You will often hear behavioral health professionals refer to substance use disorder* (SUD) as a family disease and you may wonder what this means. Especially since, in most cases, it is clear who the “sick” person(s) in the family unit is by virtue of who is abusing substances, making poor choices, and ruining everyone’s sense of safety. As an addiction specialist, I run into this dynamic often. In my professional experience, around 65-70% of the cases I’ve handled, it is a family member who first reaches out for help for their loved one, often long before the person struggling with SUD is interested in treatment themselves. When I suggest to the family members that they should focus on themselves, it can come as a shock and many times is met with resistance and even anger. This is understandable, they aren’t the ones lying, cheating, or stealing in the name of drugs and/or alcohol. It’s not their life on the line. So how is putting the focus on the person who isn’t the one struggling with substances going to fix the problem? The answer is not simple, but hopefully by the end of today’s blog you’ll have a better understanding of how family dynamics play a role in active addiction, what family members can do to change this by focusing on themselves instead of the person struggling, and how the family can heal from the devastation SUD causes.
First, let’s start with the word enabling. No one likes to hear this word. It has taken on many negative connotations and no one wants to hear it in relation to themselves. Being an enabler means being the person that will solve or fix the problems of someone else to the point where the person struggling will rely on their enabler for nearly everything. Enabling typically isn’t something any of us do knowingly. In fact, enablers are most often fierce lovers and protectors of the people they love. Their only crime is that they love too much and tend to put others’ needs ahead of their own. Is this really such an awful thing? No it is not. If you are a fierce lover and protector of those you love, please stop judging yourself. If you have a loved one who tends to enable, ask yourself how you’ve benefitted from this as well, and then cut them some slack. They are good people trying their best to fix a serious problem, doing the only thing they know how to do, which is love by fixing. However, the question is: is this enabling behavior effective when it comes to SUD?
With almost every disease out there it is helpful to fiercely wrap our love around the person afflicted and try to protect them from pain. This is exactly what we should do and it feels natural and normal. One thing to emphasize is the fact that addiction is disease. Science has proven that there is a disease process that takes place in the brains of those that have SUD. The only time for many people with SUD that there was a choice was on day one. After that the disease process takes hold, and they have little understanding or control over what happens next or why. However, the disease of addiction is not like other diseases. In fact, it’s the exact opposite. Where we end up feeding the disease instead of fighting it. The idea of pain is very important concept when it comes to an individual with SUD. Pain is the reason why they started using to begin with, and why they continue to use. Pain is also the reason why they will hopefully one day want to stop.
Up until now, you have most likely thought of pain only from the standpoint of active use. If there is pain in your loved one’s life, they will need to use to escape it. This is typically one of the reasons why people enable their loved ones. The idea being: if I can just keep him or her from feeling pain, emotional and/or physical, then they won’t need to use. It does make sense until you ask yourself the following: can life exist without pain? Does your life exist without pain? Do you know anyone who has never felt and will never feel pain? In my experience, both professionally and personally, life is pain and pain is life. Unfortunately, one can not exist without the other. So if your loved one uses substances to escape pain, what are the chances that, if you fix the problem of the day, they will never again need the substance to remove the pain of life? Pretty slim right? To the point of impossibility actually. So can we agree that the problem isn’t the pain itself, but more that your loved one uses substances to cope with pain? Let’s take this a step further and recognize that the problem was never actually the substance use. Of course the substance use created more problems, but it was never the root of the problem. The problem was always the pain, of which the substance use was a symptom. He/she ended up using the substance to cope with the pain, which for most existed long before the use.
