Caring about someone who struggles with substance use can be many things—devastating, overwhelming, scary, frustrating, confusing, even annoying. It is never simple, with an obvious road map to follow. Most people in this situation have the best of intentions, but little clarity about what to do. This is often complicated by external forces such as shame, stigma, and poor advice.
Figuring out how to support and care for someone struggling with substance use can become a struggle in and of itself. The advice given most often, by both lay people and professionals falls along the lines of tough love. The biggest problem with tough love is that it just is not very effective.
What is tough love?
While there is no singular definition, it tends to involve confrontational interventions and ultimatums for the person with the substance use issue. Failure to choose the “right” path on the ultimatum subsequently involves withholding of love, support, financial assistance, being able to be a part of the family, etc. In this method, there are essentially two primary goals: 1) ensuring the person with the substance use issue moves to abstinence 2) ensuring the person administering the tough love is not guilty of enabling or co-dependency.
Debunking enabling and co-dependency
Unless we are procuring substances on their behalf, we do not really enable someone’s use. Loving them, providing housing, making sure they eat, or driving them home when they are too intoxicated to drive themselves is not enabling. It is life support. It is kindness.
Certainly, there are people who act in co-dependent ways, but simply being in a relationship or staying connected with someone with a substance use disorder does not imply co-dependency. (It is worth noting, that co-dependency is not an actual diagnosis. It makes no appearance in the DSM.) The failure to provide tough love does not indicate that someone is behaving in a co-dependent manner. Many well-meaning professionals get this wrong and often with dire consequences.
In Practicing Harm Reduction Psychotherapy, Patt Denning provides the example of telling a young wife with two small children that she was co-dependent and enabling her husband by calling into his work on his behalf when he was too drunk to go in. After taking Denning’s advice, the young wife stops calling his boss and the man loses his job. This further exacerbates his drinking and plunges the family into poverty. Denning reflects on this and realizes she caused harm to this family by focusing on whether co-dependent and enabling behavior were involved, NOT on what would best meet the needs of the family.
The importance of connection
At our core, we are social beings. Although we know this, this fact is often at odds with our individualistic culture. Studies have been highlighting the very real effects that loneliness and isolation have on our mental and physical health. Being lonely can raise cortisol levels (the stress hormone) as much as being punched. Feeling isolated can weaken our immune system. Loneliness is not merely a side effect of depression, but rather it leads to depression.
Healthy relationships and connection cannot cure addiction, but they are absolutely core components of recovery and safety. According to Maia Szalavitz, “Compassion is part of the cure, not the disease. Our societal belief that toughness is what works instead is a huge part of why our drug policy is so disastrously inept and harmful.”
The role of boundaries
In giving up on tough love, please know that I am not suggesting that the alternative means that your life must become overrun by the needs and the whims of the person in your life with addiction issues. Quite the contrary. The antidote is not to swing the pendulum all the way to the other side. It is to establish boundaries.
Boundaries are not about what you think will change someone. Boundaries should be about what is and what is not ok with you. They should reflect what you need to feel safe and respected and take your needs and values into account.
Part of the fallacy of tough love is that it is often used as punishment for failure to change. This can lead to resentment on both sides. In boundary setting, you are not trying to change anyone’s behavior, but rather setting limits on what works for you.
For example, throwing your son out of the house for continuing to use drugs would be an example of tough love. Telling your son that when he is high, his younger siblings are frightened and do not feel safe would be an example of boundary setting—the focus is not on what the other person is/is not doing, but rather how actions impact the needs and safety of other people.
Tips and Strategies for partners, family, and friends
1. Promises cause problems. The cycle of making/breaking promises is exhausting for everyone.
2. Be realistic about what you can take on. You do not have to overextend yourself emotionally, logistically, or financially to show you care.
3. Clarity of purpose. Am I setting limits or am I trying to change the other person?
4. Talk to them. All too often we are so sure what people struggling with addiction need that we forget to ask for their input about their needs, their thoughts.
5. Do not become the gate keeper. There is no surer way to destroy a relationship than taking the role of being the “enforcer” of sobriety. This will generally lead to mutual resentment, and create an atmosphere of rebellion, failure, and disappointment.
6. Embrace the progress. Even the tiny successes. They are building blocks and should not be overlooked.
7. Stop taking the actions of a person in active addiction personally. Easier said than done, but a critical part of good boundaries.
8. Take care of yourself. This is hard for you and it takes strength to love in times of difficulty.
Support for caregivers
In addition to the stress of caring for someone struggling, you likely have other areas of your life that you would like to focus on. Exploring ways to get your own needs met, while supporting your loved one in a way that respects your beliefs and boundaries is something we can work on together. You do not have to face this alone.
Sources
Denning, P. (2000). Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. The Guilford Press. New York.
Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press. New York.
Hari, J. (2018). Lost Connections. Bloomsbury, New York.
Mate, G. (2010). In the Realm of Hungry Ghosts. North Atlantic Books, California.
Szalavitz, M. (2016). Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Picador St. Martin’s Press. New York.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.