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Counselor's Corner: The Trauma of Early Opioid Recovery and the Need for More Family Therapists

January 15, 2021

Stephanie Brown describes early recovery as the trauma of early recovery for families (White, 2011). This is particularly true as it pertains to opioid use disorder. The client returns home from substance use disorders treatment and the trauma begins. Below is a list of traumatic events and challenging emotions that happen in early recovery.

Resentments. The family may have spent years  dealing with theft, deceit, financial ruin, emergency room visits due to near fatal opioid overdose deaths, prison visits etc. Resentments can still be strong in early recovery which can lead to powerful arguments. 

Disequilibrium. Years of family life being centered around opioid use disorder, the family feels completely lost in early recovery.

Loss of status. During active addiction the spouse/partner received lots of praise from family, friends and neighbors for holding the family together while their partner chased opiates. People frequently made comments like, "You're a super parent. You're the mom and the dad." In early recovery the spouse who initiated recovery may now want to share parental responsibilities. This too can be met with tension.

Loss of freedom. During active drug use both parents lives may have been centered around the opioid use disorder. Leaving the kids less supervised. During active addiction they may have been able break curfew, avoid homework etc. Now in recovery the parents may be less Laissez Faire in their parenting style. This can lead to more parent child conflict.

Fear. In early recovery the family may carry lots of fear, which leads to tension. This could include a fear of relapse, fear of re-incarceration, and a fear of overdose death. One spouse said to me, "Each time he spends 15 minutes in the bathroom I fear that he's in there shooting up heroin."

Grief. It is common in early recovery to grieve the absence of the drug. One of the early stages of grief is anger. This anger can lead to family conflict.

Divorce. Many couples that survive active addiction do not survive the trauma of early recovery. The loss of equilibrium, arguments and resentment often lead to the disintegration of marriages.

The Need for Family Therapists

Much of substance use disorders treatment involves individual and group therapy. Family therapy is often a neglected modality. While many programs offer Family Night once or week or once a month, that is not an intense enough dosage of family support to counter the trauma of early family recovery. As a profession we need more therapists who are: trained to engage families in therapy; Skillful in utilizing evidence based approaches to family therapy; able to work with couples; lesson tension between parents and children during early opioid recovery; and provide these services in offices and homes. 


White, W. (2011). Unraveling the mystery of personal and family recovery. An interview with Stephanie Brown, PH.D.

Hands and family
Mark A. Sanders, LCSW, CADC; Illinois State Program Manager, Great Lakes ATTC, MHTTC, and PTTC
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