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Addiction and Recovery in 3 Short Chapters: Chapter 2

Young Man with His Hand on His Forehead

Chapter 2 

Recovery

Over the months John’s legal issues and mandated first offender meetings demanded he miss important out of town meetings, additionally, just getting to work was a huge issue since his license was suspended. He felt at some point he had to tell work what was happening, but he feared what would happen when he did. The strain at home added to John’s shame and humiliation. The DUI happened over 10 months ago but he and Carol still had not talked about it.

The impact on his marriage and on his professional life was mounting and John wondered why he was still drinking after the DUI, especially given what he was now going through and after promising Carol he would stop altogether. As John’s denial began to painfully crack, John had to grapple with the reality of his drinking. It became more and more difficult to justify his drinking. John woke up early one morning after another evening of hiding his drinking, but this time something changed in John. For reasons that morning he saw for the first time the destructive power drinking has over him, and has had over him for a long time if he were truly honest with himself. He needed help, everything he had worked for, everything he had with Carol was at risk.

Puzzle piecJohn had hit bottom and decided to get help, he began an outpatient program and got into recovery. Carol was relieved and felt that the problem was finally being addressed and that their life could maybe get back to normal. At first Carol didn’t think she needed any help, this was about John and his drinking. After getting a call from one of John’s counselors she reluctantly agreed to attend a family group where she was told she would learned about addiction, recovery, and codependency. She was shocked to think any of this was something she should work on, that addiction had impacted her and that more was needed than John getting into treatment.

John worked on staying sober and attended his outpatient meetings regularly. He was introduced to AA and started attending meetings others in his group went to. Much to his relief his work situation stabilized after he told his boss that he was in treatment, his boss even expressed his support. Carol began attending Al-Anon, and while she wasn’t sure she was going to continue to attend, she agreed that for the time being she maintained a once a week schedule.

Finally, both John and Carol were getting support to help them manage their individual recoveries, but surprisingly to them both, things did not get any better between them. Carol noticed that she still seemed angry and anxious most of the time. What if John relapsed, would he tell her, or would he again lie about drinking? Even though she was being told addiction is a disease, she struggled with not really understanding how he could have let his drinking put everything at risk. Why did it take getting arrested for him to finally see how bad his drinking had become? Countless times she had told him if he had to drink, don’t drive. She just gave up telling him this; she wondered if some of this was her fault, maybe she should have done something to prevent things from escalating? Carol kept asking herself was there something else she could have done?

Between his work, her work, and all the meetings John was going to she saw John less than ever. They hardly spoke to each other, and when they did, neither knew what to say. Carol was devastated by what she had been through because of John’s drinking, and while she was relieved he was getting help, she had no idea what to expect next or what she should be doing. She had so many questions about their relationship and how they should manage things now that he wasn’t drinking. How much should she say to family and friends? What did he actually do in his groups, and were these groups actually helping him? How were they going to deal with the damage from his drinking? How should they deal with decisions they need to make about finances, purchases, work, even chores around the house. Carol was exhausted and felt lonely in the relationship and in her own home.

Things were so different now in recovery; they both seemed clueless about how to manage much of anything in their relationship. When Carol asked these questions in her support group she was told to work her own program, focus on her needs, let go of trying to control the future, and not to focus on the relationship at this point. Carol wondered why they weren’t supposed to work on issues affecting them both or their relationship when so much needed attention. Obviously, neither one of them had any idea how they were supposed to go forward with recovery now in their lives. Much to Carol’s disappointment and shock, these feelings didn’t feel all that different to Carol from when John was still drinking.

