type a refection reading summary that includes personal refection. - Identify one or more concepts from each chapter that is/are most interesting to you. Describe why you find these concepts interesting, for personal or professional reasons. Describe why these concepts are important for addiction counselors to understand. Create 3 or more sentences for each chapter. Attached are the chapters reading are to come from.

 

ΙΝΤΡΟ∆ΥΧΤΙΟΝ
Ωηατ
Ηαππενσ Ωηεν τηε ∆ρινκινγ Στοπσ? CHAPTER ONE What Happens When
the Drinking Stops? T his is a book about the alcoholic family in recovery. Why the family? Much of the literature on addiction and its treatment still focuses
on the drinking alcoholic, with little or no attention to the family as a
whole. In seminal works, Joan Jackson (1954, 1962) described the
spouse of the alcoholic many years ago, and Steinglass, Bennett,
Wolin, and Reiss (1987) outlined the dynamics of the alcoholic family
more recently. But neither focused on recovery. And, as was true for
the individual alcoholic, coalcoholic, and children of alcoholics 20
years ago, there is still no knowledge base about the family’s experience of recovery. All of the attention has been on drinking, with the
implication that abstinence would be the answer to everyone’s problems. It was incorrectly believed that if the alcoholic stopped drinking
and participated in a program of recovery (perhaps professional treatment and definitely Alcoholics Anonymous), the family would heal
itself. Not so. We know from years of clinical experience and from the
wealth of information now available regarding children of alcoholics
that alcoholism affects the entire family, as individuals and as a whole.
So does recovery. We wanted to find out how.
We already knew that many marriages and partnerships do not
survive addiction. But what about recovery? Is the damage of drinking
so great for some that, in their view, they are beyond repair? Or, is recovery itself so full of unexpected change that many couples give up,
determining that abstinence has not solved the family’s problems after
3 4 INTRODUCTION all, and there is no hope for the couple? Who stays together, why, and
how do they do it?
As you’ll hear from couples and families in recovery, abstinence is
as hard or even harder than drinking because it reveals so many problems that were obscured by the family’s focus on alcohol. Denial looms
as large as ever as the family faces the harsh realities of delusion, illusion, and collusion that predominated during the drinking and that
are now laid bare by abstinence. In so many families, the entire system
became organized by alcoholism. What is left to organize the family in
recovery?
With the knowledge that many couples end their relationships
following abstinence, we wanted to know what happens for the couple
that stays together. Why are they still together in recovery and how
has this occurred? Have they had certain experiences, or completed
tasks that have helped and what do they know about the pitfalls?
Is it possible that some couples end their relationships too soon
(and others not soon enough) because recovery in the first few years is
so hard, and because there is no “map” to chart the way and no other
couples with whom to share their experiences? We believe this is so.
Not every couple will or should survive recovery. But many more couples might decide to wait with a little more knowledge about what is
normal based on the experience of those who have come before. In
this book, you’ll hear that many of our families are glad they waited;
and some don’t know yet. THE RESEARCH
These questions formed the base of the Family Recovery Research
Project. We worked with 52 couples and families with lengths of abstinence ranging from 79 days to 18 years. We asked them to participate
in a live, 3-hour, audio- and videotaped interview, to take five tests of
individual and family function, and to answer a comprehensive demographic questionnaire. In contrast to this one-time interview and testing, we also worked with three couples with long-term sobriety in an
ongoing couples group. Meeting once a month for five years, this
group gave us data about the process of recovery for the intact couple
over time. Finally, we developed a curriculum for families in recovery.
Called MAPS (for Maintaining Abstinence Programs), it consisted of
12 weekly meetings for couples and families with more than a year of What Happens When the Drinking Stops? 5 abstinence. In these meetings, we outlined the process of recovery for
the family, based on our belief that education about what to expect
and what is normal following abstinence would be helpful. It was. Participants unanimously valued the information and the experience of
sharing with other couples and families. The research interview is in
Appendix A, and a summary of the study sample is in Appendix B.
