Enabling or supporting what’s the difference? Don’t beat yourself up about it, it’s a question that comes
up often. These are terms that are very familiar to anyone living with addiction. The terms that we use
can be so important. For example, if we see our role as supportive it’s all good, but if we’re labeled an
enabler it’s assumed that we’re part of the problem. How does this distinction affect treatment
outcomes? How do these attitudes contribute to our bias and harmful ideas about substance use
complications? If our child or friend, patient or client, was suffering from a physical illness would we
have the same attitude, lay the same blame? Of course not, and we know that without support there’s
What we can’t understand or what we haven’t experienced evokes confusion and fear when what the
person desperately needs is compassion and support. People with substance disorders are usually well
into the problem before they seek help. Unfortunately, treatment outcomes would be so much more
positive if the addiction is caught and treated early. Feelings of shame and guilt that accompany the
humiliation of substance compel people to hide it for as long as they can.
Dr. John Kelly, an addiction researcher at Harvard and director of Massachusetts General Hospital’s
Recovery Research Institute, says that the language we use plays a critical role in avoiding the stigma
that keeps people from getting timely help. For Kelly, the term “abuse” implies a moral choice when we
know that it’s so much more complicated.
“The other thing we’ve learned in the last 25 to30 years is that chronic exposure to drugs in the brain
produces radical impairments and changes in neurocircuits of brains, in particular to do with reward
and memory and motivation and impulse control and judgement. So these different cognitive
capacities are impaired so radically that it makes it very difficult for people, even when they want to,
to stop” –Dr. John Kelly
Dr. Kelly, the Office of National Drug Control Policy, and the International Society of Addiction Editors,
among many other experts in the field, are quickly becoming aware of how much language effects our
perception and our response.
“What we found was that when people were exposed to certain terms, for example, when people
were described as a substance abuser verses having a substance use disorder, people were more likely
to view the person as needing punishment as opposed to needing treatment, and these were
doctoral-level clinicians in the field.”-Dr. John Kelly
Bias created by the language we use may well lead to inferior care and less empathy and responsiveness
toward the patient. This reality makes them more susceptible to unbearable feelings of shame and guilt,
leading them to fear reaching out, and to lie about what and how much they’re using. Hey literally try to
hide from those who can help. Sadly, statistics show that only one in ten people with substance use
disorders get the help they need.
There is nobody who wants to experience a substance use disorder. Nothing is more frustrating than
watching a healthy human being destroy themselves and take grave chances with their very lives. Living
and working with people who’ve become drug dependent can be gruelling but for those of us who have
loved ones with substance use disorders there is no choice. If you’ve never experienced the cravings
induced by drugs, some literally designed to highjack our brains, you really have no idea of how
horrifying and all-consuming they are.