John too was overwhelmed with all the changes in his life and in their ?????????????????relationship. He felt so many feelings about what he felt he had done to Carol because of his drinking. He felt shame despite learning that addiction is a disease impacting the areas of the brain linked to judgment and choice. John had heard that in addiction the brain is “hijacked”, meaning that the stop switch doesn’t work. It is one thing to understand a bit about the neurobiology of addiction, and quite another thing to manage all the feelings that seem to emerge when sober. There were so many things John wanted to share with Carol about what he was learning. There were times he was struggling with not drinking, or simply felt depressed; he didn’t want to worry Carol or dump anything else on her. Yet, he also felt anxious when she would briefly share that she was thinking about stopping Al-Anon, yet he knew he was told by his sponsor to “stay on his own side of the street”, and to not work her program, He was warned to be successful in recovery you have to focus only on yourself.

John was anxious about their relationship and where they were going. He was told this is “future tripping”, and to take one day at a time. While that made sense when it came to trying to stay sober, it didn’t make sense when it came to their relationship. John desperately wanted to talk about what was now happening in their relationship, and how to make recovery a part of their new couple life. He wondered if the relationship would survive the next year of not talking to other, only focusing on their individual paths.

John and Carol felt that their individual recovery programs were important, but it also seemed as if there was a huge barrier still between them. They wondered if they would ever feel like a couple again. People reassured them that recovery took time and that they needed to be patient before trying to address their relationship.

One evening John and Carol finally had a serious discussion about their relationship, acknowledging just how strained it was despite how well they were both doing in their individual recoveries. “This wall between us, it seems so high and impossible”, Carol finally admitted to John. John nodded his head in agreement but didn’t know what to say or to do.They wondered what might recovery look like if they could also address their relationship as well as their individual recoveries. Neither of them knew that there are options for recovering couples, that there are ways to cross over that wall without sacrificing their individual recoveries.

Wall

 CHAPTER 3

Addiction and Recovery in 3 Short Chapters: Chapter 3

Chapter 1
Chapter 2
Chapter 3

Recovery – Alternative: Going Forward with Couple Recovery

Over the months John’s legal issues and mandated first offender meetings demanded he miss important out-of-town meetings, additionally, just getting to work was a huge issue since his license was suspended. He felt at some point he had to tell work what was happening, but he feared what would happen when he did. The strain at home added to John’s shame and humiliation. The DUI happened over 10 months ago but he and Carol still had not talked about it.

The impact on his marriage and on his professional life was mounting and John wondered why he was still drinking after the DUI, especially given what he was now going through and after promising Carol he would stop altogether. As John’s denial began to painfully crack, John had to grapple with the reality of his drinking. It became more and more difficult to justify his drinking. John woke up early one morning after another evening of hiding his drinking, but this time something changed in John. For reasons that morning he saw for the first time the destructive power drinking has over him, and has had over him for a long time if he were truly honest with himself. He needed help, everything he had worked for, everything he had with Carol was at risk.

John had hit bottom and decided to get help, he began an outpatient program and got into recovery. Carol was relieved and felt that the problem was finally being addressed and that their life could maybe get back to normal. At first Carol didn’t think she needed any help, this was about John and his drinking. After getting a call from one of John’s counselors she reluctantly agreed to attend a family group where she was told she would learned about addiction, recovery, and codependency. She was shocked to think any of this was something she should work on, that addiction had impacted her and that more was needed than John getting into treatment.

Carol met with the counselor, despite her reservations and having more than a Lifejacketlittle bit bit of anxiety. The counselor asked her how she was doing, how thing have been since John started recovery. At first Carol didn’t understand what she was being asked and thought the counselor was asking her how she thought John was doing. The counselor gently redirected her to talk about herself. Over the course of the session Carol heard herself begin to tell her story to the counselor, her real feelings and how difficult things have been for her. Much to Carol’s relief, not once did she feel blamed. Carol was told that recovery is not about blaming the addict or the partner, that it was important to understand what happens in addiction and learning new ways to develop healthy practices for individual and relationship growth. Carol responded that while that sounded like a good approach, in fact Carol was very angry and did blame John. The counselor smiled and stated that Carol’s feelings were normal, that living with addiction is actually traumatic for both partners. Carol hadn’t really thought about John’s own addiction being traumatic to him as well. Carol stated that she needed to understand more about alcoholism as a disease.

