Thursday, November 1, 2007

Gender, Part Two---Gender in Recovery, Part Two

In my previous post I wrote about a piece of research that found gender and marital status seem to enhance or lessen the likelihood of long-term sobriety. Specifically, the researchers found that 8 years after completing treatment, married men and unmarried women were more likely to be clean and sober, while unmarried men and married women were less likely to remain abstinent. In that post I wrote about why married men are more likely to stay clean and sober than unmarried men.

Today's post is about why unmarried women seen to do better in recovery than married women. Joan and Hank are a couple who illustrate the difficulties married women encounter in recovery. When they came to see me, Joan had about 18 months of sobriety. They called me because they were having trouble with the sexual part of their relationship. Joan had met Hank in a bar when she was still drinking and quickly fell into a sexual relationship with him. Before she got sober, she and Hank usually split a bottle of wine and/or got stoned before going to bed for sex. Both Joan and Hank reported that Joan had been very involved in their sexual encounters during this part of their relationship, and both of them spoke about how delighted they both were with the sexual part of their relationship.

Joan surrendered to the reality of her alcoholism, attended a 30-day outpatient program, and began going to AA meetings about 6 months after she and Hank got married. Her discomfort with sex, which actually began shortly after the wedding, escalated after she got clean and sober to the point that she had begun to dread the times when Hank approached her for sex. Hank, who was still drinking and using pot on the weekends, was frustrated and impatient with Joan about her lack of sexual desire. He blamed the situation on Joan's participation in AA, saying Joan was being influenced by "those AA dykes who hate men." Needless to say, Hank's attitude and behavior only added to Joan's difficulties in wanting to be sexual.

As we explored Joan's past, I realized that Joan had probably been sexually abused by her dad's alcoholic brother. Joan acknowledged how her uncle would always want her to sit on his lap and give him a kiss when he visited and how he made sexually inappropriate remarks in her presence, but she had no memory of any direct sexual encounters. It was clear, however, that talking about this uncle stirred up angry and unhappy feelings. When Joan married Hank, some of these feelings began to emerge when she and Hank were making love; they became much stronger after she sobered up.

Joan's probable sexual abuse (I would label her uncle's behavior as sexually abusive even if he never had intercourse with her or persuaded her to perform oral sex on him) is not at all uncommon for women who have become addicted to alcohol or drugs. In fact, my wife, S, who is also a therapist, has worked with at least 200-300 alcoholic/addict women over the past 25 years, and EVERY SINGLE ONE OF THEM was either sexual abused or the victim of unwanted, inappropriate sexual behavior before becoming adults. Drinking alcoholically and/or using mind-altering drugs became a way of coping with the pain, anger, and shame these women experienced as a result of the abuse.

A common coping mechanism for people who have been sexually abused is to split off sexual feelings from the feelings of emotional vulnerability. It is as if a person can be sexual as long as their is no commitment to an ongoing deep emotional connection. But when an alcoholic woman who was sexually abused as a child marries and also sobers up, she is suddenly quite vulnerable emotionally, opening herself up to the pain, anger, and shame of her sexual abuse whenever she and her husband try to make love. One way to avoid these feelings is to shut down her sexual desire; hence Joan's loss of sexual interest in Hank after they married and she got sober.

Hank's response to Joan's apparent loss of libido only made things worse. She was trapped between stirring up uncomfortable feelings if she engaged in sex and being the recipient of Hank's anger and contempt if she didn't. It is not surprising, therefore, that Joan went back out and resumed drinking a few weeks after she and Hank began seeing me. It was the only way she knew how to cope in a marriage that neither supported her sobriety nor helped her work through her childhood history of sexual abuse. I suspect this kind of situation is one the primary reasons that married women are less likely than unmarried women to achieve long-term sobriety.

Wednesday, October 31, 2007

Gender, Part One---Gender in Recovery, Part One

I recently read a piece of research about the differences in recovery by marital status and gender. The article was based on an 8-year follow-up of people who had completed treatment for alcoholism and/or addiction. The findings were intriguing. Married men were more likely to remain clean and sober than unmarried men. On the other hand, it was unmarried women who were more likely to still be clean and sober after 8 years (married women actually had a higher rate of abstinence after one year of recovery, but more married than unmarried women failed to remain abstinent over the 8 year period.) The authors of the article said the finding was unexpected and were at a loss for the explanation.

