Keys to Recovery Interview

I was delighted  to be asked and honored to take part in one of the excellent “The Hope Interviews” with Steve Jones for the recovery newspaper “Keys to Recovery” – our interview is on page 9 and it was a  experience strength and hope type interview from both a 12 step recovery and a neuro-psychological perspective, showing how these perspectives are very compatible and how we need a spiritual solution to a neuro-psychological problem.

I Am What I Have Been Looking For.

  1. Do you find yourself needing approval from others to feel good about yourself? Yes_____ No_____
  2. Do you agree to do more for others than you can comfortably accomplish? Yes_____ No_____
  3. Are you perfectionistic? Yes_____ No_____
  4. Or do you tend to avoid or ignore responsibilities? Yes_____ No_____
  5. Do you find it difficult to identify what you’re feeling? Yes_____ No_____
  6. Do you find it difficult to express feelings? Yes_____ No_____
  7. Do you tend to think in all-or-nothing terms? Yes_____ No_____
  8. Do you often feel lonely even in the presence of others? Yes_____ No_____
  9. Is it difficult for you to ask for what you need from others? Yes_____ No_____
  10. Is it difficult for you to maintain intimate relationships? Yes_____ No_____
  11. Do you find it difficult to trust others? Yes_____ No_____
  12. Do you tend to hang on to hurtful or destructive relationships? Yes_____ No_____
  13. Are you more aware of others’ needs and feelings than your own? Yes_____ No_____
  14. Do you find it particularly difficult to deal with anger or criticism? Yes_____ No_____
  15. Is it hard for you to relax and enjoy yourself? Yes_____ No_____
  16. Do you find yourself feeling like a “fake” in your academic or professional life? Yes_____ No_____
  17. Do you find yourself waiting for disaster to strike even when things are going well in your life?  Yes_____ No_____
  18. Do you find yourself having difficulty with authority figures? Yes_____ No_____

Answering “Yes” to these may indicate some effects from family dysfunction. Most people could likely identify with some of them. If you find yourself answering “Yes” to over half of them, you likely have some long-term effects of living in a dysfunctional family. If you find yourself answering “Yes” to the majority of them you might consider seeking some additional help.


While  I have been waiting to start EMDR therapy (don’t ask!?) I have been exploring my childhood with my wife.

As opposed to simply talking about the past, I have been allowing the sometimes painful emotions to come up from past episodes in my life. Instead of intellectually distancing myself from these mainly traumatic or abusive events from the past, I have been simply allowing myself to feel these emotions however painful. And boy have some of them been painful!

It was my father’s anniversary of this very premature death last week, 28 years since he left this mortal coil. He died at a pivotal point in my life. I had just left home and started University, the future promised so much.

A lot of my future problems were not helped by not having a father figure to “guide” me in some ways or to square some parts of the past perhaps?

Who knows?

I can’t believe how much I grieved his anniversary this year. In fact, I cried on and off for two full days which is something I could never do before.

I wasn’t crying for him nor myself but for our shared loss. I just sat there and cried when I needed too, for the bottom of my heart. It didn’t kill me. Didn’t make me want to run away.

This is all a function of a decade in recovery, the ability to do something I couldn’t do before.  To sit with very painful emotions and just allow them to come and go.

I was told in early recovery that I would properly grieve the loss of loved ones, particularly my parents, as my recovery went on (they both passed on while I was drinking) but this was more than that.

I was not only grieving my father’s passing but also grieving my dysfunctional childhood.

According to a rather excellent book I have been reading recently  Healing the Child Within by Charles L. Whitfield, M.D.    we need to grieve our pasts in order to heal the past and move form a False Self to a more integrated True Self.

The false self may also be called the co-dependent self, unauthentic self or public self.

To quote and para phrase from this book ” Our false self is a cover up.  It is inhibited, contracting and fearful…It is envious, critical, idealized, blaming, shaming and perfectionistic.”

“Alienated for the True Self, our false self is other-orientated, i.e., focuses on what it thinks others want it to be…doesn’t know how it feels or does know and has censured these feelings as “wrong” or “bad”.

Our false self tends to be the “critical parent”…It pretends to be “strong” or even “powerful”. Yet its power is only minimal…it is in reality usually fearful, distrusting and destructive.”

