Enabling

How it Affects Addiction and Mental Health Intervention & Treatment Outcomes

Enabling Definition

1. A process whereby someone (i.e., the enabler) contributes to continued maladaptive or pathological behavior (e.g., child abuse, substance use, mental health disorders) in another person. The enabler is typically an intimate partner or good friend who passively permits or unwittingly encourages this behavior in the other person; often, the enabler is aware of the destructiveness of the person’s behavior but feels powerless to prevent it.

2. The process of encouraging or allowing individuals to meet their own needs and achieve desired ends. A therapist aims to empower clients to believe in themselves, develop the confidence to act on their desires, and affirm their ability to achieve their goals. See also empowerment.

Empowerment Definition

1. The promotion of the skills, knowledge, and confidence necessary to take greater control of one’s life. In psychotherapy, the process involves helping clients become more active in meeting their needs and fulfilling their desires, aiming to provide them with a sense of achievement and a realization of their own abilities and ambitions. See also enabling.

2. The delegation of increased decision-making powers to individuals or groups in a society or organization. —empower vb.

When thinking of Empowerment, think of the Chinese proverb:

“Give a man a fish, and he will eat for a day.  Teach a man to fish, and you feed him for a lifetime.”

Why does an Enabler Enable their loved one who is an Alcoholic, has a Drug Addiction, or Mental Health Disorder?

The enabler receives a reward or a benefit when they enable. It certainly comes from being codependent or having a dependent personality disorder. It also primarily stems from feeling needed and having a sense of purpose. If it did not fill these two voids, then the person would not do it. Is this need so great that an enabler is willing to sacrifice their loved one to feel better? The answer is yes, and the reasons are the same as those of the addict or alcoholic who uses drugs or alcohol, or one who suffers from mental health disorders. Family roles are no different in the way they seek comfort from a problem. All the family roles that are created by the addiction or mental health disorder stem from the primary enabler, providing all of their attention to one person.   

Enabling an Addiction to Alcohol or Drugs v.s. a Mental Health Disorder

Families of loved ones with mental health disorders or addiction concerns almost always believe or want to think the problem is a mental health disorder, but why? Surely there are earlier diagnoses that would lead one to believe this. There are observed behaviors that are most certainly a concern. There may have been trips in and out of hospitals and facilities. Sometimes, because of the loved ones’ lifestyle choices, a family believes that it must be a mental illness. We believe that all of these thoughts can be contributing factors to the family’s opinion. From our experience, we know where the driving force of the mental health diagnosis by the family comes from. Not because we boast an arrogant opinion as to what we believe you are thinking. We know this because those who finally surrender and admit it tell us it is easier to accept a mental health disorder than an addiction. It provides a greater justification to hide behind to continue enabling the loved one. This point is made because, regardless of whether or not it is an addiction, a mental health disorder, or a dual diagnosis, the family has every right to make changes that benefit both them and their loved one.

“Family members almost always believe the issue is a mental health disorder over an addiction. Among the several reasons for this, the primary one is that it is easier for the primary enabler or codependent to justify the enabling when it is believed to be a mental health primary rather than a substance use disorder”. 

Substance use disorders are listed in the same Diagnostic Statistical Manual (DSM-5) as all other mental health disorders. Symptoms and behaviors of both addiction and mental health are similar. Addiction can and will exacerbate mental health disorder symptoms, and mental health disorder symptoms can lead someone to self-medicate with drugs or alcohol. No family, clinician, or psychiatrist is instructed to diagnose a mental health disorder as the cause of the behaviors when any amount of drugs or alcohol is present, until it can be proven otherwise. Families who use a mental health disorder to enable must understand that, regardless of the diagnosis, enabling does not improve the situation or the outcomes. Whether mental health is causing the alcohol or drug use or alcohol or drug use is causing the mental health symptoms, enabling prevents your loved one from asking for help, feeling consequences, and advocating for their own care by way of empowerment. Nowhere in any textbooks or professional advice does it say that it is ok to be a codependent enabler just as long as the person is not presenting mental disorder symptoms. In fact, it says the opposite. In cases of true mental illnesses, in the absence of any substance use, the intervention strategies may change. What remains the same is that the family and the environment make the necessary changes that enable the loved one to take the steps needed to improve the quality of their life and condition. Reducing or eliminating enabling behaviors can be difficult when mental health disorder symptoms are present, and the effects are the same as they are when enabling is present with an alcohol or drug addiction. 

Enabling strips your loved one of the empowerment of advocating for their own care. The truth about enabling, though, is that it does just as much for the enabler as it does for the loved one. Because of this, enablers will pull out all the stops to maintain the status quo. There certainly may be a mental health disorder of concern that warrants the family’s fears. The problem is that the family is in no position to make the diagnosis for their loved one or the facility. In cases of mental health disorders with no substance use, which is rarely the case, a family is still allowed to be exhausted by the current situation. No person with a problem, whether medical, addiction, or mental health, is permitted the right to dismantle the lives of others, unless, of course, the other is ok with their life being dismantled. 

While the person with the mental health disorder or addiction is hurting the family, so is the enabler. As the enabler detaches from providing attention and affirmation to the other family members, they seek out maladaptive family roles and coping skills. Over time, the family becomes disintegrated, and reaching an agreed-upon solution becomes difficult, if not impossible. Every time the enabler makes the intended patient comfortable, they make everyone else in the family uncomfortable. 

