Last week I sat down with Miki MacDonald, a family nurse practitioner at St. Joe’s Internal Medicine. My main goal was to talk about support for those who support loved ones with a substance use disorder. There is stress and strain on family members; they constantly wonder if they are doing the right things. I was interested in getting a medical professional’s opinion. What follows is the interview with Miki:
Q: Do you have the opportunity to connect with loved ones of those struggling with a substance use disorder?
Miki: Yes, I do … often.
Interestingly, people who are related to people who have substance abuse problems also carry shame. Sometimes it takes a while for people to actually disclose to me that they have a loved one with an addiction problem … so I always feel honored when somebody actually discloses this because it’s a sign that they trust me. I’m pleased they disclose because I feel it’s an opportunity to help two people … or more since substance abuse is a family and community problem.
So when this happens the main thing is to dispel shame because they actually feel like their loved one’s problem rubs off on them and reflects badly on them especially if they are a parent. They feel they have failed their child. … Even a spouse, they feel they’ve done something that has interfered with that person getting better.
The key thing is clarifying that it is not necessarily something they have done. … This problem can arise in anybody. We really don’t understand why some people have it and some don’t. We have theories about it … a genetic theory or upbringing or social events. … Trauma can cause this, but we really can’t say for sure. So blaming people is useless. Blaming ourselves is useless. Shame is useless. … It interferes with care and recovery.
Q: What advice or resources would you give to a loved one supporting a person with a substance use disorder?
Miki: The main thing is to help guide them. … I think most people feel helplessness; the caregiver, family and friends … even health-care providers feel helpless — as well as the person with the addiction feel helpless.
How to deal with helplessness? Offer things to do … resources. In Bangor we have groups that help people. For example Al Anon, which is mostly based on alcohol dependence, but you can use it for any kind of addiction. … I can actually hear it in the speech of people who go to Al Anon. … It’s not that they’re talking like inspirational bumper stickers … like “one day at a time; easy does it.” … They are speaking from a perspective of “I love this person, and I support them, and I do not want to enable them.” They also speak in terms of “it’s not about me, it’s about them.”
So, you can tell when somebody has been coached in the Al Anon philosophy, and it helps people get grounded so they aren’t lingering in an imbalanced way to help someone.
The other thing I recommend is therapy. … There is a dynamic that occurs with a person who is with a person with addiction. It throws that care-giver or loved one off balance. They need to ground themselves, so they can effectively care for themselves and their loved one. I think there is tremendous help to be had from therapy.
Q: Can a caregiver make recovery harder for a person with a substance use disorder?
Miki: They can. They can make it harder, I think, in two ways that are different and extreme. One is shame, and one is enabling. If a person is struggling with addiction, and you’re constantly rubbing their nose in it and make them feel like a loser, you’re not helping them. … Feeling badly about yourself, if you have an addiction, makes you feel more like leaning towards using because you need a backbone. You need to find so much self-esteem, so much positive energy to get better. If somebody is constantly reminding you that you have an addiction, it just makes things worse. So sometimes we actually recommend people stay away from their loved ones if that dynamic is going on.
Q: How can you pick up on the fact that a family member/supporter may be treating the person with the substance use disorder in this way?
Miki: I might not pick up on it when I’m talking to the family member or supporter … but I bring it up because it’s hidden under there. … I’ve seen it in people’s families. They’ll say, “You’ve ruined our lives;” “You’re no good;” “You’re never going to get over this.”
Using words like “never, always, forever” … I think those words should be removed from the language because they are phony. A person is not always going to be quote “an addict,” not always going to be “a mess.”. People get better. As long as there is life, there is hope. So people will do it in subtle ways. … Loved ones may be treating their family member in this way and may not know it; we need to be aware of our words.
Q: Does tough-love work on a child with a substance use disorder?
Miki: Yes, if you are doing tough love, tough love is good. I mentioned shame and enabling. Tough love is the reverse of enabling. Enabling is the other side of shame. They both dis-empower the person. Shame dis-empowers with quotes such as, “You’re always going to be a loser. You’re always going to be this way. It’s been 20 years, and you’re still not better.”
And then enabling, by doing for the other person, you’re actually saying, “You don’t have the strength to do this yourself.” The loved one that pays off the speeding ticket themselves or goes to the store and buys them a six-pack or gets them the money they know deep down inside is not going to food but to heroin … those are enablers. It is in those ways you can truly mess up a person’s recovery.
I thank Miki for her time and insight, and I hope this interview helps answer someone’s questions, gives someone peace, and allows someone the ability to rest and realize they are doing the best they can do.
To connect with Miki, call St. Joe’s Hospital at 907-1000. Al-Anon Information Services for Maine can be reached by calling 284-1844.