Together, the four of us developed a regimen to support her recovery, one that included individual sessions as well as meetings with this network. To this we added AA meetings, and the network members supported her in attending the meetings during later sessions, when she expressed misgivings about them. Nancy and I continued to meet with her network while she focused on ways to protect her continued abstinence and on the psychological issues that would allow her to achieve full recovery.
She had a few slips back into drinking while in treatment and was once prepared to give it all up. Her network was behind her continued abstinence, though. We all consulted together at these times of crisis. With each slip we would work together to understand what certain drinking cues—situations and emotional states—led to the relapses. We would then plan together how Nancy could handle these cues when they came up again.
As time went on and Nancy's abstinence was secured, our network sessions were held less frequently, but were not called off, and her individual therapy continued. In network sessions, the three of us would act as a sounding board for her recovery. We also provided the assurance that if Nancy slipped again, even after treatment was over, there would be a resource to draw on to secure her return to sobriety.
The nature of network support is further evident in the way we drew on one particularly meaningful relationship to bolster Nancy's abstinence. We often spoke with her sister on my speaker phone during our network sessions. Although her sister lived in a remote city, Nancy had a trusting relationship with her, and the sister had been very distressed for years over her drinking problem. This relationship was one that added strength to the bonds of affiliation that supported Nancy's recovery.
I call on a variety of devices that enhance the effectiveness of the network, like introducing relapse prevention techniques into network sessions, using formal written agreements, and managing medication intake. There are many tortuous turns on the road toward recovery.
In 1972, I was appointed a career teacher in alcoholism and drug abuse by the National Institute on Mental Health. Expertise and competence at treating this problem was so uncommon then that the federal government was eager to support young medical school faculty members in the hope that their academic commitment would lead them to become involved. I took this mission seriously. In my searches of the literature, I found nothing on the technique of resolving a drinking or drug problem for a patient who came to the doctor's office. But soon my colleagues began to send me addicted patients to treat, and I felt obliged to do the best I could.
Since then, researchers in addiction have begun to develop a systematic understanding of how drug and alcohol dependence wreak their effects on thinking and behavior. But there are still very few descriptions of a comprehensive approach that the therapist can apply to addicted patients. Detoxification regimens, research approaches, and hospital programs are available, but they do little to clarify the day-to-day struggle that must be staged while recovery is achieved with a patient who is living in the community.
Few therapists venture beyond recommending to alcoholics that they attend AA or take a long break from job and family and go away to a rehabilitation hospital. Beyond this, psychiatrists, psychologists, and social workers simply apply their "usual" approaches to treatment and hope that they will be useful. And because "usual therapy" rarely solves these problems, it is assumed by many that hospitalization is the only safe treatment for addicted people. It is not. An astute application of what we now know about addiction can avert hospitalization for the large majority of substances abusers.
For relapse prevention, I draw on behavioral techniques that have emerged from psychology and physiology for managing impulses for drug-seeking, along with a supportive network for self-examination. Awareness of the relationship between addiction and symptoms of depression and anxiety is also essential; alcoholics are prone to depression and suicide. All these issues must be brought together for effective treatment.
How does network therapy fit into our evolving understanding of addiction? Addicted persons generate great conflict and resentment among their family and friends. On the one hand, persons close to the addict have long been angered by his lack of responsiveness and by a history of many disappointments that he has conferred on them. On the other, they are remorseful over his unhappiness and the losses that he has suffered. The tension between anger and guilt makes it all but impossible for individuals close to the addicted people to approach them in an objective way. They are likely to overreact at one time and castigate them, and at another time they may shrink from asserting their concerns and be overly permissive, even enabling their addictive behavior.
Professionals have begun to consider the orchestration of family dynamics to move the addicted person toward recovery. One important approach has been a technique for intervention with the reluctant substance abuser, which brings his family together to plan a confrontation designed to impress him with the immediate need for hospitalization. With aid from a professional, family members can thereby work together, spurring the patient into action. Multiple family therapy groups for substance abusers have also come into use to create a setting where a diversity of issues are melded together to neutralize individual resentments. The sense of community engendered can be supportive, and aid in achieving compliance with an expected norm of abstinence.
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