I’ve Been Enabler in Chief. I’m Through.
This post contains several comments and responses. Read from the top…
Jamp desperately needs a break but his partner feels he's punishing her. She is determined to stop drinking without professional help this time. Jamp needs space and a break from worrying.
"My girlfriend has been through detox 6 times this year. 2 Detox facilities, and 4 ER visits. She just left one after refusing to transfer to a long-term rehab center and now is adamant that she will never drink again. I need a break from worrying about her and her drinking 24/7. I've asked for space, but she says I'm punishing her for finally getting help. I know we're encouraged to reward sobriety. How do I take care of myself and not have this framed as me "kicking her out" just when she's getting sober?"
Isabel Cooney responds to this initial comment:
I desperately need space, I'm worn down
Hi Jamp, thanks so much for your question. Your Loved One (LO) has been in and out of detox and ERs over the last 6 months. She has now opted out of treatment at a long-term rehab center and is talking about going her recovery on her own.
You're exhausted, and aware that you need more time and space to take care of you, yet you desire to do things as gently as possible, so as not to discourage her or throw her off track.
We commend you for both of these objectives, and we think it is feasible to accomplish both.
Rather than "asking for space," we suggest you gently "take some space." Here's what the microcosm of this might look like in a typical, day-to-day application of CRAFT:
Family member and Loved One are in the living room together. Loved One is cracks a beer, or is hungover, or otherwise pushing their family member away with aggressive behavior, blaming talk, etc. Family member (rather than saying "please leave, you're drinking and you know I don't like that") quietly says, "I'm going to read in my room. See you tomorrow."
The family member has taken her own needs into her own hands — who better to do so than oneself? — while making a point about the use/behavior, and letting her absence be felt… all this without saying more than 10 words. No conflict, no requests, no time for tension to mount.
In your situation, you seek to both support her sobriety, and support yourself. Riding her rollercoaster over the months and years is taking a toll on you and you must replenish your energy.
Remove yourself, rather than asking them to leave
We suggest that you be the one to take a leave, if only a temporary one. Again, this way you are telling, not requesting. Taking what you need and not expecting anyone else (especially someone who has just a few days' or weeks' sobriety) to be looking out for you.
Figure out where you can go, where you'll still be close enough to see your LO regularly, and where you'll truly be able to disconnect from the dynamics and drama of home. A place that feels peaceful, where no one will be asking you a million questions… where you are free to process and recuperate as needed.
Once arrangements have been made, find a moment that feels peaceful between you, and let your LO know in a gentle way what your plans are. Here is a sample of language you might use:
"Dearest, I love you. I am so proud of you for wanting to take your recovery by the horns. I believe in you and I want to be a great support to you.
I've decided to allow myself a short break away from home, for 1 week (2 weeks? 4? fill in the blank here) — please know this is by no means a punishment. It's more about me. I care about you so much, and these past 6 months have been emotionally exhausting for me.
I can feel that my levels of fatigue and stress are high, and I know I won't be much help to anyone like this. I hope you'll understand that I'm giving myself this time to rest and recuperate.
I would love it if we could keep seeing each other while I'm gone. (Brainstorm some crafty covid-friendly date/outing options beforehand and mention some ideas). And if you agree, I'd like it if we could check in daily by phone?
I am so looking forward to knowing you sober, for our relationship to grow and evolve. Thanks for understanding my needs right now."
In case it wasn't obvious, the idea of dates/informal outings, and phone calls, is *rewards*. As long as she's not using, you really want to keep rewarding her, even if you just can't be that "rock" at home right now. She needs to feel your presence, your encouragement, and know that you're appreciating her sobriety. But of course, your.oxygen.mask.first !!!
The other thing we would really encourage you to do (and maybe your hiatus will give you the space and time you'll need, but feel free to start now, too) is immerse yourself in Module 4, "How Do I Talk to My Loved One?" (Here's the link) — this will help you vastly improve your communications, better manage difficult moments, and practice making requests that get you a "Yes" in response.
Keep us posted, we are rooting for you both. xo
Jamp has responded, providing further details about their current living situation. He feels he's been "enabler in chief" and his fear for her health is preventing him from taking some sorely needed steps away and finding space to breathe.
