Couple Recovery: There is a path to follow

Many people and events over the last eight years have contributed to my interest and commitment to researching and exploring the concept of helping relationships where one or both partners are in recovery from chemical dependency.  My firm belief is that individual and couple recovery approaches are not mutually exclusive. We know from research that long-term successful recovery from alcoholism has a strong correlation with a positive and healthy relationship. That really isn’t surprising if one thinks about it, but what is surprising is why we don’t account for that variable in treatment – sooner than later in the recovery process.

Certainly there are circumstances when the relationship will need to take a back seat with efforts focused on individual recovery, but even then, it can be helpful to give couples strategies to manage these times. In active addiction, the elephant is the unspoken reality of that addiction. When couples are managing recovery, I don’t think we need to create a new elephant by discouraging and avoiding the reality of recovery in their lives.

Mike had been in recovery for almost 15 years and recalls how difficult the first year of recovery was, on him and especially on his relationships with his wife and family. He states that he wished he had been able to talk to his wife  about some of what was happening for him and in the relationship. Instead, the advise they received at Mike’s treatment program was to focus on their individual recoveries only. They followed this advise, remaining silent on the recovery issue and on all the changes they were experiencing – recovery was off-limits. He was to work his program, she was to work on hers. Ellen too regrets that they didn’t have the tools to even acknowledge the huge changes taking place in themselves, their relationship and in their family. They now have those tools and for the first time feel they are a couple in recovery, they feel closer together, and support the idea of  ”Couple Recovery” sooner not later in the recovery process.

I am a therapist and researcher. A brief bio: I  have specialized in chemical dependency treatment since 1987 in my private practice; I have completed two addiction certifications, Advanced Drug and Alcohol Training (UC Santa Cruz) and Master Addiction Counselor (National Certification); I have trained with leaders in the field; worked as a clinical director of a drug and alcohol clinic; and did my doctoral dissertation on long-term recovery process in couple relationships as a part of the Family Recovery Project, directed by Co-Founders Stephanie Brown, Ph.D. and Virginia Lewis, Ph.D., at the Mental Research Institute in Palo Alto. The overwhelming consensus in the field has been that doing couples work in early recovery was a bad idea. Over time, in my work with individuals and couples in all stages of addiction and recovery, I came to see that not addressing couples issues was in fact a critical oversight. It isn’t couples work that is the problem, it is how to approach the couples work that becomes the central issue. Assessment is core to determine what kind of approaches are appropriate in any given situation. Relationships don’t go away once a person begins recovery, wouldn’t it be better to account for that reality in recovery?

   Getting on the right track

After I completed my dissertation and completed my doctorate I was invited by Dr. Virginia Lewis to stay at Mental Research Institute as a Research Associate. We co-founded Center for couples in Recovery. The research continued and I learned that the skills used by couples in long-term recovery could in fact be adapted to couples early in the recovery process. My clinical experience in individual couple therapy and multi-couple therapy groups was confirming that Couple Recovery indeed had a place, even in early recovery. As I shared my model at professional conferences at the American Association of Marriage and Family Therapists, and the California Association of Marriage and Family Therapists, the feedback from therapists was consistently positive as we raised the issue: “Why aren’t we helping couples in addiction recovery?”

I found out through my friend and colleague Lynda Voorhees, MFT, Certified Gottman Therapist,  that that the research-based Gottman Method Therapy model and interventions were very congruent and compatible with my developing model of treating couples in recovery. I did not have to rediscover the wheel!  Fast forward – I completed the Gottman training, became Certified in the Gottman Model and went on to complete training as a Gottman Method Consultant and Trainer and began presenting my research at Gottman Conferences.  John Gottman expressed his enthusiasm for this model and research and offered to collaborate on this relational approach to addiction treatment I had named “Couple Recovery Development Approach” (CRDA). John graciously invited me to co-author a chapter he was invited to write for Routledge Press, and he asked me to include in this chapter my own research on recovering couples (Case Studies in Couples Therapy: Theory-Based Approaches, 2011) e. Additionally, John asked me to join the Relationship Research Institute as a Research Scientist and suggested we apply for funding to set up set up a randomized clinical trial in treatment programs comparing outcome results from standard treatment with outcomes from the CRDA program.  John’s encouragement, support, and mentoring has been an invaluable experience for me personally and professionally and I am deeply appreciative to him for his contributions to the field of relationship therapy and for his nudging me along on my own journey.

