Archive for April, 2014

Let’s Ban the Word “Enabling” From Our Professional Lexicon

Apr. 15th 2014

Let’s Ban the Word “Enabling” From Our Professional Lexicon

 

In my experience, enabling is an overused and simplistic concept that is no longer helpful in our work with affluent families and the chemical dependency field.  When our well-off clients face addiction in family members, as professionals we need both a sophisticated understanding of affluent family culture and academic and clinical training on addiction.

  • These are both complex systems and when they interact, their complexities multiply.

Let’s look at how to reframe the discussion from these combined perspectives.

 

The Disease Concept

One major task is to educate families on the disease concept of addiction.  They are almost always immersed in guilt, shame, blame and remorse, with high levels of conflict.  Introducing the word “enabling” into this emotional cauldron only increases its intensity, particularly the finger pointing and shaming among parents.

  • Our job is for the family to understand that addiction is a disease and that we can work together to encourage their loved one to recover.

This is a therapeutic task that takes time, listening to our clients and defusing the confusion, anger and hurt.

 

Analyze Family System

Because addiction is a chronic disease we take a systematic, long-term approach to recovery, which means coming up with a plan to manage the problem over many months.

  • First, we look at the strengths and weaknesses of the family as a whole in terms of where there are positive or negative influences on recovery.
  • Then we work with the different parts of the system to create an environment that supports recovery.

There are also very likely long-standing personal and economic relationships that will need to be modified.  These are not going to be changed overnight just because someone comes along and says “stop enabling”.  It’s not going to happen, or if it does it is only temporary, as these relationships will soon resume.

 

Organizing the Family System to Support Recovery

Another perspective on enabling comes from the article:

Erasing Misconceptions About Enabling (January 2007 edition of Addiction Professional Magazine)

            It is time for therapists who work with addicts and their families to reevaluate a concept that has existed in the addiction literature for some time.  For far too long we have been careful to ensure that families (including anyone in the addict’s natural support system) avoid enabling at all costs.

            It is the therapist’s job to help the family move beyond the guilt and compunction so often associated with the misperception that enabling is a bad thing.  Enabling is a high-energy expression of love for the addict and should be reevaluated, then redirected, toward behavior that enables recovery, not addiction.

            “The Family Factor” is based upon the premise that of all the people involved with an addict, it is the natural support system that almost always constitutes the most decisive and powerful outside influence.[i]

Because enabling is such a loaded word I prefer saying “let’s direct the family’s resources (both emotional and tangible) to support recovery, not addiction.

 

Dual Diagnosis Addicts

Many addicts have co-occurring disorders, meaning they also suffer from abuse, PTSD, learning, depression, etc.  In addition to their primary drug of choice, they may be prescribed medication for anxiety, pain or ADHD.  Adopting aggressive stands to force them into treatment is counterproductive and often a recipe for disaster, particularly if their condition is not adequately assessed.  Dual diagnosis addicts end up exploited, overdosing, or otherwise reacting in other negative ways to all or nothing threats.  They need a nuanced, supportive approach over time.

 

Legally Permissible but Clinically Contradicted

While it may be legally permissible to cut someone off, doing so (or recommending a family do so) without a thorough understanding of an addict’s co-occurring disorder or support system in place borders on malpractice.

Ask these questions:

  • Is there a current assessment by clinician competent in the co-occurring disorder(s)?
  • What alternative intervention techniques have been tried, such as family meetings, sober companions, therapists, professional outreach, etc.?
  • Do you think the addict has the street smarts to survive or will she/he move in with her dealer or start selling drugs?
  • What fall back support system is in place if resources are cut off?

Remember, if you suggest a trustee or family take this action, you are responsible for what happens.  Far too often, the interventionist advising the family disappears when bad things happen, leaving the family holding the bag.

 

Check Your Personal Attitudes Regarding the Wealthy

Many times the person recommending cutting off funds to stop “enabling” has stated or unstated resentments against the affluent and this advice reflects his/her “wealthism”.  Some advisors and counselors resent affluent addicts, viewing them as undeserving, overindulged rich kids.

  • Terminating support to stop “enabling” reflects their resentment and accompanying desire to punish the addict.

These people also take advantage of the natural enmity in parents towards their son or daughter because of their addiction driven behavior. The parents agree to the decision out of anger and, when they have time reflect or consult a qualified professional, regret their actions.

 

Enabling is both a crude tool and a pejorative term that implies there is an easy solution to deep-seated, long-standing problems.

Using the word “enabling” connotes that if enabling is stopped the addict will then see the light and get help (or if not, suffer the consequences)  In reality, the addict may go to treatment (if there is leverage), but be so resentful that relapse is inevitable – one reason why recovery rates are so low for all groups (except pilots and doctors).

 

Keep two ideas in mind when giving advice on addiction in family business:

  • The key role played by the therapist in the family’s decisions making process , and
  • The family is the most important outside influence in supporting recovery.

Of course, family and family business are almost intertwined, and particularly so when addiction is present.

 

Here’s what one parent has to say about her young adult son, after she realized he needed treatment for his drug use:

            Postscript:  As with all children struggling with addiction, my sons’ is a battle not easily fought.  Staying clean has taken the places previously reserved for sports, or homework or making movies.

            He is supported and loved, and he is most certainly not alone.  Breaking familiar patterns of behavior, hard work and clear communication will be instrumental in his continued sobriety.

            If it takes a community to raise a child, without doubt, it takes that same community to keep a child off drugs.  He is fortunate to have such a community of committed supporters, holding him accountable to staying on a good path.[ii]

Amen!

 

So let’s stop using words like “enabling” and “tough love” in our work with families.   (By the way, why ever combine “tough” and “love” together?  It makes no sense.)  Rather let’s deepen our understanding of both complex family systems and addiction as a disease, to better serve our clients long-term interests.

 

(c) 2014 William F. Messinger



[i] “Erasing Misconceptions About Enabling” by James M. Pederson, Addiction Professional, January/February 2007

[ii] Lynn Benson, Star Tribune, 8.6.11

 

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