Understanding the role a person played within their family system is a valuable for a recovering meth, heroin, or alcohol addicts.  What follows is an adaptation and expansion of the work of Alfred Adler, Claudia Black, Virginia Satir and Pia Mellody.

There are five basic family roles.  Here is a list of the roles and some of their attributes.

1. Hero (often, but not always, first born) – successful, goal oriented, leader, high achieving, organized, self-disciplined, willing to hide family secrets, perfectionist, rigid, not prone to play, anxious, high expectations of self and others, struggles to relax, often uncomfortable outside a clearly defined hierarchy,
2. Mediator (often, but not always, middle born)  – Calm, empathetic, warm, great listener, smiles readily, gentle, peaceful, sometimes says “yes” when they mean “no,” high fear of anger and conflict, people pleaser, high tolerance for inappropriate behavior.  Tend to develop a small group of very close friends.
3. Lost Child (birth order varies) – flexible, easygoing, wiling to follow, doesn’t want to be a burden, feels forgotten / neglected, blames self, low self-esteem, often depressed
4. Mascot (often, but not always, last born) – Fun loving, social butterfly, outgoing, funny, sometimes sarcastic, laid back, sometimes irresponsible, not prone to planning ahead, sometimes impulsive, willing to take risks, large number of friends.
5. Scapegoat (birth order varies) – Creative, often a great storyteller, willing to expose family secrets, intolerant of hypocrisy, tells it as he sees it, expresses anger readily, can be explosive, sometimes legal trouble, social problems at early ages, tendency to experiment with drugs and alcohol.

By their nature, roles like this are generalized.  Very rarely will you meet an individual who conforms to all the descriptive terms associated with a single role.  More often people will play multiple roles in their family of origin.  The first role has generally been adopted by the age of 6, though it may change several times prior to and during adulthood.  The most likely times for roles to change are during adolescence (ages 10-12) and when there are significant changes to the family system.   Significant changes in the family constellation can include death, serious illness, divorce, a sibling leaving home, adoption, and addition of a step-parent and/or step-siblings, etc.

Somewhere around the 30-35th day of sobriety the addicted brain begins to enter Post-Acute Withdrawal. The symptoms vary, but the most challenging and pernicious of them are dysthymia and anhedonia. Dysthymia is a technical term used to identify low-grade, consistent depression. A person doesn’t feel awful – they can still work and function and socialize, it’s just that doing so is unpleasant and uncomfortable. Anhedonia is another technical term used to characterize the inability to feel pleasure. This simply means that things that I used to find worthwhile and sustaining no longer feel good. Sex, television, food… nothing scratches the itch.

Meth addicts, alcoholics and heroin addicts seem to struggle when they’re in situations that feel futile. The dysthymia and anhedonia that accompany PAWS would probably be almost tolerable if it didn’t last 3-4 months. Here at Sober Way we notice a “month three syndrome” where during their third month – often around day 75 – our clients become fixated on a reason they need to leave treatment. Family, job, pets, “I want to get back to normal life”, the list is endless because the reason stated is rarely really the real reason. PAWS has kicked in and the addicted brian is looking for something – anything – to feel ok again. The problem is that often clients will leave treatment and when they discover that whatever they were fixated on doesn’t work they return to what does.

That’s why we hold to a six month model here. The 30-day treatment model was established in the 1970′s and remains mostly because “that’s how we’ve always done it.” Long-term treatent does work. Our experience is that clients who complete a six month program and participate in online aftercare to transition back home have a high success rate.

The primary difference between an alcoholic, drug addict, meth addict, or other addict and a “normal” person is that for someone who is not addicted drug and alcohol use is something that is seen as a problem. For the addict their drug of choice is the solution. See the difference?

What’s interesting is that for most addicts their drug of choice starts out as one of their primary repositories of hope. “When I drink, I feel like I am someone.” “When I’m on meth, I’m sexy and so is everyone else.” “I was just shooting heroin because it made me feel ok.” The great fantasy of every addict is that they will someday be able to control their use, because their use is often the only thing in their lives that gives them a sense of hope, a sense of that they can make it and belong in this world.

Of course we know the end of the story. It’s a false hope; in fact it’s hopeless. When methamphetamines, marijuana, alcohol, heroin or any other drug becomes the center of my world, I find it gradually starts asking more and more for less and less. When I stick with it anyway, hoping in that which is becoming more and more hopeless, that’s when I know I’ve crossed the line between addict and recreational user.

I remember one father who told me “no daughter of mine is going to live under a bridge Greg.” I said “sir, I admire your love of your daughter, but if you cannot bear to allow her to choose to live under a bridge than you are likely choosing to let her overdose in your basement.” The young woman in question was using massive quantities ofheroin.

