Turn families` desire to rescue into a positive

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.

Third, teach families to be responsible to the addict and not for him. After years of living someone else's life, it may be difficult to recognize when that other person is ready to take over. Stepping in at unnecessary times can be a difficult habit to break. It also can feel threatening—the idea of not being needed in the same ways as before. Affected family members tend to feel responsible for others' actions. As children, they may have developed the faulty belief that the reason either parent used substances had to do with them. Help families recognize their motivations for enabling and who they really may be enabling for. Guide family members through this maze in order for them to be more accepting of their own limits and to come to better terms with their decisions.

Finally, recognizing the difference between chemical and emotional impairment can help in understanding a more effective way to respond. Using a simple formula to help families distinguish between hurting and helping may enlist their cooperation in evaluating their behaviors more effectively and honestly. The formula is this: When you enable, you take something away, such as ridding one of responsibility, decision-making, problem-solving, or intense feelings that can encourage behavior change. When you help, you give something: the ability to make decisions on one's own or a feeling of accomplishment.

When someone is too impaired to think on her own, taking action may help her get to the place where she can regain control of her life. In this instance, the person is not taking away the loved one's ability to think on her own because physically she is unable to do so at that moment because of substance use. If she is in a state where he can think and is feeling the consequences of addiction, allowing the person to have those feelings may encourage behavior change.

Eradicate stigma

Just as addiction has been stigmatized, so has the term “enabling” and those who engage in these behaviors. Recognizing and appreciating a family's struggle to know when to step in or step back provides the impetus to remaining in a dialogue that will help give family members confidence and insight. Shaming them into reacting in ways they are not ready for is not the answer.

As professionals, we need to be patient and respectful with a client's pace and readiness to change. Enabling may not always be feeding the addiction, but rather paving the way for help to be sought.

Maria A. Avila, LMFT, CAP, has a private practice in Miami and is Adjunct Professor at the University of Miami, where she teaches courses in substance abuse to graduate students.