James M. Pedersen
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.
Every day in our field, well-meaning counselors sit with families torn apart by the consequences of trying to help an addict toward a sustained recovery. Families will routinely recount situations when they gave the addict money, bailed him/her out of jail, cosigned for a new living situation, etc. Then it backfires. Filled with a mixture of anger and guilt, family members then hear us say those awful words: “You’re just enabling him. If you want him to get better, you have to make him take ownership for his own behavior.”
Now armed with guilt over having been branded a “sucker,” a “bad parent,” or some other label, family members are more than ready to deny even what seems the most reasonable request from the addict.
A new perspective
Here's a way of reframing the discussion. Enabling, at its very essence, is a high-energy form of love. It is sacrificing, giving, protecting, helping, advocating, supporting, nurturing and, yes, loving someone with the disease of addiction. The real issue lies in what kind of enabling the family is engaging in.
There are two very distinct forms of enabling. First, there is what I call dystonic or dysfunctional enabling. Dystonic enabling supports the addict's disease. Dystonic enablers will provide the addict with money in order for him to buy drugs. Dystonic enablers advance the addict's continued addiction, and sometimes do this to relieve guilt because they consider their loved one's addiction their fault. Other examples of dystonic enabling are:
Giving the addict money for (they are told) a monthly rent payment, rather than saying no or writing a check directly to the landlord.
Lying for the addict to employers, law enforcement officers, family members, etc.
Giving the addict money in order to pay drug debts.
Allowing the addict to steal from them without creating and enforcing consequences.
The second form of enabling is what I call syntonic or positive enabling. While dystonic enabling supports the addict's disease, syntonic enabling advances the addict's recovery. Examples of syntonic enabling include:
Refusing to lie to the police about a crime the addict committed.
Agreeing to transport the addict to a support group meeting.
Following up on the agreed-upon consequence of having the addict leave the home for violating terms of a “trust contract” with the family.
Analyzing each situation
Translating this concept into the therapeutic encounter first calls for explaining to the family that enabling is a high-energy expression of love. It is positive when it supports recovery, and it is negative when it supports the disease. Determining which it is requires that the family “stop the world,” or cease all other activity and carefully examine each specific situation. It is imperative to include the addict in this process—for in the long run, the facts are friendly.
Almost every family member with whom I have worked has had to pass through the dystonic enabling phase in order to arrive at syntonic enabling. They have had to be hurt, ripped off, lied to, and “played” enough times, without doing anything about it, until finally they are sick and tired of it. Of course the family members are indignant and ready to punish themselves and the addict—usually creating more of a distancing in family communication.
Here lies an opportunity for the therapist to help the family “stop the world” and either deny the addict for the right reasons (“We think it will enable your addiction”) or support a request when appropriate (“What you’re asking seems to be something that will help you in your recovery”).
The conventional concept of enabling seems to focus almost exclusively on what persons should not do. This falls short of offering families a positive outlet for the wonderful, caring energy of wanting to do something—anything—to help the addict.
James M. Pedersen is a member of NAADAC, The Association for Addiction Professionals, and maintains a private practice in Madison, Wisconsin. This article marks the launch of a regular column on family dynamics in treatment.