Substance Illness and Family Enablement
Written by and for people with Lived Experience
Today’s Learning Moment – 09 14 28 Issue:
Substance Illness and Family Enablement
If you have a family member struggling with substance illness, you’ve probably
been accused of enabling. In that word is a world of hurt, anger, guilt,
resentment and stigma. Is some level of support OK? Should we cut them off
completely? What works and when does it become destructive? How would you know
when your step over the line and become an “enabler”?
What is enabling anyway? Why is there a perception that it’s bad? Let’s take a look and clarify what enabling
is, and what it isn’t. We also may
challenge or surprise you about what you may have heard about enabling.
If we act out of a sincere sense of love, loyalty, and concern, act to protect, cover up for, make excuses for or become more responsible for our loved one with substance illness, we are probably stepping over the line and behaving as enablers.
The term enabler is almost always stigmatizing both for ourselves and our loved ones. Often a lot of judgement is attached to behaviour that is seen as enabling behaviour. This stigma can be the cause of guilt and shame for the one who struggles with the illness and for a family affected by it. Enabling can be done without real awareness and is likely out of a lack of current evidence-based knowledge of substance use disorder. The fear of harm to and losing your loved one drives families to do what they feel will pull their person with substance illness back from the brink.
There is a very fine line between enablement, boundaries, entitlement and abuse. These terms are inexorably linked and can become a cycle that we can’t extricate ourselves from. We enable, which makes our loved one feel entitled, we try to set boundaries which they counter with manipulation and abuse and the cycle continues.
While there is much to discuss around enabling we’d like to focus on do’s and don’ts in this article. Here is a helpful web resource for further information. https://www.healthline.com/health/enabler
Let's look at some real Do and Don’t tactics you can use:
Do’s:
Empower Them - Walking beside them
o
Help
them find and access the resources they might need. In the beginning, this will
include harm reduction resources as they may not be ready to take the steps to stop
using substances.
Help them learn tools and skills to problem solve any issues that arise for
them. You can do this together when things are going well between you. You can
look up all kinds of skills online. You
can learn these skills together. Point them in the right direction, but don’t
solve it for them. Walk with them but don’t lead or follow.
For You -
o
Practice
self-care for you and your family. As
much as possible keep family routines, take time for you and the rest of your
family. Consciously implement calming activities for yourself.
You may even be able to include your loved one when things are going well in
activities that are healthy and family-oriented. This will give them hope and recognize that you
have compassion for them even though they are struggling with substance
illness. They are more than their disease. Your love and care in these moments
counter their guilt and negative self-image.
o
Set
clear and understandable boundaries or conditions that will establish the
nature of your relationship. A clear
boundary or condition can be slightly flexible but not manipulatable. An
example might be “I won’t give you cash, or my bank card. I might give you a gift card for a grocery
store, a place to eat or a phone card”.
Make it clear that this is what you are willing to do, no more, no less.
o
Take
time when you give them answers. Time is your greatest tool. With time you gain
clarity and it allows you to remain consistent to boundaries you already have
established. Thinking things through is a powerful tactic in preventing
enablement behaviour. Often they’ll recognize they need to find a different
option and will already have solved it for themselves before you answer.
Remember that communicating and collaborating
with them is much more useful and empowering than you trying to take control
and trying to change your loved one when they may not be ready or able to stop
using substances. Trying to control them brings us to the don’ts
Don’t Enable: - By taking the lead or
blindly following
o
Don’t
Ignore behaviour: When you notice they
are under the influence of a substance, try to avoid accusing questions. Instead
point out what you see. “I see your eyes
are red, you’re stumbling and slurring your words, you don’t look well. It makes me think that you’ve taken
something.”.
Questions like “have you been using again” only triggers what is called an
addiction survival response to lie.
Lying is almost reflexive when the person is struggling with their
illness, for many reasons. Sticking to
observable facts significantly reduces the opportunities for lies.
With the opioid crisis, it is important that you not ignore your loved one,
turn them away, discipline them or lecture when they are under the
influence. For two reasons.
o
First,
we know that your loved one could be unpredictable.
o
Second,
we know there are substances out there that have been poisoned and could be
deadly. Harm reduction is paramount when someone is under the influence.
The safest choice is to find a way to monitor
them while they are not disrupting other family routines. This is possible if you have agreements made
out beforehand around what your loved one needs to do if they do end up using
while at home. Make it clear that this agreement is the condition upon which they
can stay or return home.
An example might be agreeing that if your loved one is visibly under the influence
they will tell you what they’ve used and you will not judge them. They will
retire to their space/room and that you will check in on them every 20 minutes
or so to ensure they are okay.
With a trusting relationship on both sides, your loved one will feel more
comfortable telling you what they’ve used. It is important to agree to have a
follow-up discussion about the event. This may link back to previous boundaries
or conditions that you and they had agreed on but didn’t work.
The choices on a condition or boundary that hasn’t work are to revise it,
eliminate it or apply the consequence you stated would occur. Never set in
place a condition that has a consequence you know you’ll never do. That sets up
failure for all of your other conditions. If they find out you won’t apply a
consequence for one condition, why would they believe you will for any
condition?
It should be very clear in your agreement that any aggressive or violent
behaviour will not be tolerated and help will be called. If there are any signs
of harm to self, such as loss of consciousness, help will be called. Part of your agreements should include If
your loved one is not at home, and you suspect they are in harm’s way you will
call for help.
o
Don’t
lecture, blame or criticize your loved one for using or relapsing: You can acknowledge that you recognize some
of the reasons they use without having to agree with the behaviour.
“I get it, you might be coping with stress and anxiety right now or you might
be using to avoid getting sick again.
But I worry and am scared that using drugs to cope with problems doesn’t
help. You seem to be caught in a vicious cycle. I’m scared you might get hurt
or I might lose you. and that hurts me”.
o
Don’t
do things for them: Doing things that your
loved one is capable of doing is taking their power away from them. Sometimes, in the beginning, your loved one
may need moral support in things like making phone calls or getting to their
first couple of appointments or even getting harm reduction supplies.
It is okay to “advocate” by accompanying at first but do not do these things
for them if they demonstrate the ability to do for themselves. Natural and logical positive consequences fit
here as the person will be more likely to feel rewarded and a sense of
accomplishment if they follow through on tasks.
On the other hand, your loved one, under the control of addictive behaviours,
can learn manipulation and your sensitive buttons if you continue to do things
for them. This leads to emotional blackmail or guilt trips that will leave both
you and your loved one in a very unhealthy place.
Each family is different and has unique experiences within their journey. Choose what’s right for you and what fits best with your family values Choose to walk beside your loved one, don’t try to take the lead and don’t just follow.
Authors: Ben Goerner & Ron Merk 2020
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