Based on my observations both in 12-Step meetings and in my work as a couples therapist, I think part of the reason for these findings has to do with how sexuality affects men and women differently in recovery. I have come to believe that the majority of men who are addicted to alcohol or other substances are also sex addicts. Whether it be obsessive viewing of online pornography, frequent trips to strip clubs,
repeated encounters with prostitutes, compulsive masturbation, or continuing "womanizing," we alcoholic/addict men are prone to act out sexually in ways that are risky for both our sobriety and our chances of developing and maintaining healthy, satisfying relationships.

My client George is a good example. George sobered up about six years ago. He was married at the time, but the marriage was in bad shape both because of George's drinking and his habit of going to strip clubs to drink. After he sobered up, George stopped going to strip clubs because of the threat to his sobriety; but he soon discovered Internet pornography and spent an increasing amount of his late evening time at home masturbating while viewing Internet pornography. About two years into his recovery, George's wife announced she was divorcing him because of his obsession with online pornography.

George came very close to picking up a drink after his wife left, but was able to stay sober with the support of his sponsor and the friends he had made in AA. Despite the failure of the marriage, George was initially unwilling to admit he was addicted to online pornography. He insisted it was harmless and something "all guys do altho they may not talk about it." He got involved in several short-term relationships after the divorce, but they didn't develop into anything significant.

About two years ago, George came to see me for counseling for help with his seeming inability to find the "right" woman. Eventually George admitted that his use of pornography and his compulsive masturbation were signs of a sexual addiction, and he began to attend SA meetings. It took awhile, but he finally was able to stop viewing pornography and to let go of the compulsive masturbation that went along with it.

And then about six months ago George met Bridget through a mutual friend. They hit it off and soon began seeing a lot of each other. George says he is experiencing the kind of emotional and sexual intimacy with Bridget he has always longed for, and he is clear that going back to Internet pornography would seriously damage their relationship. But a few weeks ago, Bridget left town to spend a few weeks with her seriously ill mother, and George reports that he is struggling not to go back online and just "check out" a few pornography sites.

As we explored what was underneath his desire to check out some pornography sites, George became aware of how much he misses Bridget and how lonely he feels without her presence. He was able to connect those feelings with the loneliness he felt during most of his childhood with a father who was always working and a mother who drank alcoholically as a way of medicating her own feelings of loneliness. George said he discovered by the age of 10 that masturbation could make those lonely feelings go away and that eventually he no longer noticed his loneliness and desire for emotional connection. He also said that in the past he wouldn't even have been aware of missing Bridget, his attitude being basically one of "out of sight, out of mind"--which was probably literally true for him.

So far I have never met an alcoholic or addicted man who grew up in a warm, loving family with a secure attachment to his parents. Although I have heard men in recovery make generalized statements about having had a happy childhood or having grown up in a good family, they either are not able to give specific examples of what made their childhood family a happy, loving one or they acknowledge not feeling very attached to their family when they were children. Not having met any men in recovery who grew up in loving, supportive families doesn't mean they do not exist; but they are definitely in the minority of those who develop the disease of alcoholism or addiction.. More importantly, I have heard far more men in recovery talk about growing up in families with alcoholic/addicted parents, angry, hostile parents, punitive parents, unavailable parents. Thus it is no surprise that most of the men I have known in recovery could be classified as having an avoidant attachment style.

Having an avoidant attachment style means not being aware of a longing for emotional connection or minimizing its importance. But all of us are born with the desire to be closely connected to someone, so a lack of awareness of such a need as an adult does not mean an absence of such a need. Add to that the fact that many, many men view sex as a way to get close, and it makes sense that many of us who are alcoholics and/or addicts become obsessed with sex in one form or another as either a way to connect at least briefly or as a way to anesthetize our feelings of loneliness and longing for connection. If we are going to find our way to a secure, healthy, mutually satisfying relationship in recovery, we must take a look at our sexual attitudes and behaviors to see where they cause relationship problems.

