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Khloe, Lamar, Lines in the Sand and the Puppy Effect

"Khloe to Lamar: You Do Drugs Again, I'm Gone for Good!" -- TMZ, Oct. 26, 2015

We may never know whether Khloe Kardashian really gave her estranged husband, former Laker and reality star Lamar Odom, a made-for-the-tabloids ultimatum. But if she did, the world understands why.

Odom was found unconscious in a Nevada brothel in October after apparently overdosing on cocaine and other drugs. And as the world also likely knows, this wasn't Odom's first experience with drugs. In 2001, he was suspended twice from the NBA for violating the league's drug policies and has reportedly been in and out of rehab over the years.

And while the famous basketballer was blessed with athletic ability, genetics worked against him by putting him at higher risk for addiction. Odom's father, Joe, is an ex-heroin addict, according to a 2009 Sports Illustrated profile, and research shows that genes are responsible for about half the risk for addiction.

I haven't met Lamar or Khloe, but speaking indirectly, an ultimatum in and of itself is neither good nor bad. For example, if someone gives their loved one with active addiction an ultimatum simply because they're fed up in the moment, chances are high that it will turn into a string of empty threats, devoid of meaning. Or, if someone gives their loved one with active addiction an ultimatum because they are told to do so but lack the "right mindset," chances are high that the ultimatum will not only fail, it will backfire.

What do I mean by the right mindset? Simply stated, it's drawing a line in the sand not for anyone else but for oneself. It is a statement by the loved one that he or she will no longer "enable" the addictive behavior. It requires accepting the circumstances of the present -- the condition of the loved one, the addict, the relationship and the addiction -- and not wistfully wishing it were different. The ultimatum is a recognition that that I must do something for myself because I cannot go on living this way.

About Those Lines in the Sand

You see, many people I work with as an interventionist assume that the line in the sand and the ultimatum is drawn so that the addict goes into rehab or otherwise stops using/acting out. There is no doubt that a distinct and worthy goal is getting the addict into rehab or otherwise to stop using, but it's really a side effect of everyone else taking care of themselves. Actually, I can judge the success of my work as an interventionist based on whether the family members get this crucial distinction and start caring for themselves.

Sometimes this dialogue and teaching evolves in full, plain view of the addict. In this type of intervention, referred to as the ARISE Model, the addict is an active participant right from the start -- there are no surprises. The idea is that when the entire family comes together to tackle addiction as a group, the addict is less likely to feel attacked and be more amenable to treatment.

Other times, however, there is a crisis severe enough to require a more surgical approach, known as the Johnson Model, the more mainstream method in which an addict is confronted by loved ones who have set up a treatment facility in advance and are prepared to transport and enroll the addict that same day. The mark of a good therapist is not only knowing who needs what approach, but also having the finesse required to apply multiple approaches.

The Puppy Effect

There was a time when I would use only the ultimatum approach (the Johnson Model) simply because doctors and therapists were all trained in that one style. "Give them an ultimatum." But it's not as straight forward as that because if you are any good as an addiction interventionist, your highest goal is to get family members, Khloe in this case, to take care of themselves. But that's tricky because love for the addict is often the most powerful weapon working against us. I used to call that enabling, but enabling is one of those words that, while it does convey accurate information, can be misinterpreted as judgment and operate to shut people down. I now look at enabling in a different way, as an overuse of the character strength love. When that approach is taken, I find that the enabler is more open to change and less likely to take a defensive stance. It's more effective and totally disarming.

What the family is dealing with in inadvertently enabling the addictive behavior is known as "the puppy effect." If I have a puppy and you see it before going away for a year, when you get back you see a big dog. But I still see the puppy, because it grew a little each day and I didn't notice it. With the family members of an addict, a little tolerance can build over time to the point that things get really bad and everyone wonders, "How did this happen? How did we get here?" No one, including the addict, meant for this to happen, or saw it coming.

Khloe appears to be all too familiar with the big dog in the room. If she is done living the way she is living, if it has caused her enough pain and suffering that she can no longer continue for her own well-being, perhaps she is in acceptance. If she is aware of the circumstances and is moving through that painful "stuff," it is indicative of major transformative growth. It will be left to Lamar to determine what he is willing to do to return to, and stay in, Khloe's life.

There is no one rule that can be applied to all addicts. To quote my colleague George Joseph, "Some people need a hug and some people need a push." Sometimes, it requires an ultimatum, as may have happened in this case. If so, let's hope that Khloe's line in the sand was drawn for herself and not as a directive to the addict she cares for. That will put the ball in Lamar's court.

Jason Powers, M.D., is the chief medical officer at Promises Austin substance abuse treatment program and The Right Step network of drug rehab centers in Texas. He is the pioneer of Positive Recovery, an approach to addiction treatment that helps people discover meaning and purpose in their lives.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.