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.

Trauma is not Codependency: Part 1

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What Box Do I Put These Feelings In?

When a partner gets into recovery all sorts of emotions tend to come to the surface. These emotions may at times feel in opposition, with hope next to fear, relief side-by-side with anger, and so on. If you have experienced these swings then you know how confusing and overwhelming emotions can be, sometimes rapidly go from one feeling to another: triggers can seemingly come out of nowhere. You may think that something is wrong with you, perhaps feeling like you are crazy. It may very well be that the recovering partner may be experiencing the same emotional roller coaster, at times feeling gratitude for recovery, and other times really struggling with all the newness and uncertainty of early recovery: “How am I am going to get through this?” “What happens next?” “How do I manage all these emotions, sober?” “My relationship? I can’t even go there!”

La Ronde's Le Boomerang Roller CoasterAs the recovering addict and partner experience these swings and ups and downs, twist and turns in their emotional life, an awareness can creep in, with increasing anxiety: “Does this mean I am really messed up?” I have heard people in early recovery ask me, “Do you think I am bipolar?” “What’s wrong with me, I should be grateful and relieved, and sometimes I am…but other times I feel sad, angry and fearful”.

Sometimes these feelings are explained as an “emotional relapse” a regression into an unhealthy emotional state, which for the addict precedes behavioral relapse. For the co-addict an emotional relapse is negative self-talk or emotions that are associated with codependent relapse: controlling behaviors; enabling the partner’s addiction; perfectionism; and low self-esteem, putting one’s own needs last.

Obviously, it is really important to figure out what emotions are being experienced and whether there is a risk of these emotions leading to relapse. For the addict and alcoholic managing emotions sober is a whole new ball game, for the co-alcoholic/addict self-care may be a new mind-set. Recognizing one’s own needs and the importance of caring for self means asking for support and help; this is not always easy, so you may need to start with giving yourself permission to reach out.

However, not all strong negative emotions related to addiction (and recovery) are a sign of unhealthy emotions of emotional relapse or of codependency. Sometimes these feelings are related to re-experiencing traumatic feelings triggered by emotional memories of the addiction. This is as true for the addict/alcoholic as it is for the co-addict. Most people have heard of Post Traumatic Stress Disorder (PTSD), but probably have not heard this associated with recovery very often. We tend to think of soldiers returning from the battlefield when we think of PTSD, but chronic trauma, and addiction is certainly that, can leave a person vulnerable to the symptoms of PTSD. The National Institute of Mental Health defines PTSD (http://1.usa.gov/cc8g:)

1. Re-experiencing symptoms:

Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
Bad dreams
Frightening thoughts.
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:
Staying away from places, events, or objects that are reminders of the experience
Feeling emotionally numb
Feeling strong guilt, depression, or worry
Losing interest in activities that were enjoyable in the past
Having trouble remembering the dangerous event.
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
3. Hyperarousal symptoms:
Being easily startled
Feeling tense or “on edge”
Having difficulty sleeping, and/or having angry outbursts.
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

While PTSD can trigger an emotional relapse, a distinction between codependency and PTSD helps us to put the feelings in the right box in terms of understanding what is happening. The adverse effects of addiction may be likened to the concept of second-hand smoking. “Second-hand alcoholism”, or second-hand addiction, refers to the negative impact on others emotionally, psychologically, spiritually, and relationally because of someone else’s of addiction. Rather than assuming the person is having a codependent relapse, consider that these feelings can be understood as a reaction to trauma.

As science continues to provide tremendous gains in understanding addiction as a brain disease, beliefs and attitudes about dependency are finally shifting away from the moral model of addiction – that is, blaming the alcoholic for having a moral weakness. Similarly, I believe that a better understanding the concept of second-hand addiction removes judgement and assumptions about partners affected by addiction as a symptom of unhealthy codependency.

More on trauma, codependency, and second-hand addiction to follow in the next blog

Recovering Couples: Dealing With Fear of Relapse

Ron had been in recovery from alcoholism for several months. He had been going to AA, had a sponsor, and spoke about his commitment to recovery and how important it was to him. It was Friday night and Ron was going to his 7:00 PM meeting again, stating that a small group was going out for coffee after the meeting. Cindy supported Ron’s involvement with AA, she didn’t really like giving up Friday nights – it used to be their night – but she realized that his recovery program was important.