"Thank you so much for this response. I wish I had found this place earlier. The situation is complicated by us being at my mother's house, while my mom is out of town. All year we were in her house in Vermont, where I felt unable to leave because she would follow (drunk). I’ve been enabler in chief all year thinking I couldn’t leave because she would die. She slept all day only woke up to drink and she would be miserable. So was I of course. Aside from the few days after each detox. But I basically waited for her to pass out so I could do my work and pretended I was fine. We came here for work that was happening in the area (we’re actors). She was sober for 5 days before we came here I was hopeful, But she went out to mail something and got drunk, and everything exploded again and I realized how bad the situation has gotten for both of us. It was obvious to all my family. That was at my limit or my bottom I guess. I didn’t want her to die so while she was in a hotel room for her movie shoot in various states of drunkenness and being passed out I reached out to a substance abuse counselor who got her to go to detox. I communicated that I wasn’t comfortable with her plan to rehab on her own and wouldn’t go to Vermont or our NYC apartment with her because I don’t trust myself to not fall back into the enabling pattern. Does this info change any suggestions? I will do my best to apply your advice. Thank you so much."
Thanks so much for providing these further details.
Learn to shift from enabling use to enabling non-use
Since you've already got the title ('Enabler in Chief' as you say in your comment), keep it, and shift the meaning. At Allies in Recovery we are quite wary of the term "enabling" for many reasons, including the fact that it puts a lot of blame on the family for the Loved One's use, and also because the term itself is neutral, not inherently bad.
We can enable positive behaviors just as we can enable negative ones. So, say hello to your new identity! Enabler (of non-use) in Chief!
Modules 5 and 6 lay out the How-to for moments of non-use and times of use.
It will take some practice, but we'll hold your hand along the way (keep checking in). Think of it as a new skill-set you're acquiring and consider that your "enabling" skills can now be directed towards a healthier and more promising objective!
Perhaps it's obvious in the words I've written above, but just in case, I'll spell it out: her using is not your fault. Her relapsing is not your fault.
You have been doing everything you could think of to keep her safe and protect her from herself. You were using the skills you had. The guilt won't serve you and we are here to support you as you move into this new realm. You wrote, "I wish I had found this place earlier," but you did find us. There's no time like the present. So now, roll up your sleeves!
The fear is so totally understandable and human
Thus far, your fear — for her health, and her life (and perhaps her reputation?) — has been calling the shots. It's perfectly normal and natural for a human being watching their Loved One repeat these dangerous behaviors to get stuck in "crisis mode."
Laurie and Kayla have just recorded a new podcast episode on learning to separate 'crisis' from 'chronic.' Firstly, in order to preserve your Self (CRAFT needs you to be in good shape to help your Loved One progress towards treatment), and Secondly, because we don't always make great choices when we get stuck in crisis mode. The episode isn't published yet but I'll send you the link ASAP.
Self-care is what you started out writing in about, last week. And you were right on the money. It's where you'll have to begin, since you're so worn down and living with so much fear and worry.
Here's a checklist to get you started with Self-care
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Our Sanctuary is dedicated to your self-care. Browse through it as often as you can;
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Listen to the podcast, Coming Up for Air, picking themes that match up with what you're feeling and/or struggling with;
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Read a few killer posts (some of my personal favorites) that may help you realize it's OK to be exactly where you are on this journey: Laurie MacDougall's posts "It's Okay Not to Have Hope," "How Do I Handle My Fear of Relapse," and its sequel, "I'm Falling Apart with Fear, I'm Not a Positive Influence Right Now." (Laurie used CRAFT to successfully shepherd her Loved One into recovery and now runs REST support/education groups, blogs for us, and co-hosts the podcast.)
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Kayla Solomon runs a popular self-care group for Allies members on Wednesday evenings. You are the focus: your needs, your struggles, and how to move the whole situation forward, for you and your Loved One.
Finally (I know, this feels like a lot of homework), please remember that the eLearning Modules are the heart of our teachings and will provide you a solid framework for preparing your intervention with your Loved One. We do suggest watching them over and over. You'll pick up something different each time.
Still rooting for you both. —Isabel
She's not using now but could lapse any time
It can be deadly to stop drinking “cold turkey” when someone like your girlfriend drinks like she does. Her withdrawal from alcohol must be supervised medically.
When a person stops drinking, their blood pressure can shoot up to dangerous levels, and they’ll struggle with persistent and miserable levels of anxiety and myriad other discomforts, not to mention, the most scary and deadly: grand mal seizures.
