Create a `newer normal` to help families heal

When working with families struggling with addiction, it is common to hear family members say, “I wish my loved one would get sober so that we can get back to normal!” This comment makes sense, as families view the period when a loved one is using as an anomaly and inconsistent with how they functioned without the active addiction. They believe that the person with the addiction is the person with the problem, and they cling to the belief that their own struggles are only transient realities that will go away when their loved one achieves sobriety. They attend family programming to better understand their loved one’s problem, to support their loved one’s recovery and to facilitate their family’s journey back to normal.

Unfortunately, many addiction professions hold this same notion. They believe the value of family participation in the treatment process lies in supporting their clients’ recovery efforts. They fail to recognize the significance of the family disease process on addiction formation and addiction resolution. While a supportive family becomes a valuable asset to the treatment process, it falls far short of treating addiction as a family disease.

If addiction is to be treated as a family disease, with genetic and transgenerational transmission, we must accept that the illness affects every member of the family. It also affects how current and future generations either inhibit or support addiction and recovery. As one generation after another is affected by epigenetic influences, childhood trauma and dysregulation of the autonomic nervous system, normal family functioning becomes skewed by family members' unconscious coping with the elephant in the room.

With each new generation, family members are predisposed to addiction long before their first drink or drug. Therefore, treatment providers must recognize that each family member’s experience of normal functioning is influenced as much by personal and family history as it is by their current struggles with a loved one’s addiction.

Understanding a normal family experience

The concept of organization is important to understanding how families perceive what is normal. From the time we were born, our family leaders established rules, roles, boundaries and routines that created repetitive, consistent and patterned interactions. These organizing principles created stable thoughts, feelings and behaviors that allowed the family to live within a desired value system and to achieve desired goals.

Family organization is shaped through a process of positive and negative feedback. On a day-to-day basis, family leaders reinforce or extinguish thoughts, feelings and behaviors, through consistent patterns of verbal and nonverbal parental interventions. Parental interventions are influenced, positively and negatively, by relationships with authority figures within their own family of origin. Primary family relationships set the foundation for establishing the stable patterns that promote family values and goal achievement.

Rules can take the form of overt and covert communication patterns, allowable limits to emotional experience and expressions, obedience to leader authority, conflict management and resolution, and rule flexibility to meet age-appropriate developmental needs and growth. Roles may include expectations for child care, financial management, chauffeur duties and enlistment of older siblings to manage younger siblings while family leaders are engaging in other role-determined behaviors. Boundaries govern the flow of information within the family system and with the outside world. They can take the form of family subsystem boundaries that shield children from parental relationship issues and prevent the triangulation and parentification of children. They often include limits to time spent with friends or with the television and computer, and also the holding of family secrets. Rituals take the form of religious or spiritual practices, participation in birthday celebrations, and time spent with extended families. Over time, stable patterns evolve into routines, which in turn become a hard-wired and mostly unconscious organizational system that feels normal to each family member.

As family members leave the nest, these same organizational negotiations take place in the formation of new families. New family leaders utilize the organizing principles from their own families of origin as templates for negotiating desired stable patterns for their newly forming family. Within this process, rules, roles and boundaries will evolve. Some will be similar to those of one family of origin and others to the other family of origin. Over time, the new family will evolve hard-wired stable patterns that create a hybrid organization that once again will become the lens for what is normal.

Family stress, problems and crises

Family stress theory defines a problem as any stressor that requires the family to initiate an existing coping strategy and to expend existing resources to solve the issue. A crisis is defined as any problem for which a family does not have a coping strategy or appropriate resources to resolve. Until a family either identifies a new understanding of the problem or develops new resources, it is forced to expend resources consistently to solve the problem, while living with the consequences of the unresolved crisis on a daily basis.

Addiction and trauma are experienced by families as crises, in that they rarely have sufficient understanding and resources needed for individual and family healing. Over time, the addiction becomes increasingly resistant to resolution, and family members must adapt to the loved one’s progressing symptoms. As the addiction and trauma remain unresolved, “build-up” stressors in the form of employment, financial, legal, relationship or behavioral problems become additional crises that demand attention. As families continue to put forth effort to resolve the addiction and trauma symptoms, they become exhausted by the need to address these other stressors simultaneously. Within this process, family members’ perceptions of the crisis and of one another begin to change.