“Carol, it makes perfect sense that you feel what you do. Both of you need individual support to deal with what you have been through. Learning about alcoholism and how it affects the alcoholic and the coalcoholic is crucial in trying to make sense out of all that has happened.”

The counselor told Carol about support groups, recovery therapists, and 12-step programs. The counselor also went on to explain what scientists have learned about addiction, and why good people do bad things, even to the ones they love the most. “Addiction is a disease that affects the parts of the brain related to reward and ultimately to judgement and decision-making.

 

“I also suggested to John, and now to you, that you both consider doing some couple work to create ways to talk about the changes that are taking place in your relationship. We have learned from research that the first year of recovery is very difficult for most couples, even with the partner remaining abstinent. Understanding how to make recovery a part of your relationship provides opportunities to support both of your individual recoveries as well as recovery for the relationship.”

Later that evening Carol and John shared their thoughts about the couples work. They both had more questions for what this would involve. The next day, in a conference call with the counselor, they asked their questions and concerns. They were told that a research-based approach to couple recovery offered understanding and tools for supporting individual recovery and couple recovery, and included how to effectively manage conflict, establish healthy boundaries, develop a new relationship with one another, and change communication patterns. They were told that especially after living with an addiction that couples often need help with ways to talk about feelings and needs, learning to find the balance between self-care and relationship-care.

John and Carol agreed that they needed something to help them right now. They both were committed to their individual recovery, but they also realized the relationship needed attention too. Neither was willing to give up their own support system, their own programs, so learning to balance these recoveries would take work.

When Wooden mannequins pushing puzzle pieces into the right placethey shared their intention to piece together a recovery approach that addressed their individual as well as their relationship recovery, some of their recovery friends expressed concern that this could take away or distract them from their individual recovery. It seemed that there are firmly held beliefs well rooted in the recovery and addiction treatment communities, but nobody could really explain how not talking about what they were experiencing in recovery was better than talking about it.

There were so many things that have changed between them, so much they had been through. Why was it better to wait a year to talk about recovery and not now? Where did this time frame come from? John heard that 80% of the relapses take place in the first 90 days of recovery; clearly this was a crucial time. John asked his counselor about these concerns.

The counselor explained that Claudia Black, a pioneer in treating families with addiction, noted many years ago the common injunction she saw in alcoholic families: ‘Don’t talk, don’t trust, and don’t feel. ‘How is this different from current approaches in recovery where we tell couples to wait a year before talking about addiction and recovery? “John reflected that not talking about recovery kind of felt the same as not talking about his drinking when he was in the middle of it. “The silence felt deafening”, John reflected

John shared his conversation with Carol when he returned home. Carol, shook her head affirming she understood and  related, “Today in a meditation I read this: ‘ Your present circumstances don’t determine where you can go; they merely determine where you start.’, written by Nido Qubein”. I think we need to do this for ourselves and our relationship.” John agreed, “I know we have to talk about what has happened, but maybe that will be easier if we start working on writing a new chapter.” Carol nodded, “It’s time.”  

 

 

 

 

C.A.R.E. to Start a Movement?

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Couple Recovery is Coming Out of the Shadows

I have worked as a therapist for a long time, but about five years into my practice it occurred to me that I didn’t really know how to help couples with substance issues. More on that in a moment, first I have a true confession, public and everything:

Back when I was trying to get licensed as a Marriage & Family Therapist, after completing the three thousand hours of internship, correctly submitting the ???????proper paperwork and documentation, the last step involved being interviewed by a three person board – California no longer does that by the way. This board was a pretty scary thing for me to think about, in fact, kind of terrifying at the time! Their job was to filter the good from the bad, the knowledgeable from the uniformed, the competent from the incompetent, you get the idea. First you had to present a case, then they present a case and ask you all about it, then…whew, they interview you, with intense analytic acumen. I remember feeling at the time that my group of three had mastered the then popular therapist flat, non-emotional face; it was really hard to get a read on any of their reactions to what I was saying. I couldn’t tell whether I was impressing them at all, or whether they were wondering, ‘How did this guy get this far? Thank God we are here to protect the public’.

