Enabling: When you can love someone to death!

                                By Dave Marley, Pharm.D. ,Former Executive Director of North Carolina, P.R.N.

In the nine years that I have been working with impaired pharmacists, I have had the pleasure of watching hundreds of seemingly hopeless cases of impaired pharmacists, regain their families and their careers. While my preferred role as Executive Director of the North Carolina Pharmacist Recovery Network, Inc. has always been that of the advocate, assisting in the relicensure of the recovering pharmacist, I’ve always believed that what we at NCPRN are about is saving pharmacist’s lives, not necessarily pharmacy licenses. We always hope that the pharmacist can recover and return to practice. Unfortunately. positive outcomes such as returning a pharmacist to practice are not always the case. In fact, when dealing with an addictive disease, sometimes the outcome is the death of a pharmacist, whether it be from a car accident, accidental overdose, or even suicide.

One of the biggest obstacles in getting the impaired pharmacist into treatment is a process known as enabling. Enabling by other people, allows an impaired individual to progress in their disease, without experiencing any of the consequences associated with substance use. It has been said for years that a person needs to “hit bottom” before they’ll seek or accept help. Enabling essentially prevents the impaired person from hitting bottom, thereby, “enabling” the disease to continue unchecked.

Enabling can take on many forms, and be displayed by a number of individuals who are classified as being “co-dependents” in the impaired individual’s life. The term co-dependent is used, because this person generally has an underlying need for the individual to continue using drugs. While this may seem illogical, especially when you consider the family members as being co-dependent, there are a number of family dynamics that come into play.

In the dysfunctional family system, everybody takes on roles and they develop their roles based on their environment. It is true that consciously each person in that system wants nothing more than for the impaired individual to get sober, but their unconscious actions serve only to perpetuate the addictive disease. In many cases, enabling involves covering up, or making excuses for the chemically dependent person’s behavior. For example, calling in sick for the person when they are really hungover, correcting misfills and not documenting them, or giving notes or old exams to the classmate who is too sick or high to get to class. What these examples do, is prevent the impaired individual from seeing the effects that their substance use is having on their lives, and the lives of those around them.

In many cases, the impaired individual goes to great lengths to develop their enabling systems. In the family, the impaired person spends countless hours conning and manipulating spouses and children. Quite often, the spouse becomes the chief enabler simply because the family finances depend on the pharmacist’s salary, and the spouse (male or female) will go to any length to prevent the finances from being threatened.

Therapeutic intervention becomes especially challenging when there has not been Board of Pharmacy involvement, and we are trying to convince someone to leave their job and seek treatment. In their practice site, they may manipulate co-workers, other pharmacists, supervisors, and in some cases even the Board of Pharmacy into believing that, “everything is okay”. The chemically dependent individual is generally a master at manipulation, and in a one on one confrontation, will usually have you believing that you are the one who is impaired, not them.

What enabling ultimately does is prevent the chemically dependent individual from getting the help they need. In most cases the enabler truly believes in their heart, that what they are doing is in the impaired person’s best interest. It has been said that, enabling is doing all the wrong things for the right reasons. In many cases, the co-dependent can literally, “love someone to death”.

Unfortunately, in this era of pharmacist shortages there may also be other motives for some employers just to keep a licensed body in the pharmacy. With family members, it usually takes professional counseling to stop the co-dependent from engaging in enabling behavior.

The fact still remains that what we are talking about is a life and death disease, one that is fatal if left untreated. Often, the discussion turns to the loss of the license, and other inconveniences associated with the consequences of addictive disease. Sometimes, it is the family’s concerns for the inconveniences, rather than recognition that this is a terminal disease, that prevents us from getting the impaired individual to treatment. In the end, nothing is harder than trying to explain to a grieving parent or spouse, why their child or significant other had to die from this disease. In many cases, the loved ones left behind are left with the nagging question of “what else could we have done?”.

We often talk about denial in the impaired individual, and how it prevents them from seeking help. In many cases, the co-dependent is in as much, if not more denial than the impaired person. In short, denial kills! In February of this year, an impaired pharmacist committed suicide, and in March another pharmacist died from an overdose.

If you are concerned that someone you know has a dependency problem, and you have not done anything to help, then you are enabling. Become a part of the solution, instead of the problem. Pick up the phone and call the North Carolina Pharmacists Recovery Network. You will sleep much easier knowing you have actually saved a life, rather than unfortunately contributed to a death.

This article is reprinted in dedication

to the memory of

Pharmacists, Bill and Mike