“…our co-dependent self tends to repeatedly act our unconscious,  often painful patterns…it feels separate…we feel numb, empty or in a contrived state. We do not feel real, complete, whole or sane.  At one level or another, we sense that something is wrong, something is missing.

Paradoxically, we often feel like this false self is our natural state, the way we “should be”….”

In the next blog I will look at how this False Self is formed in our childhood interaction with our parents.

So how do we become the True Self?

Via a process of grieving according to this insightful book.

“A trauma is a loss…we experience a loss when we are deprived of or have to go without something that we have had and valued, something that we needed… or expected.

Minor losses or traumas are so common and subtle that we often do not recognize them as being a loss. Yet all of our losses produce pain or unhappiness: we call this train of feelings grief.

When we allow ourselves to feel  these  painful feelings, and when we share the grief with safe and supportive others, we are able to complete  our grief work and thus be free of it.”

I will blog on the actual grieving process in later blogs.

The purpose ultimately of this grieving process is to return one to the True Self. What does he mean by this? Again we can see by quoting and para-phrasing some extracts from this book.

“Our Real Self is spontaneous, expansive, loving, giving and communicating. Our True Self accepts ourselves and others. It feels, whether the feelings may be joyful or painful.  And it expresses those feelings. Our Real Self accepts our feelings without judgement and fear…

Our Child Within is expressive, assertive, and creative. It can be childlike in the highest, most mature, and evolved sense of the word…taking pleasure in receiving and being nurtured…

By being real, it is free to grow…

…when we are our True Self, we feel alive. We may feel pain in the form of hurt, sadness, guilt or anger, but we nonetheless feel alive.

Or we may feel joy, in the form of contentment, happiness, inspiration or even ecstasy.

…we tend to feel current, complete, real, whole and sane.”

I have had increasing flickers of these real emotions  on a daily basis the longer my recovery has gone on. It is great to see these as the real me.

It is certainly the me I want to be and will continue to strive to be.

The light at the end of the destination is me.

I am what I have been looking for.


This book is well worth reading if you also believe you were reared in a dysfunctional family and have suffered the shame-based trauma ever since.

This and other similar books were written in the 1980s and it is kinda strange there seems to have been a lot less in recent years as they describe shame-based family trauma so well.

It may be that these books need to be explored via neuroscience and neuro-psychology to update the effects family trauma has on the developing brain and how this maps onto later addictive behaviours, especially as my false self sounds kinda like my alcoholic and addicted self.

It is a real message of hope. When reading this book,  parts of my psyche that I have always labelled alcoholic could equally be reappraised as being this false self created for me via a co-dependency fostered in my own dysfunctional family.

It was suggested to me 8 years ago that I check out this Adult Child stuff but I resisted it.

It is only via researching neuroscience and seeing the demonstrable effects of child mistreatment that this stuff all kinda makes sense now. Certainly in a way I never understood before.

Perhaps I was not ready to understand. Perhaps the time is now to fully get to grips with my past.

When I say my past, this is not completely accurate as the past lives on in this false self. This false self is a negative, mal-adaptive self schema which I inherited from my parents and they probably inherited something similar from their own parents?


Healing The Child Within Discovery and Recovery For Adult Children of Dysfunctional Families by Charles L. Whitfield, M.D.

Filling that “Hole in the Soul”

When I first  arrived in AA I was told by a big scary looking man that in AA you will get better.

That “we will help you by loving you back to health”.

I was quite alarmed by this situation to be honest “loved back to health”? Was this guy some relic from the hippy era?

What he said, was very threatening to me. It suggested unconditional love, a concept that I was only partially familiar with.

I had always knew my father loved my unconditionally but this was less the case with my mother. I knew she loved me in her vague, through a  distant Valium haze but part of me was always reaching out, crying out for more. More love.

I found that love in liquid form in alcohol. Or so I felt. Alcohol was constant. It always delivered without fail, transported me to the person I would much rather be. Allowed me to escape the person I did not want to be.

I now accept my mother suffered from addiction just like me and I have immense compassion for her because of that, she did the best she could under the circumstances. I forgive her completely and love her completely.

She was not a bad person she as an ill person just like me.

Did this relationship with my primary care giver have any effect on my teenage drinking and later alcoholism?

