Tough Love & Recovery

By Nick Barton.

Can tough love be usefully applied to achieve recovery?  Applied, that is, principally by a family to one of its own or by a psychosocial programme to one of its clients to achieve recovery from addiction. If we are talking about the family as a whole, then it is recovery from a system and an interpersonal culture controlled and thus corrupted by the consuming dynamics of addiction. I was going to say it takes no prisoners. But actually, that’s all it does.

Tough love commonly seems to mean not tolerating certain behaviours, drawing lines, setting boundaries and doing so very deliberately. Tough love perhaps needs to be viewed in relation to its opposite which, in the context of addiction, is usually referred to as “enabling”.

In contrast to its positive everyday meaning, enabling in the context of addiction tends to mean the range of contorted accommodations which third parties make for a person’s harmful conduct, often from fear or insecurity. More reflexive in its quality, it has the same intention as tough love: to make things better or at least to prevent them getting worse.

Given the desperation often felt, people can swing between the two. It is not easy relating to someone in the throes of an addiction, and it is particularly hard the closer you are to them. It can be frustrating, infuriating, painful, anxiety provoking, crazy making and distressing. As we know, there is a lot of fear at work in and around addiction, much of it to do with loss – loss of other, loss of self, loss of control, loss of reality, loss of hope.

WHAT WORKS?

I am often approached by people seeking help with an addicted person in their life. They want to know: What should I do? How should I behave? What’s the trick, formula, secret, technique – prescription even?  
These questions are driven by the anxiety of helplessness. Understandably, the family want the addictive behaviour to stop and they want their loved one back. They want it fixed.

There is comfort to be had in something that works. They (we?) want something as efficient and effective as a switch. So if someone comes up with an approach with a seemingly simple formula as tough love appears to promise, there will be plenty of takers.

But can you get someone to stop their addiction by the way you relate to them?  No (but see last answer in this paragraph). Can you improve your life by the way you relate to someone with an addiction?  Yes. Could that have a positive effect on the addicted person?  It could have but don’t count on it and don’t do it for that reason.

I looked at two lists of advice on dealing with an addicted person. They are all about what you should do or not do to, for, with or about that person. I call this taking aim. Who knows: they might be more or less helpful. But my point is that only item 10 in one of these long lists suggests a look at oneself.

YOUR MOTIVE IS IMPORTANT

When you start turning the business of relating to another into a technique, you have left the realm of genuine relationship and have turned to manipulation. You will have joined the culture of addiction because manipulation is a common feature of the psychology of addiction. And the more you rely on it in that way, the less you will see the other person fully for who they are. The further from love you will be. The more the manipulated person will sense that your interest in them changing is for your benefit, rather than theirs. They will react accordingly.

One problem with toughness is it can become inflexible, rigid, unseeing, unfeeling. It might be more about steeling yourself against your own vulnerabilities than anything else. If you rely on a formulaic approach, you can create a trap for yourself and will surely miss something. Let’s think systemically. It’s not just about the addicted person or just about me. It’s about addiction and us.

Perhaps if we think less in terms of tough love’s effect on the other and think more in terms of what re-setting our own care does for us, everyone may benefit. Whatever you do when you’re living or working with addiction, you need to be in good shape yourself.

Setting boundaries and the like is not a bad thing but do it for the right motive: because it protects you. This is assertive, not tough love. You cannot control the effect of that on the other person. It might have an effect, or it might not.

BOUNDARIES AND TOUGH LOVE

We know from research on parenting that limits consistently and calmly applied improve the life chances of children – but not on their own. Encouragement and sensitive response are the other essential ingredients.
Addicted people often unconsciously issue invitations for us to treat them badly. We don’t have to accept those invitations. It is all part of the low-self esteem and poor self-view from which so many addicted people suffer. In a way, they feel that they deserve it; that’s what many were taught as children.

Is there any evidence to support tough love? Not much and it’s mostly anecdotal and folklore. There is evidence that in some contexts – such as US youth boot camps – tough love can be counterproductive and cause psychological damage. The National Institute of Health in the US said that “get tough treatments do not work and there is some evidence that they might make the problem worse”. There is evidence that a nurturing attitude to helping is better than confrontation in encouraging loved ones into treatment.

Does the concept of tough love have any relevance in the context of a treatment programme? When reviewing the expectations of conduct at Clouds House rehab some years back, we involved the clients in that process. I was struck by the following remark… “We hate the rules and expectations but don’t you dare get rid of them”. The person went on to explain that rules and boundaries helped to make the place safe and they gave reassurance to the clients that someone was confidently in charge.

What must be avoided are rules for their own sake. That’s just about controlling. It is important how they are applied. It has to be about providing a safe place for everyone: to protect the individual and the group and to ensure that the programme can function as people expect. As long as it is clear and makes sense, everyone has a choice.

Another client told me once how important it was that Clouds treated clients with such dignity and respect and that the staff had such integrity. “Why is that important?” I asked. “I am sure it’s right but how does it actually help you?”
“Because then we don’t have to waste time thinking and worrying about you lot,” he replied. “We can concentrate on what we need to do for ourselves.”

Perhaps it is that if we all spent more time looking to ourselves, those to whom we relate would have the space to do the same. What a person does will have a better chance of being helpful if it from flows from someone who has attended to how they are.

So how tough is too tough? When it stops being about relationship and systems and becomes about engineering and manipulating to achieve a result. Then it can too easily become punitive and abusive and nothing to do with love.

 

This article was originally posted on addictiontoday.org

Nick Barton has been CEO of Action on Addiction since 2008, before which he was CEO of Clouds (now part of AonA) which he joined as a consultant psychologist. He has been instrumental in developing interventions to support families and carers affected by substance misuse since 1986 and founded Families Plus to respond to their needs, driving its Moving Parents and Children Together programme as an evidence-based response to children living with parental substance misuse and addiction. In 2008, the charity opened the Centre for Addiction Treatment Studies. Nick was a member of the Psychiatric and Substance Misuse committee of the Independent Healthcare Association, and sits on the board of Substance Misuse Management in General Practice, was a member of the Topic Expert Group for NICE standards in drug treatment and sat on panels advising government. Nick was awarded an Honorary Doctorate of Health from the University of Bath (pictured) in recognition of his work.

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