What’s Wrong With Tough Love Addiction Treatment?

Tough love addiction treatment has long predominated the recovery community, to the detriment of addicts and their families. But the tough love approach is fundamentally antithetical to the reality of addiction and fails to recognize addiction as a brain disorder and psychological symptom. If your loved one is struggling with addiction, knowing what to look for in addiction treatment and steering clear of damaging treatment approaches could mean the difference between recovery and relapse.

Seeing your loved one struggle with drug addiction is a living nightmare. The fear, the sadness, the shame, and the sense of helplessness can be overwhelming, and it’s often difficult to know where to turn. Unfortunately, many families, at a loss for what else to do, are drawn into the tough love narratives that dominate much of the addiction treatment community in the United States, particularly for young addicts.

Built on the idea that addiction can be punished and shamed out of you, this treatment philosophy frames addiction as an arbitrary, moral choice, and suggests if you’re treated meanly enough, you’ll wake up and make a different choice. Even treatment programs that purportedly agree with the definition of addiction as a chronic brain disorder often incorporate punitive and confrontational elements that stand sharply at odds with ethical medical care. And these aren’t rogue institutions or singular aberrations; indeed, sentencing young drug offenders to military-style boot camps has became an increasingly common alternative to incarceration in the past several decades, often leaving the public with the impression that such a treatment approach is known to be effective. After all, why else would the legal system support their use? In fact, it is pervasive within the community as a whole and finds an array of articulations, from hard-core reform institutions to 12-step practices focusing on moral culpability. But what research and addicts themselves tell us is that tough love addiction treatment doesn’t work.

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“I Felt I Didn’t Measure Up”

“As a former addict, who began using cocaine and heroin in late adolescence, I have never understood the logic of tough love,” journalist Maia Szalavitz writes.

I took drugs compulsively because I hated myself, because I felt as if no one – not even my family – would love me if they really knew me. How would being ‘confronted’ about my bad behavior help me with that? How would being humiliated, once I’d given up the only thing that allowed me to feel safe emotionally, make me better? My problem wasn’t that I needed to be cut down to size; it was that I felt I didn’t measure up.

Szalavitz, author of the book Unbroken Brain and a fierce advocate of treatment reform, believes that tough love treatment is fundamentally antithetical to recovery and acts as a significant barrier to healing. Even when she realized she needed help, fear of punitive treatment kept her from seeking it, and she firmly believes that her addiction was prolonged by the lack of positive alternatives to tough love care.

The trouble with tough love is twofold. First, the underlying philosophy – that pain produces growth – lends itself to abuse of power. Second, and more important, toughness doesn’t begin to address the real problem. [Addicts] aren’t usually ‘spoiled brats’ who ‘just need to be taught respect.’ Like me, they most often go wrong because they hurt, not because they don’t want to do the right thing.

In many cases, tough love addiction treatment not only doesn’t work, it actually feeds into the pain and shame that are driving addiction in the first place while revealing a profound misunderstanding of the nature of addiction itself.

Addiction as a Brain Disorder and Psychological Symptom

“People have been trying to deal with addicts by punishing them, withdrawing from, and condemning them throughout history, without helping them at all,” says Dr. Lance Dodes, former Director of the substance abuse treatment unit of Harvard’s McLean Hospital. “It makes sense that these approaches fail, since addiction is neither a bad habit nor a sign of laziness or immorality.”

Rather, addiction is a legitimate medical illness marked by observable brain changes that cause escalating drug use. As Szalavitz points out, the initial impulse to use and to remain in an active state of addiction are typically psychological symptoms of unbearable inner turmoil, often in the form of a diagnosable mental health disorder. Tough love does not change the structure or behavior of your brain, nor does it cure psychiatric illness any more than it cures diabetes or high blood pressure or asthma. Unless a treatment program recognizes addiction for what it is, offers scientifically-proven interventions, and addresses the roots of addictive behavior, it is exceedingly unlikely that it will be able to guide its clients toward sobriety and psychological wellness.

What to Look for in Addiction Treatment

Luckily, things are beginning to change. Scientific research has expanded our understanding of addiction and begun to break through myths surrounding addictive behavior, while public awareness campaigns have disrupted deep-rooted stigma. At the same time, the opioid epidemic sweeping the US has had the unexpected effect of significantly changing the national conversation regarding drug addiction treatment and recently led to expanded availability of pharmacological treatment by almost tripling the number of buprenorphine prescriptions physicians are allowed to write, translating into prescriptions for 70,000 more people. Slowly but surely, people are becoming more aware of the failings of tough love addiction treatment and the need for effective, evidence-based alternatives that will address addiction as the illness that it is, not a choice, not a moral shortcoming, and not something that can be shamed out of you.

So what should you look for in addiction treatment for your loved one?

  • On-Site Medically Supervised Detox: For many types of addiction, the recovery process begins with detoxification. Unfortunately, some treatment centers work under the assumption that the withdrawal process must be uncomfortable and traumatic to encourage sobriety. This, however, is false. A safe, comfortable withdrawal process supervised by highly trained detox specialists with the resources to minimize symptoms is the best way to begin the recovery journey.
  • In-Depth Psychological Testing: Addiction is often deeply tied to mental illness, and that mental illness must be identified and treated alongside the addiction in order to break the cycle of emotional and behavioral dysfunction.
  • On-site Medical Staff: Many assume that all addiction treatment programs are supervised by medical staff, but this is not the case. Selecting a treatment program with on-site psychiatrists specializing in addiction medicine is critical to ensuring that your loved one receives medically-guided care of the highest caliber, and that they will have access to any medications they may need, including relapse prevention medication and psychotropic therapies.
  • A Comprehensive, Personalized Treatment Plan: Each person’s experience with addiction is different, and everyone has their own unique challenges and strengths. As such, your loved one’s treatment plan must be tailored to their individual needs in order to create meaningful pathways toward recovery. By offering an array of evidence-based individual and group therapies in addition to holistic and experiential therapies, your loved one will be able to engage in a truly transformative process of growth, healing, and self-discovery that minimizes the risk of relapse.
  • Family Programming: Family support is known to be a critical element to the recovery process. If deemed appropriate, the treatment program you select should support and honor your role in your loved one’s recovery and offer you specialized resources to guide you on your own healing journey while nurturing your family bonds through education, empathy, and love.

All services should be delivered in a warm, inviting, and non-judgmental environment of inclusivity, where your loved one can feel safe and supported as they do the difficult work of recovery. Addiction medicine should always be practiced with compassion and kindness, never threats, humiliation, or rejection; your loved one should be welcomed into a positive recovery community where they can learn to honor, nourish, and accept themselves without the use of dangerous substances and without the desire to self-harm. That is what effective addiction treatment looks like.

“Here you’re just seen as a person who deserves to live, and you deserve a chance,” says Szalavitz. “And it’s that that gives people hope. And it’s that that shortens the period of addiction.”

Alta Mira offers a comprehensive suite of treatment programs for people struggling with drug addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our innovative services and how we can help you or your loved one start the journey toward lasting recovery.