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The Grief Process of Addiction
It's a family affair It's a family affair One child grows up to be somebody who just loves to learn and another child grows up to be somebody you'd just love to burn. Momma loves both of them you see it's in the blood. (Family Affair, Sly and the Family Stone, Sony/Epic Records)
How many times can you lose the same person? What do most people wish for when they lose a loved one? The universal hope is that when they wake the next day, it will all be a dream. The person that they lost will be standing in front of them healthy and ready to be embraced one more time. This illusion can play itself out many times in the family of an addicted person. The addiction takes over and the bottom falls out. There are harsh words, possible violence, theft and feelings of being out of control. A few hours, days or weeks later the families are often faced with the loved one they knew who is now not under the influence. Sorry, vulnerable and repentant, the addict is asking for another chance.
The grief process that never ends is the nature of addiction. Delineated by Elizabeth Kubler-Ross, the stages of denial, anger, bargaining, depression and acceptance are interrupted each time the addict resurfaces. When the addict attempts sobriety, the family is often waiting with hope and open arms. This is perhaps the hardest aspect of the addiction process. How do you give up hope and let your partner, son, brother, daughter, sister, father, or mother self-destruct without any hope or support from the only people who would give them a chance at all? Family members will range in emotion from disgust, anger, disinterest, rejection, hurt, sadness, loss and futility. These same emotions are mirrored in the addict who often feels entitled to his or her excesses with drugs and reacceptance in addition to now expressing remorse. It can be hard to find compassion in these moments. Family members may wish they could finish the grief process and move on. Outsiders will look at the family members askance. No one can understand how anyone would give this person one more chance. The only explanation is that "blood is thicker than water." It is not logical.
The root of codependency, of wanting to control the person and addiction and taking personal responsibility for another's choice to use drugs, is a deep human desire to want to see those you love succeed and go further than you've gone. It is refusing to lose your highest dreams for the person's health and soul. It is a human striving to attachment and love. It is not wanting to lose this person you have loved. It is desire to want your family continue to grow and prosper. It is wanting to believe that your parents (if they are the addicted ones) really can take of you. It is wanting to believe that we are all given chances and deserve to move forward and grow. It is wanting to believe self-destruction and death can ultimately be reversed. With all these complicating and conflicting feelings and thoughts it is hard to know which way turn when the bottom drops out one more time.
In truth there are certainly cases in which
people with many years of substance abuse recover. One only has to look to the programs
like the Delancey Street Foundation to see astounding stories of addicts and ex-convicts
at their absolute bottom pulling themselves up to lead fulfilling and drug-free lives.
Counselors in drug programs with youth are now advocating long-term treatment right
from the start to help kids choose drug-free lives. Drug programs under the Nixon
Administration succeeded more frequently because of the focus was on long-term treatment
(The Fix,Massing). The common thread in all of these approaches is holistic.
They treat not only the addict and the substance abuse but the need for an integrated
approach to a drug-free life that reestablishes the excitement, joy and value of
just being alive. The families who are not addicted themselves are also trying to
help the addict regain this footing. What they lack is the tools and authority these
programs have to support the recovering person's healthiest intentions. (Please note
the authors are aware that addiction runs in families. In cases where there are several
addicted members in the same family an approach to treat each addicted member could
be indicated as the homeostatic function of families will pull a recovering person
back into the addiction if that is the family status quo. In such cases it is advisable
to help the motivated individual in recovery separate from the family.)
Just as therapists cannot treat their own
families, the families of addicts need outside support to navigate the waters of
recovery. The ACCEPT©model addresses each
of these stages. Assessment, Compassion
and Confrontation, combined with Education of the addiction process will
effectively deal with each layer of denial, anger, and bargaining. It may be
helpful to discuss
this grief process of loss with your client families. Psychotherapy will be most
helpful in dealing with the depression and the loss of the dreams each member
has held for the addicted person. Once again the Twelve Step programs are free
and invaluable
to help reach a level of acceptance regarding our lack of power in helping anyone
change who is not motivated. Additionally most substance abuse treatment programs
have groups to provide family therapy and support. Although the addict is not
going to change without intervention and our compassion for them may remain steady,
we
can continue to try and change our interaction with them and not participate
in the
drama of addiction.
There is a joke in AA: "We may have a disease, but those people are sick!" referring to the codependents, the enablers, the people who, in their love and compassion, unwittingly make it easy for the user to continue to use. This is the wife who calls in to her husband's workplace, saying he has the flu when he is sleeping off a hangover. This is the husband who tells the kids that "Mommy doesn't feel well" and heats up hot-dogs, because Mom is taking too many prescription drugs to function. This is the partner who is always ready to be the "designated driver", who counts the drinks, pours the liquor down the toilet, flushes the pills, etc. The parent who shrugs off the failing grades of their stoned teenager, saying "kids will be kids" and "as long as they don't drink and drive, it is OK" is an enabler.