Here’s where things are at:

Phase 1: In collaboration with John Gottman, I further developed CRDA through John’s insights and suggestions for additional interventions and adaptations inspired by Gottman Method Therapy research. John’s suggested a workshop format followed by multi-couples groups as a follow-up. I thought that was brilliant! Additionally, feedback from the monthly meetings of the Recovery Forum at Mental Research Institute has been a steady stream of support, feedback and encouragement. The Recovery Forum consists of therapists interested in addiction treatment, research, education, and writing – much like the old days at MRI  - a think tank.

Phase 2: In May, 2011 I offered a CRDA workshop at Santa Clara University Professional Development Department (thank you Dr. Jerry Shapiro) training therapists, counselors and students through explaining the model and having participants role play the couple exercises. I offered the workshop again in July at Swedish Hospital in Seattle, this time co-presenting with John Gottman who brought his latest work on trust and betrayal – a very relevant addition to the workshop – and an additional technique for relationship repair. These workshops functioned like focus groups of therapists sharing their responses and ideas about the interventions and how to best help couples in early recovery

Phase 3:  In September I am giving the workshop to couples at three drug and alcohol treatment programs: Thank you to Sequoia Center in Redwood City, CA; Alternative Options in Cerritos, CA (Los Angeles area); and Bayside Marin Treatment. Sponsored by a grant for Center for Couples in Recovery at MRI, couples will take this two-day workshop to learn and develop skills in conflict management, problem solving, managing emotions, ways to support individual recovery programs, repairing the damage from the past, and how to develop a “Couple Recovery”. At the end of the workshop, we will once again ask for feedback in this prototype workshop.

Phase 4: We will be seeking funding from NIAAA for a two-year randomized clinical study looking at the effectiveness of standard treatment in outpatient programs verses couples given CRDA interventions on  measures comparing relapse rates, relationship satisfaction, quality of life, and taking a closer look at the relationship between relapse rates and relationship satisfaction or dissatisfaction. The couples in the CRDA group will be given a two-day workshop with six follow-up multi couple group sessions.

Phase 5:  Don’t know what that is yet, but that’s ok – (One phase at a time)

Many people have supported this work, too many names to mention here, and I am grateful for your support, ideas and encouragement. It will take a community to make “Couple Recovery” a standard part of addiction treatment and recovery approaches. CRDA is simply one approach, not the only approach – Recovering Couples Anonymous (RCA) has been a leader in advocating a couple approach to recovery. Now we have research to help us with a road map to find our way through the maze of couple recovery issues and challenges.

I will keep you posted on how things go over the next month. I’m always interested in thoughts and ideas about couple recovery so I welcome your responses.

Trust is basic to the foundation of any significant relationship, it’s really hard to imagine anybody feeling comfortable in a relationship where  trust has been consistently broken. How do couples affected by addiction deal with the ongoing issue of trust – or more to he point mistrust? Many addicts and alcoholics in recovery will often focus on one day at a time, the position that one can’t guarantee never using again, all one can do is take recovery day by day, or perhaps hour by hour. So what does this mean to the partner who is being told, or simply knows and understands that reality?

Tom had been struggling with his wife’s recovery from alcoholism from the start. At first he felt tremendous relief when she began going to AA meetings and reassured him of her commitment to deal with her drinking problem. Tom found that his relief was  soon replaced by increasing anxiety, plagued by a relentless internal and silent stream of anxiety fueled by questions he couldn’t turn off: “Are  her eyes blood-shot, maybe she’s tired, or has she been drinking?” “Why isn’t she home, the meeting was over 40 minutes ago?”  Will she drink if I tell her how angry I really am at the mess her drinking has caused?” “Will she drink because of the stress she feels at work?” “Is that alcohol I smell on her breath or is it the new toothpaste she bought?…Why did she buy new tooth paste?”

Jana knew her husband struggled with trust, and while she could understand his anxiety, she also resented it. From Jana’s perspective she was doing everything she could to work her program, stay sober, manage a high pressure job as a mid-level manager in a major accounting firm, and tend to the thousand other things on her plate. What bothered Jana the most was that Tom’s mistrust was starting to feel like the new elephant in the living room – they both knew it was there, but nobody was talking about it. Their relationship felt as off  balance as it did before Jana stopped drinking, just in a different way.

