We continue Bill White’s interview with Stephanie Brown on family recovery. I cannot emphasise to you enough how important Stephanie’s work is.
‘Bill White: It poses the question of what the ideal scaffolding would be like that could support recovery.
Stephanie Brown: I think we understand much better today that the family encounters a vacuum on entering recovery with or without formal treatment or outpatient therapy. This vacuum within the family, and the same kind of vacuum in the community – the neighborhood, town, city, work, school, and social environments – is a significant problem.
Current treatment ideas and formats could be extended into something quite wonderful. The treatment center could expand its focus to include the care of families and extend their responsibility beyond what is now included in treatment into a process of sustained continuing care for the families they serve. As people leave treatment, there would be a much stronger “hand-off” to professional and peer-based supports, including alumni groups and mutual aid groups.
The idea of a recovery coach is growing now, which I think will be a tremendous help to individuals and families. The notion of a recovery coach emphasizes the necessity for continuing care and reduces the “dropping off the cliff” experience that has previously characterized family experience. I hope treatment centers will become more active in support of their patients in the months and years following the first treatment experience.
Bill White: You see part of that support coming from the treatment center, but a great deal of that support also coming from the larger community itself.
Stephanie Brown: I would like to be able to see family support resources developed in the larger community by treatment centers, and I think this could begin by mobilizing their alumni as a family-focused recovery support resource.
Bill White: There’s been a recent rise of new grassroots recovery community organizations and recovery community centers. Might these be a source for long-term family support?
Stephanie Brown: Yes. What is necessary is a “holding” environment for the family – one that is active rather than passive – a support network for people post-treatment and for people who haven’t been in treatment. The recovery community is beginning to organize supports for individuals and families beyond 12-step meetings that can support recovery as part of broader life in the community.
Bill White: From your studies, Stephanie, how long does that support need to be provided to families?
Stephanie Brown: I would say a minimum of a year. What I envision is the apprentice model we discussed earlier – that people who use the supports will pass on their experience to newcomers leaving treatment centers, on referral from a therapy experience, or simply entering recovery on their own. It’s probably the case that most people who find recovery have not been in formal treatment programs or even any kind of therapy.
Thus we need to conceive of “community supports” as a loosely organized network separate from any one treatment center or person. Ultimately, community supports could be part of community medical centers or other kinds of local educational and support services that currently exist, such as the widely available community support networks for cancer patients.
Bill White: If those sanctuaries of support were embedded in the community, there wouldn’t have to be a finite time period attached to it; families could be supported almost across the family life cycle.
Stephanie Brown: You are correct, and I wouldn’t want to put a timeline on such support. The developmental model functions according to need and process, not time. Individuals and families have varying needs for support and professional help at varying times throughout their recoveries; people with 12, 15, 40, or more years of recovery may find a need for new or renewed support. Basically, the need for recovery support never ends.
Bill White: When I first read the book you and Virginia Lewis co-authored, what struck me was you talked about family recovery following treatment, not in terms of days or months, but in terms of years. None of us in the field at that time had that kind of vision.
Stephanie Brown: I think that’s correct. That’s where the developmental perspective is helpful. The normal process of recovery for the individual and family is not all forward progress. Normal development is back and forth, not always just straight ahead growth. Periodic problems, or even ongoing struggles, are normal and expected as part of healthy growth, so they should not automatically be interpreted as a problem with recovery.
Not only do individuals and families look and feel worse at the beginning of recovery and as they move forward, but the process itself – a deepening of memory and emotional understanding – will often create pain and conflict that can be misinterpreted as pathology rather than part of a growth process. The signs of potential relapse and the signs of significant growth are not always easy to distinguish.
The same difficulties that can lead someone to relapse can also lead to a deepening of the recovery experience, just as the emergence of pain, conflict, and struggle in recovery can be a sign of progress as often as it can be a sign or warning of relapse potential. Years of recovery growth will hopefully provide a healthy foundation to enable people to tolerate deeper emotional work – often dealing with traumas from the past.
Bill White: Over the years, you’ve had an opportunity to consult with treatment programs in the development of family programs. How would you describe the state of family treatment and recovery support today?
Stephanie Brown: Treatment centers are still primarily focused on the addicted individual. They have not been able to add a family focus that allows family members to also be viewed as identified patients. They still are looking at the family as appendages to the addicted person, which is a huge problem in my perspective.’