Sometimes the embarrassment factor can be your friend
Can you increase the embarrassment factor (allow Natural Consequences to occur) and lessen the secrets that surround the situation?
Call in first responders when your Loved One is passed out. What if the ER talked to her and pushed her to detox. What if the detox pushed her to a rehab you'd helped find.
Do it over and over. This is CRAFT: you are recognizing the patterns, inserting yourself into key moments. Intervening with an intervention.
In your case, the looming danger suggests you may want to create a different outcome for your girlfriend. …
Are you willing to have her perhaps appear in the press “being treated for alcohol problems?”
We are suggesting that in moments of use, you be prepared to step back from her, get her to the ER, let her be embarrassed, perhaps let it be public. Don’t shield her in any way from this loop.
Keep the rehab door wide open, shine the light on it when she's sitting in detox.
The current cycle includes a detox – EXCELLENT. Now sharpen up that cycle, making it even more effective by adding in:
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more detox visits by calling in 1st responders when she's passed out, and
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letting her suffer the embarrassment if you think that could help.
All of this may need to be wound around her work. Losing her work may be a consequence no one can afford to have happen, especially in these times.
All my best — Dominique Simon-Levine
My husband is an active alcoholic and denies this. He gets “black out” drunk in front of my 7-year-old daughter and I. I called the police yesterday because I thought he was going to die. How do I get him to leave the house? I’m trying to make it uncomfortable for him by not doing anything for him like the laundry, cook, etc…He sleeps in a seaparate bed. He won’t leave though. I want him to leave if he won’t get help but he won’t. Short of divorce, what can I do?
In RI there aren’t nearly enough detox facilities available … they were all filled last time my son wanted to go. Can you imagine? Actually there was 1 place that had beds but refused him admission based on a prior time he was there (because of an “overfriendly goodbye” between him and a staff member (actually just had a bond created during rehab- but affection with staff is prohibited, understandable…. )–so there’s That huge problem when the loved one decides to go get help! And another thing i found out to my surprise and disappointment, if your loved one is on suboxone, they are limited to which detox/rehab will take them… Any insight on this is helpful. Anyone ever hear of this? Can they ever go out of state without private insurance (my loved one has neighborhood health and medicaid) Thank you.
I am a treatment provider who has has fairly extensive experience working inpatient units treating SUDs. I have also been a RI resident for the last year. If a staff member participated in “an over friendly goodbye” with a patient/client, it would be on the clinical director/administration to handle that employee boundary situation appropriately. There should be no blame on a behavioral health patient seeking recovery from disease. Providers should EXPECT that clients may experience boundary confusion in these instances. There is a power differential between providers and patients, and if the administration recognized at the time that a staff member inappropriately exploited that dynamic, even while saying “goodbye”, IT SHOULD BE ON THE FACILITY TO DISCIPLINE & RE-EDUCATE THE STAFF MEMBER, THEY SHOULD NOT PENALIZE YOUR SON!! Refusing to consider him for admission because of something a staff member did sounds VERY ILLEGAL to me! Good luck!
He’s Ready For a Detox Facility. Why Is It So Hard to Find One?
Kmsbarton’s Loved One is working on his recovery. Now he’s ready to commit to a treatment program, but is encountering barriers at every turn. As frustrating as these obstructions are, they can often be overcome. Here’s our advice.
In Rhode Island there aren’t nearly enough detox facilities available. They were all filled last time my son wanted to go. Can you imagine? Actually there was one place that had beds, but it refused him admission based on a prior time he was there (because of an “overfriendly goodbye” between him and a staff member. Actually he just created a bond during rehab, but affection with staff is prohibited, understandably). So that’s a huge problem when the Loved One decides to go get help! Another thing I found out, to my surprise and disappointment, is that if your loved one is on Suboxone, they are limited in which detox/rehab centers will take them. Anyone ever hear of this? Any insight on this would be helpful. Can you ever go out of state without private insurance? My Loved One has Neighborhood Health and Medicaid. Thank you.
COVID is making substance use disorder treatment beds, chronically in short supply, even more difficult to secure. I recently looked into a detox bed for someone in Portland, Maine, and was told the detox center was closed due to a nursing shortage. There are also census limits like never before. In some places (like homeless shelters), they are allowed to admit only 50% of their pre-pandemic numbers.
