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.

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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.