‘Unraveling the Mystery of Personal and Family Recovery: An Interview with Stephanie Brown, PhD’ by Bill White (Part 3)

Unknown-4Bill White: In 1999, you published a book with Virginia Lewis that virtually transformed my own understanding about family recovery from alcoholism. Could you share with our readers how the book came to be written and some of its major conclusions?

Stephanie Brown: The book came at the end of a ten-year research project that Virginia and I undertook in 1990 to study the process of recovery for the family. I had always wanted to know what happens to the whole family when the drinking of one or both parents stops.

We asked the same main question I had asked previously: is the process of recovery for the family similar to the process for the individual, and do the stages of active addiction and recovery I identified for the individual hold true for the family? We discovered pretty quickly that these stages do hold true and that they are a good guideline for understanding what happens with recovery growth following abstinence.

We realized we needed a different kind of model to understand the processes involved for the family. So, we developed a matrix in addition to the linear, sequential stage model. Through the matrix, we included domains of experience along with the stages of family change in the academic book that was published in January, 1999.

The domains of experience allowed us to look at the environment and family system in addition to individual experience. The environment includes the context and atmosphere of family life in which we all live every day, but rarely think about or acknowledge. We looked at the atmosphere, the mood, the tone, the feeling, the emotional experience of living within the addicted family as it transitioned into recovery and beyond. We quickly identified trauma as an organizing theme for the change process.

Bill White: Yes, you used the phrase “trauma of recovery” that just stunned me when I first read it.

Stephanie Brown: By 1994/95, we were well into analyzing family data and clearly saw that the experience of trauma, so starkly evident during active addiction, continues in the beginnings of recovery. Most people expect that when the drinking stops, everything is going to be fine, and it isn’t. It isn’t for the individual, and it definitely isn’t for the family. New kinds of problems actually emerge with recovery, totally unexpected because no one knows what to expect with abstinence, and the family members do not know how to operate without the drinking.

The family system in active addiction achieves homeostasis by adapting to the pathology of addiction. The family system works during active addiction to maintain the status quo, but when you enter active recovery, those mechanisms no longer work. And, there are no family system mechanisms yet developed to support healthy living or healthy relationships.

That leaves the family in the beginnings of recovery without structure to nurture and support the health of family members or the family as a whole. There’s a vacuum in the system, which often creates more trauma – new trauma – which we labeled the “trauma of recovery.” Clearly, this vacuum is a time when the family needs much greater external support to help “hold” them in their new recovery process. The transition from exiting formal treatment to achieving stable family functioning is still a huge vacuum for many families.

We found, sadly, shockingly, that children are often more traumatized in the beginnings of recovery than they were during active addiction. The traumas of new recovery often involve abandonment by both parents as the parents are told to focus on their own recoveries. It used to be, in the ’80s and ’90s, that both parents might be instructed to go to meetings to focus on their own recoveries, and, in essence, not to worry about their children, which is a huge problem. We’re seeing corrections in that model as parenting and the importance of continuing, or starting, a new focus on your children is now a part of treatment programs.

Our research families – the adults and many of their children – told us that the children felt initially abandoned and lost with recovery for their parents. They didn’t understand what was happening, and many were frightened. They knew their parents were supposed to be doing something that was healthy and good for the parents, but many kids were left to fend for themselves. One young adult told us he felt guilty having needs as an 11-year-old with newly recovering parents because they were working so hard to be sober, and he didn’t want to be a burden to them.

Continuing our summary of the research design, we explored the environment, the family system, and individual development as three domains of experience. To assess changes in these over time, we did a three-hour live, videotaped interview with families, and a number of paper-pencil tests of family system function.

We analyzed the interviews word-by-word to determine the stages, key issues, and themes that occur for the family and family members in recovery. We also tracked developmental process in each domain. The data and the books describe what is “normal” in family recovery and how to assess family movement, process, and points in each domain where a family or individual can get stuck.

Bill White: You’ve proposed that the roles, rules, rituals, and other homeostatic mechanisms that allow the addicted family to function must collapse and be replaced in the recovery process, and you’ve recently talked about the need for what you call scaffolding that can support the rise of a new family process. What happens if families don’t have that kind of scaffolding?

Stephanie Brown: Most families in recovery have not had that scaffolding, which means external structures of support. In the early days, family members were viewed as “support people” for the addicted person, an extension of “codependent” family dynamics. In essence, they were expected to become the “scaffolding” for the newly recovering addicted person.

It’s only recently been recognized that family members need their own separate recoveries as individuals, and that they must “detach” from their unhealthy involvement with the addicted person. This is of course what Al-Anon teaches. But this is tricky to understand.

It’s easy to think that family members are not supposed to care about others in the family. It’s another paradox: family members can be supportive of others’ recovery as long as they have their own, and that their own individual recovery comes first. What needed to change was the expectation that family members would continue to abdicate their own needs, as they had done during the active addiction, to watch out for the needs of the recovering addict.

Families who participated in “family programs” during the ’80s and ’90s were provided some degree of “scaffolding” during the course of that treatment, but not much because they were not the “identified patient.” As many told us in the research, they felt important before the addicted person entered treatment, and unseen as soon as the addicted person was in treatment. Structural supports, including education, recovery planning, and support people, were only available to the addicted person post-treatment.

There were some pioneer programs, such as the children of alcoholics services provided at the Betty Ford Center in Palm Springs and a few family programs that provided education and support for family members’ recovery. But there is a vacuum in understanding the need for continuing focus and services to address the primary needs of all family members in transition and early recovery.

The 12-step programs of AA, NA, and Al-Anon have always provided the “scaffolding” of individual support. These programs help people tolerate and survive the vacuum in the family system that occurs when the pathology of the addiction-organized family system collapses with the onset of recovery.’