Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

542 V. TREATMENTS FOR ADDICTIONSover the newfound sobriety, the family members feel empty and depressed. It isnot surprising that members of newly sober families tend to interact in the sameway they did while one of their own was abusing alcohol and/or drugs.Couples often experience a feeling of “walking on eggshells” at home anddrift into a kind of emotional divorce. Both partners want to preserve sobrietyand peace, so they interact sparingly and hesitantly, unwittingly reestablishingthe same patterns of closeness and distance that they enacted previously. Forexample, a recently sober alcoholic, wanting to talk with his wife about his feelings,approached her late at night, waking her from a sound sleep, just as he didwhen he was drunk. She, in turn, rebuffed his awkward attempt at communication,leaving him to go sulk alone, just as once he went off to drink alone. Thus,when recovering couples get to know each other anew, they often find themselvesbored, irrationally angry, and unable to resolve problems that were onceavoided with the help of intoxicants (e.g., O’Farrell, 1993).In the case of addicted young people, a family crisis can be anticipated 3 or4 weeks into this part of treatment (Stanton & Todd, 1992). Commonly, thecrisis occurs in the marital relationship of the parents, who take steps towardseparation. Many addicts have become “dirty” again to reunite their families.Siblings and children of recovering substance abusers also can exert unintentionalpressure to revert to old ways. Gradually, families begin to noticeother problems, long hidden from attention by the magnitude of substanceabuse. As the blur of intoxication clears, children who were once consideredhelpful are suddenly seen as withdrawn and depressed; children who were onceseen to be doing fine in school may be seen as just getting by, and the teenager’smarijuana smoking may be noticed for the first time.Family therapists disagree about how quickly family problems should beresolved in this stage. Berenson suggested that it is advisable to begin this stagewith a hiatus from therapy while things calm down; thus, he does not scheduleregular appointments but tells clients, “Get back to me in a month or so”(Stanton, 1981b). Meanwhile, he encourages his clients to continue their selfhelpgroup activities, with the understanding that if their distress continuesbeyond 6–12 months, family therapy will resume on a more regular basis. Then,after a period of sobriety, Berenson returns to a more orthodox therapy schedule.Others (e.g., Bepko & Krestan, 1985; Steinglass et al., 1987) believe thatregularly scheduled family therapy sessions can be very helpful at these times,especially if they focus on solving the series of problems that hound these familiesand wear them down.Therapy in this stage should be focused on keeping family members as calmas possible (Bepko & Krestan, 1985), while they establish a newfound stabilitythat is not based on substance abuse (Steinglass et al., 1987). Toward this end,therapists work to minimize stress and deescalate conflict, congratulate individualsfor their contributions to family recovery, encourage individuals to focuson their own issues, predict and address common difficulties in recovery and