Anticipatory Grief and Family Recovery


There is an implicit assumption within prevailing models of addiction treatment that family health improves spontaneously upon recovery initiation of the addicted family member. That assumption is evident in the paucity of family-oriented treatment models and the lack of post-treatment monitoring of family functioning and family member health. Stephanie Brown performed a great service when she referred to the impact of addiction recovery on the family system as the "trauma of recovery." Her work underscores two critical truths: 1) recovery can be destabilizing to families whose roles, rules and rituals have become organized around active addiction, and 2) family members and family units need sustained support through the recovery process.

Medication Candles--grief loss.jpg Photo Credit--Olga Yastremska

There are numerous obstacles that inhibit family recovery from addiction. One of the most critical is the cumulative effects of anticipatory grief (AG). AG is a process through which grieving begins in expectation of an imminent loss. It is the rehearsal--the progressive letting go--that unfolds as a loved one approaches death or as we experience the forthcoming relocation of a friend or the end of an intimate relationship. AG is particularly evident when families have experienced numerous near-death experiences of a family member with a terminal illness. AG helps prepare family members for the final loss event and may be experienced so intensely and completely that some family members feel little emotion when the anticipated death occurs. While such lack of emotion can spark guilt in oneself and condemnation from others, it often reflects not a lack of grief but that a prolonged process of grieving has been prematurely completed.

For families facing addiction of a family member, every unexpected absence, every late-night phone call and every knock on the door elicits images of injury and death. These feared tragedies are repeatedly visualized and experienced with each episode marking an increment of physical and emotional disengagement. When instead of dying, this person enters recovery and seeks our emotional re-engagement in their life, we are faced with a wrenching question: "Can I, and how do I, reopen my heart to someone whose past words have been so untrustworthy and who, for my own survival, I have had to emotionally bury?" Hope, trust and affection are difficult and sometimes impossible to rekindle under such circumstances.

To family members reading this, know that such a response is normal. Continue to protect yourself by testing this rebirth process. Bestow unconditional love to the extent you can and bestow your trust in conditional increments. This relational healing will take a long time, and in the meantime your anger over past insults and disappointments will need to find healthy outlet. That said, the recovery prognosis of your family member will be enhanced by your capacity for care and support, no matter how initially limited that may be. Know that every day people can and do begin a lifelong recovery process and that recovery often brings a progressive transformation in character and values. Re-engage the family member as a new person. Join them in this leap of faith into recovery for both of you.

For those members of the Lazarus Society (those entering recovery) reading this, be patient with your family and friends. Recall the harm you inflicted on these relationships. Recall how your words could not be trusted. Speak with your actions, not fresh promises. Restoring trust and affection will take time--in some cases, a very long time. You must enter these relationships as a new person. The person you were and became through your addiction is dead and buried in the minds and hearts of those you are now inviting back into your life. Be patient as they cast aside the baggage of your prior relationships and relearn to trust and love you.

Anticipatory grief grows and protects in active addiction but must be transcended in the process of recovery.