Tough Love: Helpful or Hurtful?

By: Michael Plahn

‘Tough Love’ has been recommended for families affected by addiction and untreated mental illness for years.  It has been the catalyst for greatly improving the lives of people I know very well.  I have also seen this backfire and become the impetus for further misery and even tragedy.

I see this topic divide, fragment, and many times disintegrate families.  What is the best approach for you and your family?  Only you (and your family) can make those decisions.  You have to live with the decisions and the repercussions of your actions.

For sake of example, let’s use the case of Paul, a 24 year-old male who has suffered from what Mom calls Depression (but he has never been diagnosed by an appropriate professional) and abused alcohol & drugs since he was 16 years-old.  He has been to two local Outpatient Addiction Treatment programs (for alcohol, cocaine, and opiate abuse) in the past five years.  However, after completion of each program, he relapsed each time within weeks of discharge.  Paul, currently unemployed, lives with his mother, father and younger sister (Angela 17 years-old).  Paul is verbally abusive to his entire family at times, and is currently using opiates (Vicodin, Oxycontin, and heroin), cocaine, and alcohol.

Dad, loves his son, but is frustrated and wants Paul out of the house unless he is sober and holds a full-time job.  Mom is upset with her son’s behavior, but concerned for Paul’s safety if she does not help him.  She cannot bear to see her baby boy “in the streets.” Paul manipulatively threatens, “if you throw me out, I’ll likely get killed in the streets.”  Angela loves her brother, but they rarely speak anymore.  Mom and Dad have warred for years over Paul and what to do for him and with him.  First Dad was supportive, but now he is intolerant and has begun to detach from the family.  There is a constant state of tension, but silence in the home and the parents’ relationship has suffered significantly.  Mom and Dad do not interact much, but if they do it is typically a verbal battle about Paul.

What should this family do?  I know individuals who were asked (in a ‘Tough Love’ approach) to either accept help and enter a reputable treatment facility (such as PromisesCaron, or Treatment Solutions Network approved programs), or leave the family home immediately.  That was just the beginning, but many are now happy and living amazing drug-free lives for several years.  They credit their parents’ refusal to allow them to live in the family home unless they were sober (and some gainfully employed) as the key event that lead to their long-term recovery.  Some were even required to take random drug screens as a condition to stay under their parents’ roof.  These individuals would tell Mom and Dad to “Kick Paul out if he is not willing to enter an appropriate treatment facility OR immediately stop using, attend 12-Step Meetings, and have a full-time job in a week.”

But, is that really the appropriate solution for this scenario with Paul and his family?  Will it work?  It’s not that simple.  Addiction and mental illness are much more complex issues than they may appear.  Honestly, if Paul could stop on his own, he likely would have long ago (there is very little fleeting pleasure at that stage of addiction).  True, there are success stories with a rigid consequential approach, but this can also be a very dangerous approach for some individuals.  Richard Rawson, associate director of UCLA Integrated Substance Abuse Programs claimed in a piece by ABC-News that coercive or confrontational approaches actually push the afflicted away from treatment.

Trust me, this could be an extremely complicated situation.  What works for one individual or their family may not have the same result for Paul’s family (or yours for that matter).  Let’s say that Paul was physically abused by his uncle (when Paul was 8-9 years-old).  What if he had a physical handicap during adolescence and as a result he was ridiculed and teased by his peers?  Either of these issues could change this situation significantly and may make Paul much more fragile than the family realizes.

These examples of underlying trauma are also likely to affect his ability to find long-term recovery.  If they are not addressed, it is likely that Paul will struggle and repeat dysfunctional patterns.  There is significant research that shows an extremely high percentage of addicted persons have also experienced some level of trauma  (which may be an underlying issue propelling the addiction).  At The Meadows, a facility that specializes in treating underlying causes of addiction such as trauma, they understand this reality.  Sadly, many people, minimize the significance of how trauma can negatively affect treatment outcomes and long-term recovery efforts.

If you were Paul’s Mom, I would recommend that you engage a qualified objective professional who can assist in determining an appropriate treatment facility and executing a compassionate loving process to intervene on your son. A competent professional would suggest solutions for the entire family’s treatment, not just Paul.  Granted, I’m biased, but LSA’s Pre-Treatment Solution is an ideal fit for this family’s situation.

There may be good reason to protect yourself and others in your home by asking an afflicted family member, who is acting dangerously, to leave.  But, as mentioned, this is more complicated than many well-meaning lay-people realize.  If you are going to embrace a ‘Tough Love’ stance, then please make sure you have professional guidance, that the family agrees as a group not to cave under manipulation, and become willing to accept the potential consequences of your ‘Tough Love’ approach.



Regional Differences Shown in Substances Abused

The overall rate of admissions to substance abuse treatment across the Nation remained stable between 1998 and 2008.  There were, however, marked differences by region pertaining to the substance for which people were admitted to treatment.

A new SAMHSA study shows these changes and the regional variations in admission rates for specific drugs.  For example, the rate of admissions for alcohol as the primary drug has declined by 15 percent nationally. In contrast, admission rates for alcohol in West North Central states (IA, KS, MN, MO, ND, NE, and SD) remained the same.

 The only region with an increase in alcohol admission rates (9 percent) in 2008 compared to 1998 was the west north central region.  This region includes: North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, and Missouri.

The highest cocaine treatment admission rates were in the Mid-Atlantic Region, which includes: New York, Pennsylvania, and New Jersey.

