncbi.nlm.nih.gov/articles/PMC9118133/
18. https://www.bma.org.uk/what-we-do/population-health/supporting-people-to-live-healthier-lives/alcohol-drugs-and-driving-consensus-statement