Tom didn’t want to upset Jana, but sometimes he couldn’t hold back the questions or the extended looks that communicated the fear and anxiety he was feeling. Jana felt guilty about her alcoholism and felt that she owed Tom a lot of patience, but it was becoming increasingly difficult for her to deal with the tension every time something triggered Tom’s fears.

We discussed their feelings in a therapy session. I told Jana and Tom that their struggles with trust were normal for a couple in recovery, especially early recovery. Things do not get automatically better when a partner gets into recovery, in fact, new problems emerge, and problems in the relationship that have laid dormant start to re-emerge. While old problems may need to be put away a bit longer for now, current feelings and struggles with trust need to be dealt with in the here and now.

What strategies might help Tom and Jana?

1. Tom needed to learn more about co-alcoholism and how to deal with his own control and fear issues regarding Jana’s recovery. Through education, group support, and an awareness of Tom’s own recovery issues, Tom would get better at recognizing and managing his feelings and accept he can not control recovery outcomes for Jana.
2. At the same time, there is a place to discuss feelings here with a model of managing feelings that breaks from traditional “stay on your own side of the street” advise. I encouraged Tom to share his feelings and to ask for what he needed when it concerned his own recovery, not Jana’s. The formula starts with: stating what is happening – expressing feelings – asking for what you need. For example, when Tom thought Jana’s eyes looked bloodshot and that worried him, I told Tom he could say, “I noticed your eyes look blood-shot. This makes me anxious and brings back old feelings”. That may be all he would want to say stating, “I just want you to know what I am feeling and why.” He may need more however and add the question “I would like to know if you did drink last night after the meeting .” I realize this approach breaks with current conventional thinking about codependency, and Jana could lie anyway, but this process at least brings the question out in the open, rather than leaving it unspoken and lingering. The “rule” in most alcoholic families is that members can’t talk about what the see and what they feel – I believe recovery is about doing the opposite.
3. I encouraged Jana to not respond defensively and to try to understand that it is understandable that Tom is going to struggle with trust because drug and alcohol dependency patterns almost always includes patterns of deceit and lying, as the dependent person struggles with their own loss of control and inability to stop. This certainly was the case with Jana’s drinking history and her attempts to hide and deny her drinking from Tom. I don’t ask partners to trust each other or to expect trust, I ask them to share what their struggles are in a non blaming way and to normalize those struggles. I stated, “Of course Tom is not feeling trust, given the toll that alcoholism has taken on trust, but if couples can manage it,  it is helpful to the recovering couple’s relationship when partners can begin to share what concerns them and know that their partner will try to hear and respond to those concerns. So Jana you could state, ‘When you look at me that way and worry about me relapsing, I feel hurt and frustrated that you may not see how hard this is and how hard I really am working, but I would rather you tell me what you are thinking then silently holding it in and withdrawing – that makes me even more tense.’

Is this codependent? I could see an argument for viewing this approach as codependent if the motivation for Jana and Tom to share feelings and ask these questions is to control or manipulate. What we are aiming for here is trying to establish a way for partners to express what they see, what they feel, and what they need – as long as it is not about trying to control their partner’s recovery.

If Tom is concerned that Jana missed a meeting this week, I could imagine standard advise as, “That’s her program, she needs to work on that; You need to work on your own program.” Not bad advise, but another approach could be for Tom to focus on sharing his feelings about this WITHOUT having a goal to change her behavior. For example, “I noticed you missed a meeting this week. I realize this is your program and that you are in charge of, but I have to say I do get a little anxious when you miss a meeting.”  I would encourage Jana just to listen and acknowledge Tom’s feelings. “I can understand why you would feel that.”

Trust (and recovery) really is a balancing act. There will be times and circumstances to not to have the above type of conversation, but I am hoping couples will work at trying to find that balance so that recovery does not become the new elephant in the living room.

