Is "Stop Enabling" Actually Right? The Science of Family in Addiction

Your family member can’t stop drinking, or gambling. You start digging through books or the internet, not knowing what’s going on, and very early on you bump into the same advice.

“Stop enabling them. Let them hit bottom.”

Don’t pay off the debts. Don’t call in sick on their behalf. Don’t clean up what they broke while drunk. The reasoning: only by hitting bottom will they wake up — until then, no one really changes.

But standing by while a family member falls apart in front of you feels like abandonment. Help them, and they drink again. Don’t help, and something irreversible feels around the corner. A lot of people get stuck between those two.

Is “stop enabling” actually correct? It turns out the research and the conventional wisdom don’t quite line up.

What “enabling” means

In clinical language, this is called enabling. It’s when family members handle the consequences of the addictive behavior in ways that make it easier for that behavior to continue. Drawing from materials at addiction treatment centers, the kinds of behavior typically classified as enabling include:

• Paying off the person’s debts, dealing with creditors on their behalf
• Calling out of work for them when they can’t get up from a hangover
• Cleaning up what they soiled or broke while drunk, in silence
• Hiding or disposing of bottles or gambling evidence around the house
• Treating verbal abuse or violence as if it didn’t happen
• Buying alcohol when they ask, picking it up for them

As long as these continue, the person stays in a state where “drinking (or gambling) still works out.” They keep their job, money still flows from somewhere, life is maintained. When experts say “stop enabling,” this is the underlying logic.

The limits of “wait for them to hit bottom”

Many families then ask: if I really do let them go, will they actually pull themselves up?

The idea that “people change once they hit bottom” is called rock-bottom theory, and it spread out of mid-20th-century AA culture. People only change when they suffer enough; while the family carries them, they can’t reach that point; therefore, let go.

But there isn’t much research behind “rock bottom.” U.S. studies show no consistent definition of what counts as “the bottom” — what it means varies wildly across individuals. As triggers for entering treatment, catastrophic events show up less often than the everyday observations and shifts in family relationships.

Another important finding concerns the confrontational approach: family members gathering to confront the person about their addiction and demand they enter treatment. Reviewing 40 years of clinical trials, White & Miller (2007) concluded: “Not a single clinical trial has shown the efficacy of confrontational counseling, and several have shown harm.” Side effects mentioned include broken family relationships and increased shame-driven hiding of the addictive behavior. Family confrontation tends to do more harm than good as a way to move someone toward change.

“Doing nothing” and “cutting them off” are not as powerful at moving someone with addiction as commonly assumed.

CRAFT, a third approach

So what does work? Over the past 20 years, evidence has consolidated around a family-support program called CRAFT (Community Reinforcement and Family Training). Behavioral psychologist Robert Meyers and colleagues developed it in the 1990s, and it’s now one of the standard options in the U.S., U.K., and other countries.

The well-known 1999 study by Miller and Meyers randomly assigned 130 family members of treatment-resistant individuals to three groups, each given 12 hours of training in a different approach. The proportion who got the person into treatment as a result:

Approach	Got the person into treatment
Family self-help group (Al-Anon style)	13%
Confrontational intervention	30%
CRAFT	64%

CRAFT got people into treatment at about 5x the rate of family self-help groups, and 2x the rate of confrontation. Subsequent meta-analyses have shown a similar pattern across studies.

What CRAFT is doing

The core of CRAFT can be summarized in two principles.

The first is to respond positively to healthy behavior. On days when the person didn’t drink or didn’t go gamble, treat the day normally. Eat a good meal together. Smile back. Say “I’m glad you didn’t drink today.” Small things, but they teach the brain’s reward system that “the days without drinking come with good things.”

The second is to not respond to the addictive behavior, and not to clean up after it. This is closest to the conventional “stop enabling.” But the important distinction in CRAFT is that this isn’t done as punishment.

“Natural consequences” and “punishment” are different. Punishment is the family actively taking something away. The family ends up cast as the enemy. Natural consequences mean simply not blocking the result of the person’s own action from returning to them. If you don’t call work for them, the person has to talk to their boss themselves. That’s not the family punishing them — that’s the result of their own behavior.

In CRAFT’s textbook phrasing: “Don’t engage with the addictive behavior; engage warmly with the sober time.” Not coldness — a shift in the intensity of engagement based on what the person is doing.

The seven specific skills CRAFT teaches family members, the research base, and where you can find CRAFT-trained professionals are covered in Family Program CRAFT: The Seven Skills.

”Don’t enable” and “cut them off” are different things

These look similar but are quite different.

In CRAFT’s framing:

• Don’t clean up after the addictive behavior. But don’t blame, and don’t take things away as punishment.
• During sober time, when they help with chores, when conversation is calm — engage warmly.
• The family is also exhausted, so build in self-protection (use a counselor, family support group, or distance time as needed).
• When safety is at stake — violence, self-harm, serious accidents — don’t leave it to “natural consequences.”

That last point is emphasized in CRAFT’s manual. Letting natural consequences play out assumes the person isn’t going to die or hurt others. Violence, self-harm, drunk driving, severe impact on young children — these are different conversations from “stop enabling.” Sometimes the right move is physical distance to protect yourself or your kids, before any treatment-engagement question can even come up. In those situations, going straight to law enforcement, medical services, or the National Domestic Violence Hotline (1-800-799-7233 in the U.S.) is fine.

The family also changes

A distinctive feature of CRAFT is that even when the person doesn’t enter treatment, the family member’s own state improves.

Multiple studies have reported improvements in family members’ depression, anxiety, and anger after CRAFT. This isn’t because they “developed better tolerance” — it’s because the program explicitly includes the family rebuilding their own life. Family members of someone with addiction often spend years with their own activities and relationships sidelined by the situation. CRAFT includes work to gradually restore those.

As the data on people who supported others showed, there’s a way in which people regain themselves through doing things. The same seems to apply to family members.

Summary

“Stop enabling” is partly correct. As long as you continue to clean up consequences, the person has fewer opportunities to face them. That’s true.

But “if you cut them off, they’ll change” or “let them fall as far as they can fall” isn’t supported by the research. Addiction is a condition involving chronic changes in the brain. It doesn’t move under punishment, shame, or coldness. More often, it moves further away.

What the science currently points to is a more nuanced posture. Don’t engage with the addictive behavior. Don’t clean up after it. But during sober time, during reasonable judgment, do engage. And the family also needs care.

Don’t carry it alone. In the U.S., Al-Anon (for family of alcoholics), Gam-Anon (for family of compulsive gamblers), SMART Recovery’s Family & Friends program, and CRAFT-trained therapists provide entry points. The SAMHSA National Helpline (1-800-662-HELP) can connect you to local resources.

If a family member burns themselves out trying to support, the person doesn’t get saved either, and the family also breaks. Getting out of that pattern takes both stopping the enabling and building structures that support you.

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References

• Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology. 1999;67(5):688-697.
• White WL, Miller WR. The use of confrontation in addiction treatment: History, science, and time for change. Counselor. 2007;8(4):12-30.
• Foote J, Wilkens C, Kosanke N, Higgs S. Beyond Addiction: How Science and Kindness Help People Change. Scribner, 2014.
• Smith JE, Meyers RJ. Motivating Substance Abusers to Enter Treatment: Working with Family Members. Guilford Press, 2004.
• Roozen HG, de Waart R, van der Kroft P. Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction. 2010;105(10):1729-1738.