Many of us are all too familiar with the concept that came out in the 1980s that described how family members perpetuated the vicious cycle of addiction. “Enabling” behaviors offered examples of how families responded and coped with their loved one's struggle with addiction and how it fed the destructive path of the addict. We have come to understand reasons why families continue to engage in these behaviors, many times knowing full well how detrimental it could be to the recovery process. Nevertheless, this concept warrants further inquiry to improve our understanding of families' resistance and the dilemmas that keep them from changing despite their better judgment. A better appreciation of this struggle may serve to elicit more cooperation in working with these families.
Doing for people what they can do for themselves is a common definition of enabling in the addiction world. Do we always know what the addict is capable of, especially under the influence of mood-altering chemicals? The ultimate family fear is pulling out of this enabling process and having the loved one die as a result. This is a very real and valid fear. The longer the rescuing has occurred, the greater the chances of this.
If one's irresponsibility has been facilitated for so long that the progression of addiction has taken hold over one's neurochemistry, the person may not be able to make decisions that will result in asking for help. At what point should the family step in, and how should it? Would pulling back and letting the loved one face the consequences of his actions at certain points be appropriate? Families struggle to accept that not taking action at times would be the helpful thing to do, as they see this as a form of abandonment.
Neurobiology has shown us how addiction works in the brain, how it hijacks the reward pathway and reinforces destructive behaviors. The power of addiction can be so strong that it has gotten families to take over the responsibilities of the addict when she is unable to. Recognizing when the addict can begin to make decisions and take control of her life is critical.
If we believe that chemical impairment takes away choice from a person with substance abuse problems, then it is up to the family to take control and make decisions for the person who is unable to at that time. The valuable question then becomes how to take over. The intervention, if the addict is not ready and is impaired, could be to have legal action enforced in order to get the person the help needed. Although radical for many, this could provide an opportunity for recovery without further risks.
The challenge for professionals in working with families is to help them recognize the types of interventions necessary and when to implement them. To tell families to stop enabling is like saying to the addict, “Just say no to drugs.” Neither is helpful. The question should no longer be, “Do I enable or not?”, but rather, “When and how should I enable?”
There can be a fine line in knowing when to step in and when to pull back. This dance is the key to facilitating recovery. It can be further complicated when boundaries are blurred or a family's self-esteem is defined by previous destructive interactions. To some family members, a sense of worthiness comes from the ongoing rescue behaviors, making it painful for them to let go of those behaviors.
Guidance for professionals
Professionals have many avenues for decreasing families' resistance to exploring this struggle. First, validate families' feelings of the real possibility of loss. Trying to convince them that they will lose their loved one, even if they continue to enable, shuts them down from further discussion. The reality is we do not really know what can happen if families discontinue enabling at some point with certain people. Generally, the quicker these behaviors stop, the better chance for recovery, yet families' fears prevent them from seeing this.
Confronting them when they say that the reason they engage in such behaviors is because they love the addicted person discounts their relationship and feelings. The more families feel heard, the more you can keep them in a dialogue that will offer clarity about the situation and themselves.
Second, help families reach the point of feeling that they have done everything possible to be of help. With this comes the recognition of limits and boundaries. This is difficult when you are facing the possibility of losing a loved one from the consequences of their behaviors.
When is enough enough? Brené Brown's research on vulnerability and shame sheds light on this struggle. She states in her book Daring Greatly, “You have to believe you are enough, to say, enough.” Believing one is worthy and deserves a better life will help to identify one's limitations and will allow for setting limits within the chaos that comes from someone caught up in the cycle of active addiction. Work on families' self-esteem, feelings of guilt and fear. This will help to facilitate a better understanding of their inherent strengths, which were robbed by the addiction and their past trauma.