Margaret and James used to have a good time together – that is when they were both drinking. They had quite a ritual, with both coming  home from work around the same time they would begin their daily pattern of  happy hour. For many alcoholic couples, happy hour doesn’t stay happy as alcohol begins to change moods, temperaments, and judgement, all leading to unhappy hour. This wasn’t the case for James and Margaret.  They rarely fought during their happy hour and often had lively conversations filled with laughter. They both saw this time  as a time to bond. Drinking time was a fun time for them, often lasting several hours. After dinner, well not so much fun, with both falling asleep usually watching television. Drinking wasn’t so fun always at other times either as health issues for Margaret and escalating work-related difficulties for James led to poor performance reviews. James sales position required some evening and at home work which simply wasn’t happening.

Remarkably, both Margaret and James decided to stop drinking at just about the same time, and both began working a recovery program. They both went to AA and eventually found sponsors.  What surprised them both was that their relationship satisfaction dropped after they stopped drinking. James had about 8 months of sobriety and Margaret with 10 months when they started couples therapy.  James discouraged, commented, “Boy is recovery a buzz kill, literally! Aren’t relationships supposed to get better? Why aren’t we having more fun?” Margaret nodded her head in perplexed agreement. This was a great question, and not an uncommon issue or concern for couples in early and in ongoing recovery.

The couples that do best over time find ways to establish new rituals of connection and find ways to celebrate and have fun that don’t involve drinking or drugging. This is especially difficult when couples have relationships with their families of origin, and one or both of those families have highly ingrained rituals around drinking , with no model of how to be together and have fun without substances. Un-recovered family alcoholism presents a major issue to confront when individuals try to establish recovery in their lives and still be a part of their familiy where drinking is central.

“What do you two do for fun now that you no longer drink?” I asked after hearing about their former happy hour (or two) nightly get together. “Well,” Margaret replied,” We tried continuing our happy hour time with non alcoholic drinks”. “How has that gone?”, I asked, kind of knowing what the answer would likely be. James chimed in, “I don’t know what to talk about. We just sit there like we don’t have anything in common anymore. Sorry honey…” as he looked at Margaret, “…but it’s really kind of boring”. Margaret started to get defensive, but then had to admit that she really wasn’t having a good time either.

      Time to Establish Some New Rituals for Fun

Trying to establish a non alcohol happy hour just didn’t work, too many associations with their drinking. They both needed to learn how to be together having fun in ways that didn’t involve drinking. Both coming from alcoholic families, neither one had family experiences to draw on, both families maintained drinking as a central activity at all family gatherings and celebrations.  As we continued our work in therapy, Margaret and James discussed new activities that they were willing to try together. For years they both expressed an interest in taking yoga, but drinking always would win out with mutual promises of “Next time”.  Now that they could, they decided to take a yoga class together, and found that the socialization following class really opened up their friend network, something long neglected. Margaret and James began attending parties hosted by the yoga class instructor and other members of the class. They found themselves open to new ideas about other things they had long talked about doing but never quite got to. James got his piano keyboard out of the closet and began to practice again, entertaining ideas of trying to get his old group together . “Who knows, maybe we can actually play some gigs again now that I won’t be so loaded that I insult the club owner”.

It turns out that play is an important drive, hard wired into all brain circuitry.  Dr. Jaak Panksepp, noted psychologist and neuroscientist, writes about the emotional command systems in the sub cortical structures in our brains that when activated predictably lead to specific behaviors; play is one of them.

All couples really need to make play a part of their relationship. It doesn’t really matter what activities you choose as long as you both enjoy it. Also, taking time for yourself to develop interests, nurturing a playful self is an important part of every individual recovery program that all too often is overlooked.

Think about the things you might want to do with your partner that could be a fun, shared experience, as well as finding or getting back to your own individual interests.

Taking the FUN out of dysFUNction means putting the FUN back in FUNctional recovery.

Recovery Has Its Ups and Downs:

Do I Want To Get On?

Several years ago Jerry and Carol (not their real names) came in for couples therapy. They stated that they had a good marriage, but that they needed a “tune up”.  Jerry talked about how he felt that stress was impacting their relationship, Carol agreed, but also expressed concern over Jerry’s drinking and wanted him to better control his drinking, like he used to. Over the next several months we addressed their relationship concerns, but what emerged as a central issue was  the fact that Jerry’s  alcohol (mis)use was seriously affecting the marriage, his relationships with his young children, and recently, his work. In our counseling sessions we had explored Jerry’s drinking and where it might fit on the drinking continuum between heavy, abusive, and dependent. Understandably, the possibility for Jerry and Carol that Jerry had an alcohol dependency was frightening, but the evidence was mounting. When Jerry opened the session to talk about his latest drinking episode, he said “I have to stop drinking, I don’t feel in control anymore”. When we discussed what happened and what led him to decide that he wanted help to stop drinking, Jerry described what he remembered about the night.

