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 Promises, Caron, 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.