At 10:00 PM Ron still wasn’t home. She tried to reassure herself that everything was probably fine, but a familiar, creeping feeling of fear and dread began a relentless path in Cindy’s mind. She tried watching television, working with her favored Sudoku puzzle, and self-reassurances, but by 10:40 she was feeling angry, upset, and physically sick. She tried calling Ron on his cell, but it rolled to voice mail. She tried several more times with the same outcome.

At 10:50 Ron calmly walked in announcing his arrival. Cindy carefully scanned him for everything she knew and had experienced when he had been drinking. She went through the check list, looking for tell-tale signs of drinking that she knew so well: they weren’t there. What should Cindy do? Everything in her felt danger, how should she manage that feeling?

Ron immediately picked up on her upset and apologized for not calling. His cell battery was dead, but he admitted he should have called her. He stated it was a great meeting, and that the group continued their discussion in the restaurant over their coffees and dessert.

When a partner fears that their partner has relapsed – either with a substance or with co-dependency – use the “soft start” technique to express your feelings and state what you need. Dr. Gottman’s research on what works in how to raise a problem or concern led him to discover that couples who mange difficult conversations tend to start the conversations with a description of what happened, how they felt about what happened, and what they want. Cindy could say this, “Ron when you stayed out later than I thought and I didn’t hear from you or couldn’t reach you on your cell phone, I was worried and scared that you might be drinking again. I need to know, did you?” Cindy could go on to say that what she needed in the future is for him to call if he is going to be late.

Some would argue that this is co-dependent, checking to see if the partner is drinking. What I have learned is that if couples can own their fears, talk about them and ask for what they need, then these fears don’t build up. Ron and Cindy are learning to simply be honest with those feelings and needs, not control the other.

Ron acknowledged and honored Cindy’s feelings and her request for reassurance and enough details about the evening to understand what happened. He could have gotten angry or defensive, but he didn’t, so the event was dealt with, repair happened, and they drew a bit closer as a result. This helps to build trust, the ability to express and be heard.            

Behind the 8-Ball: When Partners Won’t Get Into Recovery

Addiction is described as a cunning, baffling, and powerful disease; the impact on relationships is devastating. When a partner is addicted, everything in the relationship changes. When the addict/alcoholic is in the middle of the disease denial buffers the addicted person from acknowledging the reality of their addiction and how it is affecting those around them. It is hard for partners to understand why their loved one doesn’t see the damage or do something about it. It seems so clear, yet, there often is tremendous resistance and anger directed at the non addicted partner. 

In Wikianswer.com, being behind the 8-ball is described as this: “In the game of pool, the 8-ball is the last ball a player must sink in order to win the game. However, until he or she has sunk all the rest of the balls (i.e. 1 through 7 or 9 through 15), touching the 8-ball with the cue ball is considered a foul stroke. Therefore, one is said to be ‘behind the 8-ball’, it means to be stuck in a position where any move will have a negative result — to be trapped with no way forward.” If you are in this situation, I imagine this sounds and feels familiar. I call this the “8-Ball Dynamic” because in active addiction, addicts often are very skilled at putting their partners behind the 8-ball: Efforts to get help, or address problems in the relationship, or simply trying to enlist support to manage the responsibilities of  life are met with anger, blocks, challenges, and obstacles of all sorts.

It is important for partners to understand that the drug of choice (or addictive behavior) is the primary relationship for the addict. When someone is in the middle of their addiction, reason and judgment are impaired. The biological impact of chemicals on brain functioning and the psychological mechanisms of denial, projection of blame, and minimization all serve to keep the addict from accepting the reality of addiction. 

I worked in a drug and alcohol treatment program years ago and learned that the staff could never really tell initially who was going to be successful or drop out of the program. Those patients that at first looked motivated could still relapse. Those most resistant to treatment sometimes proved to be the poster child for addiction recovery. We never know what will happen; people can come to that place of “surrender” and suddenly “get it”. In the meantime, all that one can do is to focus on taking care of themselves. Get help and support, go to Al-Anon and/or other support groups. Remember you can’t control your partner, no matter how loving or how angry you get. Recognize the “8-ball dynamic” for what it is, a symptom of active addiction. Don’t buy into the blame or accusations of why the addict is using, instead try to focus on help for yourself. It is a hard thing to do, but you don’t have to stay behind that 8-ball.