Addiction Recovery for Couples: Path for Healing or A Ticking Time Bomb ?

Time bomb

“I don’t know. Will managing relationship issues while managing my own recovery blow up on me?”

Okay, alcoholism or drug addiction has impacted your relationship and you are sorting through what all this has meant to you. Most importantly, you are trying to stay on track with your own recovery and wellness because you realize you have to. For too long you feel like you have lost yourself in this disease, one way or another. There is so much to sort through and to come to  grips with. A lot of the time you feel overwhelmed, especially when you see your partner and the triggers get tripped. You try not to react, but sometimes you can’t stop it.

The good news is that there are recovery options for the alcoholic and co-alcoholic. The recovering community extends open arms to those struggling with dependency and co-dependency. People whose lives have been touched by addiction know what it is like, and can offer support, hope, and tools to recover from this powerful disease.

While you realize that self-care is the center piece of any good recovery program, you still have a relationship, either with the alcoholic or co-alcoholic, and that too seems to need some attention. In so many ways, things have not gotten better between you, even after recovery.

We know from the research that the transition from active dependency to early recovery is very difficult on relationships – This is normal! Moving into recovery brings its own set of problems: it is new, unknown, and so much is going on that even though things are better in many ways since recovery, not everything seems better or easier. Unfortunately the toll that addiction takes on couples is reflected in divorce rates that are somewhere between 4-7 times higher than normal, with many divorces taking place after beginning recovery. The idea that couples should not address their relationship issues until well into recovery, perhaps a year or more, is an untested belief. On the contrary, we know from longitudinal research that relationship wellness is one of the single biggest predictors of long-term recovery success.  Perhaps the problem is that we have not given this idea of couple recovery much of a chance, nor provided the right tools for couples.

Trail in Temperate Rainforest

It seems that for some the position of avoiding the couple relationship is bound up in the fear of losing individual recovery if the relationship takes any kind of priority. However, the reciprocal relationship between successful individual recovery with the health of the couple relationship is established in the research literature. What if couple recovery included a strong emphasis on supporting each partner’s individual recovery, while at the same time offered tools for couples to begin to more effectively manage the changes in their relationship as well as start to deal with the baggage of addiction? What if couples were given a path to take that would provide some direction in:

  • Figuring out a way of incorporating recovery somehow into the relationship
  • Help managing conflict
  • Guidelines for setting boundaries
  • Understanding what healthy relationships need
  • Know what predicts relationship melt-down 
  • Support each other’s recovery, without taking responsibility for it
  • Learn ways to prioritize one’s own recovery without having to ignore the relationship
  • Be able to differentiate between unhealthy codependency and healthy interdependency

There are plenty of good reasons and times to only focus on one’s own recovery and not try to deal with the relationship. Sometimes it’s a matter of timing, sometimes it has to do with simply not having any desire to have much of anything to do with the relationship. However, in those instances of living with recovery while also having to manage some aspect of the relationship – like shared parenting responsibilities, joint decision-making, or wanting healing in the relationship – then a relational approach to recovery should at least be considered with specific goals in mind, which obviously could vary greatly for each couple.

The path will not be easy, recovery is not easy, and there are risks for sure. How to decide whether you are willing to explore the concept of couple recovery? One way to grapple with the idea of going forward with a couple approach  is when there are good reasons for wanting things better in the relationship, regardless of why and to what end. Couple recovery  may actually ultimately be the path of least resistance, all recoveries considered.

compass

I would love to hear any thoughts about the idea of couple recovery and what the pressing issues are for couples in long-term or early recovery. Thanks 

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Trauma Is Not Codependency: Part 2

When you get wrapped up in feelings, be cautious in how you label those feelings

In my last blog article, “Trauma Is Not Codependency: Part 1”, I addressed the importance of acknowledging and understanding that active dependency on drugs and alcohol creates trauma for both the addict/alcoholic, as well as partners and family members of the addicted person. I’m sure this is not really a news flash for anyone, but I do wonder if many recovering couples recognize and understand that it is normal that the impact of active addiction does not end when the alcoholic (or addict) gets into recovery. In fact, despite initial feelings of relief that the partner is now in recovery, there may be ongoing struggles with feelings, such as: fear of relapse, being on guard, or experiencing an enhanced state of sensitivity to the partner’s behaviors  (hypervigilance); nightmares, startle responses; depression, and generally, feeling triggered and on alert.