Highest heroin treatment admission rates were highest in the Mid-Atlantic and New England regions.  This includes: Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania.

Highest treatment admission rates for opiates other than heroin (1998 to 2008) were in the East South Central and New England regions of the U.S.  States included are: Kentucky, Tennessee, Mississippi, Alabama, Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island. 

The highest methamphetamine/amphetamine treatment admission rates were found in the Pacific Region, which includes: Washington state, Oregon, California, Hawaii, and Alaska.

For the complete study, visit SAMHSA’s website.

Photo source: SAMHSA

Drug Rates Increase Among Youths (12 to 17) and Young Adults (18 to 25)

According to the recently published 2009 National Survey on Drug Use and Health (NSDUH),  among youths aged 12 to 17, the current illicit drug use rate increased from 2008 (9.3%) to 2009 (10%), despite a previous decline between 2002 and 2008, from 11.6 to 9.3%.

The rates amongst young adults aged 18 to 25 also increased from 19.6 in 2008 to 21.2% in 2009, driven largely by an increase in marijuana use (from 16.5 to 18.1%).

Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

  • Marijuana use among youths aged 12 to 17 increased to 7.3% in 2009 from 6.7% in 2007 and 2008.
  • Prescription Drugs for nonmedical use among youths aged 12 to 17 had declined from 4% in 2002 to 2.9% in 2008, then held steady at 3.1% in 2009.   Increases also occurred among young adults aged 18 to 25 from 5.5 to 6.3%, driven primarily by an increase in pain reliever misuse (from 4.1 to 4.8%).
  • Ecstasy use among youths aged 12 to 17 declined from 0.5% in 2002 to 0.3% in 2004, remained at that level through 2007, then increased to 0.5% in 2009.
  • There were decreases in the use of cocaine (from 2.0 to 1.4 percent) and methamphetamine (from 0.6 to 0.2 percent).

Where do the prescription drugs come from?

Among persons aged 12 or older in 2008-2009 who used pain relievers nonmedically in the past 12 months, 55.3% got the drug they most recently used from a friend or relative for free. Another 17.6% reported they got the drug from one doctor. Only 4.8% got pain relievers from a drug dealer or other stranger, and 0.4% bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 80% reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor.

The NSDUH is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older.


Illicit Drug Use Shows Year Over Year Increase

According to new information from SAMHSA, illicit drug use increased in 2009 among persons 12 and older to an estimated 21.8 million Americans aged 12 or older (8.7% of the 12+ population). These were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. 

Illicit drugs include: marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

The following Illicit Drug Use Statistics are from the recently published 2009 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

  • Marijuana use increased and is the most commonly used illicit drug. In 2009, there were 16.7 million past month users, 6.6% of the 12+ population, which was an increase from 6.1% in 2008.
  • Cocaine use increased to 1.6 million current cocaine users aged 12 or older, comprising 0.7% of the population in 2009. These estimates were similar to the number and rate in 2008 (1.9 million or 0.7%) but decreased since 2006 (2.4 million or 1%).
  • Hallucinogens were used in the past month by 1.3 million persons (0.5%) aged 12 or older in 2009, including 760,000 (0.3%) who had used Ecstasy. The number and percentage of Ecstasy users increased between 2008 (555,000 or 0.2%) and 2009.
  • Prescription Drugs increased to 7.0 million (2.8%) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month in 2009. This is an increase from 2008 (6.2 million or 2.5%).
  • Methamphetamine use increased in 2009 from 314,000 (0.1%) in 2008, and 502,000 (0.2%) in 2009.

Most illicit drug users were employed. Of the 19.3 million current illicit drug users aged 18 or older in 2009, 12.9 million (66.6%) were employed either full or part time.

Among those aged 50 to 59, the rate of past month illicit drug use increased from 2.7% in 2002 to a whopping 6.2% in 2009. This trend partially reflects the aging into this age group of the baby boom cohort, whose lifetime rate of illicit drug use is higher than those of older cohorts.

4.2% of the population aged 12 or older (10.5 million persons) reported driving under the influence of illicit drugs during the past year, which is similar to the rate in 2008 (4%).


Drug Study Shows Alcohol is Most Harmful

A new study published online Monday in the medical journal, Lancet, shows that alcohol is  more dangerous than illicit drugs such as heroin and crack cocaine.

The study assessed harms caused many substances, including alcohol, cocaine, heroin, ecstasy and marijuana, and ranked them based on how destructive they are to the individual who takes them and to others in society.  Measures of analysis included how addictive a drug is, the harm it causes to the human body, environmental damage caused by the drug, such as its role in breaking up families and its economic costs, such as health care, social services, and prison.

In the overall rankings, alcohol outranked all other substances, followed by heroin and crack cocaine.  Alcohol was the most destructive overall for several reasons such as when drunk in excess, alcohol damages nearly all organ systems.  Alcohol is also connected to higher death rates and is involved in a greater percentage of crime than most other drugs, including heroin.  Heroin, crack cocaine and methamphetamine, or crystal meth, ranked as the most lethal to individuals. Lower on the list were marijuana, ecstasy and LSD. 

The study was paid for by Britain’s Centre for Crime and Justice Studies and can be viewed online here at the Lancet Medical Journal.

If you or someone you love is struggling with addiction, LifeSkills Authorities can help.   Call 312.265.0909 or click here to contact us now and learn more about our addiction consultation, intervention and recovery coaching services.

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