Jerry attended an important meeting in San Francisco that ended very successfully with his small company closing a lucrative deal. After the meeting he and two of his colleagues decided to celebrate and go out for drinks, something Jerry had not done before because of his policy not to drink at work-related events. Over the course of the evening Jerry drank too much,  neglected to call Carol, and somehow got home safely after 2:30 am. The next day Jerry felt tremendous shame and anger at himself, there were parts of the evening he could not remember and the parts he did remember were embarrassing. He knew he had hurt Carol and felt like he had hit bottom.

Jerry decided to begin going to AA and agreed to pursue referrals to therapists specializing in addictions for individual therapy. The decision to get into recovery from dependency is not an easy one for most people. Self-identifying as an alcoholic or co-alcoholic is a huge shift in one’s identity. Also, learning what works to stay sober and manage life – all at the same time – takes effort and  adapting to a new way of thinking, behaving, feeling. It comes with its “fits and starts”. Carol and Jerry continued couples therapy, and Carol agreed to begin her own recovery in Al-Anon. She also attended with a close friend a recovery group with a Christian orientation that she felt would be a good match for her.

Couples Need Their Own Recovery

Each Person Finds Their Own Way of Moving Through the Ups & Downs

Carol found the support from her groups extremely helpful. At first she felt embarrassed, self-conscious and a little guilty that she was somehow ‘telling a secret” about her husband’s drinking problem. However, she also felt others understood her and supported her in her recovery and what she needed to do to stay on track in her recovery.

Jerry too  found AA difficult at first. After he committed to go, it still took another 3 weeks before he was able to walk through the door of a meeting. Once he was there he stated it was easier. He found a sponsor 1 month later and stayed in close contact with the sponsor. There was one occasion, several months after Jerry started attending AA, when Jerry “experimented” with having a glass of wine at the restaurant he and Carol went to with another couple they were close to. Jerry felt uncomfortable telling their friends that he wasn’t drinking, so he had just one glass and made an excuse for not having more.

Jerry and Carol shared that even at the time both agreed to this plan ahead of time, that they felt uncomfortable with the decision. While the glass of wine didn’t lead to more drinking, Jerry shared that afterwards he started thinking again about drinking, and wondering if perhaps he could control his drinking this time. Work with his sponsor, some additional meetings, and work in our couples sessions all seemed to help him become clear about the risks and soon he felt clear again about what his recovery was about – his commitment to abstinence.

The couples work focused on a number of issues:

1. Helping Jerry and Carol adjust to the tremendous changes taking place in their relationship on a day-to-day basis
2. Exploring ways to support each other’s recovery without taking responsibility for it – keeping boundaries clear
3. Finding a way to talk about how each felt affected by alcohol and the impact it has had on them personally and in the relationship – without blame or accusation

Couple Recovery Allows Room for the Relationship

With All of Its and Downs

Carol and Jerry began to find ways to talk about their concerns about all the changes that were happening in their relationship: what they were going to tell friends and family about Jerry not drinking anymore; the time away from each other as they both were involved in their own recoveries; struggles with fears of what the future would hold, and the ever-present fear of relapse; dealing with some of the baggage from the past and the impact of alcohol on their relationship, and now the impact of recovery on their relationship; the awareness that both Carol and Jerry had alcohol issues in their family of origin, and how this factored into their recoveries and their relationship.

Central to couple recovery is the focus that each person is responsible for their own recovery, but both partners are responsible for the relationship. Supporting each other’s recovery doesn’t qualify as “codependent” when boundaries are clear and the focus is on finding ways to appropriately discuss individual needs and relationship needs without blame and without taking on all the responsibility. While active alcohol or drug dependence often becomes the “elephant in the room”, recovery can become the new elephant. Every relationship has its ups and downs, recovery aside, what helps is to find ways to connect that work for both partners.