What I really remember most is one of the final questions they asked, something like this: “Is there a group or type of client you feel you don’t work well with, or that you feel uncomfortable with?” Hmm, I thought a while.  “Well I don’t feel that I’m very effective with alcoholic clients or drug addicts”. There I said it, I was truthful and now they are going to suggest I go back for intensive training and try again in another year or two, or three. Maybe they will, kindly of course, suggest I  get career counseling and look at other options. It turns out I passed.

What is striking to me is that I was still struggling with that discomfort with alcoholics and addicts almost five years after being licensed.  The problem I became  aware of at the time was that literally 80% of my clients had substance issues that were affecting them and their relationships, and I still didn’t know what to do. This started my journey on trying to know what to do. I began reading, began coursework and completed the Advanced Drug & Alcohol Training Certificate at UC Santa Cruz.  I had the opportunity to lead a men’s group at a treatment center, and over time became a clinical director of the program.  My training and affiliation with Dr. Stephanie Brown at and the Addiction Institute led to the wonderful opportunity to take on research through the Family Recovery Project, that Stephanie and Dr. Virginia Lewis co-founded at the Mental research Institute. My dissertation was on couple recovery from that research project. I got my doctorate and continued at MRI as a Research Associate while continuing my private practice. Virginia and I ended up co-founding the Center for Couples in Recovery, where I have continued my research for the last 10 years.

the idea!Needless to say, I feel very different about working with individuals and couples struggling with addiction and recovery. I now understand that addiction is a disease, we now know a lot about the neurobiology of addiction. A useful understanding of addiction, in my opinion, is the Bio-Psycho-Social-Spiritual-Cultural model, accounting for the many dimensions of addiction. We also know a lot about what it takes to make relationships work.

The problem I see now is that while we talk about addiction as a “family disease”, we don’t really treat it that way. When an addicted partner gets into treatment or recovery, often the couples are separated and told to not get involved with any kind of couple work. While it is crucial for partners to  establish their own recovery from this disease, I have come to learn that it is quite possible to address couple relationship issues as well, supporting individual recoveries as well as the couple recovery. By providing couples with tools to manage their relationship while they are trying to manage their own recoveries (hopefully), greater success is likely. Longitudinal research informs us that 8 years post primary treatment for alcoholism, couple and family relationship health was identified as a statistically significant variable. Or, stated less like a research geek, if your relationship is healthier, the chances are better for continued recovery.

Colorful Fireworks

Couple Recovery: Will it explode or fizzle?

C.A.R.E. – Couples Addiction Recovery Empowerment 

Is there a place for couple recovery? Couple Addiction Recovery Empowerment (CARE), is a concept or approach in recovery that accounts for the relationship, supporting the idea of dealing with three recoveries concurrently: both individual recoveries, and the couple recovery. This approach is a very different model than the current models of recovery and treatment. How did this come together for me? Here’s the story on that.

I trained with Drs. Julie & John Gottman, and have been very involved  with the Gottman Institute for the last eight years. We are currently collaborating on integrating our research models into a relational approach to recovery. This approach, the “Couple Recovery Development Approach” (CRDA), blends the Gottman research on what works in relationships and what predicts relationship meltdown and divorce, with the CRDA model emerging from my research. This collaboration with the Gottmans and the Gottman Institute has led to developing a new Gottman workshop for recovering couples, “A Road Map for the Journey: A Gottman Workshop for Couples in Addiction Recovery”. This model is also clinically applicable for individual therapists and recovery counselors to help couples develop couple recovery. 

Two very newly created internet resources I have created:

  1. http://couplerecovery.org/ A website providing information and group forums to share ideas and stories on about couple recovery.
  2. https://www.facebook.com/CoupleRecovery A Facebook page “Couple Recovery Development Approach”, offering resources and another opportunity to share and create community.

