Enabling or Life-Saving?

Enabling or Life-Saving?

By April Wilson Smith, MPH  

When I was struggling terribly with alcohol and Post-Traumatic Stress Disorder, people used to ask my mom, “Has she hit bottom yet?” 
My mother would answer, “Bottom would be dead.”  


My mom was there for me through hospitalizations, running out of money, losing a job, and missing many family holidays when I just couldn’t get it together to stop drinking.  Her friends would often accuse her of “enabling” because she continued to love and support me, even though I returned to drinking after periods of abstinence.  


My mom’s love and support was, and is, unconditional.  Never from the time I was born has she said I had to do or be anything to be loved.  I am her daughter, and that is enough.  I did not have to go to a good college, I did not have to have a good job, and I did not have to be sober.  I did all three, at various times, but her love never faltered even when I did not.   


  I contrast my experience with that of a close friend.  She was in and out of the hospital with multiple drug problems, complicated by the fact that she has Type 1 diabetes.  Her parents’ Al-Anon group told them that they were “enabling her” by keeping her on their health insurance. So, they kicked her off. After that, she could not afford the insulin that was needed to keep her alive. 


Fortunately, my friend was helped by Philadelphia’s harm reduction organization, Prevention Point, which helped her get on Medicaid.  Her endocrinologist gave her enough insulin to make it through until her Medicaid coverage began.  But think about what her parents’ Al-Anon group convinced them to do.  Denying a brittle Type 1 diabetic insulin could have been a death sentence. 


What those who push the “enabling” narrative fail to understand is that making life worse for a person who is already suffering doesn’t motivate them to change: it drives them to give up.  Conversely, having a strong reason to live is a big reason why people get better.  Think about it. Are you more likely to give up your main coping mechanism when you have lost almost everything, have no joy in life, and can see no real reason to live?  Or are you able to give up the thing you use to medicate negative emotions when you are finally feeling hopeful?  


Many people fail to understand the terrible fears that underly and perpetuate addiction.  I medicated fear and anxiety, even panic, with alcohol.  Unfortunately, alcohol just makes anxiety worse and in the long-term creates more things to be afraid of.  There were many moments I was unable to see straight without something to take the edge off.  Fear of very legitimate stressors, including financial insecurity and the prospect of losing my job or my home, drove me to drink more, not less.  Gaining some stability in life by living in a safe place and working at relatively stable jobs gave me the chance to address my alcohol problem.  The constant drum beat of terror took a long time to go away, but it never would have gone away without real, concrete help, financial and otherwise.  


“Hitting bottom” for many means losing all friends and family, being financially destitute (including homeless), and engaging in behaviors that under better circumstances a person would never consider.  Is that really where you want to see your son or daughter?  At the worst part of my battle with AUD and PTSD, I ran out of money and had to turn to my parents for help.  Fortunately for me, they were both able and willing to help me get out of a bad living situation and stay solvent until I got a new job.  If I had continued to live in terror, not knowing how my cat and I would eat or sleep, I do not think I would have been able to get back on my feet.  Everyone’s idea of the impossible is different, but basic things like safe housing and loving human contact are necessities.  Providing those things is not “enabling” use, it preserves life.   


We have to accept that we cannot stop people from drinking or using drugs.  Locking people up may work for a short time but it almost always backfires. If people do not learn the skills to manage their lives, they will have problems the second they are not under lock and key.  Inpatient programs with locked doors and heavily monitored halls give patients the idea that they cannot control themselves and cannot be trusted.  Losing all control leaves a lasting negative imprint on the psyche, turning out people who are likely to behave in dangerous ways.   


Helping people move beyond dangerous patterns is a viable path to a better future.  Heaping suffering on top of suffering only makes it worse. The horror of losing things and people that matter, having less and less to live for, does not help people climb out.   


My mother once said to me, “You’ve suffered enough.”  It took a very long time for me to believe that, even after the crisis was over.  Believing that I was safe and that a happy future was possible were key to moving forward.  Acting every day as though I deserve self-care and care from others is essential to staying well.  


Love, contact, medical care, and financial support are not “enabling.”  They are lifesaving.  

April Wilson Smith, MHP

April Wilson Smith, MHP

April Wilson Smith, MPH, is the Director of the Peer Guide Program for North Star Care, an innovative health care company that provides telehealth harm reduction-based treatment for people with alcohol use disorder. She is a longtime member and former director of organizational development for Harm Reduction, Abstinence, and Moderation Support (HAMS), a 10,000 member worldwide, online group of people who want to change their drinking. She holds a Masters in public health from Thomas Jefferson University and presented her thesis work at the Harm Reduction Coalition’s 2016 national meeting.