Lastly, I have come to believe that one of the reasons that marriage or a "new love interest" (Vaillant) greatly enhances the chances for long-term sobriety for men is the way a happy intimate relationship takes away many of the reasons we become alcoholics or addicts in the first place. A partner whom we trust and love provides us with the kind of emotional connection that most of us lacked during our childhoods and the years we were drinking and using. Although we may have married someone before we got into recovery who could have provided that kind of connection, our drinking and using lead us to behave in ways that seriously disrupted the relationship. It is only when we are clean and sober and willing to do the necessary work to heal and sustain a marriage that we reap the benefits of marriage to our sobriety.

Monday, October 29, 2007

The Steps and Relationships in Recovery---Concluding Post

Most married folks in AA have very happy homes. To a surprising extent, AA has offset the damage to family life brought about by years of alcoholism. Permanent marriage breakups and separations are unusual in AA.
12 Steps and 12 Traditions

Would that the above statement were as true today as it may have been when written more than fifty years ago. It would be wonderful if going to meetings, getting a sponsor and working the steps were all that is needed to have a happy home in recovery. But my experience as a marital therapist as well as my observations as an active member of AA tell me otherwise. Working the steps is a necessary part of finding marital happiness in sobriety, but for most couples today it is far from being sufficient. Making relationships work in recovery requires more knowledge and skills than can be gained simply by working the steps.

Making any marriage work requires much more effort these days than it did when 12 Steps and 12 Traditions was written. During the Fifties, divorce was not seen as a real possibility for most couples even when partners in a marriage were deeply unhappy with each other. In such circumstances husband and wife often separated emotionally, living parallel lives, but they were less likely to separate physically and even less likely to end their marriage altogether. Nor was living together without being married viewed as a viable option by most couples a half century ago.

The Sixties and Seventies saw a major change in societal attitudes and practices regarding marriage and divorce. If one or both partners came to feel that their differences were insurmountable and remaining together was too painful emotionally, then separation and divorce became the solution for many couples. Although the divorce rate has diminished somewhat in the last two decades, it remains substantially higher today than it was for the parents of the Baby Boomers. As a result, staying married has become an ongoing choice, not an obligation---and that means that all couples, in recovery or not, have to acquire the skills and outlook that make it possible to stay together when the going gets (or has been) rough.

I suspect that the AA marriages Bill W was talking about in 12 Steps and 12 Traditions were not quite as happy as Bill stated. First of all, I wonder how happy and close Bill and Lois actually were in view of Bill's continuing extra-marital affairs. But more important, I wonder how accurate Bill's perceptions were about the marriages of other early AA members. I can't tell you how many times in the last 25 years a husband/boyfriend has urgently called my office requesting a first meeting ASAP because his wife/girlfriend has just announced she wants to end their relationship---in the initial counseling session I invariably hear the woman talk about how she has long been unhappy about the relationship and has repeatedly voiced that dissatisfaction, but the husband/boyfriend seemed unable/unwilling to hear her unhappiness until she had reached the point of no return and was ready to walk out the door. So I have become a bit suspicious when a guy in recovery pronounces his relationship as happy and free of problems unless I have also heard the same thing from his wife/girlfriend. We men seem to have a huge blindspot when it comes to accurately perceiving the state of our intimate relationships.

And that brings me to the next issue I want to talk about in this blog: gender. Men and women really are different, and those differences are significant when it comes to making a relationship work in recovery.

Thursday, October 25, 2007

Step Twelve, Part Three---13th Stepping

It is only where "boy meets girl on A.A. campus," and love follows at first sight, that difficulties may develop. The prospective partners need to be solid A.A's and long enough acquainted to know that their compatibility at spiritual, mental, and emotional levels is a fact and not wishful thinking. They need to be sure as possible that no deep-lying emotional handicap in either will be likely to rise up under pressures to cripple them.
12 Steps and 12 Traditions

This is such important advice, and any good sponsor will be familiar with it. The 12-Step emphasis on avoiding any major changes in one's life during the first year as much as possible is particularly apropos when it comes to relationships---neither entering into a romantic relationship nor ending an ongoing relationship for the first year of recovery. Beginning or ending a relationship is highly stressful (although it doesn't feel that way at first when we have fallen in love and life seems so beautiful), and successful early recovery depends on keeping the stresses in one's life to a minimum. All of us with some time in the program have watched newcomers disregard this advice and the results have usually been poor if not disastrous.