Recovery Can Replace Dependency as the New Elephant in the Room

He doesn’t Look So Scary, Does He?

Looking Ahead at Recovery: What do you see?

I remember as a kid, we would be on vacation at some scenic observation area on the way, and there they were: those coin-operated binoculars. I also remember being absolutely fascinated with those things, thinking how cool they looked, all metal and indestructible, those beauties could swivel to move the viewing area vertically and horizontally. All it took was an available binocular and 25 cents.

Somehow, I couldn’t seem to appreciate the view until I was able to take a turn. If they were all being used I would feel impatient, scanning for the one that seemed to have the shortest line. Except, there weren’t really lines typically, it was more like people milling around either not interested in using the binoculars and simply standing close to one, or people actually waiting for the next opening.

Even as a kid I knew  it was good to have strategies when hoping to get some coveted time with the viewer on a popular vista. I would scout for the people looking for change, men digging deep in their pockets and women opening their purses, find something away from where they are standing. Next, I would check out where the kids were, they always wanted to use the binoculars. I would be on the lookout for people hitting the binoculars and yelling out something like “Hey, what’s the matter with this thing? It just ate my quarter!” Somehow losing 25 cents to a machine becomes very important to our sense of injustice in those moments. Well anyway, avoid that machine. Finally, when I would actually get my cherished time on the binocular, I would really want to make good use of that time, zooming in on every area within that view. You never really knew for sure just how much time you had, so every second counted. A little trivia – the average time ranges from 1.5 minutes to 2.5 minutes. These devices have been manufactured since the early 1930′s by a company called Tower Optical, they are still in operation and only make about 35 devices a year. The basic design has never changed and I think they still charge 25 cents.

It turns out that about the same time Tower Optical began producing their viewers that theories about alcoholism began to emerge. As early as 1930, long before the advent of family therapy as a field, treatment concerns for the alcoholic focused on the importance of family interactions in influencing drinking patterns. In the 1940’s and 50’s psychoanalytic theories focused on the wives of alcoholics, speculating a relationship between the wife’s personality functioning (usually described in negative terms) and her ending up in a relationship with an alcoholic husband. It wasn’t until the late 1960’s when family therapists began applying concepts and theories again to alcoholism treatment specifically.

When I look ahead at recovery I see us rediscovering what the theorists started with in the 1930′s – relationships as a core issue when treating chemical dependency. Looking at addiction as a “family disease” should mean treating the whole family. There is a circular relationship between the addict/alcoholic and the family: each affects the other. There has been a lot of research on that relationship, and only now are we beginning to see the importance of that circular relationship in recovery as well. Recovery means so much more than not using the substance – more on that in a later blog.

Let’s imagine that you are standing with other people at an interesting vista. Let’s make the vista the future of recovery and trying to figuring out what’s helpful to you (if you are in recovery) and to other recovering people. Let’s further imagine that we all have a viewer available. Wouldn’t it be great if we could share what we see? What part of the scene jumps out? What is the vision we can share with others. Looking out, what do we hope to see? I’m betting couple recovery is out there, ready to be seen and rediscovered.

You may remember or heard of the old movie, “”Yours, Mine and Ours”, with Lucille Ball and Henry Fonda (1968). A remake starring Dennis Quid and Rene Ruso came out in 2005. The movie was loosely based on the true story of Helen and Frank Beardsley who had 8 and 10 children respectively at the time their former spouses died. They ended up marrying and became  an instant family of 18 children, an endless interest to an amazed public. Most of the original movie was shot in San Francisco by the way.

In a most unlikely scenario, apparently things worked out fairly well for the Beardsleys.  They learned how to adapt their life styles and make things work, requiring creativity, perseverance, and learning what works. So what does this movie have to do with recovery and couples?

Last Friday I spoke about couple recovery at a speakers luncheon sponsored by Bayside Marin Treatment Center. The setting was a wonderful sample of a beautiful sunny day in San Francisco – sights, sound and food – right on the Embarcadero. The venue was at the Delancey Street Restaurant associated with Delancey Street Foundation, the leading self-help residential program for those who have hit bottom around alcohol, drugs, including the  homeless and those who have been in jail or prison. Volunteer efforts from some of the best chefs, restaurant owners and wait staff launched the resident staff who then in turn trained those after them. This is a core philosophy of Delancey Street, learn and pass it on.  The residents learn success, productivity and ultimately contribute back to the community. Another unlikely scenario that has worked out because of creativity, perseverance, and learning what works. A model community.

