Wednesday, May 14, 2014

“Don't Trade a Headache for an Upset Stomach” – For Families of Addicts, it's Not Always Black and White

The title quote, from a decades-old Bufferin commercial, captures a situation in which the solution to one problem (headache) causes another (aspirin-induced stomach irritation).  The reality is that similar dilemmas arise frequently in the world of behavioral problems including addictions, though there is never a shortage of people offering black-or-white advice.

It’s usually quite burdensome to be dealing with an actively alcoholic family member.  Aside from the scars that the experience tends to leave on children (who grow up to become ACOAs, Adult Children of Alcoholics), for adults involved there are the unending demands to manage and navigate a situation characterized by irrational and sometimes unpredictable behavior.

The term “enabling” refers to anything that other family members (usually most focally the spouse) do that shield the alcoholic (or addict, of course) from the naturally flowing consequences of his or her behavior.  This concept took off around the 1960s (by my recollection), and treatment providers urged family members to avoid enabling, since it tended to prolong the alcoholism by preventing the alcoholic from “hitting bottom.”  True enough, and generally a good idea, but at the time it was particularly hard for wives of male alcoholics (many of whom did not have their own income) to step out of their enabling roles, since it might well mean not having the means to keep the family fed and sheltered.  In real life, most decisions are not black and white. 

In recent years, I have often found myself addressing the dilemmas and emotional pain faced by parents and (grown) children of alcoholics/addicts.  Take, for example, the parents of a 20-something young adult addicted to opiates (usually a combination of heroin and painkillers).  If they continue, as is their natural inclination, to provide financial subsidies to their child, they may be “enabling”  – it makes it that much easier for the younger person to sustain the addictive behavior.  At some point, the parents may really need to withhold such support until their child is genuinely in treatment and on a path toward recovery.  On the other hand, they also know that withdrawal of financial help could increase the likelihood of their child’s being homeless, engaging in illegal activity to get the substance, and becoming more socially marginalized.  It is one of life’s many no-win situations, and none of us is in a position to judge those who confront it.

Another example is an alcoholic woman I saw, pushing 80 yet still in very good physical and cognitive shape (when sober).  Her adult children, who at my suggestion met with an addiction specialist of their own, moved her from her apartment and into one of their homes indefinitely, well aware that, by track record, on her own she was likely to resume drinking and let her health slide.  While their efforts were potentially life-saving, there was also an element of angry frustration.  (I remember similar feelings, borne of repeatedly being disappointed and lied to, toward my own alcoholic father many years ago, and I was not inclined to be nearly as sacrificing of my own life.)  The other side of the story is that this elderly woman, who herself had made great sacrifices to raise several children (now successful adults) now felt slapped in the face, in a sense imprisoned and robbed of respect and decision-making power in her own life.  In reaction, she became more depressed (though abstinent), and seemed destined to spend the rest of her life that state (but at least alive).  It was sad and ironic for me to feel the greatest sympathy and alliance with my patient, even though I, too, saw that her commitment to sobriety was iffy.  

That story has not yet reached a conclusion.  But I raise these examples to highlight the fact that life, even in cases of severe addiction, there is no one, clear answer.   This is why, as a therapist, I join individuals and families in wrestling with their situations, and attempt to provide information, perspective, and emotional support, but I seldom give one-size-fits-all advice.