Like many alcoholics I have spoken to over the years I too seemed to suffer from the  “hole in the soul” they spoke of.

That not feeling whole, like something in you, some part of you was missing.

Having a curious mind, I always wondered what it could be? It must be something that can be discovered? I wasn’t happy to leave it was a vague spiritual condition.

It felt too emotional just to be a spiritual thing, although it is also that.

It felt like I was lacking in something, something in my make up was not there or in diluted measure?

Later I found out that this relationship with my mother was called an insecure attachment and that lots of people in recovery had this insecure attachment with their mothers or whoever reared them.

This insecure attachment they said often resulted in novelty seeking and hunting out some “secure attachment” elsewhere, in a bottle, syringe, sex, a poker machine, food or other addictive behaviours.

It is lonely recently that I found there is a brain chemical linked to this insecure attachment called oxytocin, the “love chemical” which effects all the neurochemical said to be involved in addiction.

Oxytocin is badly affected by the stress reaction to insecure attachment, abuse trauma and a tough upbringing. The oxytocin is then reduced which reduces the other chemicals too and we search for these at the bottom of a glass.

Unfortunately alcohol seems to give us cocktail of these chemicals in liquid form. But never enough.

For a while anyway, it gives us the illusion of attachment, of that fleeting feeling of being part, of being loved.

Through the years all these chemicals start running dry and the drink stops working.

We are then left with the problems we had before we put a glass to our mouths.

So when the drink stopped working and I had to go to AA – not one wants to go  there, let’s face it, it’s because we have to!

So the big scary guy may have been right all along. I have found that he is right over the years of attending AA.

I have found a new, surrogate family  in AA, a “learnt attachment” within the fellowship of others in the same boat as me, who have felt the same as me. I have found this attachment to others, by being looked after and trying to help others – my oxytocin, the “love chemical” the “cuddle chemical” has gone up dramatically while my stress has plummeted as I have bonded with others in recovery.

This connectedness is my spiritual solution to a neurobiological problem.

I now feel part of for the first time, I have filled the hole in the soul with love given and received.

Alcohol and Drug Abuse Affects Everyone in the Family

The USA ‘s #1 health problem is alcoholism and drug dependence.  For decades, NCADD and our National Network of Affiliates have seen how the disease of addiction not only affects the individual, but millions of family members.

Fathers, mothers, single parents, couples straight or gay, regardless of ethnicity or social group, rich or poor….drug and alcohol abuse can destroy relationships.  Most of all, young children and adolescents suffer the greatest from the effects of the abuse of alcohol and drugs in the family.

But, with help and recovery, both for the individual and the family, families can heal together.

What Can Families Do ?

Learn About Alcohol, Drugs, Alcoholism and Addiction:

Our ability to cope with anything is a function of how much we know about what we are up against.  Although you have been living with alcohol and/or drug problems for some time, learning about alcohol and drug addiction is a critical first step.  You cannot rely on common sense or popular myths (preaching, complaining, acting like a martyr, dumping the alcohol or drugs).  Getting the facts about how alcohol and drugs affect the individual and the family is very important.

Seek Help and Support For Yourself:

The disease of alcoholism and addiction is a family disease and affects everyone close to the person.  Not only does the alcohol or drug user need help, so do you, even if you don’t realize it at the time.  You and other family members need and deserve appropriate education, help and support in finding healthy ways to overcome the negative effects of the disease.  Education, counseling and Mutual Aid/Support Groups can help you realize that you are not alone, that you are not responsible for the drinking or drug use and that you need to take care of yourself, regardless of whether the person you are concerned about chooses to get help.

NCADD Affiliates offer a range of services including help for individuals and family members.  If you are concerned about your own alcohol or other drug use or that of someone you care about—a child or other relative, a friend or co-worker—please make the contact.  You will be able to speak to someone who will listen, assess your needs and provide information about available services, costs and how to deal with another person’s alcohol and/or drug use.  Help is just a call or visit away—Make the contact now!

Learn What You Can Do To Help:

Treatment programs, counseling, mutual aid/support groups are all options for getting help.  Only the person using alcohol and drugs can make the decision to get help, but you can help create the conditions to make that decision more attractive.  Seeking help and support on your own can encourage interest in treatment or self-help.  Look into treatment options and costs together and express your belief that treatment will work.