My research couples consistently identify emotions and managing emotions as one of the toughest parts of recovery.  It’s not surprising if we think about the person recovering from addiction needing to develop a whole new set of behaviors supportive of abstinence and of recovery, but also needing a way to understand and cope with the roller coaster of emotions without numbing. Similarly, the alcoholic’s (addict’s) partner will need to identify their own unhealthy behaviors created by active addiction and develop ways to disengage by focusing awareness on own needs and on self; it is no less of a challenge for the coalcoholic to manage emotions. Often times intense feelings of fears, worries, and upset feelings for the coalcoholic are understood to be a codependent relapse, the sign of unhealthy emotions and an inability to detach. I believe that this take misses the mark. 

A relapse for an alcoholic isn’t really a relapse unless there is the actual behavior of drinking or using. Having thoughts, cravings or ideas of using may be warning signs for possible relapse: but it isn’t a relapse. Hopefully the alcoholic learns through work with a sponsor, program or recovery therapist or coach how to read these potential relapse triggers and what to do about it.

I believe that the same is true for the coalcoholic (the addict/ alcoholic’s partner) in that feelings and thoughts are different than behaviors in defining relapse. For example, you could argue that the coalcoholic who feels responsible for their partner’s addiction is demonstrating active codependency. Another position is that while these are feelings that warrant exploration, understanding, and probably education, unless that person actually takes action to try to control the alcoholic’s behavior, then this is in the category of learning to manage the feelings and it is not a relapse merely because you have those feelings at all – it’s what you do with those feelings!

Addiction and Post Traumatic Stress Disorder PTSD

A big part of recovery is learning new behaviors to replace the old behaviors, which ultimately can apply to perceptions and beliefs as well, replacing old beliefs with new beliefs and thoughts. This is the essence of “working a program”, integrating new ways of thinking which ultimately helps us to actually change behaviors. These new understandings can change our feelings about ourselves and partners and lead to new ways of acting and living consistent with healthy boundaries and healthy relationship patterns. What happens when intense feelings are felt in reaction to an event or feared event, and no amount of logical thinking, education, program or reassurance helps?

It might help to understand that the consequences of active addiction always involve levels of trauma, for both the alcoholic and the coalcoholic. So how does this relate to feelings? Our brains are wired to be on the lookout for danger, and past experiences become a measure of what is dangerous. It is perfectly normal and understandable for these trauma reactions to emerge in early recovery and well into recovery.

When we get our button pushed: emotions follow

When we get our button pushed: emotions follow

A couple I am working with James and Karen (not their real names)  have been seeing me for about 10 months. James has been in recovery from alcoholism for 4 months and has stayed alcohol and substance free during that time. He has been attending Alcoholics Anonymous 3-5 times a week, just found a sponsor and is attending an aftercare program once a week. Karen has been attending Al-Anon once a week and sees an individual therapist trained in addictions treatment.

James and Karen came into a session reporting having had a major breakdown in their relationship. In the prior week James came home from an AA meeting later than usual. He called to let Karen know he would be late, that he was hanging out with some AA friends getting coffee after the meeting. James reported, “She was a mess when I walked in the house, she totally lost it. I didn’t do anything wrong, I called, what else could I have done, get a note from my sponsor (he said sarcastically)?” Karen reported that when James called to say he would be late, at first she felt a little uncomfortable, but almost immediately after hanging up her feelings escalated into raging anxiety, dread, anger, and fear. She described feeling nauseous, “Sick to my stomach, I couldn’t help it”. So did Karen have a full blown codependent relapse? Is this a sign of her pathology and her need to control James schedule and whereabouts? I think a more useful way to understand Karen’s reaction is that she was experiencing Post Traumatic Stress Disorder (PTSD). These feelings are triggered from previous trauma of the countless times during the active drinking years that James would come home late, often calling with lies and excuses, coming home drunk, then denying drinking and escalating in his aggressive and accusatory defensiveness. Karen’s feelings are normal in the sense that it is understandable why she reacted the way she did given the trauma she has experienced and the triggers embedded in James phone call. The issue isn’t that Karen had these feelings, it’s more about identifying and learning to manage these trauma reactions.

James didn’t do anything wrong but he did need to understand- as did Karen – that her reaction was an involuntary trauma reaction triggered in the parts of the brain designed to protect us from danger. The hippocampus (memory) and amygdala (emotions) are linked through an emotional memory sequence that aims at identifying possible threats.

I don’t believe it’s ever helpful to pathologize these reactions, but rather, I explore where they come from and help couples understand trauma reactions. When James understood Karen’s reaction was PTSD, and not about him “screwing up again”, he was able to move more toward compassion. Similarly, when Karen was able to see her reaction as a full blown PTSD, then she was able to better let go of her guilt and SHAME for her feelings. We discussed what to do in the future when there are strong reactions that likely have been triggered. This isn’t to say that additional individual focus like extra support from Al-Anon or a sponsor and/or a therapist wouldn’t be helpful or appropriate as well, in fact, we in fact explored these options. Identifying and understanding triggers and PTSD will be an essential tool for both James and Karen in their navigating recovery individually and as a couple.

