Ask an Expert: Does "Tough Love" Work?

By The Fix staff 01/12/15
Today's question is on whether using a little tough love can help an addicted loved one.

I am having issues with a family member around drug usage and what I now believe is addiction. Is "tough love" going to help or hurt?

Lance Dodes: If addiction were viewed as a kind of bad habit, or a sign of laziness or immorality, then it might make sense to be "tough" on the person who has the problem. Indeed, people have been trying to deal with addicts by punishing them, withdrawing from them, and condemning them for much of human history, without helping the problem at all.  It makes sense that these approaches fail, since addiction is neither a bad habit nor a sign of laziness or immorality. 

Far from it, addiction is a very understandable psychological symptom, one that is essentially identical in its mechanism and function as other compulsive behaviors such as having to compulsively clean your house or exercise. Of course, addictions are more dangerous but their inner emotional workings are the same. And nobody would suggest that we deal with compulsive house cleaners by withdrawing from them, or would believe that they will stop cleaning if only we discipline them. So why do people think it makes sense for addiction?

When people engage in compulsive activities like excessively cleaning their houses, they generally don’t cause much harm or pain to those around them. It is easy to empathize with them, to see their suffering and to be drawn toward them to help, rather than feel like beating sense into them. But when people’s behavior is harmful or painful to those around them, they are often consciously or unconsciously viewed as self-centered, thoughtless, and immoral. Once this thought has set in, it’s very difficult to maintain a rational perspective toward either the person or the problem from which he or she suffers. It begins to seem reasonable and fair to treat the person as though she is bad, or stupid, or lazy. 

It's a short step from there to believe that it makes sense to be "tough" on her. Certainly, living with an addict is very often frustrating, enraging and depressing. But these reactions, understandable as they are, are not a good basis for deciding how to deal with loved ones, or with the problem they are facing.

The first step in dealing with someone suffering with addiction is to understand for yourself how addiction works as a psychological symptom (my first two books - The Heart of Addiction, and Breaking Addiction - are devoted to this). Having this knowledge can help you avoid the extra pain of believing that a family member's addiction means that person no longer cares about you, or is intentionally trying to hurt you. It also opens up a way to talk with the addicted person, and to help that person understand his own behavior in a new way. At the point you both appreciate that addiction is something comprehensible and, therefore, potentially solvable, the possibility opens up of restoring the damage that has been done to your relationship.

A spouse or friend can never fix another person's addiction, but there is a much better chance of helping both yourself and your addicted friend if you approach the problem by understanding it better, rather than attempting to control it through discipline or withdrawal.  Said another way, you may have to withdraw for self-protection, or simply to move on with your life. But that is very different from the false idea that you can affect addiction by punishing the person suffering with it.



Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking AddictionA 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.   Full Bio.

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