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Section 7
Addictions: Family Roles

Question 7 | Test | Table of Contents | Addictions CEU Courses
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On the last track, we discussed we have discussed the characteristics of a family entering recovery. We also discussed the three key steps family members of addicts make as they become ready to enter recovery. These three steps are, accepting they cannot control the course or consequences of the addiction, realizing that family interactions have been controlled by the addictive process, and finding out that addiction is an illness.

On this track, we will discuss the label of "enabler", and ways in which family members can reframe their role to better help their own health and that of the addict.

As you are aware, the term enabler first entered the therapeutic vocabulary about 25  years ago, when the recovery group movement was still fairly new, and originally meant specifically ‘someone who passively or actively made it possible for an addicted person to drink or use drugs’. More recently, I have observed that the term enabler is broadly used to covey the idea that addicts are powerless over their behavior, and thus are dependent on others to manage their lives for them.

Transfer of Blame
Have you seen, as I have, family members of addicts who deal with excruciating guilt because the label enabler makes them feel that they have been an active member, or even a cause of the problem? My client Betty, 45, had been married to her husband Jim, an alcoholic, for 20 years. Betty stated, "I was advised by my last therapist to kick Jim out of the house if he kept drinking, and cut off all financial support. I couldn’t put my husband out on the street! I know it’s my fault he’s still drinking, but what could I do?"

I find that sometimes, the addicted family member picks up on this concept, and come to believe that anyone who does not crack the whip over him or her is an enabler, and jointly responsible for the continued addiction. 

Jim stated, "I was in groups for a while, doing ok, but I started drinking again. But when I showed up for work all disheveled, no one said anything. Betty didn’t do anything. So I kept drinking. It’s their fault. They’re the ones that should have done something. I’m not responsible! Betty and my so-called friends at work enabled me!" As you can see, Jim used a distorted interpretation of enabling to completely transfer blame, and keep considering himself in a helpless state.

My client Gary was in a similar position with his wife, Joanne, who had been addicted to tranquilizers for two years.  Joanne, 32, had been unable to hold a job for more than six months at a time, and had been hospitalized several times, and jailed twice. Gary would invariably bail her out and pay her bills, and plead with Joanne to get help, but his pleas always turned in to ugly arguments. Gary worked full time while balancing the needs of the couple’s three young children, and a significant portion of his paychecks went in to filling Joanne’s tranquilizer addiction.

I observed that Gary had fallen in to a pattern of apologizing in public for Joanne’s odd behavior and outright rudeness, and calling her employers, when she had them, to make excuses for her absences. When I asked Gary about his pattern, he stated, "I love Joanne! I put up with it, because there’s a chance that our family can remain together."

Why Labeling as 'Enabler' is Counterproductive
It can be tempting, by currently accepted patterns, to label Gary is codependent and an enabler, who, in effects, keeps Joanne locked in to her addiction. From Joanne’s point of view, not all of the family’s problems are caused by her addiction, which is a fair assessment. However, to her, Gary is not the same man she married.

Joanne stated, "I married a real sweet, laid-back guy. But now he’s insufferable! I only started using tranquilizers because we kept having more and more problems. God… Gary is just such a pain now! All he wants is to deprive me of the one thing that keeps me going and makes me happy!" Clearly, Joanne perceives Gary’s anti-addiction attitude as picking on her. She remained determined to keep using tranquilizers, despite Gary’s ‘immense overreaction’. Joanne went on to state, "look, I’ve tried my hardest to reason with Gary. If he decides to leave, so be it. It’s not my fault if he can’t cut it."

I find that to label Gary an enabler in this case is counterproductive. Would you agree that labeling Gary in this way also turns him into an identified patient, when in fact he is the non addicted partner in the relationship. Although Gary apologizes and compensates for Joanne’s addictive behavior, he has done his best to keep all of his family safe and at least partly functional.  

In this case, I believe applying an illness label may undermine Gary’s motivation to heal his family, and trap him in a shame spiral. As you can see, Gary is already experiencing significant feelings of guilt and self doubt. Traditional codependency counseling would have Gary withdraw from Joanne, and spiritually compensate for the loss of the love of his life. If Joanne ‘came to her senses’ in a manner acceptable to this form of treatment, then Gary could welcome her into his new, compensated lifestyle.

Gary often described severe feelings of guilt regarding his ‘enabling’ in our sessions. Gary stated, "I feel like Joanne’s problems are all my fault.  If I had only nagged her less, or supported her more! How can I give her an ultimatum and tell her I’ll leave her if she doesn’t stop if I am partly responsible for her continuing to use?"

Affirmation Exercise, 4 Steps
To help Gary with his feelings of guilt, I asked him to try making a simple affirmation exercise part of his daily routine. As I describe the exercise I used with Gary, see if you use a similar simple affirmation technique with your clients. I stated to Gary:
Step 1: "try to set aside a five to 10 minute period every day, and find a quiet place where you can sit or lie down comfortably without distractions.
Step 2: Imagine a peaceful scene, like a favorite place from your childhood.
Step 3: Relax your mind, and let yourself feel calm and safe.
Step 4: Next, repeat positive affirmations to yourself. What are some statements you could tell yourself that would emphasize your good qualities?"

Gary stated, "Well, I am a very warm and loving person. I’m a great guy. I trust myself." Are you treating a client like Gary who is struggling with guilt, who might benefit from a positive affirmation exercise? Would playing this track be beneficial to your Gary?

On this track, we have discussed the label of "enabler", and ways in which family members can reframe their role to better help their own health and that of the addict.

On the next track we will discuss the ‘collapse’ stage of recovery. In my experience, the three most important points to consider when discussing the collapse stage are, letting go of long-standing routines and rituals, letting go of old attitudes and behaviors, and the fear of ‘walking backwards’.

Peer-Reviewed Journal Article References:
Abar, C. C., Jackson, K. M., & Wood, M. (2014). Reciprocal relations between perceived parental knowledge and adolescent substance use and delinquency: The moderating role of parent–teen relationship quality. Developmental Psychology, 50(9), 2176–2187. 

Rusby, J. C., Light, J. M., Crowley, R., & Westling, E. (2018). Influence of parent–youth relationship, parental monitoring, and parent substance use on adolescent substance use onset. Journal of Family Psychology, 32(3), 310–320.

Slesnick, N., & Zhang, J. (2016). Family systems therapy for substance-using mothers and their 8- to 16-year-old children. Psychology of Addictive Behaviors, 30(6), 619–629.

When did the term enabler first enter the therapeutic vocabulary? To select and enter your answer go to Test.

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