Trust: A Tricky Balancing Act

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.

Yes Virginia, There is Family Recovery

It has been a long delay since my last blog entry, a very busy year professionally and personally. I do hope to keep momentum going with raising the issue of relationships and addiction recovery.

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.”

Recovery: Where Does My Relationship Fit?

OK, you are in recovery for an addiction or for codependency. Everyone is telling you to work your own program, focus on yourself and on your recovery. The message is  very clear: For now, put your relationship on the back burner. That sounds right to you, but the problem is that everyday you are struggling in your relationship. Increasingly you are feeling distant from your partner and you don’t know if you should even address your relationship concerns, after all, you are supposed to focus only on yourself. Feeling puzzled about where to place your relationship?

As a therapist and researcher I am interested in the “big picture” of addiction recovery. I have learned from my research couples that by addressing individual recoveries and relationship issues, you are creating the best opportunity for successful long-term recovery. A study by Humphrey, Coos, and Cohen (1995) supports this idea. The study followed 385 previously untreated alcoholics at three years and eight years after treatment to find out what factors led to successful long-term recovery. The results from the study indicate that the quality of family relationships is the most predictive variable of whether the alcoholic will maintain successful recovery eight years after treatment.  Additionally, outpatient or therapy sessions and attendance in AA sought in the first three years of recovery increased the likihood of continued recovery at the eight-year mark.  

We know that couples with alcohol problems have higher rates of divorce than the general population and we know that recovery does not necessarily reverse that trend. I believe that the recovery jigsaw puzzle challenges us to try to figure out where to place the relationship piece. Where that piece is placed is going to vary from couple to couple and will depend on a number of factors. I have met with tremendous resistance in the recovery field to this idea, but based on my research and other research that supports this position, I think they are wrong. 

I am interested in hearing from couples and from recovery professionals about your experiences addressing relationship issues in the context of addiction recovery. What has worked, what has not worked, what ideas do you have on how to figure out where to place that puzzle piece? My ongoing research on recovering couples is based on learning from the folks who are in the middle of it. I will post comments and hopefully we can create dialogue.    

Addiction Recovery: Different Paths

There are many paths to recovery; one size does not fit all. One path is inpatient treatment. As a therapist working with couples before and after inpatient treatment I have found a glaring difficulty for many of the couples: they are on completely different paths from each other. The following are “composites” of the stories I have heard from couples when a partner has been in rehab.

John was admitted to an out of state “name brand” rehab unit. His partner, Mary, initially received a telephone call from the case worker to get some information about the family, and Mary was given information about family week. John was in treatment for over 70 days, during which time Mary’s phone calls to the program were essentially ignored and no further contact from them was made until family week, two days before John’s scheduled discharge. Their response to her anxiety about what happens after inpatient treatment: “Go to Al-Anon and work on your own program”. 

Alan wondered why the family therapist at the program that his wife was admitted to keep talking about his contribution to her drinking, and how he needed to support her in new ways. While he felt this was a very important thing to discuss, he wondered why nobody seemed interested in how his wife’s alcoholism of the last 11 years has affected him and their family. He was told to work his own program, which Alan was willing to do, but Alan also wanted to know how they could deal issues as a couple. There were a lot of responsibilities and issues that still needed to be addressed: their son’s school difficulties, finances, and her parents intrusion into their lives, to name a few. He was told to put these issues on hold for now.

Carol didn’t understand why Jim had to go to so many AA meetings, after all, he stopped drinking and she needed him to help out more at home and with the kids: she felt depleted. Jim was panicked, Carol was pressuring him to not go to the Thursday night meeting, Jimmy needed help with homework. This was his home meeting and the place he felt he got the most support after leaving the hospital. It felt like a no win situation to the both of them

These different paths need to be identified, named, and explored, creating a dialogue around the impact of addiction and recovery on the relationship. It is important that partners work their own program and get support for themselves outside of the relationship. The piece worth adding is: How can couples support each other’s recoveries and at the same time not sacrifice their own?

Couple recovery means at the very least acknowledging that there are three concurrent recoveries: Each person’s individual recovery, and the couple relationship in the context of recovery. My belief is that treatment programs too often heavily emphasize the addiction recovery, they suggest recovery for the other person, and completely ignore the couple relationship. It’s time to look at the bigger picture and all the challenging questions that come with that awareness: How can we best support people in their recoveries and in their relationships?