I believe that we are at a new era in addiction recovery. Bringing the relationship into the process of recovery adds an important dimension of recovery that has the great potential for each partner to feel support and understanding in their own recovery process. At the same time relationship issues no longer need be ignored or avoided. By developing a couple recovery three recoveries are addressed: each individual recovery and the couple recovery. Several of the therapists I spoke with after the talk expressed excitement and enthusiasm for this concept and the need to include the relationship in recovery.

To some, this idea will seem like another unlikely scenario, but we now know through research that couple stability predicts long-term sobriety. We also know that there are certain tools and relationship skills that all couples can benefit from and will greatly influence relationship stability.  I am suggesting that we put the research together with creativity, perseverance, and learning what works for each couple.

I want to thank Bayside Marin Treatment Center for sponsoring the luncheon and providing the opportunity to share ideas on helping recovering couples.

For more information on the Delancey Street Foundation in San Francisco Click Here

Joel is just now dealing with his amphetamine use and coming into the realization that he may have an amphetamine dependency. This is a huge transition for anybody who begins to realize that “Maybe  I CAN’T control this”.

“What’s happened Joel”, I asked, suspecting the answer would relate to his drug use. “Well, I made a phone call to a Mexican pharmacy. They sent me my order (a stimulant used to treat ADD) and I used them over the weekend. This feels like such a dead-end”.  

Joel had relapsed, but had been able to tell me. Relapse and shame tend to go together, as they have for Joel. “I’m glad you told me. Let’s talk about what happened. Does your partner know you used?” Joel and I used the rest of the session to deal with what he shared, and what next steps he might consider.

 It turns out that Joel did tell his partner. While I am not working with the couple, I offer ideas to Joel about considering relationship issues in the context of his recovery.  Relapse translates to the need to reevaluate the current program and strengthen it somehow.

How can couples manage relapse? One of the strategies I talk about with couples is to have a relapse strategy in place. Once somebody has committed to sobriety/recovery, the couple can talk about what they would do and what would need should the partner relapse. For example, one couple I worked with came up with a plan that should there be a relapse, the addict partner would take the next steps in increasing a recovery plan to include an evening treatment program. His partner said she would need to be able to tell her family, so she could get support. She also talked about her need to be in a couples support group or 12 step program like Recovering Couples Anonymous (RCA). Both partners said they were committed to the relationship and would want to work in ways to manage recovery for the both of them individually and as a couple.

Couples who can talk about relapse – the thing they hope will never happen - are better equiped to deal and manage with relapse if they are prepared. Hopefully relapse fears can freely be talked about, and built into an ongoing dialogue.

Having said that, we still take it one day at a time. 

Jeff spoke about the deep roots that alcoholism has had in his family. He is an adult child of two active alcoholic parents and his brother is in recovery from addiction.  It turns out that in his family, despite his parent’s active alcoholism, not all family gatherings are so bad. I asked how Father’s Day went, he replied that it actually went OK. Jeff went on to say that is sister had a great idea that he really liked.

It worked this way. Jeff’s sister asked Jeff and their brother to write out 30 separate positive things about their father – these had to be real appreciations and expressing gratitude for what each person genuinely felt. Jeff’s sister took the lists and cut out each affirmation and put them a nicely decorated jar. The gift they gave their father was a nicely decorated jar that every day, for 90 days, he could pull from the jar one of the affirmations that one of them wrote.

Jeff was quite taken with this idea stating, “I wish somebody would do that for me”. This exercise in positivity stands in great contrast to the negativity often experienced in alcoholic families. The challenge is in the ability to find the positive, and to feel one could honestly express gratitude and appreciation to the family member or partner.

It certainly would have been OK for Jeff to pass on this idea if he didn’t feel comfortable participating.When I asked Jeff about how he felt about writing these positive things about his father, he replied that it helped him to remember some of the positive things his father did, “He did do some things right.  He was there at my sports events in high school, and has tried to support me through some of my recent challenges”.  For Jeff this worked, much like a gratitude list works in AA. Jeff gained something for himself  in the exercise.