A critical aspect of this research and prior studies involves membership in Alcoholics Anonymous (1955) and Al-Anon (1984). In
the original study (Brown, 1985) of the individual alcoholic, all subjects were members of AA. Thus, the model that emerged was a theory
of recovery only for people who stopped drinking and belonged to AA.
In our Family Recovery Research Project, membership in AA and
Al-Anon was not required. It turned out that the majority of self-identified alcoholics did belong to AA and a smaller percentage of their
partners belonged to Al-Anon (see Appendix B, Table B.1). A few of
our couples used religion and/or therapy as their primary source of support and had no involvement in AA or Al-Anon. Some used all.
Many of the individuals who used both the 12-step recovery program and therapy viewed them as complementary. We heard few, if
any, worries that therapy might interfere with the 12-step philosophy,
a concern expressed by many of the participants in the research on alcoholics 20 years ago (Brown, 1985). In fact, many felt their 12-step
recoveries were greatly enhanced by individual, couple, or family therapy.
We found that the developmental model describes a process of
profound change over time, which is very much related to being in
AA and Al-Anon but not limited to these programs. The critical
mechanisms of change involved the experience of “hitting bottom,”
the acceptance of “loss of control,” and reaching outside the family for
help.
We found significant differences in the experience and the process of recovery depending on whether both partners, one partner, or
neither sought outside help. To a very significant degree, the ability to
seek help and engage with help outside the family was the most critical factor facilitating long-term change. We will emphasize this paradoxical finding throughout the book.
We state it now because we are very biased. We both believed in
the positive benefits and, indeed, the power of AA and Al-Anon before we started, and this belief shaped our work. We still do. In this
book, we will confirm “loss of control,” the core of AA philosophy 6 INTRODUCTION (Brown, 1985, 1993), as the central organizing principle of active addiction, abstinence as the cornerstone of recovery, and the unequivocal value of AA and Al-Anon. We learned something about why these
programs are so helpful to the individuals and the family, which we
will report.
From our interviews with families, a theory emerged that is consistent with the earlier developmental model of recovery for the individual. We will outline what recovery is like, what to expect, and even
what’s normal. Abstinence marks the beginning of a new developmental
process that has a profound, complicated impact on the whole family.
The theory that emerged from our research confirmed our clinical
experience but also yielded unexpected findings. It sometimes shocked
the families, and it may also surprise our readers. The necessary, normal process of growth and development goes against some cherished
beliefs of what should be normal and healthy, and especially how we
think people change. It also challenges therapists’ principles and ideas
about practice: what to do, what not to do.
This model of change is counterintuitive. It goes against the grain
of what we tend to think is normal. So, some therapists may well have
to shift figure and ground, letting go of their ideas of what change
should look like and how it occurs; otherwise, what we describe below
won’t make sense. This turning upside down is exactly what families
have to face as well.
It is never easy. In fact, many of our assumptions (based on
Brown’s prior research) in undertaking the work are still controversial
among professionals. Certainly families who are still drinking fight
these core principles, sometimes almost literally “to the death.” Only
from the vantage point of being “in recovery” can they see that their
old beliefs, behaviors, and conflicts kept them drinking and kept them
locked in pathology. Let us now look at the controversial assumptions
and paradoxes that underlie and shape the whole book. KEY ASSUMPTIONS AND PARADOXES
1. Abstinence is not recovery. Abstinence provides a necessary
foundation for the beginning of a developmental process of recovery. With the cornerstone of abstinence in place, the entire family
may embark on a major process of change that occurs both quickly
and slowly over time. What Happens When the Drinking Stops? 7 2. Recovery is a developmental process, not a singular event and not a
prescribed outcome. Becoming abstinent is a process and an event. It is
also an outcome—the targeted goal of treatment interventions. Today,
since many therapists are strictly problem focused, help can mean fixing people and a belief that therapeutic success should come quickly,
with measurable improvements. While a focus on problem resolution
can be enormously useful for many kinds of difficulties, it can severely
limit the therapist who is working with the drinking or recovering alcoholic family.
