'NOT MY KID': THE ENABLING TRAP

An article in the Ambler Gazette last weekend about parents in Blue Bell, PA acquitted of charges of hindering a police investigation of their young adult son reflects the potential trap of enabling that many parents face when their children brush up against possible consequences from their substance abuse.

Please note: I’m not intending in any way to make a judgment about these parents, but I’d like to use their situation to identify a common issue among parents who are worried about their children’s drug and alcohol use.

Enabling occurs when you begin to lose your way and get confused about how to protect your children’s safety. You desperately want to believe your kids are telling the truth and therefore can be easily convinced that everything is okay, often telling yourself, 'Not my kid'.

Parents who are aware of their teenage children abusing drugs and alcohol are very familiar with enabling. When children are showing problems associated with getting high, a dramatic shift in the family often occurs.

The ‘not my kid’ mindset is a set up. The addict becomes an expert at manipulating and deflecting responsibility onto others and takes advantage of your love and protection to selfishly get what she wants without regard for the consequences or impact on others.

The whole family begins to react in unhealthy ways to accommodate the addict’s behaviors, because confronting them directly creates messy, often embarrassing conflicts.

Out of love, concern, shame, and fear, you become uncertain about how to best intervene. Living with a child with a drug and alcohol problem is like being in the back seat of your car as you are driven around by your inexperienced, untested young driver—the daily out-of-control, often terrifying feelings become unbearable at times.

The world of the enabler is like a yoyo, jerked back and forth across the line between being over involved trying to protect and cover up for your child, to being so angry, scared, and helpless that you want to give up. You swing back and forth between looking the other way and wanting to stalk your child’s every move.

Intervening can feel daunting. Here are some guidelines to make it easier:

• Educate yourselves by arming yourself with facts about drugs and alcohol to be credible when talking to your kids.
• Learn more about the dynamics of enabling.
• Confront your denial: Parent's instincts about a problem are usually correct. Avoiding and ignoring the problem makes you part of the problem.
• Take care of yourself by getting support:

-- Reaching out for help is a way for you to take care of yourself. Start by sharing concerns with spouses, partners, and trusted friends to help feeling less ashamed, overwhelmed, and helpless.

-- Community programs like Al-Anon and Nar-Anon can be lifelines for families struggling to regain balance in their lives.

-- Online communities such Parenting the Addict Child are excellent resources for those who aren’t comfortable with groups or 12-step programs.

THE ONGOING AMERICAN TRAGEDY UPDATE

Several weeks have passed since I first wrote about the Tucson atrocity AN ONGOING AMERICAN TRAGEDY expressing dismay at what I described as an ongoing American tragedy: How the American public’s ignorance about mental illness and the shame and stigma associated with mental illness and mental health treatment directly contributes to the lack of appropriate treatment that could reduce the vulnerability of the mentally ill and the likelihood for them to commit these crimes.

I’m encouraged that the predictable blame game has seemed to run its course and some of the national debate has shifted a bit towards turning to a more responsible discussion of the woefully inadequate mental health and addiction treatment system in the United States and what needs to be done with the architecture of this system to reduce the likelihood of another attack.

As information became available about the perpetrator’s drug abuse issues, the silence about the drug abuse use part of the problem has been deafening.

Let me fill you in on the field of addiction psychology’s version of the blame game. It occurs thousands of times every day when decisions about who will provide the care for a mentally ill person who also abuses alcohol and/or drugs. Or, alternately, when a substance abusing person with serious mental health issues needs treatment.

Substance abuse and addiction never exist in a vacuum. Although I’m simplifying here for illustration purposes, addictions are a result of the interaction among our biological and emotional makeup and social/environmental influences. Problems that addictions cause are associated with the negative choices we make, often as ways of helping us feel better in the short run.

As humans we tend to move towards rewarding activities and away from uncomfortable ones. People with mood problems (depression, bipolar disorder), anxiety (panic attacks, excessive worry, obsessive-compulsive rituals) and schizophrenia (unwanted systematic delusions and beliefs) sometimes turn to alcohol and drugs as available options to self-medicate their brain disorders that create constant and intense emotional pain for them.

Professionals refer to this common and intertwining nature of mental health and addiction problems as a co-occurring disorder. Unfortunately, our treatment system forces us to split the person’s problems up in order to find the appropriate treatment program. Treatment programs are usually more prepared to address either the mental health problem or the addiction. This makes finding adequate, comprehensive care extremely difficult.

Our field has come a long way since the mid 1980’s, when, as an on-call clinician looking for an emergency hospital admission for a person who likely would be out on the street without immediate treatment, I’d have to stand by on the phone while administrators [a.k.a. those paying for the care] would literally argue over who had responsibility for the care. And I’d often be on the other end having to deliver bad news to the client: the comprehensive care he/she really needed wasn’t available. I then had to make a makeshift plan for the person to ensure the person’s safety for that moment until we manufactured a Plan “B”. These administrative “turf” battles are rare now and the dichotomy between mental health care and addiction is better today, but not much.

