Emotional Health and Well-Being in Recovery, Part I

Individuals with behavioral health (BH) disorders and their families frequently experience emotional distress associated with these disorders. This affects their well-being and quality of life if strategies are not used to manage emotions or moods. This article discusses common emotional problems identified in several surveys with clients and family members. A follow-up article in the next issue of Counselor will discuss BH treatments that focus on emotional or mood problems and review specific recovery strategies to manage emotions and moods for clients or family members. 

The term “emotion” refers to a feeling and related thoughts. It is both a psychological and a biological state in which a range of impulses to act on a given emotion may be experienced. Emotional health is the ability to be aware of emotions and moods, and to understand how physical factors, thinking, and behaviors affect feelings. Universal families of emotions across cultures include anger, sadness, fear, enjoyment, love, surprise, disgust, and shame. Universally recognized facial expressions include fear, anger, sadness, and enjoyment (Eckman, 2003). Both positive and negative emotions are important to experience (Kashian & Biswas-Diener, 2014).  

“Emotion” and “feeling” are terms used interchangeably, while “mood” refers to a prolonged emotion such as sadness evolving into a depressed state. Some people have a certain type of temperament or disposition, such as those who are optimistic, cheerful, pessimistic, depressed, anxious or angry. We all know people who are down or depressed most of the time or who are chronically angry and get upset at the smallest thing. Some manifest sufficient symptoms and severity to meet criteria for a mood or an anxiety disorder.  

Emotions help us adapt to situations or protect us from potential harm (e.g., anxiety or anger) or enrich our lives (e.g., love or gratitude). Guilt may lead us to make amends to another we hurt or motivate us not to repeat a behavior that is wrong or violates our values or morals. Boredom may lead us to engage in more interesting or meaningful activities or change a dead-end relationship or job. Emotions are one part of our total health, along with physical, other psychological, social, interpersonal, spiritual, and financial components.  As a society we focus more on physical health and appearance than we do emotional health and how we manage our feelings and moods.  

An emotion or mood can be experienced in positive and negative ways. Emotions can cause problems when they:

• Are too intense, extreme or chaotic as seen in mania or clinical depression
• Lead to verbal or physical violence towards others
• Lead to self-harm or suicidal thoughts or behaviors
• Have an adverse impact on physical health or recovery from a disease
• Are expressed too freely or inappropriately
• Are avoided or suppressed
• Interfere with recovery and impact on relapse to addiction
• Harm relationships and the overall quality of life

Managing emotions or moods is a problem for clients with all types of psychiatric or substance use disorders (SUDs). For example, individuals with a borderline disorder often experience intense anger in response to a mild transgression and may hurt themselves or act out in ways that harm relationships. Individuals with antisocial disorder may use anger to control, manipulate or terrify others through threats or acts of physical aggression. Individuals with an addiction may relapse if they do not use coping strategies to manage a negative emotional state or mood (Marlatt & Donovan, 2005).

Key emotional tasks include managing both positive and negative emotions, reducing negative and increasing positive emotions, and being aware of others’ emotions in social interactions (Goleman, 1995). Our emotions can contribute to physical disease, psychiatric illness, addiction, or recovery from a medical or BH disorder (Anderson & Anderson, 2003).  

Several quality improvement (QI) initiatives my colleagues and I conducted with nearly three hundred clients in outpatient care for a SUD and seventy-three family members identified managing emotions—as well as problems with specific emotions—as their primary concern in treatment or recovery. The first survey, “Challenges of Recovery,” was administered to 168 AMS clients in ambulatory care for substance use and/or co-occurring psychiatric disorders. Clients identified needing help managing emotions as the number one issue facing them in recovery. Failure to do so would their risk of relapse. Anger, anxiety, boredom, depression, emptiness, guilt, and shame were identified as affecting their recovery and well-being the most. In some instances, clients had anxiety or depressive disorders indicating a more severe problem than difficulty managing emotional states such as feeling anxious or depressed.

The second survey, “The Impact of Disorders on the Family” was completed by over one hundred clients who rated the overall impact of their substance use and psychiatric disorders on their families. They rated the adverse impact of both disorders on the family as very high, and identified a number of specific emotional, behavioral or economic effects on their family. Almost the entire cohort (91 percent) identified “created an emotional burden on my family” as the most significant issue impacting on their family.  

