Stephanie Brown, in her book The Alcoholic Family in Recovery, discusses four distinct stages that the alcoholic and the family surrounding him or her must go through to achieve recovery:
The 1st stage is the Drinking Stage and is highlighted by the family denying that any family member has a drinking problem, while at the same time giving reasons to anyone who will listen why the drinker has the right to drink.
The 2nd stage is labeled Transition, and the focus is the beginning of abstinence for the drinker. This is a time for the family of the alcoholic to finally come to the realization that the alcoholic cannot control his/her drinking and the co-alcoholic cannot control the drinker. (A co-alcoholic is defined as the person(s) who enables an alcoholic by assuming responsibilities on the alcoholic’s behalf, minimizing or denying the problem drinking, or making amends for the alcoholic’s behavior [Drugs.com, accessed 4/28/2015].)
The 3rd stage, called Early Recovery, is when this couple works on individual healing, versus the healing of the whole of the family unit.
The 4th stage is Ongoing Recovery, where “individual recoveries are solid and attention can be turned back to the couple and family” (Brown, 1999, p114).
Stage 1: The Drinking Stage
Therapists working with the family in the drinking stage must focus not only on the drinking behavior of the alcoholic, but also the distorted belief system of the rest of the family that emotionally and physically supports the drinking. The family must quit denial and support of the drinking, and begin to find avenues to reach out for help.
For the therapist dealing with a drinker in the drinking stage, the imperative is for the drinker to begin abstinence. Attempts are made to help the drinker gain insight into why life has become for so many in the family unit unstable. However, in the final analysis, it is up to the drinker to begin the process of recovery. The therapist helps to break down the walls of defiance in the drinker’s belief system that they are in total control.
Stephanie Brown describes the insanity of the drinking stage in being like a dance: “The drinker leads and the co-alcoholic follows in a way that keeps them dancing. The leader may stumble, drift away, step all over the follower, or even break up the dance by changing partners. The co-alcoholic’s only response is to try and keep the dance going” (Brown, 1999, p 171).
The therapist must encourage the family to help the alcoholic end the dance by realizing they cannot control and enable the drinking and that only when they reach out for help outside the family system may they be led into the stage of transition.
Stage 2: Transition Stage
The transition stage is a complex ebb and flow during which the alcoholic works through no longer drinking, and the family struggles with the transition of living through the end of the drinking to the beginning of abstinence.
The environment within the family at the end of drinking is made up three distinct variables:
- Increasingly out-of-control environment
- Tightening defenses to prevent or forestall systems collapse
- A last ditch attempt to maintain denial and all core beliefs
The therapist has a multitude of functions in the beginning stage of transition. The therapist must help guide the alcoholic to realize the loss of self-control with their drinking and, with this understanding, help the alcoholic realize that they must reach out to outside help (ie, AA) to have any realistic chance to stay sober.
In the meantime, the therapist has to help the family—who has been dealing with supporting the drinker’s world that is now beginning to crack and crumble—realize their need for help (ie, Al-Anon) in handling how the denial, core beliefs, and out of control behavior made them, as much as the alcoholic, a prisoner of the drinking.
The therapist is a guide to help find sobriety, and a place to go for information when life is a bundle of confusion. “Are you going to meetings?” “How are you feeling?” “Take it one day at a time, first things first, and set priorities” are statements repeated by the therapist until the client can recite them for themselves.
As the family begins to move from drinking to abstinence and to the later half of the transition stage, Brown describes four focal points the family must be aware of:
- To focus intensely on staying dry
- To stabilize the out-of-control environment
- To allow the family support system to collapse and remain collapsed
- To focus on the individual within the family
The therapist, after seeing that the family is stable enough and has lifeboats in place (AA & Al-Anon), can begin to investigate underlying feelings that may be triggers or causes of past and current drinking relapses. The therapist must also be attentive to how children in the family are being cared for and if they are handling the changes to the family structure.
Forward movement is the key and the best way to help clients reach for and know when is the right time for the family to move to the next stage: Early Recovery. In reality, this may take years based to severity of the past drinking.
Stage 3: Early Recovery
The main difference between the transition stage and the early recovery stage is a general lessening of the physical cravings and psychological impulses for alcohol. The therapist must always look for potential relapse signs, but this factor lessens as time moves forward.
An item the therapist must address in the early recovery stage is continual support within the alcoholic’s family to stay focused on their own recovery. By this stage co-alcoholics, if they are not getting support of their own, may become weary of the lack of attention from the alcoholic who is busy trying to gain support (AA) to stay sober. The co-alcoholic may have been the controller of the drinker and now has to live with decisions of the family being completed by committee. It is imperative that the therapist is able to construct support for both the alcoholic and the co-alcoholic; each has issues that must be addressed so that recovery can continue.
As recovery moves forward, hidden and latent issues that fostered drinking or was created by the trauma of the drinking environment may need individual attention. Not only does the therapist become the guide for the family, but also the provider of information in this stage.
The therapist must:
- Continue to teach abstinent behaviors and thinking;
- Keep families in close contact with 12-step programs and help them work on the steps;
- Keep focus on individual recovery, seeking outside supports for the family;
- Maintain attention for the children in the recovering family; and
- Keep a continual eye on potential issues, such as the onset of depression, emotional problems, sleep problems, fear, and/or helplessness.
Stage 4: Ongoing Recovery
This final stage is relatively stable in comparison to the earlier three stages. This is because recovery is now solid, and attention can be turned back to the couple and the family.
The family focus lies in the area of staying on task (sobriety) and committed to recovery, and building up the structure of the family after it had been torn down in the earlier stages. The family had reached for outside help (AA, Al-Non, therapy) and now, after finding themselves and actually liking what they see in the mirror, it is time to do the following:
- Heal the emotional separation issues
- Look in-depth at what damage had been done to the family due to drinking
- Study the underlying causes of the drinking behavior
The ongoing recovery stage is a time for the creation of healthy relational dependence within the family and the understanding that recovery is a process, not an outcome (Brown, 1999).
The therapist’s main functions in this stage are:
- Make sure family is continuing abstinent behavior
- Expand the family’s alcoholic and co-alcoholic identities
- Ensure that everyone maintains programs of recovery (work the 12-steps and internalize 12-step principles)
- Focus on the couple and family issues
- Explore spirituality issues and past childhood and adult traumas
As I constructed this article, I was struck in many ways how involved and complex the role of the therapists is during an alcohol recovery process. It is more than being a listening ear in the background; it is a juggling act of many aspects of recovery.
The therapist is one step ahead of the family—guiding the family and the drinker to realize the importance of changing behavior; all the while wondering if what they are trying to accomplish will actually work.
The family and the drinker must come to a point in their lives that only when heartfelt change is ingrained will real change occur in the family. In truth, the magic of recovery is with the drinker and the family, not the therapist.
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