Bill Milliken’s description of the tough love approach includes: “I don’t care how this makes you feel toward me. You may hate my guts, but I love you, and I am doing this because I love you.”
Over the last few decades, society to some degree has adopted iterations of this “tough love” approach to dealing with substance use disorders in many family scenarios. This approach is largely unmanaged and usually happens between immediate family members and even within the so-called “rehabilitation industry” itself.
This “tough love” includes a range of aggressive or confrontational practices that are theoretically intended to break down the defence mechanisms that accompany substance use disorders until the targetted person concedes and changes to the intended life to sobriety.
In other words, if we are just mean, cruel or become deeply punitive enough under a facade of “healthy boundary setting”, then people with substance use issues will simply roll over, wake up and stop using drugs or alcohol compulsively.
All good in theory…best interests at heart…but…
Four decades of hard evidence show that confrontational and punitive approaches to addiction treatment are ineffective, harmful, and clinically inappropriate.
In spite of empirical evidence that these “tough love” approaches create more harm, are open to abuse and on the whole, don’t work for the majority of people that need more mindful addiction care.
While we know you cannot force someone to change (at least not for any length of time). Tough love “forcing recovery” still remains the most common go-to approach adopted by society when dealing with substance use disorders worldwide.
Why do “we” continue to attack “addicts”, even when we know it is wrong?
Because we feel morally justified.
“They chose to be a junkie/drunk and have created untold issues in our family, now it’s their turn and they must deal with the consequences of their actions.”
The hammer of vengeance.
The very words used “addict”, “alcoholic”, “drunk”, “junkie” de-humanise and emotionally distance friends, fathers, mothers, brothers, sisters as from their family. This outcasting in turn makes it easier to ignore the medical treatment of their condition on the grounds of social, moral or spiritual failures.
We would never speak of a cancer patient as “The Cancer” and as a family deny them help and care on the grounds of their moral failures for contracting cancer.
Yet it still seems perfectly acceptable calling a person with a heroin use disorder a “junkie”, “drug abuser”, “addict” and deny them appropriate help and guidance on personal moral grounds as if being “a heroin junkie” fully embodies their past, present and future characters.
Tough love creates an unnecessary climate of resistance from people living with addictions for seeking and receiving professional help as nobody would logically choose to be punished.
The words we use hold power, immense power and at a time when that family member needs the most support tough love pushes them away often with devastating results.
No person in the history of addiction has ever chosen to be an “addict”, it was never an aspirational life goal. Addiction is never a conscious life choice yet so often that is what it seems to immediate family members. In almost every circumstance of addiction, there are deeper underlying causes that have nothing to do with the substance and have more to do with what is actually driving individual persons self-defeating behaviours?
It is often hard for families to accept that they may well have played a key role in the process of the person’s addiction problem (albeit it was never their intent). Tough Love is far easier beating stick that unburdens the guilt back onto the person with the critical disorder.
We need to have the guts to ask the hard questions of ourselves, even if we fear and know the answers.
- What happened to this person that could be forcing them to escape using heroin as a safe target?
- What kind of help will work for this person and what role can or should I play, knowing the circumstances?
The saddest artefact of “tough love” is that it is perpetrated through “trusted” family members and “authoritative” experts. People living with addiction disorders begin to internalise and accept that they are beyond redemption and consequentially have no other choice but nose-dive their lives to “rock bottom” and die or are forced to claw back their lives from absolute personal devastation. They do not see alternative solutions because they are not provided with realistic alternative solutions.
Unfortunately, we still live in an era of ignorance and stigma when it comes to addiction.
Generations of people have been brought up to believe that ostracising people with substance use and mental health issues is not only acceptable but also the right thing to do. We pull away.
Propaganda based belief systems have been instituted by global governments “war on drugs”. Not only does this dictate stigmatic laws but further incubate and perpetuate addiction sub-cultures that are not able to openly receive appropriate help.
If your only tool is a hammer then every problem begins to look like a nail.
The perception of tough love being a working solution is an example of how cognitive dissonance still perpetuates in societal viewpoints of addiction recovery. Even in the face of contrary evidence that supports care, understanding and non-judgemental empathy are required for people to recover from addictions, we default back to what we believe and have been told by our government, legal systems and worst of all our social family connections.
Recovery Direct Care Centre in Cape Town
Recovery Direct is a Cape Town rehab and care centre that operates a multidisciplinary team of registered counsellors that follow well-established principals in the effective treatment of addiction, depression, anxiety and chronic stress. The care centre environment places the needs of the patient above all else to ensure that we are dealing with the root of the problems being experienced. Successfully overcoming past trauma, complex relationship dynamics and persistent family issues through highly focused and guided professional therapy.