And yet, and yet. My own experience flies in the face of this advice. Soon after I met S, realized I was (and am) an alcoholic/addict, and got clean and sober through Alcoholics Anonymous, S and I started dating seriously. We began living together when I had less than six months sobriety. 23 years later, we are still together, quite happily married, and our relationship is a cornerstone of my sobriety.

There are several reasons, it seems to me, why we were able to form a close relationship so early in my recovery that didn't threaten my sobriety. First, S had been involved in Alanon for many years before she met me and had learned how to detach with love when I would start to be a little squirrely. Second, I had been divorced for 8 years and had been celibate for almost a year before S and I met, so I was ready and emotionally available for a serious relationship once I got clean and sober. Finally, S told me she decided to take a chance on me despite my lack of time in the program because "you do your work." By that she meant that my willingness not only to get deeply involved in recovery, but also my willingness to use any other tools (personal therapy, couples counseling, reading, and talking with S) that would enhance both my recovery and my ability to be a responsible partner in our relationship.

It was not all smooth sailing by any means. I acted out in a dry drunk manner far too many times during the first year of our relationship. Several times I was convinced we weren't going to make it. But S's steadfastness and love for me, my deep love and admiration for her, and my willingness to take responsibility for my crazy behavior and seek to change it kept us together through the difficult times. Looking back, I have come to believe that my recovery has occurred because of our relationship during my early sobriety, not in spite of it.

In his wonderful long-term study of alcoholic men (The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery), George Vaillant found that AA was by far the most frequent reason that the men in his study were able to get sober and remain sober. But he also found that "a new love relationship---unscarred by the mixture of guilt and multiple psychic wounds that alcoholics inflict upon those whom they love--becomes valuable in maintaining abstinence."

That has certainly been true for me. Although S knows all about my drinking and using and the many problems it caused me and others close to me, she has never experienced me being drunk and/or loaded. There is no guilt for me to carry because of multiple psychic wounds inflicted on S before I got clean and sober. As a result, it has been much easier for our relationship to remain "current," so long as I practice the 10th Step, consciously taking my inventory and making prompt amends when I am wrong.

So I can't say that getting involved in a new love relationship in early recovery is always a mistake, is always a serious threat to continued sobriety. Most of the time, staying out of new relationships until a solid foundation of recovery has been built is excellent advice. This is especially true about relationships formed between two people new to recovery. Both of them lack the emotional stability and the relationship skills to make a partnership work. The odds of being able to achieve a good relationship are very low, while the odds of one or both of them going back out to drinking and using are very high. But if we meet someone who loves us, sees the person we can become provided we take our recovery seriously and work very hard to change, and can stay fairly balanced and detached whenever we momentarily fall down in our efforts, then I agree with Vaillant's findings that a new love interest can be a core part of our successful path to recovery.

Wednesday, October 24, 2007

Step Twelve, Part Two---Carrying the Message

Having had a spiritual awakening as the result of these Steps, we tried to carry this message to other couples, and to practice these principles in all aspects of our lives, our relationships, and our families.
Step Twelve, Recovering Couples Anonymous

In 12-Step meetings we share our experience, strength, and hope about our recovery as a way of carrying the message about recovery from addiction to the alcoholic/addict who still suffers. By telling our story of what our life was like before we stopped drinking and using and what our life has become in recovery, we let newcomers know there is a solution to the problem of addiction and we support each other to remain committed to recovery.

I wish there were more willingness among those of us in good relationships to share the experience, strength, and hope about this part of recovery. What I have heard in meetings about relationships tends to be either how difficult and unhappy they are or a general statement about being in a good relationship without any details about what makes the relationship a good one or what the person has done to get to that place. I think it would be helpful if those of us in happy, loving relationships were more willing to talk about what we have learned and what we have done in recovery to develop and maintain such relationships.

This is an important way of carrying the message to the alcoholic/addict who still suffers because almost all of us are either in fairly dysfunctional relationships or no relationship before we surrender and begin the process of recovery. It is so helpful when we are struggling with that First Step and the implications it has for our lives to hear people talk about the possibility of being in a truly loving relationship when clean and sober.

