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 

The Couple Recovery Development Approach: It’s Time (Special Thanks to Dr.John Gottman)

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.

Swinging Into Recovery From Addiction

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?