Tough love – does it hurt or help a person with an addiction, aka substance use disorder (SUD), get the help they need?
I regularly get some form of this question – generally because there’s so much confusion about what it means. Unfortunately, there is no single definition of tough love applicable to addiction.
Some experts believe tough love means to cut off all support and contact in order to help a loved one hit their bottom and thus seek help. Others believe there is some middle ground, such as paying their rent or car payment so they have housing and transportation to and from a job (when they get one). And still others believe it’s staying in contact, expressing your love and support and willingness to help when your loved one reaches out for help with seeking treatment.
For a majority of family members, some or all of these approaches are tried at one time or another. And for some, there’s no other answer than, “I’ll do anything I can because not to could mean they’ll get worse, or worse, yet, they’ll die.”
To help those with whom I work as a family addiction education consultant and/or recovery coach, I ask the following questions, and in our work together, we answer them. I say, “in our work together,” because there is no one nor right way to support or help a loved one with addiction, aka substance use disorder, but there are some common road blocks to success no matter where a person falls on the “tough love” continuum.
What do you think addiction is?
Answers vary from poor choices, lack of willpower, it’s a disease (but I don’t see why it’s considered a disease), to name a few.
The “correct” answer is, “Addiction is a developmental, chronic, often relapsing brain disease.” Whew! That’s a mouthful, I know, but it’s a complicated disease, as are most chronic diseases, for you see, disease, by it’s simplest definition is something that changes cells in a negative way. When you change cells in a body organ, you change the health and functioning of that organ. Addiction changes cells in the brain — the organ that controls everything a person thinks, feels, says, and does. Check out the National Institute on Drug Abuse (NIDA) > “The Science of Drug Abuse and Addiction: The Basics.”
Does your loved one have any of the five key risk factors for developing addiction?
These risk factors influence how a person’s brain develops — in other words, how their brain cells talk to one another and map repeatedly used neural networks as their “go-to” thoughts, feelings and behaviors. These are important concepts to understand because addiction is a developmental brain disease. The key risk factors include:
- genetics (are there persons in the immediate or extended family with addiction (substance use disorder?)
- early use (did they misuse the substance(s) during adolescence and/or early adulthood?)
- childhood trauma, aka ACEs — adverse childhood experiences — (did the person experience verbal, physical, emotional abuse; neglect; parental divorce; parental substance misuse?)
- mental illness (does the person have bipolar, depression, anxiety, or ADHD, as examples?)
- social environment (what was the home/social environment like; how were substances used by others in the family?)
Understanding these helps a person appreciate that treating/changing the treatable risk factors (e.g., childhood trauma, mental illness, social environment) is critical to relapse prevention and success in long-term recovery.
Do you understand the characteristics of addiction – what makes it addiction vs substance abuse?
The four key characteristics of addiction include: tolerance, loss of control, cravings, and physical dependence. Understanding these helps a person appreciate why anti-craving medications, behavioral modification therapy, and medically supervised detox may be necessary to successfully treat addiction.
Are you familiar with the concept of “setting boundaries?”
You’ll likely have heard this expression and perhaps told you need to set better boundaries. If you’re not familiar with it or are having trouble setting boundaries with your loved one, check out my post, “Setting Boundaries YOU Can Live With.”
Are you aware of the many methods of effective addiction treatment?
In other words — there is no one size fits all. For more on this, check out NIDA’s Principles of Effective Treatment.
For more information on the above and other related concepts…
No one can answer the tough love question – “Is it helpful or harmful?” – for you, but answering these kinds of questions is a start towards answering the question for yourself. Additionally, critical to helping you answer this question is recognizing how deeply you’ve been affected and appreciating that you need support and help, as well. Unfortunately, to address what that might look like is beyond the scope of this blog post.
Always feel free to contact me at 650-362-3026 (PST). There is no charge for the initial call.