“They just don’t understand” is a phrase I hear regularly in aftercare programs for individuals returning home from inpatient addiction treatment. Here I will look at some of the pressures faced by people in recovery when returning home and look at advice from experts in the field and individuals in recovery themselves.
The value of involving and educating families of those recovering from addiction issues is widely recognised, with some treatment programs providing open-days and family therapy (although families often lack the time, resources or willingness to engage at length with these). Even when families try to engage, individuals continue to report challenges and lack of understanding from loved ones upon returning home.
In 2019 I began a project to help communicate the needs of those in recovery to loved ones. I started by asking individuals still in treatment, the question: “what do you most wish your loved ones knew about addiction/recovery/rehab?”
Common themes were:
- Returning home from previous treatment episodes, feeling “suffocated” and “controlled” were common.
- Lack of understanding around the need to prioritise recovery over other obligations, with some families already imposing work and financial expectations before treatment completion. This is a concern as losing focus on recovery and its maintenance often precipitates relapse.
- Loved ones perceiving addiction and its associated behaviours as a free choice, with individuals envisioning returning home feeling deeply emotionally and morally indebted.
- Being unable to have a “bad day”, and express negative emotions, without assumptions being made of a relapse.
- Not understanding recovery is an indefinite process without necessarily being “cured”. Thus, being unable to have “just one beer” and the need to continually attend support meetings.
Everything changed when Covid-19 hit. Many rehabs closed their doors, forcing individuals home before treatment programs were completed. The focus of my work then became examining how these individuals would manage the rollercoaster of emotions often accompanying early recovery. The absence of face-to-face support groups and limited opportunities for exercise and socialising outside of the home appeared to create a perfect storm. Despite these challenges, the majority of people I contacted remained in recovery. So, how did they achieve this?
A. Connect with others in recovery
Online support groups “provide an invaluable opportunity to connect with other people who have managed to use the principles underpinning their recovery to take care of themselves during these challenging times,” says Dr Terry Spokes, clinical director of Bali Beginnings rehabilitation centre.
He also stresses the importance of providing online aftercare groups. Although some rehabs had these in place before Covid-19, they have become more important for many individuals.
Umar, in recovery from amphetamine addiction, was forced to leave treatment early due to the pandemic and he described aftercare groups as “…very powerful, probably the most important part of my week. I really like NA meetings as well, but in the group, I feel safer, we can give and receive feedback and share back.”
The fundamental importance of connection was echoed by everyone I spoke to, although this also took the form of phone calls to friends in recovery, sending messages on social media and online 12 step support groups.
B. Effective communication
The value of healthy, honest communication with loved ones was emphasised by many individuals, such as Tom, who is 2 years into recovery from alcohol and heroin addiction.
“I’m really grateful for my parents support. However, our relationship was much easier when I was in treatment. At home, I sense their anxiety when I’m even in the slightest bad mood, which makes it worse. I think the most important thing was having my own space, even though it was just a bedroom it at least gave me the chance to switch off. I had to tell them that if I’m in my bedroom for half the day it doesn’t mean there’s something wrong or I’m using. I feel honestly, but respectfully communicating these needs and feelings is what got us through. Sometimes I had to bite my tongue, and I’m sure they did, but I’m glad we did it.”
Healthy communication and boundary setting are often most challenging with those closest to us. However, education, self-reflection, personal space and a big dose of patience can hugely improve stress levels and quality of life within the home.
Maintaining a healthy lifestyle and routine has become far harder during the pandemic, however, it is strongly associated with improved mental wellbeing and healthy relationships. Research by Ingram et al. (2020) found changes in diet, exercise and sleep patterns were associated with more negative mood. Waking up and sleeping at the same time, regular exercise, meditation and a balanced diet are important things to consider.
Joanna, in long-term recovery from cocaine addiction, said: “My family still don’t understand recovery, why I need to meditate every day and stick to my routines, but fortunately they can see the change in me, and the longer my recovery goes on the less they question me”. For excellent advice on lifestyle management during lockdown read Rhi Wilmott’s article “Keeping your sense of meaning during lockdown”.
Despite fearing the worst when contacting individuals for the second half of this project, I was pleasantly surprised by the ways in which recoveries were maintained. I learned Individuals’ determination and resourcefulness persisted in the face of Covid-19. The importance of connecting with others in recovery is nothing new, but the ways in which this is done are changing. For many, learning how to use Zoom and Skype has replaced trips to community centres and church halls, for now at least, with those attending online group therapies and 12 step meetings appearing to manage more easily.
So, what’s the take-home message? Management of relationships with loved ones in or outside of lockdown, and recovery in general, requires honest communication, commitment to self-development, lifestyle management and above all, connection with others. The best thing you can do for your own, and someone else’s recovery today – contact a friend, or three!
*All names and personally-identifying details of those in recovery have been changed to protect anonymity.
Ingram, J., Maciejewski, G., & Hand, C. J. (2020). Changes in Diet, Sleep, and Physical Activity Are Associated With Differences in Negative Mood During COVID-19 Lockdown. Frontiers in Psychology, 11, 2328.
Bio – Ian Taylor – has worked in the addiction for over six years, during which he graduated from The Open University with first-class honours in a social science degree. He is currently in the final year of a Psychology MSc at Birmingham City University, working as an assistant psychologist and conducting research on addiction in marginalised groups in Indonesia. Special interests include addiction, cognitive neuroscience, cognitive behavioural therapy and addressing inequalities in healthcare.