If Needed, Consider Family Intervention:

If the person you are concerned about is unable or unwilling to seek help, you should consider a planned, professionally directedintervention. Intervention, with support of a trained and experienced interventionist, is a powerful tool for the family to receive education, guidance and support, with a focus on getting the person to accept treatment.

Be Patient With The Recovery Process:

As with all chronic illnesses, everyone needs time to recover and regain health.  For both the individual and family member, there may be relapses or breaks in treatment.  Old tensions and resentments may flare up occasionally.  Learn from these events and stay focused on recovery.

Hope For Long-Term Recovery: 

While addiction to alcohol and drugs has no known cure, the disease can be stopped once the individual abstains from alcohol and other addictive drugs.  Today, there are millions of Americans living life in long-term recovery from addiction to alcohol and other drugs.  And, millions more family members and children of addiction have also found recovery!


NCADD link


Artwork Copyright

Alcoholic Outsider Artist

Childhood Maltreatment and later Alcoholism/Addiction

One old timer I know often says two things that I often take issue with – 1. there are as many alcoholisms as alcoholics and that 2. we all come to AA in different boats but end up in the same dock.

Thanks to having a wife in Al Anon I have had the benefit of her insight and from other al-anons who state how remarkably similar we alcoholics are in our behaviour, particularly in dealing/coping with distress and stress, our emotional reactivity and at times immaturity (or so-called defects of character), I disagree that we are so different in our addictive behaviours.

All addictive behaviours from alcoholism, substance addiction, eating disorders to hypersexual disorder seem to be based on an inherent problem with emotion and stress dysregulation.

I believe I have a distress based condition. It results in what appear to be distress based reactions such as perfectionism, distress intolerance and frustration intolerance, normally exemplified in my shouting at my PC when it doesn’t work quickly enough or crashes!

I also believe I have distress based impulsivity, I want that thing, whatever it is, NOW. That anything!

In fact I have noticed when I want something, anything, I end up pathological wanting it in no time at all! It seems then like I NEED it. I too think this is based on distress and heighten stress reactivity.

In fact it is through this pathological wanting that my so-called defects of character that my examples  of emotional dysregulation appear.

If I can’t get what I want, all range of negative emotions spill forth such as intolerance, impatience, arrogance, pride, shame, selfishness etc .  They only appear when I want something and you are getting in the way of me having it!!

So there is a link between my motivation (which is dysregulated due to the effects of chronic stress which turns simple wanting into something more akin to “needing”) and my subsequent emotional dysregulation.

So where does this distress come from? Is it purely the effects of chronic stress dysregulation caused by years of neuro toxic brain damage or does it go back further, into childhood?

I do not think we all have separate alcoholisms, I feel we have remarkably similar reactions to life and these centre on an inherent difficulty regulating stress and emotion.

I also believe we have come to recovery in similar boats. In fact the majority of us have come to recovery in a remarkable similar boat so much so that it would resemble a gigantic ship rather than a boat. That boat is the ship of childhood maltreatment.

Child maltreatment has been frequently identified in the life histories of adolescents and adults in treatment for substance use disorders, as well as in epidemiological studies of risk factors for substance use and abuse.

 Child Maltreatment

One study (1) suggests there is ample evidence exists for higher rates of substance abuse and dependence among maltreated individuals.

In clinical samples undergoing treatment for substance use disorders, between one third and two thirds evince child abuse and neglect histories (Dembo, Dertke, Borders, Washburn, & Schmeidler, 1988Edwall, Hoffman, & Harrison, 1989Pribor & DiWiddie, 1992Schaefer, Sobieragi, & Hollyfield, 1988).

In the US a survey of over 100,000 youth in 6th though 12th grade, Harrison, Fulkerson, and Beebe (1997) Harrison, Fulkerson, and Beebe (1997) found that those reporting either physical or sexual abuse in childhood were from 2 to 4 times more likely to be using drugs than those not reporting abuse; the rates were even higher for youth reporting multiple forms of child maltreatment. Similar findings have been reported by Rodgers et al. (2004) and Moran, Vuchinich, and Hall (2004).

