Understanding How Enabling, Family Roles, & Behavior Affect Addiction and Mental Health Treatment Outcomes
What Enabling Provides a Family System
A person enables for various reasons, often having little to do with the person suffering from a substance use disorder. Most people understand enabling a substance user often takes away their ability to face consequences. The question is not so much what is the enabling providing for the substance user, it is moreso what is it providing to the enabler?
Family Focused Strategies for Addiction and Mental Health Intervention
Addiction Affects Family Members Differently Than You May Think
When a loved one begins to use drugs or alcohol, their relationships with others begin to change. Everyone reacts to addiction in their own way. However, a substance use disorder often brings more problems and devastation into the home. Is it the family member with the substance use causing the chaos and confusion? Could it not also be the family member’s attention to the substance user that is causing the maladaptive roles to form and the resentments with one another that follow?
At Family First Intervention, we understand how difficult it can be to see what has happened within the family system. One of our many goals is to educate those affected by addiction and help them see how the whole family shifts and why.
How Does Addiction and Mental Health Lead To Dysfunctional Family Roles?
If I were to ask a room full of people who or what is the problem, they would almost inevitably say the addict or alcoholic and their behaviors. Although that is undeniably true, is it the only problem? Family members’ underlying resentments and anxiety causes them to be as much if not more frustrated with the primary enabler and others within the system. This often causes the other family members to fight and be at odds with others’ views and suggestions. The primary enabler can cause an internal struggle for the attention, affection and approval that has been almost entirely given to their loved one with the addiction. The family often makes it about the alcoholic or drug addict creating a diversion from some of the internal problems that needs to be addressed. Misplaced emotions, resentments of others, lack of education, acquired maladaptive coping skills coupled with a lack of communication between family members is often the culprit. As a result, family members take on counterproductive roles within the family system to help them through. Families who are flooded risk being able to change effectively and unbiasedly due to misplaced emotions. This is often why just “talking to them” about stopping their addiction fails utterly. This approach does not address the big picture nor the underlying family problems and only scratches the surface.
Family First Intervention has identified some of the most common reasons that a substance use problem affects a family system, even in previously healthy households:
- Substance use disorders cause family members to take on maladaptive coping skills and become flooded in their ability to make rational, effective decisions.
- Substance use disorders turn family members against one another. Family members start to acquire reasons to avoid helping their loved ones. There is often something gained by holding onto certain family roles such as the hero or the enabler who seeks to remain feeling needed in the relationship.
- The family system often approaches the problem from the direction of the substance use being the primary problem. Our research shows it is far more effective to address and repair the damage to the family system before help can be offered effectively.
- Family members avoid confrontation and the fear of rejection. Creating Ambivalence and Confrontation is proven to be the most effective method to move a substance use disorder client through the stages of change when applied therapeutically and professionally.
- Family members frequently find objections to solutions offered. This is often due to unresolved and misplaced emotions. Some family members unconsciously avoid the steps required to help their loved one in order to hold onto the new family patterns of confusion and chaos.
- The longer maladaptive family roles are left unaddressed, the more damaging and lasting an impact they can have on the entire family and their loved one.
- Family members often blame the addiction as the cause of the family problems when the problems more frequently stem from the family members reacting to the other family roles.
An intervention is not about how to control your loved one with a substance use or mental health disorder; it is about learning how to let go of believing you can.
Family Roles that often occur within a Family affected by Addiction and Mental Health
To better understand how these harmful behaviors can prevent effective solutions while affecting the family, we’ve identified the most common inherited family roles. Please keep in mind that many of these roles can be an extension of others and exist simultaneously:
- The Substance User = Is the role that draws the most attention and for obvious reasons. Substance users act out the families’ untreated guilt and shame while self-medicating their own. The chaos they create forces all others to react to it. The addiction starts the process for the primary enabler which in turn initiates a dynamic that forms all the other family roles. The substance user is often viewed as the only person who needs to be fixed. A family almost never realizes this isn’t true until the substance user enters a rehabilitation facility. Once the substance user is removed from the family system, the roles played by others further degrade, and the family starts to break down. Fortunately, this is a temporary situation as the family works its way back to a sense of normalcy, learning to operate without the chaos and reactivity caused by the substance user and others playing roles. The sooner family members enter their own recovery, the sooner they can start to function as a healthy family again.