Denial is usually thought of in the context of denying addiction. I suppose one could argue denial could also be related to not acknowledging positivity as well. There is compelling research that when we are feeling negative about a relationship, awareness of anything positive about the relationship isn’t noticeable or on the radar at all. Neutral and even positive interactions are viewed as negative.

Think about whether this could work in your relationships that could benefit from a boost and whether you would want to discuss this idea with your partner and/or family members. Good luck.

The blog title is taken from a piece of Christmas folk lore. In 1897 little eight-year-old Virginia O’Hanlon wrote a letter to the New York Sun asking for the truth about whether there really is a Santa Claus, because  her friends told her there wasn’t. The editor, Francis P. Church, wrote the following:

“Virginia, your little friends are wrong. They have been affected by the skepticism of a skeptical age. They do not believe except they see. They think that nothing can be which is not comprehensible by their little minds… Yes, Virginia, there is a Santa Claus. He exists as certainly as love and generosity and devotion exist, and you know that they abound and give to your life its highest beauty and joy.”

Churches response was an instant sensation and has become one of the most famous editorials ever written. It was reprinted in the Sun annually, until 1949 when the paper went out of business.

So what does this have to do with couples and recovery? The long-held belief in the addiction recovery field has been to keep recoveries separate, each individual is encouraged to work their own program and “stay on your own side of the street”. As a recovery therapist, I can’t argue with the emphasis that should be placed on individual recovery. However, by adding a relationship focus in the recovery process you address a way of helping couples and families in the transition through the stages of recovery, in my opinion, is core to a more holistic approach to recovery. My research on successful long-term recovery processes points to the very important role of couple and family relationships can have  in successful outcomes.      

My colleague and friend, Dr. Virginia Lewis is Co-Founder and Co-Director of the Family Recovery Project, at Mental Research Institute (MRI) in Palo Alto. Additionally, she is Senior Research Fellow at MRI and an excellent clinician in private practice. Virginia invited me to continue my research on couples in recovery and together we co-founded Center for Couples in Recovery, at MRI. Virginia’s emphasis on family recovery as an essential component of successful long-term recovery, focuses on the importance of relationships in recovery, describing the complexities and difficulties families encounter, and normalizing those challenges.

There are many in the field that don’t believe in a relational approach to addiction treatment. To them I would say, “Yes, Virginia is right, there is family recovery: It’s exists. Let’s work together to help couples and families manage better, and educate those who don’t believe.”

Some years ago I remember leading a family group at a drug and alcohol treatment center. I opened the group with the question: What does it mean to be a family or couple in recovery? Some people struggled with the idea that the non-addicted members of the family had some part in going forward in recovery. Until that moment many partners had viewed their (addicted) loved one as having the problem; the idea that the non-addicted partner too had recovery issues didn’t fit their expectations of treatment. Either the idea of couple/family recovery never occurred to them, or they simply admitted to feeling angry about having to take some responsibility for fixing things given that they weren’t the ones with the addiction. This feeling is very understandable. The damage to relationships from addiction usually has a history built on broken promises, and countless unintended disastrous outcomes. It is like something destructive has invaded the family unwelcome but unshakable, that is until recovery. Family members often cling to the hope that once the alcoholic/addict gets into recovery their lives can finally be normal. What we know from the research is that while recovery is the end of something – active addiction, it is also the start of something – a healing process and the beginning of building new relationships in family and couple life.

Addiction in the family can be thought of like a mobile or wind chime, one of those hanging art objects that have parts connected by lines, so that when the wind blows all the parts all move. Think of the family as the parts of a mobile and think of addiction like the wind. The wind blows and all the pieces are affected. Recovery is like that too, like addiction recovery affects everybody in the family. All the pieces of the mobile are still connected, but what moves the pieces is different. Families need to know that adjusting to these changes takes time. Everything may seem different and even though the alcoholic isn’t drinking, there still are problems, issues and concerns that need to be addressed: This is normal!

So what is recovery? That is a question that a hundred people might answer a hundred different ways. I would begin the answer with the idea that individual recovery is taking stock of how the addiction has impacted oneself and starting to address the question of what the individual needs to do to keep what is healthy in their lives and change what isn’t healthy. I also would emphasize that the same thing needs to happen with relationships. How has addiction affected relationships and what changes will make those relationships healthier?