If you’re a fierce lover and protector you’re likely very confused right now wondering, “What the heck do I do now?”. Everything you’ve known how to do up until this point has to do with fixing, saving, and praying that if you just fix and save enough, eventually they won’t need to use anymore. What I am about to ask you to do next will feel vey counterintuitive and you may not have the appropriate skills to do it, yet. That’s okay. This is where the idea of focusing on yourself will come into play and we’ll come back to this in a moment. First we must get back to talking about pain. I’m guessing you’ve probably heard of the idea of “tough love”. Another antiquated term that I don’t very much like. It sounds punitive and punishing to me, and I’m not in the business of punishing someone for their illness. However, there is some truth to it since it will most likely take more pain in order for your loved one to seek recovery. Instead, I prefer to look at SUD and recovery on a scale, where on one side there is the pain of active use and on the other is the pain of sobriety. Currently, your loved one feels more pain on the side of sobriety because we must acknowledge that it is incredibly painful for your loved one to be sober. Outside of the withdrawal pain, which is typically the easiest to overcome, there is the pain that existed prior to the use that was never dealt with, along with the pain of all of the not so great things they have done while they were using. For him/her to be and stay sober is near impossible at this point without treatment and support.
Now let’s talk about the other side of the scale – the active addiction side. If your loved one is currently using, it’s most likely lighter than the side of sobriety. How can this be, you ask? Especially considering all of pain the use has caused your loved one and your entire family? The answer is simple: they get to escape the pain with the high. This is what drugs and alcohol do – they remove pain. This is no shock, but what might feel shocking is the realization that, while you are sitting in all of the pain they have caused with their use, they get to escape it. In addition, they don’t have to remember some of it because another benefit of using is the fact the drug sometimes makes it impossible to remember. So up until now, the use has protected them from a lot of the pain that you have experienced. Hence the reason why the scale is tipped in the favor of active use. Now this is where enabling come in.
Up until now, you or someone in your family has done your/their very best to keep away the pain of active use – and for good reason, as discussed above. But this is causing the scale to stay tipped in favor of the substance. We never want to punish our loved one for their use, which means this can become tricky. We also never want to punish for the sake of punishing and seek revenge by intentionally trying to hurt them for the hurt they have caused. Instead, we want to encourage and allow the natural consequences of the use. What is a natural consequence? Any consequence that has occurred due to the use of the substance. Many of things we have a tendency to want and try to fix, such as paying rent because your loved one is in arrears and is about to lose their housing because he/she spent all of their income on drugs, or lost their job due to the same. Or fixing their car that was smashed while driving under the influence, or hiring an expensive lawyer to get them off of criminal charges directly related to their use. I know what you’re thinking: how the heck can I let someone I love become homeless, not have a car, or go to jail? My answer is this: has fixing in the past worked? Has removing these consequences lead your loved one down the path of recovery? If the answer is no, then at a minimum we need to agree that something needs to change, and unfortunately the change is probably going to have to start with you.
This is why we say addiction is a family disease. Because not only does it affect the whole family, but it often takes the closest people to change and heal before the person themselves begins the process. “How do I begin,” you ask? Learn as much about addiction and recovery as you can. Learn about boundaries and recognize that up until now, any lack of boundaries has contributed to the disease. Try something different. This something different includes allowing your loved one to face their own consequences, and for you to just love them. Not fix, just love. Your family has been in hell and you all deserve peace. All the fierce lovers and protectors will struggle with this the most. You will need help and support. This will be very hard and totally different from what you feel is right. It will mean you have to put your own needs first for a while. You may have to figure out what your needs actually are. Figure out how to get yourself back into the equation. This is your work and it should be your focus. While you do this, allow your loved one to focus on themselves. They were always the one who could fix their problem anyhow. Please don’t misunderstand me. I don’t ever want you to stop loving or turn your back on your loved one. In fact, I want the opposite. I want you to take care of yourself so you never have to. I want you to tell your loved one you love them too much to allow them to live like this any longer. I want you to teach them that they are capable of fixing their own problems. That they deserve better, regardless of what has happened in the past. I want you to be strong enough to take a step back, let the pain come, and allow that scale to tip in favor of their recovery. I want you to begin to heal, so your loved one will eventually want to follow suit – which means you will need to start with you. Only after focusing on yourselves, will the family as a whole begin to heal.
*Clinical term for addiction to a substance, or substances
Written by Kristin Young, LICSW, Director of Clinical Services