The Family Research Project: A Summary

The Family Research Project: A Summary

by Stephanie Brown
Renowned substance-abuse specialist Stephanie Brown discusses effective therapeutic interventions for families of alcoholics during the recovery process.

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Sometimes a new idea offers such a radically different lens that it challenges conventional wisdom and even turns standard theory and practice upside down. Children of alcoholics (COA's) and adult children of alcoholics (ACOA's) were new ideas of this kind. We believe that our Family Recovery Research extends this revolutionary perspective. Since 1989, we (Stephanie Brown and Virginia Lewis) have been asking the question: Is there a "normal" developmental process of recovery for the family, similar to the long-term process of change that has been identified for the alcoholic and for children of alcoholics? What happens over time when one or both parents stop drinking? Are there predictable, defined stages? What is the impact of abstinence on the family and on the individuals within?

I have often asked over the years, "Why do people resist looking at recovery? Why does the focus of research and treatment remain fixed on the drinking alcoholic?" While so much effort has been targeted toward a "goal" of abstinence, the focus has always stopped at that point, as if everything is expected to turn out well once the drinking stops. It is not so simple. Abstinence marks a positive beginning rather than an end. Recovery is a difficult, painful process of radical change that is never easy and rarely smooth for anyone involved. Without knowledge about what to expect, including the paradox that what is normal and necessary to long-term positive change is also disruptive and even traumatic in the short run, the impact of such turmoil can cause further damage. Over the last six years, we have interviewed and tested 52 couples and families (those who were together for a least five years during drinking and who are still together in recovery), with sobriety ranging from a few months to over 18 years, in order to discover what recovery is like. We have examined the process of change according to length of sobriety within three domains: the environment, the system, and the individuals within.

Research Findings

  • The four stages of recovery already defined for the individual hold true for the family: Drinking; Transition, the move from drinking to abstinence; Early Recovery, the stabilization of abstinence with new learning, much uncertainty and constant change; and Ongoing Recovery, when massive change has been consolidated and the family is guided by the organizing behaviors, values and beliefs of recovery.
  • The environment, or context, of the drinking family is traumatic and harmful to children and adults. It remains unsafe and potentially out of control into Early Recovery, which may last as long as three to five years. In Ongoing Recovery, the environment is safe and not thrown off track by the difficulties and crises of "normal" life. One family looks back:
In the first year, we lived on pins and needles. There was more tension than there was during the drinking because no one knew what to expect. Before, the drinking was known; it was predictable. Now, our nerves were raw and ragged. We all feared an explosion. It took years before we felt calm and secure.
  • The unhealthy drinking family system must collapse as the family enters recovery, permitting attention to shift from the system to the individuals. Many families do not accomplish this collapse or they do not survive it. Because there is so much disruption with abstinence, and so much turmoil caused by the collapse of the system, many families break up, seeing that things have gotten worse, not better. Our data explain how outside support networks (12-step programs, treatment centers, therapists) provide a "holding environment" for all members of the family, a cushion and substitute for the drinking family system that has collapsed. Families utilize these outside supports to weather the difficult changes of the first three to five years. It may be five to ten years before a stable, strong sense of healthy family is secure. Change like this does not occur from inside the family in the vacuum created by abstinence. It requires external guidance and supports. Yet conventional treatment wisdom often leans in the opposite direction: much of family therapy is aimed at bringing individuals together, to focus on a "we." Our work demonstrates the importance of an individual focus during the early period. Another family remembers:
In early recovery we could begin to talk about an "I" and a "you." We didn't dare try to communicate as a "we." For the first two years, we didn't talk to each other without first calling our sponsors and we didn't talk about important things for at least five years. We led parallel lives and slowly got to know each other again.
  • The process of individual recovery takes years, not days or months, and can enable lasting, in-depth changes in the family. Unfortunately, there is sometimes an unrecognized dark side: children may be neglected as parents focus exclusively on their individual recoveries and abdicate parenting responsibilities. One parent told us:
Early recovery was a self-obsessed time for us. Our children had a "recovering Dad" and a "recovering Mom," but who was taking care of them? No one. I will be forever grateful for sobriety, but I have a profound regret that we abandoned our children in the service of our own recoveries.

The Trauma of Recovery

Data on the process of family recovery shocks us with mixed news: Yes, recovery is positive; the end of the drinking is extremely important and lays the necessary foundation for in-depth change. But that process of change, which we have called the "trauma of recovery," is difficult. Families may not survive it, and without sufficient knowledge or supports, children may suffer unknown and unintended consequences of this time of uncertainty, instability and radical change.

No wonder there is resistance to focusing on recovery.

It is hard to see what's really there and what is normal. In our culture we idealize short-term cures, "symptom reduction" and magic answers, refusing to understand or accept that solutions to massive problems require difficult, painful choices and a long time in the process of change.
 
We think it will be surprising to many that children experience a "trauma of recovery" in addition to the horrors of drinking. It is grim news to learn that children may feel worse, not better, just like their parents, and they may experience physical abandonment as well as continuing psychological isolation due to their parents' recovery.
 
There is great danger that news like this will be rejected, or denied. Or, we will rush to the obvious, but wrong, conclusion that parents should not follow individual recovery programs. We must face the fact that what is essential for parents may be inadvertently damaging for their children, but only if we deny it. Once we acknowledge this reality, we can address the holes in our treatment programs so we may better protect children AND support parents in their recoveries. We can also focus on the absolute need for support structures outside the family, which we are calling "community systems," and on the need to expand our ideas of prevention to include recovery. Our current theories and practice for the professional treatment of alcoholism and the family leave people hanging without necessary knowledge and support.