- The Primary Enabler = This role’s primary function is to react to the substance user. What ensues is denial, minimization, excuses, and attempts to manage a failing family system, all the while continuing to provide comfort and care for the substance user. The enabler role creates a trickle-down effect that inflicts significant devastation on the family. While most families believe the substance user is the source of all the resentments and grief, it is the primary enabler who has the greatest impact on the family system. This family member often feels the need to enable as it provides something rewarding in return; otherwise, he or she would not do it. By the primary enabler taking on this task, other family members and relationships take a back seat to the substance user, and this leads to family disruption. It is frequently played out due to guilt and shame and perpetuated by the satisfaction of being needed in the relationship with the substance user.
- The Martyr = Is the family member seen as the victim of the substance user’s behaviors. The martyr is the one who screams for help and then rejects help when offered. In a group setting, this person can be seen as the “yeah…, but” client. Although martyrs are truly affected, their fear of change and what will happen to them resulting from an intervention or their loved ones seeking treatment is prioritized. The martyr may think, for example: “If [the loved one] leaves for treatment, how will I pay my bills?” The martyr is not a bad person, but is terrified by the prospect of a new normal. Martyrs may not even realize the true reasons for their objection to an intervention. The question the Martyr often struggles with internally is what happens to me if the substance user improves?
- The Hero = The hero is an overachiever, a perfectionist, with little ability to listen to and follow suggestions from professionals or others. The hero seeks unconsciously to sabotage efforts to help the substance user. In doing so, others are prevented from improving the situation and ending their roles. Heroes impede others’ efforts to be in control, from becoming, instead of them, the savior and shining star of the family. The hero has to be seen as the one who fixes the problem and thus is resentful of the primary enabler. The substance user does well one day, and the enabler is overjoyed. The hero has several accomplishments for many days but earns far less recognition. Heroes are angry and medicate their feelings with perfectionism. As with the martyr, there is a hidden agenda. If the substance user gets better, will he or she gain more attention from and become a hero in the eyes of the chief enabler?
The enabler certainly inflicts the most damage to the family system, but the Hero role is by far the most harmful to the healing process, even more so than the enabler. Should the hero participate in the process, he or she often insists on taking the lead with little to no collaboration with other family members. The hero needs to be the one who calls the shots, hires the treatment team, and determines the treatment plan, the length of stay, and so forth. The Hero role always operates with a hidden agenda designed to protect a carefully crafted “perfect” image. In the final analysis, the hero fears that if the substance user or other family members take charge or get better, the hero’s star will not shine as brightly in the eyes of others. If the interventionist has the participation of the hero, our experience suggests that this family member will either be very judgmental, question everything, and say this will never work, while being disrespectful at times. The either extreme is silence during the family group consultation. So-called hero’s silence or disruptive behavior often ends when the conversation ends, at which point they attempt to undermine or contradict recent exchanges with the professional. The hero perhaps causes the most damage to the family in that he or she prevents more families from seeking help than any other role.
- The Scapegoat = This role acts out in opposition to the hero. As the family system balances out and complements the dysfunction, the Scapegoat sees that the perfectionism and overachieving ways of the hero are unsuccessful, so they become defiant and oppositional to draw attention away from the enabler. Scapegoats often search for new people to associate with and build a parallel family of friends and acquaintances who “understand” them. Like the other roles, everyone is trying to draw attention away from the primary enabler who has given all he or she has to the substance user. We believe human connections are so profoundly needed that people will do just about anything and everything they can to achieve and maintain them.
- The Lost Child = This role sees both the hero and scapegoat roles as ineffective so the lost child goes silent and withdraws. Many clinicians feel the lost child is attempting to go unnoticed. We disagree. In several interviews with those who have adopted the lost child role, we have found them attempting to be noticed by eliciting concern for their withdrawn behavior. The lost child is hoping someone notices the withdrawal from the family and asks him or her to return to the fold. This strategy, similar to the one adopted by the hero and the scapegoat, also backfires. Until the substance user is in treatment along with the other family members, these roles will not start to return to a state of normalcy.
- The Mascot = As suggested in all the other roles, mascots have a strategy as well. They use humor and jokes and make light of the situation to cope with the trauma within the family system and themselves. They pretend things are OK while actually making it more difficult for others to get better. By using humor and jokes, they offer the family the illusion of normalcy and divert attention from the chaos and confusion. They may be laughing on the outside, but they are crying out in pain on the inside.
“The most formidable challenge we professionals face is families not accepting our suggested solutions. Rather, they only hear us challenging theirs. Interventions are as much about families letting go of old ideas as they are about being open to new ones. Before a family can do something about the problem, they must stop allowing the problem to persist. These same thoughts and principles apply to your loved one in need of help.”