These new resources are works in progress and any and all feedback is greatly appreciated.

Care to join the movement? It’s going to take a community.

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 

What I Have Learned From the Gottmans: Where to Start?

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Okay, Let’s Start with the Research

John Gottman’s research on the longitudinal course of relationships began in 1972 when he and Bob Levenson  asked the question: What predicts divorce? At the time there were only six studies on divorce and none were at all helpful. John and Bob did not exactly have a vote of confidence from the academic and research community. John, a professor at the University of Washington, and Bob a professor at UC Berkeley, received much skepticism  with responses characterized by the question: “Social scientists can not predict individual behavior very well, how can you predict relationship behavior?” John and Bob’s research outcomes surprised even them; relationship behavior is predictable, they indeed found out what is associated with relationship breakdown and with relationship stability.

The three areas of John and Bob’s research involved: interactions, physiology, and perception. It turns out that each of these areas have significance in understanding and determining relationship trajectory: either towards stability or instability. What they discovered was that relationships have a  balance between negativity and positivity, called”set points”. In dysfunctional relationships these set points are habitually toward negativity with a dynamic of blame and/or withdrawal, referred to as the “Four Horsemen of the Apocalypse. With over 90% accuracy John and Bob could predict what would happen to the relationship with the knowledge collected in just a few hours. The  consistent escalation in negativity impacts the couple’s ability to repair hurts and conflicts just as the consistent calm characterized in the healthy relationships was an indicator for relationship stability.

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The research was multi-dimensional, involving over 3,000 couples from every major racial and ethic group in the United States, and included a twelve year study of committed gay and lesbian relationships. This is pretty compelling stuff, but what happens next sets this cutting edge research in a unique category of research. It is one thing to  have learned about these relationship patterns and dynamics that provide a way of understanding and predicting relationship trajectory, but it’s quite another thing to make use of it in a very practical and applicable way. It wasn’t until John began collaborating with his psychologist wife, Dr. Julie Schwartz Gottman, that methods were developed to help couples. The outcome of this innovation of blending science and practice was a relationship model developed by the Gottmans, the “Sound Relationship House (SRH) theory. The SRH model provides a map for working with couples involving three different components of relationship – Friendship, Conflict, and Meaning –  broken down into 7 different levels. The SRH model is a non-linear, interactional model, with separate but related levels that effect each other.

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Now Let’s Talk About What They Did with the Research

Together, Drs. Julie and John Gottman co-founded the Gottman Institute, a vision aimed at helping couples and training therapists in this research-based approach of couple therapy. The Gottmans created “Art and Science of Love:  A Weekend  Workshop for Couples, an intensive experiential workshop where couples are provided tools and given information on what emerged from the research.

Additionally, through Gottman Institute has trained countless therapists over the years and has developed training program options with opportunity to deepen the understanding and application of the SRH model. In the spirit of “pass it on”, the Gottmans have transitioned from providing all the training to training Certified Gottman Therapists to be trainers and to continue what has been this important work.  What a gift it has been to be a part of this work. Untold hours have been spent by the Gottmans and their team under the able direction of Etana Dykan Kunovsky (who has been there from the start), and Alan Kunovsky, developing and continuing to evolve the workshops for couples and the the training workshops for therapists.

I’m not intending to write this article as an advertisementt, but rather as an acknowledgement and public appreciation of a brilliant model of research and practice that has  developed into a process of bringing  important information about relationships to couples and to therapists.

What I believe drives the success of this model is the underlying philosophy John and Julie hold, that the SRH theory and methods of intervention are continuing to evolve and be developed and deepened. Like all healthy relationships, growth is ongoing, we are never really done in the sense of reaching a certain stage of development – “Whew, we have arrived”. Rather the ups and downs, success and failures all lead to a sense of continuing change and growth.