An enabler is anyone whose life energy is spent focused on whether or not someone they love will use drugs or alcohol, who continues to weave the web of illusion that "everything is under control". A joke from Al-Anon "What happens when a codependent dies? Their partner's life flashes in front of their eyes."
Therapists can make the
best enablers. We
are trained to understand, to empathize, to justify present behavior because
of the trauma in the past. How
many of us stop to ask ourselves if this is helpful to the client? We often are
not trained in confrontation techniques, which is part of the process of helping
someone
break through denial. While their are specialists in "Intervention",
a process in which a therapist gathers together concerned friends and family
of the
addict for confrontation and beginning treatment, it would behoove most therapists
to look at our own tendency toward codependency. Go to our chapter on 
Comprehensive Treatment Strategies for a look at the therapeutic skills necessary to
treat an addict or enabler.
Codependents are very good at taking care of others. It is easier to focus on someone else's life than on our own, yet, ultimately much less rewarding. There is more immediate gratification in enabling. We get to be the "good guys", the rescuers, the helpers, the healthy ones. Families can be fertile breeding grounds for codependency to develop. It is very easy to go from being the good child, the parentified child or the caretaker, to being an enabler.
When you are raised to believe that:
1. Your own needs are selfish
2. You don't have a right to feelings
3. Everything that goes wrong is your fault
4. If only you did the right thing, you could
keep everything under control
5. Whatever you do, don't tell anyone the family
secret
6. Never talk directly to the addict (because
that might make them use even more!)
7. Always walk on eggshells and always be good!
8. Never let your own needs get in the way
of others, then you are a good candidate to be a codependent (or a therapist!).
It is important to also realize that many of these same family constellations can lead one to become an addict, as noted by addiction specialist Claudia Black in It Will Never Happen to Me. In the case of the parentified child there is an extra reward in being able to get high and release the burden of responsibility for the family's well being ,if only for the moment of being high.
As entitled as addicts are, codependents are equally unentitled. Melody Beattie, in Beyond Codependency(p.12) defines a codependent as "a person who has let someone else's behavior affect him or her, and is obsessed with controlling other people's behavior."
The great illusion that the spider of addiction and codependency weaves is that of control. While the addict is caught in the web of believing he or she can control the addiction, the codependent believes that he or she can control the addict. It is no accident that the serenity prayer in all the anonymous meetings (AA, NA, DA, OA, SLAA, CODA, Al-Anon, Alateen, InternetA, etc.) is
God grant me the serenity
to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
To
successfully treat a codependent, the first step is for the clinician to
assess his or her
own level of codependency. We invite
you now to take the Codependent/Enabler's Questionnaire. The
second section of the checklist, developed by Melody Beattie, seems particularly
relevant to many therapists.
(Codependents often use language like "you make me feel ______", or "I was made to feel like____")
Melody Beattie, author of Codependent No More developed this check list:
Note
on Authorship: this website was created by a recovering addict and
survivor; I am not a chemical dependency therapist or mental health professional.
Except as otherwise cited, opinions offered here are the result of my own
life experience and a great deal of reading in the Recovery and Mental Health
fields. You may cite this site for academic reference, however in keeping
with twelve step traditions regarding anonymity I request you identify the
author as "Will H. - RecoveryMan.com Webmaster"
You
may also go to The National Council on Codependence for
their description of codependence.
A
few years ago there was a lot of recognition of a constellation of behaviors
identified as "Adult Children of Alcoholics" which
include many of the same features as codependents. Go to the Questionnaire: Did you grow up with a problem drinker? for more information.
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Did You Grow Up with a Problem Drinker?
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"Reprinted with permission of Al-Anon Family Group Headquarters, Inc., Virginia Beach, VA."
When a client comes into therapy and most of the session is spent talking about someone else, that is a good indication that there is some enabling occurring. As you gently direct the person back to their own experiences, they may at first have a hard time finding them. 'Karen' is both an enabler and an Adult Child of an Alcoholic (ACA or ACoA).
'Karen' could initially spent only 30 seconds talking about herself before moving onto her partner's feelings. One of her early dreams was "I came to therapy. All of 'Joanna's' (her partner's) things were there, in the office. They were very lovely, but I was surprised that there were so many, and began to resent it." That dream became an important touchstone in the therapy, because whenever she started to talk too much about Joanna, the therapist starting looking around, imagining we were surrounded by Joanna's stuff. Karen would begin to laugh, and try to talk about herself. Karen's mom was alcoholic, and her dad was absent, so Karen from an early age was very good at negating her own experiences and feelings. As the therapy progressed, she realized she was very full of feelings of grief and rage, both about the past and the present. Obsessing about how to placate Joanna, and whether or not Joanna would drink, and how to say "good morning" to Joanna served to protect Karen from the intensity of her own feelings. She resisted going to a codependents groups for a long time, saying she didn't believe in God, that it wouldn't help, that it wasn't so bad, etc. When she finally went, she said it was like a "warm bath. I never realized how alone I always felt."
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