Substance Use Enabling: Cause or Effect?
This is the first in a series of blogs contributed by our PM clinician Gregory Rennie, who will introduce you to various aspects of addiction and its treatment using psychotherapy. Gregory Rennie provides access to collaborative care with PM psychiatrists via the Psychotherapy Matters Virtual Clinic (PMVC) for his clients.
Family members are affected by the disease of chemical dependence (addiction) just as much as the person with the dependence and more often than not, harder hit. Family members seldom get professional help because it is thought that the problem is alcohol, drugs or gambling and if the person simply stops, things would be back to normal. This is a common misconception. Often, the families need support once the individual is in recovery.
In my work with family members impacted by someone’s chemical dependence, I’m often asked about enabling. Unfortunately, the true meaning of the word is often distorted by popular media.
Merriam-Webster Dictionary defines enabling as a verb, that means“to provide with the means or opportunity or to make possible, practical, or easy.” Unfortunately, in the popular media, the family member is seen as someone who has caused the person to drink or use drugs. No one is the cause of someone’s dependence on a substance or behaviour such as gambling.
Chemical dependence is a brain disease. In my many years of practice, I have worked with many family members, and have yet to meet someone who is the cause of someone’s substance use problems.
Often a parent or spouse will get resistance from the individual if they attempt to block or interfere with use of the drug of choice. If you are a family member of an alcoholic or addict, you already know what I’m referring to. The individual who has addiction behaves in a way that is highly persuasive and manipulative. Their actions tend to encourage a reaction that lead facilitation of continued substance use.
In the following examples, the individuals are at risk of experiencing a negative consequence as a result of their chemical dependence. Unknowingly or inadvertently, the family members in these examples have enabled them to continue using leading to experience of negative consequences.
In the first example, a son is at risk of being charged with possession of a controlled substance. His mother finds a large amount of marijuana in his bedroom and is worried that if he uses it in public, he will be charged although she does not want him smoking it in the house either. Telling him this will certainly result in resistance. He yells at the parent and starts an argument and perhaps brings up the fact that the parent used to smoke when she was younger or that the other parent likes to have a couple glasses of wine at dinner. An argument ensues and the son uses marijuana to “calm down” from the conflict. He may feel afterwards that his parents “pushed” him use marijuana.
It is much easier for the parent to give in or negotiate than stand her ground. Her reaction to his behaviour can inadvertently lead to providing him the opportunity to continue using. The son’s behaviour has put the wheels in motion. The mother agrees that he can continue using marijuana but only in the garage. At school the next day, they find a large quantity of marijuana in his backpack and he is charged with possession.
In the next example, a husband with dependence on alcohol is at risk of losing his job. His wife wakes up in the morning to realize he spent the night in the basement drinking, is intoxicated and not able to go to work. He was previously warned by his employer that if he is drunk at work one more time, he would lose his job. Concerned that he will be fired, she calls his boss and tells him that her husband is in the hospital and won’t be at work. The next day he goes back to work and is found drinking on the job and is fired.
In an effort to protect someone from negative consequences, a family member often reacts by intervening. It makes perfect sense to protect a loved one but working with individuals with chemical dependency. However, over the years in practice with addiction, I have come to realize that many people would not have sought out help if it was not for the experience of negative consequences of substance use.
If lives are not in immediate danger, often it is best not to intervene one way or another, even if it may result in a criminal charge or loss of job. These consequences may lead to the moment of clarity the individual needs to feel motivated change.
Often, families seek help for the individual but not for themselves. Commonly, the focus is on the person with chemical dependence or substance use disorder. When they get well and are in recovery the expectation is that everything will be fine. Yet years of reactionary behaviour can have an impact on the family member. Roles change in the family dynamic when the person is in early recovery. It can be difficult to cope with change especially if (unintentional) enabling behaviour has gone on for a number of years.
Issues discussed with the family member in counselling are enabling, codependency, issues of trust, control and fears of relapse. It takes time for a family member to understand chemical dependence. Education is the first step. Many great resources are freely available on the internet for family members. As a psychotherapist, I suggest professional guidance on the most credible resources. I strongly recommend resources by the Centre for Addiction and Mental Health in Toronto, Ontario at www.camh.net, or in the United States, the National Institute on Drug Abuse at www.drugabuse.gov.
In my experience, many family members recover from the impact of chemical dependence or substance use disorder.
The views expressed in these blogs are the author’s own and not necessarily reflective of those of Psychotherapy Matters. Information provided here and anywhere else on PsychotherapyMatters.com is for learning purposes only and should not be used to guide treatment of clients/patients. Copyright © 2016 PsychotherapyMatters.com