Among youth with Child Protective Services documented maltreatment, Kelly, Thornberry, and Smith (1999) reported one-third higher risk for drug use among those with an abuse history. In a large epidemiological study, Fergusson, Boden, and Horwood (2008) have shown physical abuse and particularly sexual abuse to be related to illicit drug use, as well as abuse and dependence.

Another Study (2) study would suggest the figures are much higher –   data were collected on 178 patients–101 in the United States and 77 in Australia–in treatment for drug/alcohol addiction. The purpose of the study was to determine the degree to which a correlation exists between child abuse/neglect and the later onset of drug/alcohol addiction patterns in the abuse victims. The questionnaire explored such issues as family intactness, parental violence/abuse/neglect, parental drug abuse, sibling relationships and personal physical/sexual abuse histories, including incest and rape. The study determined that 84% of the sample reported a history of child abuse/neglect.

A third study (1) stated that, using the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein & Fink, 1998; Bernstein et al., 2003) to assess childhood maltreatment in a community sample of active drug users, Medrano, Hatch, Zule, and Desmond (2002) found that 53% of women and 23% of men were sexually abused, 53% of women and 43% of men were physically abused, 58% of women and 39% of men were emotionally abused, 52% of women and 50% of men were physically neglected, and 65% of women and 52% of men were emotionally neglected.

Substance abusers, in addition to having higher rates of childhood maltreatment than members of the general population, have been found to have levels of psychological distress that increase with increasing severity of all types of childhood maltreatment (Medrano et al., 2002). This association is important considering that stress increases an individual’s vulnerability to addiction and addiction relapse (Goeders, 2003; Sinha, 2001;Wills & Hirky, 1996).

There is also evidence that the way in which people cope with stress is related to substance use. For example, researchers have found that greater use of avoidance stress-coping strategies (i.e., disengaging from investing effort to cope with a problem) is related to a greater likelihood of drug use initiation, higher levels of ongoing drug use, and a greater probability of relapse, whereas greater use of active stress-coping strategies (i.e., taking steps to deal with a problem) most consistently functions to protect individuals from substance use initiation and relapse (Wagner, Myers, & McIninch, 1999; Wills & Hirky, 1996).

Childhood maltreatment may influence substance use behavior through its effect on stress and coping. There is emerging evidence that childhood maltreatment may negatively affect the maturation of self-regulatory systems that enable an individual to modulate and tolerate aversive emotional states (Cicchetti & Toth, 2005; Hein, Cohen, & Campbell, 2005). Childhood maltreatment may disrupt neurobiological development and elevate subjective stress by biologically altering the brain’s response to stress (Bugental, 2004;DeBellis, 2002; Heim & Nemeroff, 2001; Heim et al., 2000; Sinha, 2005; Wills & Hirky, 1996). Childhood maltreatment may also affect an individual’s characteristic style of coping with stress so that he or she may be more likely to rely upon maladaptive strategies, such as avoidance of problems, wishful thinking, and social withdrawal, rather than active strategies, such as seeking information and advice from others (Bal, Crombez, Van Oost, & Debourdeaudhuij, 2003; Futa, Nash, Hansen, & Garbin, 2003; Krause, Mendelson, & Lynch, 2003; Leitenberg, Gibson, & Novy, 2004; Thabet, Tischler, & Vostanis, 2004).

Elevated stress and maladaptive coping related to childhood maltreatment may translate to greater substance use behavior by making the coping motives of substance use appear more attractive (Wills & Hirky, 1996). Indeed, substance users commonly report using psychoactive substances such as alcohol, cannabis, and cocaine to cope with stress and regulate affect (Boys, Marsden, & Strang, 2001)

Most cocaine dependent inpatients reported multiple types of childhood maltreatment, and only 15% reported no maltreatment at all, (similar figures to study 2).

“Our findings suggest that the severity of overall childhood maltreatment experienced by recently abstinent cocaine dependent adults has a significant relationship with perceived stress and avoidance coping in adulthood.

Our findings suggest that having a more severe childhood maltreatment history may result in a greater sensitivity to stress…basic coping skills training may not be adequate in decreasing distress and avoidant coping in order to decrease substance use and relapse. Additional interventions that focus on stress tolerance, altering appraisals of stress, stress desensitization, and affect and emotion regulation skills may be of particular benefit to patients with childhood maltreatment histories.