With our emphasis on process, we’re talking about the big picture,
the long haul, and a natural order of change. Time is essential. Much
of the process is evolutionary and developmental, rather than prescriptive. Change is incremental and layered. It builds on itself. It is also a
process of “fits and starts,” as one family described it:
“We went through a series of crises which pushed us to a new
level. Then we’d stabilize until another crisis would push us
again.”
As an interactive process individuals must accommodate to the
changes they are making, which in turn generate further change and
accommodation. Several of our families described this process as a
“ripple” effect. Change builds upon itself and leads to other changes.
A couple with 8 years of recovery illustrates:
“The kinds of changes we were making at 5 years simply weren’t
possible at 6 months, nor did they have the same meaning.
Change is the result of the accumulated strengths of the new
foundation. The positive energy of recovery gave us different attitudes, which changed the way we related to each other.”
Still, therapists will ask: What kind of success is it when many
people feel worse, look worse, and function worse in abstinence than
they did when they were drinking? And what kind of outcome is this if
everyone is happy about it, or at least philosophical and accepting?
What kind of outcome is it if the family says that it’s falling apart, that
nothing works anymore, nothing makes any sense, and they’re all
grateful they got here—or that it’s so bad they don’t know if it’s worth
it or whether they should stay together? Many therapists, looking for 8 INTRODUCTION measurable improvement, will not have an easy time with such outcomes, at least at first.
In a developmental frame, human beings are dynamic, fluid, and
changing, rather than static. So are families. Applied to alcoholism
and the alcoholic, abstinence is not an end or a static state but the beginning of a new process of development.
In the developmental view, growth and change occur over time
and can be defined according to the particular task and stage. Growth
is hierarchical in the sense that the early or beginning tasks and stages
lay a foundation on which further, more complex development can occur. Problems in the successful completion of any task or stage may be
traced to unfinished tasks or missing pieces along the way. Holes in development can contribute to ongoing problems that require intervention and repair.
The developmental view applies to most theories of human
growth ranging from the biological (including neurological and
psychophysiological) to cognitive, behavioral, and emotional approaches. It also applies to the progression of drinking and recovery.
The program of AA, including the 12 steps, outlines a process of
growth that takes place over time in which each task and stage follows
from and builds on the preceding one.
Through “working the program” individuals in AA and Al-Anon
learn how to track their ongoing development in recovery, including
watching for problems and recognizing holes that need attention and
perhaps repair. Many individuals and families in therapy are doing the
same thing.
In this longer, comprehensive view, what might be labeled as a
problem—to be fixed—in a short-term frame, can be seen instead as
part of a stage, part of a process. It may seem and, in fact, it may be
very negative in the up-close moment, but a wide-angle lens casts a
different view. It gives context and perspective. We may then decide
whether or not to intervene. We do not assume the family is headed in
the wrong direction, although we assess the possibility. It is just as
likely that they are actually moving toward a more positive way of relating. We might tell them, for example, that the disruption and turmoil they are experiencing at 6 weeks’ or 3 months’ abstinence is normal, that they do not need to try to stop it, or fix it. Families do need
support in living with it, however, which we would address directly.
Are they going to meetings, sharing with others? At this point in time,
we assess structural support rather than targeting symptom reduction
as the goal. What Happens When the Drinking Stops? 9 What does this mean for therapists? Being in recovery is not itself
a problem to be treated, though unfortunately it is sometimes seen this
way. That’s because recovery is often just as traumatic as drinking, but
in different, paradoxical ways. Many changes that are necessary to
move to abstinence and to set a recovery foundation in place are
themselves traumatic. Thus, individuals and families are faced with
the dilemma that what is absolutely necessary to establish and maintain recovery can also cause problems and even damage, without
awareness and support. Years into recovery, families may go back to remember and resolve the trauma of “what it was like” and “what happened” in drinking and recovery.
