Stages of Family Recovery

Recovery is a profound process of change when substance use is involved, transforming the substance into something other than the driving element of the family. This transformation brings hope and optimism for a better future. (Reiter, 2019).  Regardless of the recovery path, there is significant reorganization within the family, which alters family rules and processes and increases engagement, honesty, and openness within the system  (Reiter, 2019).  Family recovery through the developmental model is identified through four stages: drinking, transition, early recovery, and ongoing recovery (Brown & Lewis, 2002).  These stages are generalizable from the individual level to the family.  

Critical tasks and focus are more complex for the family; therefore, structure is necessary to include multiple factors and perspectives simultaneously as the individual and the individual to others are included (Brown & Lewis, 2002). Further, it is necessary to separate the experience and the impact of the environment and the context of life from the system's workings.  The process of family recovery unfolds developmentally in two separate and interactive tracks, the “domains” and the “stages” (Brown & Lewis, 2002, p. 17).  The domains focus on three arenas of change: the environment, the family system, and the individual.  Change simultaneously transitions within these domains according to the stage of recovery.  The stages are defined by the task of change, the length of time, and abstinence (Brown & Lewis, 2002).

In the drinking stage, family members alter everyday routines, which their routines shift to focus on drinking or attempting to prove to themselves and others that their addiction is not occurring and does not affect them, which indicates that the family functioning and tension are increasing and not being addressed within the system (Reiter, 2019).  During the drinking stage, the clinician must develop a solid therapeutic alliance with the individual family members, as this relationship is pivotal in helping members to change their perception regarding denial and accept addiction in the here and now as it is an elemental part of their lives and is affecting individuals in the system.  By addressing family members' beliefs about drinking, which are typically based on denial, distorted beliefs are created to assist the family in maintaining functioning around the addiction (Reiter, 2019).

When the environmental domain is unsafe, tension, anxiety, and emotional pain increase as the system is often centered around addiction, and they attempt to protect themselves from the aftermath.  The family invokes rigid rules and roles, which consist of resistant boundaries within the system and outside.  Individuals within the system subsequently begin to conform to the needs of the addicted individual, resulting in the suppression of their needs.

Mindfulness of the various stages in family recovery is not just necessary but crucial for effective clinical intervention. The system’s needs vary from stage to stage, and the clinician's ability to be mindful and focused is key in formulating intervention plans and providing the necessary support. (Brown & Lewis, 2002). Clinicians must be flexible, as their ability to rapidly intervene at concrete behavioral levels while simultaneously shifting to a reflective, analytic stance is critical. This adaptability is essential in addressing the complex needs of the family system.

References

Brown, S., & Lewis, V. (2002).  The Alcoholic Family in Recovery: A Developmental Model.  The Guilford Press.

Reiter, M. D. (2019).  Family Recovery.  In Substance Abuse and the Family: Assessment and Treatment (Second edition, pp. 345–368).  Routledge, Taylor & Francis Group.