It is also an important way of carrying the message to those of us in recovery who are struggling to learn what a healthy relationship is and how to go about achieving it. Sharing this kind of information is vital to our sobriety, because failed or failing relationships are one of the primary reasons people relapse or continue to be unhappy even though they are clean and sober. It is also vital to the health of our relationship because it helps remind us of the ongoing effort we must make to maintain the open, positive relationship with our partner that we treasure and that contributes so deeply to our continued sobriety.

Tuesday, October 23, 2007

Step Twelve, Part One---A Spiritual Awakening

When a man or a woman has a spiritual awakening, the most important meaning of it is that he has now become able to do, feel, and believe that which he could not do before on his unaided strength and resources alone. He has been granted a gift which amounts to a new state of consciousness and being. ... In a very real sense he has been transformed.... He finds himself in possession of a degree of honesty, tolerance, unselfishness, peace of mind, and love of which he had thought himself quite incapable.
12 Steps and 12 Traditions

One of the things most of us alcoholics and addicts could not do on our own before recovery was to be in a healthy, mutually satisfying relationship. Most of us grew up in families that were fairly dysfunctional---if there was not outright violence and emotional abuse and/or abandonment, there was usually an atmosphere of tension and unhappiness in our childhood home. At least that's been my observation as I've listened to people talk about their childhood in 12-Step meetings or in my office. As a result, when we become adults and enter into relationships we usually bring a number of dysfunctional beliefs and behaviors to our partnerships.

When we first get into recovery, we tend to point to our addictions as the source of all our relationship problems. But as we acquire time in recovery, many of us discover that we are still encountering a good deal of difficulty in our closest relationships. Even when we have some time in the program and have diligently worked the steps, we often still find ourselves in an unsatisfactory relationship with our partner. If we are able to avoid placing the blame for this state of affairs on our partner (or on ourselves as "f**ked up" alcoholic/addicts) and take responsibility for understanding and correcting the dysfunctional attitudes and behaviors we learned while we were growing up, then with a strong commitment to change and the hard work that entails we are likely to find the happiness and satisfaction in our intimate relationships that we have always longed for.

I believe the kind of spiritual awakening described in the 12x12 is essential for anyone who wishes to be in a healthy, functional close relationship. The qualities listed in the quote at the beginning of this post are the qualities that are necessary to make relationships work well. There is a growing body of marital/couple research that demonstrates how vital honesty, tolerance, unselfishness, peace of mind and love are to the well-being of a relationship. When those qualities are absent, intimate relationships inevitably deteriorate over time, ending either in separation and divorce or a miserable, distant relationship in which partners increasingly move to live separate, parallel lives while still living together.

The spiritual awakening created by working the Steps and the personal qualities engendered by that awakening will not in themselves bring about a loving, healthy, mutually satisfying relationship. They are necessary, but not sufficient since most of us will have a lot of work to do to change the dysfunctional beliefs and behaviors we learned in childhood. But those qualities will give us the ability and the strength to look at these issues, to acknowledge how our childhood experience has negatively affected our ability to be loving partners, and to persevere in our efforts to adopt healthier beliefs and actions in our relationships.

Friday, October 19, 2007

Step Eleven, Part Four---Our Common Prayer and Meditation

We sought through our common prayer and meditation to improve our conscious contact with God as we understood him, praying only for his will for us and the power to carry that out.
Step Eleven, Recovering Couples Anonymous

One of the things that attracted me to S and S to me was our joint excitement about following a spiritual path in recovery. We spent many hours during the first few years of our relationship talking about our spiritual experiences and reading to each other things that inspired us in the spiritual books we were reading. Over the years we have attended first church and then a Buddhist sangha together. About ten years ago I suggested we pray out loud together at night just before going to sleep, and we have done that virtually every night since except when we are not together because one of us is away. During the past year we have begun trying to meditate 30 minutes together as many mornings as we are able.

There is no question in my mind that our spiritual life together has been a core piece of our deep bond with each other. There is also no question in my mind that all our talking and joint spiritual practices have been central to my recovery and to the spiritual awakening that Step Twelve promises will occur as a result of following the Steps. I am so grateful that we have this fundamental spiritual bond with each other, a bond which has only become stronger as the years have passed. It is the most powerful evidence we have that our relationship is God's will for us.