If I am the parent of a child and she comes to me and says “dad, I made a mistake and I need some money for rent this month. Can you help me out?” For me, I am quite likely to give her the money she needs, particularly if it’s an amount that isn’t problematic for me. I love my child and I want what’s best for her, and I remember being young and making mistakes. If my child is “normal” (the word I typically use for people I don’t know very well) giving her some money to help her out along with a few words on the importance of learning from the experience could probably be considered healthy, loving parenting. If, on the other hand, my child is an addict, I have just subsidized her next high.

If I am the spouse of an addict and I call in sick to work on their behalf, tell lies to my family and friends about what they are doing and/or scramble to cover a bounced check I am allowing them to avoid the natural consequences of their behavior. This tends to facilitate a lower bottom rather than solve the problem.

If you’re the spouse of an addict, check out www.alanonphonemeetings.org or use google to find alanon meetings in your area. Al-anon teaches the principles necessary to help a you offer opportunities for life to the addict in your life.

This is not a terribly popular message. In fact, the entire advertising industry is built around the idea that if we have the particular product or service being offered it will relieve our pain. We all have a desire to go around rather than through.

Explaining the value of pain is one of the most difficult elements of recovery to present to the addict. We say “You’ve not experienced pain without medicating it for a decade (often longer). We’re going to take away your medicating and leave you in tremendous emotional, spiritual and physical pain. It will typically last about 5 months. Once the 5 months is finished, you’ll have less pain, but still quite a bit more than you’re used to. You’ll need to develop skills for coping with that – the same skills everyone else you know developed in junior high school. So, I can promise you a life full of the pain you have been working so hard to avoid. Ready to sign up?

It’s the truth and it hurts. A lot! It’s a tough sell, to say the least.

By Greg Struve, MA, LAC

Clinical Director

The Road to Recovery from Drug Addiction and Alcoholism Early and Middle Recovery Defined By Greg Struve, MA, LAC Clinical Director A Sober Way Home Prescott, Arizona Based on the work of such imminent psychologists as Terrance Gorski (1986) and the authors of the Matrix Model (NREPP, 2006), we now understand that the course of recovery usually involves predictable stages. These stages tend to be similar regardless of the substance involved in addiction. The time frames which will be discussed here will more closely follow the Matrix model. Gorski’s work tends to be a bit less rigid in terms of the timing of the stages.

Recovery is accompanied by withdrawal symptoms, both acute and post-acute. An acronym commonly used for the latter is PAWS, post-acute withdrawal syndrome. This painful syndrome is one of the major reasons that early recovery can be such a challenge, especially in the case of methamphetamine addiction for which recovery tends to be uncomfortable for a more extended period of time.

The first six months of abstinence from the drug of choice is usually referred to as Early Recovery. The second six months is referred to as Middle Recovery. Today’s blog entry will present a quick overview of these periods. Subsequent entries will present a more in-depth look at each of the stages involved. Social anxiety is symptomatic of recovery during the entire first year. PAWS usually spans much of the Early Recovery period. Middle Recovery is usually characterized by a reorienting of the self to the social demands of the world. It is during the second six months that the underlying causes of social anxiety can be addressed. This is facilitated by attendance at 12-step meetings where the individual is given unconditional acceptance regardless of their behavior.

Most individuals who become addicted to drugs or alcohol start at a relatively early age, usually beginning with alcohol or marijuana and sometimes with behavioral addictions such as an obsession with pornography or eating disorders, all of which act on the brain in a similar fashion to drug use. This frequently occurs by the time the individual is in high school. Individuals, who anesthetize emotional pain with addiction at this early age, also anesthetize their emotional growth and development, becoming “frozen emotionally”. Consequently, individuals in early recovery display the emotional maturity of an early teenager or one even younger.

Our next Blog will take a more in-depth look at PAWS. Please join us then. References Gorski, T. T. (1986). Relapse prevention planning: A new recovery tool. Alcohol Health and Research World, 11, 6-11, 63. NREPP, (2006). Matrix Model, retrieved from: http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=87

Accountability and acceptance are highlighted as the process of addressing and understanding the consequences of addiction and co-occurring disorders are exposed and processed.  As the client begins to feel and experience emotions more clearly they are guided through work surrounding anger, denial, shame and guilt. The basic principles of a 12 step foundation are introduced and the client is drawn into the therapeutic process.  The focus is placed on understanding the cycle of addiction, identifying triggers and developing new coping skills.  Dual Diagnosis conditions and issues are addressed. The ground work for family systems work is established.