It’s evidenced daily by the responses in hospital emergency rooms when a mentally ill intoxicated person shows up, or when police are called to homes when a mentally ill family member is acting scary and threatening. “He’s drunk, he needs to sober up”; “He’s high on drugs. What do expect us to do?” are the usual responses of first responders. Parents and family members of those with co-occurring disorders live with the fear, dread, shame, guilt, and helplessness associated with these scenarios that are regular occurrences for them.

When someone has diabetes, cancer, or heart disease, their condition usually can be treated comprehensively with the necessary multidisciplinary approaches available. Good luck to the person with an emotional problem and corresponding substance abuse problem looking for quality, comprehensive care. It rarely happens. Part of this is due to the above dichotomy in care, but the major problem is due to the unwillingness of insurance companies and shortsighted employers who purchase insurance plans for their employees to provide funds necessary for the adequate care of mental health and addiction problems.

The Mental Health Parity and Addiction Equity Act of 2008 provides insurance for employed people. People with severe co-occurring disorders can’t keep jobs, so not much help there. President Obama’s Patient Protection and Affordable Care Act of 2010 is a step in the right direction, but the reality is that insurance rarely provides enough coverage for the seriously mentally ill and/or the chronic disease of addiction.

DJ Jaffe, a national advocate for the seriously mentally ill, displays insight and irony in his Huffington Post depiction of “Mom [as] the new mental institution, given the responsibility to see their loved one stays well but not the ability to enforce medication compliance or get the mental health system to take action….Mrs. Loughner never wanted Jared to become a headline for hate. This is the mental health system we have in America. It caters to the well not the ill”

It takes an enormous amount of courage to ask for help for an addiction or mental health problem. It’s usually even more difficult for parents and family members (and yes,especially the Mom’s!) to reach out for help for their loved one. I’m hoping the national debate will allow more people in the mainstream of America to learn more about the true nature of mental health/addiction problems and treatment, reduce the shame and stigma associated with asking for and receiving help, and give our moms and all the members of our families a better chance to be productive members of our families and society.

What happened in Tucson is a horrendous tragedy. What’s happening on a daily basis to the millions of Americans with co-occurring disorders who are not able to receive proper care is a tragedy we can actually do something about.

HOW DO I KNOW IF MY CHILD HAS A DRUG OR ALCOHOL PROBLEM?: The answer isn't the most important thing...

As an addictions specialist, I get lots of calls from worried parents. It’s usually a bad news/good news scenario. The bad news is that most of the parents calling are beyond the point of wanting to know if their child is getting high--they’ve known it for a while by the time they finally pick up the phone to call.

The good news is that even though addiction is a progressive and chronic problem, without a commitment by the addict to maintaining a sober lifestyle, it can be a very treatable problem, especially with early intervention. And that initial call inquiring about a problem is a very important and necessary step in the process of getting help.

I use the word “process” because people come for help for a substance abuse problem with varying levels of motivation and ambivalence. Most people I see initially are being prodded or coerced to attend treatment: by a parent, spouse/partner, friend, doctor, or a lawyer.

Even parents, who are usually feeling terrified and often desperate when they are calling about their troubled teenager or young adult, have some level of ambivalence about seeking help. They’re scared, or guilty, or embarrassed or usually a combination of these or other uncomfortable feelings. They’ve probably put off for a long time making that first call. The process of reaching out for help mirrors the process of addiction recovery itself: it’s not a straight line but a series of steps: two forward, one backward, up and down, ebbing and flowing.

The importance of that initial call by a parent is not based so much on the content of the discussion--the specific information shared--but the fact that the first call represents two crucial factors that need to occur in the early recovery process to increase the likelihood of a successful parental intervention: the willingness to educate yourself about addiction and recovery; and taking steps to reclaim control of your parenthood.

Education

Accurate information is a front-line weapon in the battle against the disease of addiction. Addiction is a complex interaction of biological, psychological and interpersonal (social, family, peer relationships) factors. The more information you arm yourself with--for example, what addiction is, about the specific substances of abuse, types of addictions, the nature and process of addiction and recovery--the better position you’ll be in to figure out the action steps to take to feel more control of your child and his/her problem

Reclaim Control of Your Parenthood

I like to view that first call for help as the first step by a parent to get back in the driver’s seat of the family and reclaim control of parenthood.

An important shift in family functioning occurs when a family member is struggling with addiction. The addict is an expert at deflecting responsibility away from herself. Family members, out of love and concern, will be often willing to accept some (or a lot!) of the responsibility and even blame for the addict’s inability to take care of herself. So in addition to giving parents some specific information during that call, I’ll have them start the process of figuring out how they can begin to focus on which aspects of the problems associated with the addict’s behavior that they can control, or actually do something about. This is the first step in the parent’s own recovery.

Taking steps towards reclaiming your parenthood will begin the process of shifting the family functioning towards a healthier state and reduce the fear and helplessness for parents.

FYI: Elsewhere on PARC, I share some basic screening tools for getting a better sense of the difference between use and abuse:

HOW DO I KNOW IF IT'S A PROBLEM?

IT'S NOT NECESSARILY "HOW MUCH"