For many families, living with the crisis will shift their focus from fundamental values and goals to surviving the crisis. This typically results in significant organizational shifts and changes to the family’s rules, roles and boundaries. As stable patterns shift to coping with the addiction, trauma and stressor build-up, coping strategies such as hypervigilance, control, enabling and enmeshment become the norm. It is within this process that we see the establishment of a “new normal” in terms of family organization.

It is important to recognize that the stable patterns associated with the “new normal” might not represent a shift at all. Many partners and parents who experienced their own childhood trauma or grew up in families with addiction, trauma and mental health issues may have entered into the process of new family development with impaired perceptions about coping with these kinds of crises. Their pre-existing emotional, behavioral and cognitive stable patterns make it especially difficult to resolve these crises in their own family. Hypervigilance, control, enabling and enmeshment may have been a critical part of the organizational negotiation long before the crisis occurred.

Family recovery: a newer normal

The goal of family healing is the creation of new emotional and interactional stable patterns that allow family members to initiate desired change and growth. A prerequisite for this type of family healing is a perceptual shift from focusing on the addicted family member’s need to achieve recovery to accepting the need for family healing. This promotes family creation of a “newer” normal that advances resource development needed to resolve the crises that have plagued the family.

For many families, this becomes a hard pill to swallow. Families that are newer to the treatment process tend to be more open to hearing this message. They are desperate for resolution and need a more direct and hierarchical therapeutic relationship. Families that are organized around the addiction and trauma are sensitive to perceived judgment and blame. Over time, attempts by professionals to help them recognize increased control, enabling and enmeshment are experienced as blaming. These families tend to respond better to a slower collaborative therapeutic relationship, where they remain the expert on the family experience and the therapist is the “curious” expert in the therapeutic process.

Once the therapeutic relationship has been developed, education offers a critical starting point for perceptual change. The educational process should begin with a focus on the loved one’s struggles to achieve recovery, co-occurring mental health issues, trauma, and how childhood trauma, family trauma and attachment struggles have complicated recovery efforts.

Families initially can be quite defensive when discussing childhood issues. When this information is presented in an educational, evidence-based and non-blaming way, family members become curious about their loved one’s struggle and begin to understand why achieving recovery has proven so difficult. In time, they often become open to questioning how these same issues may have posed a challenge in their own lives.

Once perceptions have been challenged, family members begin to risk speaking, feeling and trying on new interactional behaviors. The experience of these organizational changes promotes new rules, roles and boundaries that create a “newer” normal that can sustain recovery. At this point, families become open to a comprehensive intergenerational assessment of addiction, trauma, mental health and other struggles that may have influenced how the client and the family have attempted to deal with the active addiction and associated trauma.

Within this process, it is important to assess how values, goals and stable patterns have evolved. Asking parents or partners to discuss what they looked like in their own family of origin offers a good starting point. Then, one can assess how they were negotiated prior to the addiction and how they changed during the active addiction. Ultimately it is important to discuss the values, goals and stable patterns that family members believe will be needed to sustain recovery.

The ultimate message

As most treatment programs have become increasingly trauma-informed and trauma-integrated, it is important to include transgenerational trauma education in our family programs. We must help family members understand the reality that a loved one’s achievement of sobriety does not resolve the family’s problems. Once armed with this new information, families can be challenged to stop waiting for their loved one to get sober and to allow their own healing process to serve as a model for recovery.

The ultimate message is that families who heal together create an environment that is inhospitable to active addiction. Conversely, when families wait for their loved one to get sober, they often create an environment that is inhospitable to the recovery of all family members.

Michael Barnes, PhD, MAC, LPC, is Chief Clinical Officer for Foundry Treatment Center in Steamboat Springs, Colo. He has more than 35 years of experience in addiction and mental health counseling, and his expertise is in developing trauma-integrated addiction treatment and in working with families. He can be reached at mike.barnes@foundrytreatmentcenter.com.