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What This Has Meant To Me

Over 10 years ago I began my own research with couples in recovery from addiction. This work has continued with the support of the Mental Research Institute (MRI), where I am a Research Associate in addition to my private practice. It turns out that we know a lot about how addiction affects couples, but not very much about how to actually help relationships impacted addiction. I too have been met with skepticism over the model I have developed helping couples in recovery, because couple therapy traditionally is discouraged unless they have years of recovery.

Much to my own surprise I have found striking similarities with SRH model and my Couple Recovery Development Approach (CRDA). What I didn’t have, however, were interventions to help couples. This is where Gottman Method therapy enters. I have been fortunate enough to collaborate with John Gottman in developing my own adaptation of Gottman therapy for recovering couples. This research/practice model developed by John and Julie Gottman has motivated and inspired me, and provided a road map of sorts on how to develop this model and get the work out to couples and to recovery professionals and therapists. Both Julie and John express their continued support and mentoring in developing a workshop for recovering couples and tools for clinicians in helping recovering couples.

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With Gratitude

Couples in Addiction Recovery Empowerment (CARE), is a concept of  relational approach to recovery, one that supports individual recovery in the context of the couple relationship, essentially creating a “Couple Recovery”. As I have learned from the evolution of John’s research to a model of practice:

  • I am grateful for beginning this phase of work with the support from the Gottman Institute and John & Julie  
  • I aspire to innovate and continue to collaborate in developing couple recovery approaches.
  • I hope to be a part of creating a vision of couple recovery as a widely accepted practice within recovery circles
  • Perhaps others will feel motivation and continue to motivate me in carrying this forward

A Road Map for the Journey: A Gottman Worshop for Couples in Addiction Recovery, is a two-day workshop I developed in collaboration with John and Julie Gottman and sponsored by the Gottman Institute and Edgewood Seattle Addiction Services. The workshop debuts April 5 & 6, 2014 at held at Edgewood Seattle. After a decade, this is quite a dream come true. I am very grateful to be a part of the Gottman Community.

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

Relapse: What Now?

Joel walked into my office looking tense and uncomfortable. He was there  for his weekly therapy session where we have been addressing his amphetamine use and depression. His eyes avoided mine, clearly he was upset about something. 

Joel is just now dealing with his amphetamine use and coming into the realization that he may have an amphetamine dependency. This is a huge transition for anybody who begins to realize that “Maybe  I CAN’T control this”.

“What’s happened Joel”, I asked, suspecting the answer would relate to his drug use. “Well, I made a phone call to a Mexican pharmacy. They sent me my order (a stimulant used to treat ADD) and I used them over the weekend. This feels like such a dead-end”.  

Joel had relapsed, but had been able to tell me. Relapse and shame tend to go together, as they have for Joel. “I’m glad you told me. Let’s talk about what happened. Does your partner know you used?” Joel and I used the rest of the session to deal with what he shared, and what next steps he might consider.

 It turns out that Joel did tell his partner. While I am not working with the couple, I offer ideas to Joel about considering relationship issues in the context of his recovery.  Relapse translates to the need to reevaluate the current program and strengthen it somehow.

How can couples manage relapse? One of the strategies I talk about with couples is to have a relapse strategy in place. Once somebody has committed to sobriety/recovery, the couple can talk about what they would do and what would need should the partner relapse. For example, one couple I worked with came up with a plan that should there be a relapse, the addict partner would take the next steps in increasing a recovery plan to include an evening treatment program. His partner said she would need to be able to tell her family, so she could get support. She also talked about her need to be in a couples support group or 12 step program like Recovering Couples Anonymous (RCA). Both partners said they were committed to the relationship and would want to work in ways to manage recovery for the both of them individually and as a couple.

Couples who can talk about relapse – the thing they hope will never happen – are better equiped to deal and manage with relapse if they are prepared. Hopefully relapse fears can freely be talked about, and built into an ongoing dialogue.

Having said that, we still take it one day at a time. 

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