Addictions: Treating the Family Struggling with Sobriety

In the last section, we discussed the effect addiction has on children. The four aspects of the addictive process affecting children are consequences of addiction affect children differently, the innocence of children, the attachment of the child to the addict, and the age and development status of the child..

In this section, we will discuss the characteristics of a family entering recovery. We will also discuss the three key steps family members of addicts make as they become ready to enter recovery. These are, accepting they cannot control the course or consequences of the addiction, realizing that family interactions have been controlled by the addictive process, and finding out that addiction is an illness.

When I think of a family entering recovery from addiction, the image of a town damaged by a hurricane comes to mind. Some individuals leave the battered town and write it off as an unpleasant memory. Most families experience intense psychological and emotional damage from the storm, and need to begin an extensive rebuilding process. I find that some of the most common signs of this damage are, a genuine desire and hope that everything will be fine now tempered by distrust, and a collective loneliness.

I have also observed signs of hopefulness and cynicism, hurt, anger and fear, high levels of mistrust for even positive changes, and the use of a defense system. In addition, my colleagues frequently see skepticism about the future, focus on short term needs and issues, and reliance on a drive for power rather than a drive for meaning in families entering recovery from addiction.

3 Steps Family Members Make as Addicts Become Ready to Enter Recovery

♦ # 1 - Realize the Lack of Control
As you know, as the family enters recovery, the first major step is realizing that family members cannot control the course or consequences of the addiction. Early in her recovery process, my client Millicent, whose 35 year old son had just entered treatment, told me "David’s alcoholism is all my fault! I couldn’t breast feed him as a baby!" I explained to Millicent that it is not their fault that he or she cannot stop their loved one’s addiction.

I find that it is difficult for family members to realize that staying up until three in the morning, waiting for their teenage addict to come home, does not help in my experience, yelling and making demands can no more stop addiction than they can stop heart disease. Do you agree that the first major step for family members is accepting that they are powerless over the course of the addiction?

♦ # 2 - Realize that Family has been Controlled by the Addictive Process
I find that the second major step for family members entering recovery is to realize that the family interactions have centered around and controlled by the addictive process. As you know, if family members continue to believe that they can fix, control, or gather the strength to beat ‘the problem’, they will continue living in denial.

♦ # 3 - Realize that Addiction is an Illness
In addition to accepting the family cannot control the course or consequences of the addiction and realizing that family interactions have been controlled by the addictive process, the third step I have observed is realizing that addiction is an illness. I find that this is also the first concrete step of recovery. As you know, some family members feel a great sense of relief when they realize addiction is an illness. However, I have observed that many family members have trouble understanding addiction as an illness.

Do you agree that this is often due to hurt, anger, and the mistaken assumption that admitting they are dealing with an illness means that they must forgive behavior they find unforgivable? My client Anna, the 19-year-old daughter of an alcoholic, told me, "Am I just supposed to forgive him because he has a disease? Am I supposed to just forget the time he peed in the corner in the middle of the night because he was so trashed he thought it was the bathroom? I’m sorry, but it doesn’t work that way for me. If he wants me to forgive him, he’s got a lot of work to do!" 

Do you find that Anna’s reaction is the most common? I find that many family members want ‘proof’, such as months of sobriety, before they begin to let their defenses down. As you know, this is normal and understandable, but family member need to open to others outside the family who can help them start the recovery process.  I find that it is useful to explain to family members that accepting addiction as an illness does not automatically absolve the addict of past behavior. 

♦ "Control Check" Technique, 3 Steps
One technique I recommend for clients who are struggling with recognizing that they cannot control the addict’s behavior is a journaling exercise I call the "Control Check".
Step 1: In this exercise, I first ask my client to write as much as they can about the addict, and what ways they think they attempt to control the addict.
Step 2: Next, I ask my client to write in what ways (mentally, physically, or emotionally) they are being controlled by the addict.
Step 3: Finally, I ask four questions for my client to write a response to:
-- a. What will probably happen anyway, even if you try to control the addict’s behavior?
-- b. How are you benefiting by attempting to control the situation?
-- c. How is the addict benefiting?
-- d. How effective have your attempts been to control the addict’s behavior?
Although this exercise can be painful, clearly it is a good method for opening up a discussion about the nature of the family’s attempts to control the addict.

In this section, we have discussed the characteristics of a family entering recovery. We also discussed the three key steps family members of addicts make as they become ready to enter recovery. These are, accepting they cannot control the course or consequences of the addiction, realizing that family interactions have been controlled by the addictive process, and finding out that addiction is an illness.

Peer-Reviewed Journal Article References:
Cordova, D., Huang, S., Pantin, H., & Prado, G. (2012). Do the effects of a family intervention on alcohol and drug use vary by nativity status? Psychology of Addictive Behaviors, 26(3), 655–660.

Ennis, E., & Trearty, K. (2019). Attachment orientations and adult alcohol use among those with childhood adversities. Journal of Individual Differences, 40(4), 187–193.

Field, M., Heather, N., Murphy, J. G., Stafford, T., Tucker, J. A., & Witkiewitz, K. (2020). Recovery from addiction: Behavioral economics and value-based decision making. Psychology of Addictive Behaviors, 34(1), 182–193.

Hodgins, D. C., Kim, H. S., & Stea, J. N. (2017). Increase and decrease of other substance use during recovery from cannabis use disorders. Psychology of Addictive Behaviors, 31(6), 727–734.

Koffarnus, M. N., Kablinger, A. S., Kaplan, B. A., & Crill, E. M. (2021). Remotely administered incentive-based treatment for alcohol use disorder with participant-funded incentives is effective but less accessible to low-income participants. Experimental and Clinical Psychopharmacology, 29(5), 555–565.

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., Miller, M., Burlew, K. A., Hodgkins, C., Carrion, I., Vandermark, N., Schindler, E., Werstlein, R., & Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713–727.

QUESTION 6
What are the three key steps family members of addicts make as they become ready to enter recovery? To select and enter your answer go to Test.