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.

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.”