Friday, December 20, 2013

Can Tough Love Sometimes Be Too Tough?

Tough Love - the practice of taking a stern attitude towards a relative or friend suffering from an addiction,  etc, to help the addict overcome the problem.

There are many testimonials of people in recovery who can tell the story about how when their family finally got “tough” with them and cut them off, that was what they needed to finally change. In other words, in many cases, “tough love” works. Sometimes tough love is clearly a valid approach for loved ones of someone who continues to engage in addictive behaviors. Sometimes, however, things are not so clear.

There can be several factors often specific to today’s world that may complicate the option of tough love for families dealing with an addicted loved one. For example, in many areas, especially in the US the widespread availability and increased purity of “harder” drugs, particularly heroin, have added a new dimension to the risks involved with choosing to allow a loved one to learn the “hard way”. Right now in this part of the world (New Jersey) there is a heroin epidemic and allowing someone to experience the consequences of their actions carries with it a real risk of death by overdose. No counselor would want to be the person who advised a family to apply tough love to a heroin abusing young person, only for the outcome to be that the person ends up dying from a heroin overdose. Try telling the family afterward that they made the right choice or they “did what they had to do”.  The family likely will second guess the tough love decision for the rest of their lives.

Another factor to consider is the prevalence of co-existing mental illness, which at times can be very severe. If a substance abusing person has a history of decompensation or suicide attempts when left on their own, the decision to apply tough love and cut that person off from family contact again is not so cut and dry. Similar to the example involving heroin overdose, if a family were to use tough love tactics on a addicted family member who also has a history of mental and emotional instability and that person ends up completing suicide or dying in some other way related to mental decompensation, then again the family would end up second guessing their decision to fully apply tough love tactics.

I am not saying that tough love should never be an option or that tough love does not work because in the right situation, it can and should be considered. I realize there are varying degrees of tough love tactics and it does not have to be an “all or nothing” scenario. I also realize that there still are significant risks involved when not applying tough love because often addicts can die right within their own bedroom, at times right under their parents’ roof when tough love was not applied. My point is however, that from counselor’s perspective, we need to have compassion and empathy for the incredibly challenging struggle that a lot of these families we work with are going through, particularly those families dealing with substance-dependent adolescents and young adults and especially those with co-existing significant mental health issues. Our advice to family members struggling with an addicted love one cannot be limited to oversimplifications such as “If he/she keeps on using, just kick ‘em out and let ‘em learn the hard way, that’s the way to do it!” When there are life and death issues involved, that is much easier said than done. Each situation and its unique risks and potential rewards needs to be carefully considered on an individualized, case by case basis. When helping individuals and families we need to both use and teach good judgment while at the same time having a non-judgmental attitude, if that makes sense. We all know by now that there are no easy answers for any of these tough decisions.

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