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Tuesday, February 19, 2013
Monday, February 18, 2013
Commentary: Why the Term “Enabling” Does More Harm Than Good
The term “enabling” is commonplace in the field of
addiction. It is used within support group settings, in treatment
programs and throughout the professional literature about addiction and
the family. I consider it one of the most frequently misunderstood terms
in our field. In fact, as my research about family caregivers of people
with substance use disorders has evolved, I have come to loathe the
term “enabling.” Here is why.
There is a great deal of misinterpretation about what qualifies as behavior that is “enabling.”
Webster’s definition of the term includes: “a) to provide with the
means or opportunity; and b) to make possible, practical or easy.”
Wikipedia notes that enabling also is used “to signify dysfunctional
approaches that are intended to help but in fact may perpetuate a
problem….” Examples include taking responsibility, blaming others or
making accommodations for a person’s harmful conduct, so that the person
is shielded from the harm it may do and the pressure to change.
Using these definitions, doing your son’s laundry might be considered
enabling, as it makes it easier for him and takes responsibility for
the chore away from him. In actuality, it may or may not be enabling
–depending on the context. If you do this chore to make things easier
for your son because he attended a self-help meeting – you probably are
supporting recovery – not enabling self-destructive behaviors. On the
other hand, if you are doing your son’s laundry because he was drunk all
weekend and will be embarrassed to go to school or work in unlaundered
clothes, then you are enabling him to continue engaging in
self-destructive behavior. You are helping him avoid the negative
consequences of drinking.
I find family members often are confused over the issue of what
constitutes enabling. Some have ardently been told that any support
offered to a recovering child or spouse can be considered enabling. The
philosophy seems to be that the person needs to learn to “fend for
themselves” or “live life on life’s terms.” This is difficult to argue.
We all need to learn the necessary skills to survive and thrive in our
environments. Especially as parents, it is our responsibility to foster
this in our children. But it does not mean that we cannot help our loved
ones in productive ways.
Recovery, especially early recovery, is hard work. Offering to
support the intense effort of this work can be helpful. For example – if
a loved one does not have access to a car, it is supportive to offer to
drive her to AA meetings, or soccer practice or any other
recovery-supporting activity.
Some say that the addicted person must take responsibility for
coordinating his or her own travel – and indeed – this can be a good
goal. But offering to help at first or occasionally does not enable the
person to escape the negative consequences of addiction – and it can
help to support recovery.
It is loaded with negative and judgmental connotations that are misplaced.
Worse yet, enabling is sometimes described as “dysfunctional,” which
can lead family members to the conclusion they are dysfunctional and
have let their loved one down. The important distinction that is
sometimes missed is that it is the behavior that is dysfunctional, not
the person. The vast majority of parents that I have met have only done
what most parents do; that is try their best to help their child. They
engage in the same behaviors as other parents. It is just that they find
themselves in a strange and difficult situation where behaviors that
normally are helpful do not function that way.
I believe that the term enabling causes more harm than good. I would like to get rid of the term altogether.
Rather than labeling a family member’s behavior as “enabling,” focus
on the consequences of the addicted person’s behavior. Ask yourself – by
doing this, do I allow him or her to avoid a negative consequence of
the drinking or drug use? If the answer is yes, resist the urge to
intervene. It is important that the person experience the negative
consequences that substance abuse renders. Also ask yourself – by doing
this, am I encouraging efforts he or she has made at recovery? If the
answer is yes, go for it! It is helpful to recognize and show signs of
support and appreciation for the hard work that an addict undertakes to
sustain recovery.
We must remember that addiction is a disease and recovery requires
ongoing maintenance. This is a lot of work – and supporting the WORK of
recovery can be a loving thing to do.
Kimberly Kirby, PhD
Director of the Parent’s Translational Research Center; Senior Scientist
Friday, February 15, 2013
Generic Drug Distributor Sues Suboxone Maker for Monopolizing Treatment Market
The generic drug distributor Rochester Drug Co-Operative
Inc. has sued the maker of the opioid addiction treatment Suboxone for
allegedly monopolizing the opioid treatment market, Bloomberg reports.
The maker of Suboxone (buprenorphine and naloxone), Reckitt Benckiser
Group, developed a film version of Suboxone that is placed under the
tongue, to replace the tablet form of the drug. According to the
lawsuit, filed in U.S. District Court in Wilmington, Delaware, this
prevented competition, because pharmacists cannot substitute the cheaper
generic version.
“Reckitt concocted a multifaceted anticompetitive scheme, executed
over the course of several years, to maintain and extend its monopoly
power,” Rochester Drug stated in its complaint. The article notes
Suboxone is used to help control opioid withdrawal symptoms.
In September, 2012, Reckitt notified the Food and Drug Administration it was voluntarily discontinuing the supply
of Suboxone tablets in the United States, due to increasing concerns
with children’s exposure and risk for accidental poisonings. The U.S.
Poison Control Centers found consistently and significantly higher rates
of accidental unsupervised pediatric exposure with Suboxone tablets,
compared with the film.
ADHD Drugs Not Effective in Many Young Children, Study Concludes
Treatment for attention deficit hyperactivity disorder
(ADHD) does not appear to help many young children, a new study
concludes.
The study followed 186 children, ages 3 to 5, who had moderate to
severe ADHD. Six years after their diagnosis, about 90 percent still
showed symptoms such as over-activity, impulse control or
inattentiveness, according to Bloomberg.
Two-thirds of the children were on medication. These children did not
show significant differences in ADHD severity, compared with those who
were not taking drugs. Almost two-thirds of treated children had
significant hyperactivity and impulsivity, compared with 58 percent of
those not taking medication.
“ADHD in preschoolers is a chronic and rather persistent condition,
one that requires better long-term behavioral and pharmacological
treatments than we currently have,” study author Mark Riddle of the
Johns Hopkins Children’s Center in Baltimore, said in a news release.
The study appears in the Journal of the American Academy of Child & Adult Psychiatry.
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