"How to Support Recovery and Not Support Addiction" was presented on Tuesday May 15, 2012, by Dr. Charles F. Gehrke, MD, FACP, FASAM. When all else has failed - what does work when confronted with a loved one’s addiction? What does not work? What can others do to help? What does not help? What role does an individual play in supporting another person’s recovery process? These and other questions will be addressed in order to assist participants to find effective methods to successfully support another person’s recovery, avoid enabling another person’s addiction, and maintain their own health and well-being. This program is part of the FREE, annual Dawn Farm Education Series. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please contact Matt Statman, LLMSW, CADC, Education Series Coordinator, at 734-485-8725 or info@dawnfarm.org, or see http://www.dawnfarm.org/programs/education-series.

1. How to Support Recovery
and
Not Addiction
Dawn Farm Education Series
May 15, 2012
Charles F. Gehrke MD, FACP, FASAM

2. For the next 75- 90 minutes:
1. Remember the title of the presentation
is: “Support Recovery” - not create or
cause it.
2. Put aside any preconceived notions and
ideas about addiction and recovery.
3. Put aside your rational thinking for a
short time.
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3. Objectives
 Learn what we do that supports addiction.
 Learn how we have to change.
 Learn what we can do to support recovery.
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4. Definitions
 Addiction - is a primary, chronic, progressive,
relapsing disease which may be (often is) fatal.
 Recovery - is a process of overcoming both physical
and psychological dependence on a psychoactive
drug and is a commitment to abstinence based
sobriety. (ASAM Textbook of Addiction Medicine ,4th edition)
 Disease - is a state of ill health characterized by the
abnormal function of one or more organs, a definable
set of signs and symptoms, a predictable course and
outcome with or without a known cause.
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5. Progression of Addiction and Codependency
Addict
Early Middle Late
no detectable effects beginning to have uses to prevent
impact on daily life withdrawal
without treatment
consequences increase
_____________________________________________________________
Codependent’s Progression
no visible effects beginning to feel responsible feels compelled to help
for the addict - feels compelled feels scared, insecure
to help - feelings of guilt overwhelmed, desperate
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6. 5/11/12 6