Signs You Might Be Enabling Your Loved One’s Alcoholism, Drug Addiction, Or Mental Health Disorder – Enabling Checklist

Much of our information on enabling is not in reference to what enabling does for the intended patient; we all know the answer to that. Our information is regarding why one enables. Since little has been discussed about the alcoholic, drug addict, or person with mental health struggles, let us remind you of the manipulation the intended patient uses to break down the enabler. The loved one with an addiction, mental health disorder, or both uses four tactics to push the primary enabler towards their three reactions to the tactics. The four behaviors used by the intended patient are Guilt, Fear, Hope, and Victim. As the loved one teaches those around them these things, the reaction by the Enabler is Comfort, No Consequences, and Encouragement. There are many more to consider, and these are the ones to build on to help you identify whether you are preventing your loved one from hitting bottom or asking for help. If consequences are not felt, then the intended patient will not move out of the second stage of change and into recovery. 

The intended patient uses Guilt to help you believe they are a Victim. Guilt and Victim go hand in hand. As long as the intended patient can help the primary enabler think that the problem is the result of anything other than themselves, the enabler feels bad for their loved one and Comforts them as a victim of circumstances. Over time, the enabler starts to side with and even defend their loved one for every Consequence that arises. As other family members point this out, the enabler defends the one with addiction and mental health disorders, angering other family members along the way. This is where unhealthy family roles start to form as the enabler begins to help the loved one overcome the Consequences they have created themselves.

People with addiction and mental health disorders instill Fear in their enablers. As long as the enabler is convinced that if they do not do certain things, their loved one will be in harm’s way, they will continue to Comfort them and shield them from Consequences. They may even provide Encouragement, such as putting up with their behavior as a result of not taking their psychiatric medication, or giving them money, or taking them to and from the bar or place where they obtain alcohol or drugs. The benefit for the enabler is the illusion that their enabling is keeping their loved one alive or out of jail. This is quite the manipulation by the intended patient, as any outsider looking in knows this is shielding them from Consequences. The primary enabler also takes on the role of being needed, and the addiction or mental health disorders serve a purpose in the enablers’ delusion of codependency. 

Hope is used by those with addiction and mental health disorders to fend off Consequences and keep the status quo going as long as possible. The intended patient will frequently make promises to quit or attend treatment to obtain Comfort from the enabler. By Comfort in this scenario, we mean things like providing money one last time, giving them one more month to move out or find a job, just getting through the next big thing, etc. The Enabler clings to the falsehood that this may be true and Comforts the loved one in their mind for the last time. The enabler justifies the actions by convincing themselves that their loved one means it this time and will follow through, even though they know this to be another act of false Hope.

When looking at the enabling behaviors below, ask yourself, with each behavior, the following four questions:

• What are the advantages of “list the enabling behavior”
• What are the advantages of NOT “list the enabling behavior”
• What are the disadvantages of “list the enabling behavior”
• What are the disadvantages of NOT “list the enabling behavior.”

Enabling Behaviors are Providing Comfort, Taking Away Consequences, & Encouragement (Feel Free to add any behavior you choose, and remember to list anything that makes their problem appear less severe than it is, as there are too many to list):

• Providing Financial Resources (Giving Money, Paying for or covering the cost of Car, Housing, Rent, Mortgage, Bills, Legal Expenses, Food, Clothing, Cell Phone, etc.)
• Believing their lies and validating their victim mentality
• Allowing them to Guilt you into believing nothing is their fault
• Taking their calls to negotiate another plan of False Hope
• Not Setting Boundaries
• Not Holding Them Accountable
• Telling others they are ok when you know they are not
• Picking them up or taking them to the bar or place where they obtain drugs
• Calling in sick for them to work
• Lying to others about where they are or what they are doing
• Living as a prisoner in your own home
• Letting them see or spend time with the kids
• Taking their side over other family members, including your other children and spouse 
• Denial
• Minimizing

These are just a few of the enabling behaviors that we observe and hear. There are many more, and as you can see, they all take away accountability and comfort the intended patient. The less of a problem they believe they have, the less likely they feel they have a problem to address. We understand how hard it is, especially when it is a mother or father enabling their child. Until you realize your helping is hurting, they will not ask for help or feel the consequences of a bottom.  

How to Shift from Enabling to Empowerment

Referring to the above definition of empowerment, shifting from enabling to empowerment begins with recognizing what you are doing, why you are doing it, and the effect it has on the treatment outcome. Identifying why determines how and when you shift. It is one thing to tell someone not to do something; it is another to understand why they shouldn’t do it. Once you know that your perceived help is actually hurting your loved one, a corner can be turned. Hiding behind excuses of mental health and comments such as they are my child hold no water. In fact, these excuses are even more reasons to stop enabling and empower yourself to empower them. We understand this is easier said than done, and we also know it can be done. Furthermore, we are aware of and witness the results of those who make the shift, and we see and hear about the results of those who do not. There has never been a documented case of a family that chose to enable over empower themselves and their loved ones and then reported it as a successful outcome. 

Shifting from Enabling to Empowerment takes time, energy, and effort; no more than what you’re doing to exert your energy to enable. In fact, you will find empowerment to be much less stressful and easier to do over time, once you understand why you’re doing it. You will realize more each day as you see the results in yourself and eventually with your loved one. At Family First Intervention, our entire Family Aftercare program is centered on resilience and empowerment for the family. We encourage self-help groups such as Al-Anon, CoDA, ACOA, and Open Alcoholics and Narcotics Anonymous meetings. Working with individual therapists and marriage counselors, as well as a sponsor from your meetings, also helps with the shift. Neither you nor Family First Intervention expects you to make an immediate shift. We ask that you stay, learn, and give it a try. The more you understand why you enable and the effects of it, the easier it will be to make the shift to empowerment.