Drug or Alcohol Abuse, Smoking, Poor Diet/Exercise: Are You Enabling Someone to Defy Doctor's Orders?

This article is for readers who have a loved one who refuses to follow doctor’s orders for recovery from a medical problem.  It assumes you have read first the article I wrote for your loved one, “Are You in Defiance of Medical Compliance?”  And like the first piece, if you read the rest of this article and get turned off, I hope you will at least have the courage and wisdom to ask yourself the two questions in the last paragraph.

Anyway, let’s call your loved one “Pat” (short for patient, and for standing pat).  You can initiate solution number one in the first article, by asking Pat to read it, and answer for you the questions it poses.  With or without Pat’s help, you can learn a lot, and find some new peace of mind in both these articles.

If your efforts to help Pat have been going on for years, you are probably doing Pat more harm than good.  If you are starting most of the conversations with Pat about unhealthy behavior, if you seem to be trying harder than Pat to produce healthy behavior in Pat, or if you are showing stronger feelings about Pat's unhealthy behavior then Pat is, these are clear signs that you are actually doing more harm than good. Your efforts to help encourage Pat’s healthy behavior are backfiring, because without your knowing it, Pat is likely to be using them to excuse or even provoke unhealthy behavior.

If your helping behavior is backfiring, and if you are a part of the problem and instead of the solution, the most accurate way to describe your help is to say that it is enabling Pat’s unhealthy habits.  Here are twelve of the most common enabling behaviors to avoid:

  • Co-indulging:  colluding, joining in with or excusing the unhealthy behavior to stay connected to Pat
  • Denying/minimizing:  making believe Pat’s medical or family problem isn’t very real or large
  • Moral compromise:  dulling or defying your conscience to appease Pat, to stay connected
  • Covering up:  concealing or outright lying to relieve Pat of the natural social consequences of unhealthy choices
  • Detective work:  your obsessions and compulsions from doing Pat’s thinking, monitoring or research
  • Taking responsibility:  over-protection by taking over Pat’s duties, especially responsibility for Pat’s health and compliance, but also things like parenting and budgeting
  • Manipulating:  using logic or persuasion, offering deals or bribes, sending others to brain-wash Pat
  • Getting on stage:  creating or entering into emotional turmoil (rather than walking out when you can, and when you can’t, just pulling up a chair and watching the show, withoutshowing emotion)
  • Blame and punishment:  playing cop or judge by shaming, hurting or getting even with Pat
  • Guilt-tripping: playing parent/martyr (“after all I’ve done for you,” “after all you’ve put me thru,” “how could you?” etc.)
  • Playing therapist:  trying to predict, explain or figure out Pat’s behavior (this is your illusion of control)
  • Playing anti-therapist:  saying or thinking Pat can’t change.

Just imagine the time and energy you will be saving by not doing these things anymore!  So what would work to help Pat learn to stop unhealthy behavior and start making healthier choices?

  • Telling the truth. Consistently but briefly, say that Pat’s unhealthy behavior, and the lies and excuses behind them, disgusts you, and make you want to leave Pat alone. Tell others the truth about Pat too – stop covering up
  • Leaving Pat alone.  When patients don’t take care of themselves, stop paying attention to them. Don't spend time with them. Don't let them see that they tick you off, just that their unhealthy behavior turns you off.
  • Taking better care of yourself.  Most enablers don't know how to do this, and so they benefit from counseling, or from talking with others who have learned different ways to respond to similar behaviors in their loved ones.  Just do the next right thing. Do something nice for yourself, or for someone else.
  • Work together with Pat’s other friends and family.  Agree to share information about Pat, and help each other abide by the guidelines of this article.  It might help for you all to sign some kind of pledge, and give Pat a copy as well.
  • Expect Pat to get help.  Pat will connect with new people, places, practices, principles, and prayers that will strengthen his new habits, or else you won’t be connecting with much with Pat.  If Pat doesn’t know where to find those new resources, you know Pat will benefit from the help of professionals like the physician, a pastor, or a counselor or life coach like me.

What if Pat doesn’t do anything, or worse still, gets worse?  Remember that like surgery or remodeling, things often have to get worse before they get better.  Give it time.  Tell Pat that by treating Pat as someone who could change, you are showing that you respect and care about Pat more now.  Pat can use this same approach with the unhealthy friends in Pat’s life, by telling them, “I am giving you more of myself, now that I am taking better care of myself and inviting you to do the same.”

No matter what happens between you and Pat, one thing will be the same for both of your experiences.  If you change and make healthier choices, you will find that your social circles shift.  Imagine those who care about you as sitting in circular rows of seats around you, with the rows closest to you giving you the most time, communication and respect.  You will soon notice that people will start standing up and shuffling around to find more comfortable seats.  Some close supporters won’t like your new choices and will take seats further away from you.  But others will move in closer and take those seats, and your circle of closest friends and family will have some new faces before long.  They will help you see very soon that all of your efforts are worthwhile.

Two last questions for you:  if you have trouble making any of these changes, if you are scared to risk rejection by Pat, perhaps you have some unhealthy habits in your own life, and you need to read the first article.  If not, perhaps you have an unhealthy dependency on Pat.  If so, admit to your other family and friends that before creating a better life for Pat, you first need to get one for yourself.

Dr. Paul Schmidt is a psychologist life coach you can reach at [email protected], (502) 633-2860.


Contact Me
Dr. Paul F. Schmidt