The fact that childhood maltreatment is a preventable phenomenon that occurs early in life and affects psychological functioning well into adulthood makes our findings relevant to clinical practice with children as well. Early identification and treatment of maltreated children may help prevent stress sensitivity or the development of a less adaptive style of coping. Assessment of coping ability and the implementation of coping skills and stress tolerance training may also be indicated for maltreated children in an effort to increase their coping efficacy and decrease their vulnerability to stress later in life.”

I may have been in recovery for a number of years now but coping with stress/distress is still central to my recovery. Dealing with the effects of childhood maltreatment not only via negative self esteem and self schema but in the real sense of coping with every day stress/distress, mainly prompted in my interpersonal relationships (other people!) and with my PC!



1. Rogosch, F. A., Oshri, A., & Cicchetti, D. (2010). From child maltreatment to adolescent cannabis abuse and dependence: A developmental cascade model.Development and psychopathology, 22(04), 883-897.

2. Cohen, F. S., & Densen-Gerber, J. (1982). A study of the relationship between child abuse and drug addiction in 178 patients: Preliminary results. Child Abuse & Neglect, 6(4), 383-387.

3.  Hyman, S. M., Paliwal, P., & Sinha, R. (2007). Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults. Psychology of Addictive Behaviors, 21(2), 233.

The Family Afterwards…

Today we listen to the research wisdom of William White in relation to family recovery, especially long term.

Family recovery is much overlooked and not adequately supported long term in terms of “after care” which is incredible when one considers that interpersonal factors such as family relationships contribute in a major way to  relapse?

Instead of spending millions upon millions on cue reactivity and attentional bias studies which look at how recovering people are supposedly constantly drawn to alcohol and substance cues in the environment like lemmings to a cliff (when this does not seem particularly evident in the literature, particularly in relation to being relapse factors) or on anti-craving medication when me and scores of other alcoholics and addicts in recovery rarely have these once they have ultimately accepted in our innermost selves that they are alcoholic/addict (and if we do, we can deal with them via our support networks), why does research funding via various funding bodies and various universities not look at the efficacy of supporting families in long term recovery, certainly to around the 3-5 year mark, at the very least?

I suspect one would find that support of family recovery long term, possibly in extended recovery communities, may be the most potent way to assist long term recovery?

Why doesn’t research address what works, and why it works rather than trying to develop the next miracle pill? 

Craving is also a symptom of an underlying condition, it is this condition that recovery should be treating?

We have the solution already? Why not support it to increase it’s efficacy long term?  We, via research and funding, could very possibly increase long term recovery, period.

Just a couple of ideas to put out there?

Back to William White and …

The Ecology of Recovery –  there appears to be a historical shift in recovery away from intrapersonal dynamics to a more interpersonal dynamic. From a recovery within with self, looking at the self,   to a fuller recovery involving others in one’s recovery life such as families and recovery communities.

Family Recovery – if we attend to families at all in recovery, it is brief and very short term. Unfortunately,   research suggests that recovery is actually “horribly destabilising” for families. 

The Trauma of Recovery

Families are at a high risk of disintegrating in the early stages of recovery. So we need to build “support scaffolding” for these families. Recovery  does little to prepare or support families in recovery. Stephanie Brown refers to this as the “trauma of recovery”!  We still do not know the extent of what that means or the extent of our roles in recovery in guiding families, according to William White.

Please also click to this link to watch a series of videos on family recovery by SAMHSA which are very illuminating about the process of recovery and describe a process of recovery I have gone through myself with both my  wife, nuclear and extended families.

The Family Afterward…factors in relapse!

The majority of relapses I have witnessed have been due to interpersonal factors, e.g. arguments at home with family and loved ones, not being able to cope with relationship breakdowns, perceived rejection by loved ones.

Research itself shows that the majority of relapses are caused by an inability to deal with distress (negative emotions) especially in the context of interpersonal relationship.

In this two part blog we have considered evidence that shows intrapersonal traits (e.g. rejection sensitivity and low self esteem) and interpersonal environments (e.g. the family environment) can interact to increase an addict’s risk of relapse.

This study (1) concludes by proposing that substance-dependent individuals with high trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse.