Being in recovery is a normal process, with clearly defined, predictable tasks and stages. It is absolutely vital for therapists to know
what is normal over time in the process of recovery or they may inadvertently try to treat, stop, or fix what is normal and necessary to
growth. It is the therapist’s job to stay out of the way of the natural
healing process, to monitor progress, and to recognize past or current
roadblocks that might interfere with people’s ability to remain abstinent and engaged in recovery. It is also the therapist’s job to know the
path, to anticipate the seemingly unresolvable conflicts families will
face, and to help them cope with these challenges in ways that will
minimize secondary trauma. The complicated task for the therapist is
to constantly assess what is part of growth—for this person and this
family—and what is a sign of difficulty that requires intervention. The
individuals and the family hopefully are doing the same thing.
It is the therapist’s task to listen, interpret, advise, educate, and
coach all along the way. It is not the therapist’s job to dictate what
change should be. For example, the therapist is not approaching the
family with a goal of helping people express their feelings more or less,
based on the therapist’s idea of what constitutes good therapy. The
therapist instead wonders how the expression of feeling at this point in
time, in this particular family, will facilitate or inhibit the developmental process of recovery. The therapist is always guided by a focus
on the organizing principles of loss of control, abstinence, and the
long-term, developmental process.
3. Recovery is an interaction and an interactive process, meaning that
there is no predetermined end or goal to achieve. It’s an interaction of the
individual’s relationship to self and other and family members’ relationships with one another. It’s an interaction that builds on itself, reinforcing and strengthening the foundation that will hold and later 10 INTRODUCTION shape healthy couple and family relationships. Recovery is the result
of the individuals’ and couples’ participation in it.
4. This interaction creates a constant, what some might even call a
chronic, tension within the family: the tension between the focus on the individuals and the focus on the family as a whole. Both are vital, though the
primary focus changes depending on the particular stage and task at
hand. In the beginning, confusion about what is necessary and what is
desirable often causes serious difficulties.
Couples need to tolerate ongoing ambiguity as part of this tension. They need to tolerate not knowing much about anything, which
is often so frightening it pushes people to premature action and closure. Recovery in the beginning is so new and so shocking, and reality
is so different from everyone’s dream, that it is sometimes hard to find
a basis for hope. It is also hard to trust in the natural process and to follow a path, usually AA and Al-Anon, when the impulse is to seize
control, carve out one’s own plan, and end the state of “not knowing”
and uncertainty.
This is why it is essential for therapists to know what is normal
over a long period of time. They can help the couple and family tolerate all the unknowns by literally mapping out the terrain, offering support and suggestions for coping, as well as tracking progress and pitfalls.
5. AA, Al-Anon, and other 12-step programs are valuable sources of
help for people who are facing addiction. Unlike most professional therapies, the “message” of recovery is carried through an apprentice model.
That is, people who have come before share their “experience,
strength and hope” with those who are following (Alcoholics Anonymous, 1955). Through this supportive, reassuring chain of shared experience, individuals learn how to maintain abstinence and build sobriety. We will emphasize and illustrate how membership in a 12-step
program helps people tolerate all the tension, ambiguity, and “not
knowing,” and literally “holds” (Winnicott, 1953) the family through
the recovery trauma of massive disruption, change, and new development.
6. Therapists can also be valuable sources of help for people who are
facing addiction. In tracking the normal process of recovery, therapists
will stand ready to intervene at behavioral, cognitive, psychodynamic,
and systems levels, based on the stage and task of recovery and the
needs of this particular family. As noted above, intervention is guided
by a focus on maintaining abstinence and the organizing principles of
the developmental model, particularly loss of control. It is not deter- What Happens When the Drinking Stops? 11 mined by a therapist’s preferred treatment modality, a shift in frame
that is often difficult for therapists. Having been trained to specialize
in one school—behavioral, cognitive, psychodynamic, or systems—
therapists may impose their preferred approach on all patients, expecting them to fit. In many cases, because of a too-specialized, limited
theoretical frame and a focus on problem resolution, the therapist ends
up ignoring the patient’s experience and the known stages and tasks of
recovery. Many therapists are as impatient as the family to finish up
with this nasty business of addiction and get on with the “real work.”
Nothing could be more off base.
