When starting treatment for substance abuse, your clinician will ask you questions about the type of substances you use, how frequently you use them, the effects your use has had on your life, and how long the problem has been persisting, among many other details. While this is pertinent to creating a treatment plan for you, it is only the tip of the iceberg. 

You can expect a provider to ask you questions about almost every aspect of your life when you enter treatment, even if those questions do not seem to relate directly to the problem you have come to treatment to resolve. Addiction is a condition that needs to be understood in context. There might be many reasons you have gotten to the point where you are with your substance use, such as stress in your personal or work life or a genetic predisposition. Dissecting the environment and relationships that influence you is a way of getting to the root of the problem, rather than just addressing the alcohol or drug use on its own.

Identity and Environment

The psychologist Urie Bronfenbrenner proposed a transforming theory regarding development and socialization in childhood that can provide insight throughout the lifespan. His ecological systems theory, as it is called, posits that you exist at the center of a small circle surrounded by several increasingly larger circles. Each circle is a different environment, with the first few representing the individual, family and friends, and school and work settings. 

As the circles grow larger, they encompass broader aspects of the world you live in, like culture, society, ethnicity, and class. These environments interact bi-directionally, meaning you can influence your environments just as your environment influences you. This theoretical framework is not just used in academic psychology; it has a very practical purpose of helping a clinician get to know you and the specific environments that shape your identity and behavior.

The first few sessions of treatment can be intimidating, especially if you have not sought out mental health counseling or therapy in the past. Unlike going to your family doctor when you suspect an ear infection or strep throat, your therapist cannot just look at you and ask about your symptoms before prescribing you a pill and sending you on your way. 

It is a more vulnerable process, and being prepared for some of the questions you might be asked can help ease your nerves. Your therapist is there to collect information to help you, not to judge you. Additionally, in most cases, what you share during a session is held in strict confidence, meaning you can be assured that what you say will not make it out of that room.

What to Expect From a Family Assessment

Upon entering treatment, your clinician will most likely perform a biopsychosocial assessment to get to know both you and your family. Just as the name suggests, this tool is composed of your biological, psychological, and social history and how those pieces relate to your addiction.

Some examples of questions pertaining to your biological history include:

  • Is there a history of addiction in the family?
  • How are your diet, exercise, and sleep?
  • Did you begin abusing substances after being prescribed medication for an illness or injury?

Some examples of questions pertaining to your psychological history include:

  • Have you ever been diagnosed with a mental health condition?
  • Have you experienced something traumatic, like violence or a loss?
  • Do you use substances to feel a certain way, like happy or calm?
  • How do you feel about yourself?
  • Have you ever had thoughts about harming yourself or others? Are you having those thoughts currently?

Some examples of questions pertaining to your social history include:

  • Who do you live with? Who did you grow up with?
  • Do you have a significant other or close friends?
  • Do you use substances with specific people?
  • How is your relationship with your family?
  • Who is in your support system?

These are only a few questions that a therapist might ask when collecting information. Depending on your specific situations and answers to the questions, your therapist might focus on one area more than the others. Your answers can help determine important information, such as the cause of your substance use, triggers and mitigating factors, and possible support for people in your family and friend group to enlist in treatment and recovery. 

Your clinician may also work with members of your family to complete similar biopsychosocial assessments and provide further context, filling in any blanks. This is why working with a service provider that specializes in family services can provide more comprehensive and effective care.


Genograms are also helpful tools in assessing your and your family’s needs. A genogram is similar to a family tree in that it shows relationships between people. Whereas a family tree is useful for showing who is who, a genogram goes a step further. It can demonstrate that you have a good relationship with your mother but a tense relationship with your father, or that addiction is common in your mother’s family and depression is common in your father’s family. 

The information gained from both a biopsychosocial assessment and a genogram can help your clinician decide the services that will be best suited to your specific situation.

There are many moving pieces involved in addiction. Genetics, relationships, experiences, and environment can hurt or help your chances of acquiring substance use disorder, and these same things can also provide the roadmap out of addiction and back to wellness. Working with a provider well-versed in tools such as genograms and biopsychosocial assessments can ensure a treatment solution tailored to you and your family’s specific needs. Addiction does not happen in a vacuum and treatment is not one-size-fits-all, and that is why Family-Centered Services takes the time to learn about you. Our licensed clinicians use assessments to identify support people and empower the individual and family unit. We offer individual and family therapy, case management, family recovery programs, and sober accountability to address addiction from all angles. We know first-hand that recovery is more obtainable when the family is involved, and we’ve made that our mission. Learn more at (509) 991-5822.