Mike Loverde, MHS, CIP
The roles and behaviors introduced below are not clinically recognized, unlike the ones described above. Nonetheless, they are barriers to the family returning to normal, and they prevent the substance user from receiving help. When people say “it takes a village,” it certainly does. The substance user is unlikely to surrender if the family system is resistant to growth and change. This is why we believe it is unreasonable to think a family can perform an intervention on their own without a professional interventionist. Doing so would fail to address the underlying problems within the family system. The roles and behaviors listed in this section will be acted out in the DIY intervention.
- The Punisher = Oftentimes, as a result of the behavior of the hero, the punisher makes suggestions about establishing hard consequences. Some of these include cutting off contact and asking him or her to leave the home with no alternative such as treatment in place. Comments may also be made such as: “They don’t need treatment; they just need a job.”
- The Redeemer = This is a behavior of the hero or enabler who needs to be in control and frequently takes on the responsibility of the one who fixes the problem. Mostly driven by ego and underlying issues, redeemers seek to be the savior who delivers the convincing speech that persuades the substance user to change. They are almost always resistant to an intervention for fear of revealing their inability to remedy the situation.
- The Ally = Seeks to avoid confrontation by siding with the addict and the alcoholic. The ally often puts people-pleasing behaviors and the need to be liked by the substance user before the family’s effort to proceed with the intervention. The ally will almost always reveal to the substance user what is going on and provide inside information as to what the family is discussing with the intervention team.
- The Denier = A very common trait of the enabler as well, the denier does not admit the existence of a problem or insists that the problem is not nearly as bad as others claim. This is often due to mental blocks and misplaced emotions, leading to a desire to avoid an intervention and confrontation. Deniers display behaviors similar to a substance user in regards to denial. By minimizing the severity of the problem, they promote the illusion that nothing needs to be addressed or changed.
- The Clueless = This role can be a family member who is not on the front lines, so to speak, and who only sees the substance user as he or she used to be. An individual who plays this role, like the denier, can also be a family member with an unconscious mental block who seeks to avoid confrontation. In some cases, the clueless may include distant relatives who truly do not know what is going on.
No One Chooses Their Roles or Behaviors Intentionally
The roles stated above happen over time. Most people we speak with are unaware of why or what they are doing. Some get angry or defensive at the mere suggestions of exploring their role. It is these roles, developed over time, that largely in part perpetuate the family problems and provide less want or need for the substance user to change or family to change themselves. Most family members believe they are being helpful and their current beliefs are valid, normal and possibly one day effective. While the family is held in these roles, the substance user accelerates by creating a diversion. The addiction destroys the family system leaving many unaware what is happening. The attention is frequently on the substance user and infrequently on the family. What ends up happening is the family is fighting one another and are at odds because nobody is on the same page. Some enable, some try to impose their beliefs on others trying to prove their stance and others may “wipe their hands” of the situation all together. When all come to the same agreement, guided by a professional, solutions become clearer and easier to execute. It is helpful to identify and repair the family system that may be preventing the substance user from seeking help.
The closer a loved one is to the alcoholic or addict, the less likely they are emotionally capable of formulating proper judgement. Emotionally attached family members are often flooded and unable to correct the problem internally. It almost always requires a third party perspective from the balcony. If a family expects their loved one to surrender to professionals for a new perspective it may be helpful for those affected to follow a similar course of action.
It can be very difficult to know who is helping and who is hurting without an expert’s input. That’s why working through the problem with the help of an intervention specialist is so vital. Emotionally driven decisions and those made in a flooded emotional state can be difficult to deliver effectively. Those members affected by the addiction are almost always unable to simultaneously be the counselor and the family. There is far too much going on making it near, if not entirely impossible to see the forest for the trees.
When Families Change So Does the Addiction and Mental Health
It is important for family members to know what they are up against. This includes Identifying family roles and behaviors that may affect positive outcomes. Knowing what a substance use disorder is and how a family becomes consumed in it allows for better judgement and decision making. In any other aspect of medical conditions and care most families would allow themselves the opportunity to learn from professionals. With addiction, it is often not the case. Families who surrender and become aware of how the addiction and their behavior is impacting the rest of the family is the first step towards achieving the goal of positive change and wellness.
Related Resource: A Complete Guide to Addiction Recovery for Your Loved One
What a family expects or waits for from the substance user, is often what is needed for themselves. A person who suffers from a substance use disorder almost always never sees the need for positive change if the family system surrounding it prevents it. While most families are waiting for them to ask for help or reach a bottom by way of consequences, it is the family that can be unknowingly standing in the way or reaching an emotional bottom themselves. It is difficult for a family to see that some of the ways they have been going about correcting the problem could be actually fulfilling an unconscious need within themselves. Nobody plans this, it just happens.