Frequently, therapists believe that recovery, or change, comes
from the therapist rather than the patient. Much of experimental research and some theories of change rest on these premises: what can
the therapist do to a patient, or what “intervention” can the therapist
bring that will cause the patient to change? This thinking can increase
the danger that the therapist will fall into the exact “thinking disorder” that the alcoholic is struggling with: the therapist assumes the
faulty belief that he or she is the agent of change and is thus responsible for figuring out how to get the patient to stop drinking. In essence,
therapists get caught in the faulty belief that they must control the patient, the same distorted logic of the alcoholic and family. If there’s a
problem, someone else is responsible for solving it. The same kind of
distortion occurs in recovery. Everyone, including the therapist, wants
to fix this disaster as soon as possible. Accepting that it can’t be fixed
and, in fact, that all is going well is very difficult.
While directed interventions are frequently helpful, therapists
must accept their own limitations in being able to make anybody
change. This truism is often a major source of countertransference:
therapists have as much distaste for the idea and reality of “loss of control” as the patients they are treating.
As in any other clinical work, therapist beliefs can be a major
source of help and hindrance. For example, therapists may feel frustrated when alcoholism is identified and yet the family rejects the
whole idea. The therapist expects everyone to go along with abstinence. Or the therapist and family may agree to behavior changes that
will support abstinence, but no one looks at the family’s beliefs about
alcoholism. Later, after several relapses and great family resistance to
change, it becomes clear that no one in the family wants Mom to be
an alcoholic and they don’t want to be an “alcoholic family.” The failure to explore the family’s beliefs, values, and wishes interferes with
behavioral change. The therapist, having grown up with an alcoholic 12 INTRODUCTION father, unconsciously supported the resistance. He or she didn’t want
to be part of an alcoholic family either. Finally, another therapist may
see that “good psychotherapy” involves a focus on the transferential
relationship between the patient and the therapist. This clinician sees
the newly abstinent patient’s attention to concrete behavioral change
and intense engagement in AA as resistance to engagement in the
therapeutic dyad and pushes the patient to focus more on the therapist, transference, and uncovering psychotherapy. The patient may respond in any of several ways: she or he complies but feels more conflict; or the patient ends the therapy; or the patient drinks. These
examples characterize the ongoing challenge for the therapist: how to
integrate complex mental health theories of psychotherapy and
change with addiction knowledge. As we outline the stages and tasks
of therapy for the alcoholic family, we will also comment on the difficult task for the therapist.
7. The model of recovery is transformational (Tiebout, 1944, 1946,
1949, 1953). Individuals who belong to 12-step programs speak about
conversion, about surrender, and giving up, which involve a radical
rupture in deepest belief—there is no alcoholism in this family and no
one has lost control—followed by a starting-from-scratch process of
development organized by the opposite belief—there is alcoholism in
this family and everyone has lost control. The alcoholic has lost control of drinking, the partner cannot control the alcoholic, and everyone has lost control to the power of a drinking, pathological family
system. Within this system, everyone’s best efforts to “fix” the problem
reinforce it. The transformation process involves two separate experiences: the individual(s) accept the loss of control and reach outside
the family for help.
8. The developmental model of addiction and recovery is organized by
core beliefs about control. Drinking is maintained by a false belief in
control; recovery is organized by the deep acceptance of loss of control. As therapists working with drinking families, we are not trying to
plug holes or help families regain control. We work to help them
widen the holes so the defensive structure, based on the faulty belief in
control, can collapse and the new building process of recovery begin.
This is an ongoing dilemma for the therapist: how to facilitate increasing disruption knowing that the result will not be a “fixed” family. In
most cases, individuals and families will feel worse and look worse.
This goes directly against the grain of what many patients, therapists,
insurers, and employers think ought to happen.
Individuals and families “in recovery” have undertaken what What Happens When the Drinking Stops? 13 some might call a bone-breaking process of change. This is a radical
shift in paradigm, not an adjustment or fine-tuning within the same
organizing structure of belief. That is why it is transformational and
counterintuitive. According to family systems theorists, the recovering
family has made a shift from first- to se...

 

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