When you live with alcohol use disorder, positive outcomes often involve the entire family.
It’s natural for families to want to band together. They’re the people who may be the most likely to stick up for you, and who may have seen you through the best and worst of times.
This sense of loyalty and dedication in the family unit can be an integral part of the recovery process for alcohol use disorder.
When the family comes together to offer support and focus on positive outcomes as a unit, it may help prevent many of the pitfalls during recovery.
You might be the one living with alcohol use disorder, but your behaviors and lifestyle may have shaped, and continue to shape, the lives of those closest to you.
In her book “The Alcoholic Family in Recovery,” Stephanie Brown takes a close, research-based look at the journey from alcohol use to recovery within the family dynamic.
She highlights how an end to substance use behaviors is just the beginning, and many other challenges can be experienced by family members during the first years of sobriety.
Marital stress, employment strain, and children acting out are just a few examples that Brown gives of how sobriety-related stress can emerge within a family unit.
The four stages of recovery
In her book, Brown discusses four distinct stages that you and your family may go through to achieve recovery:
- Drinking stage. This stage is highlighted by the family denying and offering excuses for the person living with alcohol use disorder.
- Transition. In this stage, focus is the beginning of abstinence and the acknowledgement by the family that alcohol use isn’t controllable by them or the person living with alcohol use disorder.
- Early recovery. This stage is when couples work on individual healing versus the healing of the whole family unit.
- Ongoing recovery. In this stage, individual recoveries are solid and attention can be turned back to the couple and family.
Substance use disorder vs. alcohol use disorder
Both substance use disorder and alcohol use disorder are diagnosable mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
They may both benefit from family-oriented therapy approaches.
Alcohol use disorder focuses primarily on the misuse of alcohol.
Substance use disorder may include alcohol misuse, but it can involve misuse of other substances as well.
Mental health professionals working with a family during the drinking stage may focus not only on the drinking behavior of the person living with substance use disorder but also any distorted belief systems in the rest of the family that might emotionally and physically support the drinking.
The family may be encouraged to stop denying the alcohol use and supporting the drinking and begin to find avenues to reach out for help.
In the drinking stage, the imperative might be to begin abstinence.
Attempts may be made to help the person gain insight into why life has become unstable for so many in the family unit. However, in the final analysis, it may be up to them to begin the process of recovery.
Stephanie Brown describes the complexity of the drinking stage as being like a dance: “The person misusing alcohol leads and family members follow in a way that keeps them dancing,” she writes.
“The leader may stumble, drift away, step all over the follower, or even break up the dance by changing partners. The family members with enabling tendencies’ only response is to try and keep the dance going.”
At this stage, the family may be encouraged to help end the dance.
This may happen through the realization that the family can’t control and enable the drinking, and that only when the person living with alcohol use disorder reaches out for help outside the family system can they move into the stage of transition.
The transition stage can be a complex ebb and flow during which the person using alcohol adapts to not drinking, and the family adjusts to the transition of living through the end of the drinking into the beginning of abstinence.
The environment within the family at the end of drinking is often made up of three distinct variables:
- increasingly out-of-control environment
- tightening defenses to prevent or forestall systems collapse
- a last-ditch attempt to maintain denial and all core beliefs
A mental health professional might have a multitude of functions in the beginning stage of transition.
They could be a guide to:
- realizing the loss of self-control associated with drinking
- finding sobriety and a place to go for information when life is a bundle of confusion
Statements frequently repeated in this stage include:
- “Are you going to meetings?”
- “How are you feeling?”
- “Take it one day at a time.”
- “First things first.”
- “Set priorities.”
They may also help guide the family as they begin to move from drinking to abstinence, then toward the last part of the transition stage.
Brown describes four focal points the family may want to be aware of:
- focusing on staying dry
- stabilizing the out-of-control environment
- allowing the family support system to collapse and remain collapsed
- focusing on the individual within the family
After seeing that the family is stable enough, underlying feelings that may be triggers or causes of past and current drinking recurrences might then be investigated.
Attention may also be given to how children in the family are being cared for and how they’re handling the changes to the family structure.
Forward movement is the key, according to Brown, and is one of the best ways to help families reach for and know when the right time is to move to the next stage: early recovery.
This may take years based on the severity of past drinking behaviors.
According to Brown, the main difference between the transition stage and the early recovery stage is a general lessening of the physical cravings and psychological impulses for alcohol.
Potential recurrence signs may be evaluated, but this factor lessens over time.
An item that may also be addressed in the early recovery stage is continual support within the family unit to stay focused on their own recovery.
By this stage family members with enabling behaviors, if they’re not getting support on their own, may become weary of the lack of attention from the person living with alcohol use disorder who is busy trying to gain support to stay sober.
At this time, the focus might be on constructing support for both the person living with alcohol use disorder and family members with enabling behaviors.
Each can face challenges that may need to be addressed so that recovery can continue.
As recovery moves forward, hidden and latent issues that fostered drinking or were created by the trauma of the drinking environment may need individual attention.
Not only does the mental health professional become the guide for the family, but they also can become the provider of information in this stage.
They will likely:
- continue to teach abstinent behaviors and thinking
- keep your family in close contact with 12-step programs and help them work on the steps
- keep focus on individual recovery, seeking outside supports for your family
- maintain attention for the children involved
- keep a continual eye on potential challenges, such as the onset of depression, emotional problems, sleep problems, fear, and/or helplessness
This final stage is considered relatively stable in comparison to the earlier three stages. This is because recovery is now solid, and attention can be turned back to the person with alcohol use disorder and the family.
The focus lies in the area of staying sober and committing to recovery and building up the structure of the family after it’s been torn down in the earlier stages.
At this point, the family may have reached out for outside help and may consider doing the following:
- healing the emotional separation issues
- looking in-depth at what damage has been done to the family due to drinking
- studying the underlying causes of the drinking behavior
Brown notes that the ongoing recovery stage can be a time for creating healthy relational dependence within the family and understanding that recovery is a process, not an outcome.
The focus in this stage is often to:
- make sure the family is continuing abstinent behavior
- expand the family’s identities in relations to alcohol use
- ensure that everyone maintains programs of recovery
- focus on couple and family issues
- explore spirituality issues and past childhood and adult traumas
If you live with alcohol use disorder, it can impact not only your daily life but also the lives of those within your family.
When you begin your journey toward recovery, your family members may also need the support of mental health professionals.
Together, you can overcome alcohol use behaviors and embrace a new family dynamic where individuals feel valued and heard, and unhelpful behavior patterns are a thing of the past.
If you’d like to learn more about support for substance use disorder, you can visit:
For round-the-clock support regarding substance use and mental health, you can call the SAMHSA National Helpline at 800-662-4357.