7. Family Recovery
Blues Joy
Intolerance
Suspicion Courage
Problems multiply Love
Worry Makes amends
Irritability
Seeps help Peace of mind
Arguments Avoiding reference Service
At ease with life
Distrust Extravagance New friends Return of respect
Self-defense
W
Unhappiness Spiritual examination Appreciates spiritual values
Depression
IT
Religious needs Return of confidence
Irrational behavior Release
HO
LP
Denial (fantasy) New interests develop
Threats made but not fulfilled Self-neglect
Trust, openness Guilt is gone
HE
UT
Takes responsibility Alibi
Honesty Return of self-esteem
Loss of interest Dishonesty
Diminishing fears
H
HE
Infidelity
IT
Imaginary illnesses Daily living pattern improves
Isolation
LP
Façade
W
Develops optimism
Uses prescribed drugs Blames others
Begins to relax
Loss of self respect Escape
Cover-up ceases
Remorse Jealousy
Becomes willing to change
Social withdrawal Shares with others
Patent medicine use Need to control lessens
Indefinable fears Recognition of role
Drug abuser Seeks help
Bankruptcy of alibis Acceptance
Admits defeat BOTTOM Recognizes disease
Chronic depression Sincere desire for help
Suicide attempts
Prepared by
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8. Support Addiction Support Recovery
 Lack of knowledge
 Education about addiction
about addiction
*Using is a choice *Addiction is a disease
*Responding to the
*Responding to the
disease
behaviors
*Enabling * Detachment
* Taking care of it myself *Ask for help
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9. Education: Believing the behaviors we see are
a choice supports the disease.
 “I wish he would…….”
 “Why doesn’t she………. “
 “He should…… “
 “If only she would…..”
 “Why can’t he…..”
 “Doesn’t she see ….”
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10. Education: Understanding addiction is a
disease supports recovery.
 Definition of disease
 A disease is:
a state of ill health with the
abnormal function of one
or more organs
definable set of Si/Sx
predictable course and
outcome
known or unknown cause
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11. Defined set of Predictable course &
Si’s/Sx’s outcome
 Craving
 Loss of control
 Compulsion to use
 Continued use in
spite of bad
consequences
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12. Education: Addiction is a disease Why? (con’t)
*Cause may or may not be known.
Currently our understanding of addiction
indicates two factors play a major role in the
development of addiction.
genetics and environmental factors
Nature (genetics) loads the gun 
Environment pulls the trigger
However: there are addicts who have no apparent
genetic predisposition nor significant environmental
risks.
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13. Education: responding to the behaviors and
not the disease supports the disease.
 Everyone/everything revolves around the addict -
what they do and do not do.
 We work to connect with the addict - to maintain a
relationship - by exaggerating our response to a
behavior
anger rage
concern panic
frustration retaliation
authority dominance
persuasion manipulation
disagreement hostility
* All these responses are motivated by: Fear
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14. Education: responding to behaviors and
not the disease supports the disease.
 Anger: (often results from: fear, guilt, hurt)
 Three purposes:
 instruct the addict
 protect the addict
 make emotional connections
 Two kinds:
 protest against unkind or inconsiderate
treatment
 hurts of the past and fear of the future
The second is very nonproductive and harmful.
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15. Education: responding to behaviors and not
the disease supports the disease.
 Perfectionism: unable to control the addict so keep
everything else under control.
 Procrastination: sees disaster in everything they might
do or try - so why even try.
 Caretaking: they take care of everything - pay the
rent, make excuses, lend the car, buy the beer!!, clean
up all the messes.
 Blaming: transfers responsibility to someone else - so
I can wait until they get their act together.
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16. Education: Enabling supports the disease.
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17. Education: definition of enabling:
 Anything we do or do
not do that gets
between the addict
and the
consequences of his/
her use of drugs and/
or alcohol.
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18. Education: Enabling - why do we do it?
 Believe using is a choice. (remember the part of the
brain involved)
 Believe using is a response to circumstances.
 Believe using is a lack of will power.
 Believe using continues because of a lack
understanding of the consequences.
 Believe using is a moral short coming.
Believing that doing something to correct these
conditions will fix (end) the addiction and the
behaviors.
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19. Education: Enabling behaviors
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20. Education: Don’t enable - detach which
supports recovery.
 Definition: is to separate ourselves emotionally
and spiritually from the damaging effects of our
relationship with the addict, to be objective.
we can continue to love and care for them
because we are detaching from their
damaging behaviors not them
learning to detach is difficult and
takes practice and time
-it is a process-
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21. Education: Don’t enable - detach to support
recovery. (con’t)
 Practical applications of detachment:
do not do things for the addict he/she should be doing
for themselves
do not save/rescue them from the consequences of
their actions. (legal, financial, family, job, etc.)
do not cover for their mistakes of omission or
commission
neither feel guilty nor responsible for their disease or
actions.
Detachment: is not getting emotionally wrapped up
in the destructive behavior (the drama) - does not mean
doing nothing
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22. Education: We will take care of it
ourselves supports the disease.
 Common misconception: problems in the addict’s
life are causing the addiction.
 Common misconception: addiction is the result of
a bad decision or an unfortunate turn of events.
 So fix the “problems” - fix the addiction
give him/her a fresh start
provide for an education
provide means to start a business
 Try to “shake some sense” into the addict
threaten, punish, relent - cycle
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23. Education: Get help/assistance which supports
recovery and responds to the disease.
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24. Education: Get help/assistance which supports
recovery and responds to the disease.
 First Step: Ask “Is what I/we are doing working”?
or “Does it just seem like it should work”?
 Second Step: Be willing to admit I/we may be incorrect in our
assumptions i.e. I/we are wrong/made a mistake!!
 Third Step: Ask “Am I/we willing to endure the pain/discomfort
of change”? (in attitude, focus)
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25. Education: Get help/assistance which supports
recovery and responds to the disease.
 How/where do I/we get help/assistance?
*Education: about addiction and
codependency
books, conferences, pamphlets, people in recovery
(recovering families, recovering addicts), open AA mtgs.
*Therapy: individual or family - therapist
with experience addressing addiction and
codependency
*Mutual Support Groups: Al-Anon, Nar-Anon,
Alateen, Families Anonymous, others
* Interventionist:
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26. Conclusions
 Remember:
 1. You didn’t cause it, can’t control it, and can’t
cure it.
 2. Taking care of yourself is one the best ways to
help someone else.
 3. Supporting recovery is like planting seeds - it
takes time to see results, you have to sow lots of
seeds to get results and there could be a crop failure.
 4. Get an education about addiction.
 5. Ask for and accept help.
 6. Set boundaries/limits - that you can and will
enforce -be firm and specific.
 7. Be certain the addict/alcoholic knows help and
support is available.
 8. Ask the addict/alcoholic ”How can I help you to
support your recovery”?
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27. 9. And most important of all:
Remember: “Addicts and alcoholics
are not bad people trying to be good
but sick people trying to get well”.
Connecticut Nursing News 3/02