Hospital emergency rooms are feeling the pinch. I learned of someone turned away from the ER recently because his complaint of bugs under the skin didn’t rise to the level of urgent. Scabies isn’t urgent, granted—but isn’t a methamphetamine addiction? No one thought to put him in front of a doctor.
It shouldn’t be this way.
It is so frustrating when the family learns CRAFT and it works, your Loved One says yes to treatment, and the doors to treatment are closed. The Loved One, out of desperation, presents at the emergency room only to be turned away. Perhaps you watch helplessly as your Loved One’s motivation for going into treatment wanes and that emotional window of opportunity closes. In our health care system, there have always been easily missed opportunities to respond to life-threatening conditions. That this shortage has worsened is completely devastating.
As those on this platform know only too well, getting that door of treatment open at the time your Loved One says, “Okay, I’ll go,” is often tough. Now, as you’re describing, it’s become even more difficult. It’s hard enough to overcome their often great resistance to accepting help with addiction. One federal study found that 50% of those who admit to a problem are resistant to accepting help—and of course, supporting a Loved One into treatment is a primary goal of CRAFT. Indeed, much of CRAFT is focused on just this, creating and noticing that little bit of willingness and presenting treatment options (or any wellness opportunity, for that matter), at that crucial moment.
They turned him away for WHAT?
And, yes, it’s hard to imagine someone with out-of-control diabetes being refused or thrown out of care for showing affection towards a staff person. Your experience warrants a complaint to the state. I don’t see how admission to a medical detoxification program is anything less than urgent, life-saving care. It should not be denied because of a hug, or even more than a hug, on a past occasion. Fraternizing with other residents is a problem in social residential settings, but you are talking about a medically necessary and life-saving detoxification unit.
Some rules may work in your favor.
There are exceptions to Rhode Island Medicaid that might allow your Loved One to be treated out of state. If the out-of-state hospital is certified to the same level as an in-state hospital, you should be able to go out of state. I’m sure this won’t be easy, but it looks possible.
I know less about Rhode Island, but in Massachusetts, there are rules now that prevent treatment and recovery homes from receiving funding from the state if they exclude folks on Suboxone (or any medication). The exclusions are still allowed in some criminal justice-funded programs and privately-funded homes, but otherwise that battle has been mostly won in Massachusetts.
When you’re punished for positive actions.
According to some administrators, having residents on MAT (Medication-Assisted Treatment) creates a problem in the therapy and treatment for those not on MAT. This misperception is supported by approaches like 12-step recovery programs in which proponents of AA (and not AA, the institution) consider people on MAT to be non-abstinent. This, despite traditions in programs like AA that state they have no opinion on outside matters like psychiatric medications and treatment care.
I recently spoke to a recovery home that does not admit people on MAT. The person we were discussing was abstinent from his opioids. So why, the director asked, would we endanger him by mixing him with people on active opioids? (Suboxone is a combination of an opioid blocker and an active opioid). And why would we put anyone already abstinent on an active opioid?
I don’t believe there is a good answer to the first question. Individuals on MAT are not high from the drugs they take, and their medication should be locked up and dispensed by staff. The second question, however, is a good one. The answer right now is driven by serious public health concerns over the risk of death from overdose.
MAT isn’t the whole answer, but it’s used because it works.
The U.S. lost 100,000 people to all drug overdoses in 2020, one third more than the previous year. Most of that increase was due to more fentanyl in the drug supply and the combination of opioids and benzodiazepines, which together create life-threatening respiratory depression. Taking Suboxone as prescribed reduces overdose deaths by 50%, plain and simple.
And with the system now also stressed by COVID, there are even more serious gaps in treatment, especially inpatient or residential care. It is also easier to put someone on Suboxone than to provide anything more comprehensive, such as a combination of MAT, therapy, let alone a residential program. I have yet to hear of anyone, perhaps ever, being turned down for MAT, except when the person had a history of diverting their medication.
The cruel irony of all this isn’t lost on us. Your Loved One starts MAT, and then isn’t allowed into more intensive treatments.
The bottom line is that families need to search harder and wider for treatment of their Loved Ones. I am sorry to hear about your frustrations, Kmsbarton, and I share them. Thank you for writing in. Your questions will help other families sorting out treatment for a Loved One.