In the third survey of seventy-three family members active in a mutual support program for family members with an addicted member, “emotional burden or pain” was identified as the most common adverse impact on the family.  In order of frequency, family members identified the following:

• Heartbreak and helplessness
• Anxiety
• Fear and worry
• Depression
• Stress and distress
• Anger and resentment
• Grief over the loss of a loved one who died from addiction
• Guilt
• Shame
• Self-blame
• Embarrassment

The family experiences a range of emotional reactions, which creates suffering and distress for the family unit and its members. In some instances, the emotional chaos is intense and overwhelming.  

These QI initiatives and my regular discussions with groups of clients in treatment indicate that emotional health issues should be a focus of clinical interventions for clients and families. They also want to increase positive emotions such as gratitude. Clinical focus on positive emotions offers many potential benefits to clients and families in treatment and recovery. Clinicians can help clients learn about emotions, and use emotion skills such as those that follow:

• Identify and label emotions and their intensity
• Express these when appropriate to do so
• Manage emotions using positive coping strategies (to reduce negative ones)
• Delay gratification or control impulses to act in ways that are not healthy
• Reduce stress, increasing self-soothing activities
• Balance positive and negative emotions

Many individuals with an addiction experience anxiety and depression when they stop using substances, examine their life, and engage in treatment or recovery. Anxiety and depression are also very common among clients with all types of psychiatric illness.

Failure to manage emotional or mood problems can interfere with recovery from any of these disorders and have an adverse effect on any area of life. For example, one client who felt depressed ate excessively to boost her mood and gained unwanted weight as a result. Another client visited medical emergency rooms after experiencing intense anxiety associated with a panic attack that he interpreted as a possible heart attack. A client in recovery from a stimulant addiction struggled with boredom during the early months of recovery and relapsed as a result of “craving some action.” He was finally able to sustain long-term recovery after he changed his thinking about his “need for action” and discovered new, healthy non-addiction-related activities that were stimulating and enjoyable. A mother of an opioid-dependent young adult daughter struggled with intense fear and worry because of the recent surge in overdose deaths among those using opioids and her concern this could happen to her daughter. Parents of an adult son killed in an accident caused by intoxication were overcome with a range of emotions. They were sad and depressed over losing their son, but also very angry that he refused to get help for his alcohol problem. These are just a few examples; there are many others that show the impact of emotions and moods on clients and family members.

Factors that influence which emotions and how these are experienced and managed include (Daley, 2012):

Some people are more prone to anxiety, anger, or depression than others due to their emotional makeup, part of which is inherited. Hormones, neurotransmitters, degree and intensity of physical pain, medical conditions, and the effects of medications, alcohol or illicit drugs also influence emotions. 

Alcohol or drug use and/or addiction can cause, mask, exaggerate or intensify emotions. Stimulant use can lead to inflated mood or euphoria that may turn to depression after the episode of drug use ends. Alcohol can affect judgment so that mild irritation is expressed as intense rage.   

Personality and cognitive abilities such as beliefs, thoughts, problem-solving skills, and impulse control can affect emotions or behaviors. Many behavioral therapies help clients change beliefs and thinking as a way to improve their emotional health and manage their impulses. 

Good connections with other people and positive social support systems can influence emotional well-being. Having confidantes and sharing feelings and related experiences often aid psychological adjustment and contribute to positive social interactions.  Mutual support programs for clients with an addiction—such as AA, NA, DRA, and others—and families with a member who has an addiction or psychiatric disorder (e.g., Al-Anon, Nar-Anon, NAMI, and others) provide an emotional respite as other members share hope, support, and ideas that can aid how a person deals with their emotions.

Accomplishments, opportunities, stability at work or home, and economic stability also affect emotions. 

Many factors contribute to personal distress and negative emotions or moods. A focus of therapies for many BH disorders is on helping clients become more aware of emotions, what causes them, how they show, and how they affect well-being. Clients can benefit from learning personal coping strategies that enable them to manage a range of negative motions. They also can benefit from incorporating more focus on positive emotions (Fredrickson, 2009). Emotional recovery offers many benefits to clients and family members.  

Anderson, N. B., & Anderson, P. E. (2003). Emotional longevity: What really determines how long you live. New York, NY: Viking.

Daley, D. C. (2012). Coping with feelings and moods. Murrysville, PA: Daley Publications.

Ekman, P. (2003). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York, NY: Times Books.

Fredrickson, B. L. (2009). Positivity: Top-notch research reveals the upward spiral that will change your life. New York, NY: Harmony.

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. New York, NY: Bantam Books.

Kashian, T., & Biswas-Diener, R. (2014). The upside of your dark side: Why being your whole self—not just your “good” self—drives success and fulfillment. New York, NY: Penguin.

Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention. New York, NY: Guilford Press.