Generally I write about ASD in these essays, but today I am writing about a different mental health issue. The story line in Parenthood involving Sarah and Seth raises the issue of substance abuse/dependence, recovery and enabling. While this storyline doesn't directly involve Max, I thought it might be a good topic to discuss for a variety of reasons - not the least of which is the impact substance abuse/dependence has on entire families, including families living with ASD.
Substance abuse/dependence is a family disorder. Generally, one thinks of only the person who is struggling with the substance abuse/dependence as being the "patient," but as we can see from this episode, the whole family of a person suffering from this disorder is drawn into the wake of the disease. Seth can't or won't seem to stop drinking. Sarah plays her role in the drama by not being able to stop herself from helping or hoping; Zeek enables in his own misguided way by continuing to reinforce a cycle of shame that fuels Seth's drinking. Sarah and Seth's children each are impacted by their father's drinking in many different ways, and each runs the risk of struggling with dependence on substances or of becoming an enabler when older.
Based on the history Sarah has with Seth, she is moving in a much healthier direction this time around by being clear about the boundaries she intends to set regarding his dependence. In fact, the boundaries she sets (and perhaps, though in a less than completely constructive manner, the boundary that Zeek sets with Sarah and Seth) leads to Seth's at least tentative conclusion that he needs help and wants to change.
Sarah begins to slip back into her own pattern of codependency, however, believing that she "needs" to be involved in Seth's recovery and that he "needs" her support. As with all those who struggle with codependency, Sarah is confusing her own desires as "needs" for the dependent person in her life. By continuing to meet these desires (which she views as needs) she runs the risk of derailing her own recovery from her codependency, as well as Seth's chances at recovery. The best way she can help Seth in his recovery is to "support" him at a distance and to continue to hold firm to the boundaries she set with herself and her children that helped him take a step toward recovery.
This process of dual or family recovery is often the part of recovering from substance abuse/dependence that the addict and the enablers miss. It takes a lot of folks to sustain an addiction; it takes all of them working toward recovery to break the cycle of dependence.
Families living with ASD are often vulnerable to substance abuse/dependency problems. The strain of care giving, the chronic nature of the disorder, the problems of separation and isolation that are part and parcel of living with a child with ASD often lead family members to search for ways out. Those vulnerable to alcohol or other substances often find themselves struggling. As a parent or other caretaker falls under the power of the addiction, they are less available for the other caregivers in a child with ASD's life - as well as the child with ASD. Often the child with ASD cannot understand what is going on, why Mommy or Daddy isn't around anymore or cannot take care of them in the evening or spend time with them. There is grief that often lacks understanding, and the other caretaker(s) often desperately try to "hold" things together - leading to cycles of difficulties as we see in this episode with Sarah and Seth.
The key to recovery is to join the whole family in the process. As the family changes, the addiction will abate. However, just like ASD, substance dependence is a chronic disorder that will require constant attention and monitoring over the years as the person living with the disorder and the family struggle to not be held victim to the disability - be it autism or addiction.
Written by Roy Sanders, M.D.