Helpful Interventions

What kinds of interventions can be helpful at what stage of recovery? Couple and family therapy in the early period of abstinence can provide education about the normal process of recovery, i.e., the turmoil and disruption to be expected, the need for parents to focus on themselves as individuals, and the importance of maintaining or learning parenting responsibilities, both concretely and emotionally. Parents need guidance in focusing on themselves without further neglecting or abandoning their children. Supportive couples therapy that does not shift the focus off of individual recoveries can provide necessary structure, concrete advice and education and a watchful eye on children's reactions and needs in early recovery.
 
As part of our research we have developed a curriculum for families with longer recovery—a minimum of six months and ideally at least a year. Called MAPS (Maintaining Abstinence Program), the classes provide a "map" of what families can expect individually, and as a system. During one meeting, a couple or family with many years of recovery (the "mentor family") shares the story of their drinking and recovery. We believe that this adaptation of the A.A. and Al-Anon sponsor can offer tremendous support and fill some of the holes which we know exist.
 
We also recommend adding an educational component to treatment programs that emphasizes the importance of family and the need to attend to family during the early days and months of abstinence. How to do this without sacrificing anyone's individual needs will require careful planning.
 
Finally, we see that couples and families with stable recovery can benefit from more intensive therapy, depending of course on their particular needs and circumstances. When individual recoveries are stabilized and secure, family members can turn their attention to relationships within the family without threatening their own progress, or forcing a return to old, unhealthy family interaction patterns.
 
We expect an outcry against our research because we recommend additional "treatment" and unlimited "continuing care" rather than less treatment, or even none. We believe that much of this care can be provided by volunteers who offer education, support, and the sharing of their experience as "mentor families" through an extension of the "apprentice model" of the 12-step programs. We see this need as an opportunity to strengthen an already existing bridge between the recovering communities and professional treatment. With an ongoing "holding environment" outside the family, individuals within can attend to their own healthier development. Later, they can shift their attention back to the family.
 
The now-grown-up child of two recovering parents listened to them tell the story of their recovery and then reflected on what recovery had been like for her:
 
From the time I was six until I was ten, my mother was in and out of treatment for her alcoholism. I went to Alateen because my parents needed me to go. I told myself that what was happening wouldn't be important to my whole life, that all of this was not traumatic. Now I know I was living in a vacuum, that I had nothing to hold onto. I was tuned out for most of this time. As I listen to them talk today, I know why. They weren't there for a long, long time.
 
This family talked about the process of coming back together. As their individual recoveries progressed, the environment became safer, and a new, healthy family system could develop. Father reflects:
 
By the time things finally started to work in the family, our two oldest kids were on their way out, so there was not time for bonding. They needed to push away, but there was nothing to push against.
 
The children, having grown up with drinking and the turmoil of early recovery, are now coming home—emotionally—to join this healthier system and repair the bonds of attachment with their parents. Much of the developmental work that should have occurred during childhood and adolescence can now take place...and does.


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Stephanie Brown

Stephanie Brown, PhD, is a clinician, author, teacher, researcher, and consultant in the field of addictions. She is a licensed psychologist with over 35 years of clinical experience and an internationally recognized expert on the trauma and the treatment of alcoholics and their families. Dr. Brown is currently the Director of The Addictions Institute in Menlo Park, California, an outpatient clinic, and a Research Associate at the Mental Research Institute (MRI) in Palo Alto, CA, where she co-directs The Family Recovery Research Project. She is currently applying this research to the development of a new extended family treatment program at Mayflower in Marin County. She is also Consulting Director of the Institute on Addictions at the California School of Professional Psychology at Alliant International University in San Francisco. Dr. Brown founded the Alcohol Clinic at Stanford University Medical Center in 1977 and served as its director for eight years, developing the dynamic model of alcoholism recovery and its application to the long-term treatment of all members of an alcoholic family. Dr. Brown served on the California State Alcoholism Advisory Board and was a founding member of the National Association for Children of Alcoholics (NACOA.) Visit Stephanie Brown's Addictions Institute website.

Awards: Dr. Brown received the Bronze Key Award (1983) and the Humanitarian Award (1984) from the National Council on Alcoholism and the Community Service Award from the California Society for the Treatment of Alcoholism and other Drug Dependencies in 1986. In 1991 she received an Academic Specialist Award from the U.S.I.A. to teach in Poland. More recently, she received the Norman Zinberg Memorial Award from Harvard University (2000), the Clark Vincent Award from the California Association of Marriage and Family Therapists (2001), and the Janet Geringer Woititz award from Health Communications, Inc. (2005).

Books and Videos: Dr. Brown is the author of Treating the Alcoholic, and Treating Adult Children of Alcoholics, and Editor of Treating Alcoholism, and A Place Called Self: Women, Sobriety and Radical Transformation. Her latest book is Speed: Facing our Addiction to Faster and Faster--and Overcoming our Fear of Slowing Down. She is coauthor of The Alcoholic Family in Recovery: A Developmental Model, and The Family Recovery Guide  and co-editor of The Handbook of Addiction Treatment for Women. She has also completed two training videos, Treating Alcoholism in Psychotherapy  and Stages of Family Recovery. She lectures widely and maintains a private practice.

CE credits: 1

Learning Objectives:

  • Deepen understanding of the goals and challenges of recovery from drinking once abstinence has been achieved.
  • Consider aspects of the stages of recovery from the perspective of families.
  • Increase awareness of the complex ways in which the recovery process impacts children and families of alcoholics.