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Is "tough love" effective?

On the night of Dec. 12, 1994, in Madison, Wisconsin, Theresa J. McGovern froze to death in a snow bank. She was 45 years old and the mother of two young girls. That night she walked out of a facility where she had been admitted to treat the disease of alcoholism. She left, drank alcohol, passed out and died. She froze to death, in a parking lot, in the snow, alone. Her father was former representative and senator, George McGovern. McGovern had a long, successful political career. In 1972 he ran as the Democratic candidate for the United States presidency. He ran and lost against Richard Nixon.

Reportedly, McGovern adored his daughter, Terry. Although she was one of five children, he admitted to having a special affinity for her. Prior to her death, Terry had been in treatment for alcoholism 68 times, yet McGovern and his wife persisted in their support. Finally, after years of being lectured by clinicians and mental health professionals about needing to practice “tough love” and to stop “enabling” their daughter, McGovern and his wife decided to follow the expert advice and limit their contact with Terry. They were told that this would allow her to reach her “bottom”. Sadly, Terry McGoverns’ bottom was death. Following Terry’s death, McGovern set out to find the research that supported the advice he heeded. He was unable to find any research.

Many addiction treatment professionals ascribe to the theory that loved ones must practice "tough love” in order to create a scenario that forces a person into treatment for substance dependence. There is no research that supports this practice. In fact, addiction experts William J White and William Miller examined the use of confrontation used for addiction as far back as 2007. In their article, “The use of confrontation in addiction treatment: History, science and time for change”, they state that, “In almost every case, if not in every case, confrontations were aggressive and when implemented had poorer outcomes then doing nothing.” So why do professionals continue to promote this as the most effective intervention? Is it simply a reckless concept that is habitually touted by misinformed professionals? The answer is not clear, yet what is becoming increasing clear is the “tough” love is not helpful.

According to Merriam-Webster, the definition of tough love is; love or concern that is expressed in a strict way, especially to make someone behave responsibly. A strict way?” What does that mean? Make a person behave responsibly? How is that possible? As therapists we are taught that we are not able to make anyone behave in any way. A person’s behavior is the responsibility of that person and that person alone. This is a foundation of human rights and responsibilities. If we could force a person to a bottom that allowed them to make the choice to stop using and to engage in treatment, then couldn’t we force a person to stop drinking or using by allowing them to see the wonderful life that they could have? We know the answer to that and the answer is no.

If addiction were not a disease, then the answer might be yes. However, addiction is a disease. We cannot “enable” because we are not in "the driver seat". Just as we cannot disable, we cannot enable. Our all consuming, unconditional love won’t stop an addict, so why do we believe that “tough” love will? The only thing that will stop an addict is THE addict. This doesn’t mean that we don’t set boundaries. Boundaries are for us. It is a way to keep one’s sanity in the face of insanity. Taking money out of the hands of an addict is not tough love. It is common sense. No, you cannot have your twenty-two year old shooting dope in his bedroom with his younger sister in the next room. Not allowing that behavior is a boundary. Setting boundaries is something we owe to ourselves and to the people with whom we interact.

So how do we begin to set boundaries? We begin by believing that we have worth. We stop allowing people to say and do things that do not feel right to us. These situations may cause us to question ourselves or enhance our feelings of worthlessness. They may pray on our insecurities. So, no, it never made sense that you were asked by your child, your husband, your partner or whomever to lie for him, or to give her money to illegally, or legally, buy drugs. Saying no to those requests are part of holding a boundary and your actions may or may not stop that person from using, but that is not why we hold boundaries. Boundaries are essential to mental health. Using is a choice that he or she will make, but setting clear boundaries is your choice. (and, yes, picking up is a choice. The compulsivity that is the essential element of the disease comes into play AFTER the person engages in any compulsive behavior. The disease is in remission when the behaviors ends and the client is being treated) They are ways to begin to withdrawal from the insanity in order to begin to have peace of mind. You can begin to regain your sense of self. If you are not strong and stable and well, then you cannot put on the oxygen mask for the person you love. The strength you build is what will “enable" your loved one, who is in the throes of addiction. This "enabling" is healthy as it "enables" one to begin to see that they can get better. As they watch you grow and strengthen, they can draw from that strength. However, even if we show unconditional love for ourselves and for the people in our lives and even if we set boundaries, we still may not be able to “raise” that proverbial bottom. Even if we have done all that you can do, our loved one may not recover. It is out of you hands and nothing you do or don’t do can do much to change the outcome. So, get healthy and do what you can live with so that you can be there for whomever may need you on this journey, most importantly, you.

In conclusion, substance use dependence is an insidious disease that we know little about, but the most successful addiction treatment in the world tells us that the addict must get to his or her "bottom". Since we know that we cannot get to that bottom for them, then we cannot effect, nor can we raise that bottom. We have no definition of what the bottom is, but it is not of our making. However, we do know somethings about love. We know that love is patient. We understand that love is kind and that it is not boastful. It is omniscient, meaning that love knows all things. Since we know what love is, then we know what it is not. Love is not tough.

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