In the first part of this blog we looked mainly at intrapersonal (i.e. within the self) traits now we consider how these factors interact with interpersonal (relationships between individuals ) factors to often prompt relapse situations.

“Interpersonal Vulnerabilities to Addiction and Relapse

Perceived criticism (PC) and expressed emotion (EE) are related constructs that are used to measure criticism by family members directed toward the patient (36,37). EE—measured with a semi-structured interview—reflects the degree to which relatives refer to the patient in critical, hostile or over-involved ways (36).

O’Farrell et al. (36) found that alcoholic patients with high EE spouses are also more likely to relapse than their low EE counterparts. They proposed the development of a vicious cycle in which increased criticism leads to increased drinking, which leads to escalating criticism. They also found that behavioral marital therapy that aims to improve communication and decrease criticism reduced relapse in patients with high EE spouses (36).

The perceived criticism (PC) measure is operationalized using the single question “How critical is your spouse of you?” Similar to high EE, high PC—a far simpler measure that is less expensive to obtain than EE—significantly predicted relapse to substance use in a sample of alcohol dependent individuals (37).

Marital distress and spousal criticism are frequently associated with worse outcomes in treatment-seeking addicts (40,41). Family cohesion has been shown to significantly predict the severity of a person’s dysfunction resulting from drug use (42), and one study reported that spousal conflict was most frequently identified by male alcoholics as the cause of their relapse (43).

Booth et al. (40) showed that support from family and friends, specifically “reassurance of worth,” significantly predicted improved treatment outcomes even in patients with high rates of prior recidivism.

They argued that enhancing an alcoholic’s sense of self-worth would increase the individual’s likelihood of recovery and called for treatment interventions that focus on enhancing social support (40). Consistent with this approach, numerous studies have shown a positive association between supportive family and friends and improved drug and alcohol treatment outcomes and enhanced psychological functioning (44,45,46,47).

Individuals who are unable effectively to regulate the negative affective states elicited by interpersonal conflict are at greater risk of becoming substance dependent and to persist in their use of alcohol and drugs despite adverse consequences (48,49). For instance, fMRI studies have repeatedly shown that threatening social cues elicit increased amygdala reactivity. Sripada et al. (48) showed that alcohol attenuates this reactivity and hypothesized that alcohol’s ability to reduce stress and anxiety is mediated by its attenuation of threat processing in the amygdala (48).

Negative reinforcement of social rejection is not the only mechanism increasing high-rejection-sensitivity individuals’ risk for addiction and relapse. Because rejection activates the defensive motivational system, these individuals frequently respond with automatic aggressive behaviors, sometimes assuming a passive form of “going out and getting wasted” to “punish” the person who rejected them. Social rejection also impairs self-regulation, further diminishing the high- rejection-sensitivity individual’s ability to employ the strategies and cognitions necessary to avoid relapse.”

As the Big Book suggests “All members of the family should meet upon the common ground of tolerance, understanding and love…Cessation of drinking is but the first step away from a highly strained, abnormal condition…”Years of living with an alcoholic is almost sure to make any wife or child neurotic. The entire family is, to some extent, ill.” Let families realize, as they start their journey, that all will not be fair weather….”


Indeed, the family needs to recover not just the obvious candidate of the alcoholic/addict. This is a family illness and everyone in the family needs to support each other in their recovery.  This hard earned wisdom often seems the profound and most profitable to all.

The NCADD  state the notion of family disease clearly …

“Alcoholism and drug addiction affects the whole family – young, teenage, or grown-up children; wives or husbands; brothers or sisters; parents or other relatives and friends.  One family member addicted to alcohol and drugs means the whole family suffers.  Addiction is a family disease that stresses the family to the breaking point, impacts the stability of the home, the family’s unity, mental health, physical health, finances, and overall family dynamics.

Without help, active addiction can totally disrupt family life and cause harmful effects that can last a lifetime.

Regrettably, no family is born with the knowledge of how to deal effectively with addiction.  It is a skill that must be learned and practiced daily.

But, with the proper help and support, family recovery has become a reality for millions!”



1. Leach, David, and Henry R. Kranzler. “An Interpersonal Model of Addiction Relapse.” Addictive disorders & their treatment 12.4 (2013): 183–192. PMC. Web. 30 Jan. 2015.

2.   Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.