What Is Tough Love?
One line of prevailing thought is that when you’re dealing with an addict, sometimes you need to use a little bit of "tough love".
The logic is that sometimes friends and family members need to be firm. If they are too compromising or “soft,” they could be enabling bad behavior.
Primetime TV shows reinforce these ideas with celebrity studded interventions to get people to comply with treatment. These shows encourage people to give the addicts in their lives an ultimatum―shape up or I’ll cut you off.
However, research shows that tough love approaches just don’t work.
Tough Love and Hitting Bottom
So, where does the idea of “tough love” come from?
Central to 12-step programs is the idea of “hitting bottom,” the premise is that unless an addict reaches their lowest point, they will not be able to fully commit to recovery.
From 12 Steps and 12 Traditions:
”Why all this insistence that every A.A. must hit bottom first? The answer is that very few people will sincerely try to practice the A.A. program unless they have hit bottom. For practicing A.A.’s, the remaining eleven Steps means the adoption of attitudes and actions that almost no alcoholic who is still drinking can dream of taking. Who wishes to be rigorously honest and tolerant? Who wants to confess his faults to another and make restitution for harm done? Who cares anything for a Higher Power, let alone meditation and prayer? Who wants to sacrifice time and energy in trying to carry A.A.’s message to the next sufferer? No, the average alcoholic, self centered in the extreme, doesn’t care for this prospect--unless he has to do these things in order to stay alive himself.”
As A.A. programs spread across the country in the 1940’s, medical professionals began to integrate its ideas into traditional facilities, including hospitals and treatment centers.
Official A.A. literature states that its steps are suggested and not prescribed. However, the “Minnesota Model,” based on A.A. principles, required patients to comply with the 12-Step program, and actively pushed people to hit bottom. This program became the template for both both 28-day inpatient rehab and outpatient programs across the country.
Programs such as Synanon, a popular commune founded in 1958 by Chuck Dederich, would use humiliation and “attack therapy” to force people to hit bottom. Synanon used tactics like sleep deprivation, starvation, isolation, and sexual humiliation to force them to surrender to their treatment. Synanon-styled treatment was popular for decades, largely due to the media attention it drew for it’s tough love-based techniques, regardless of the fact that the majority of people who entered it dropped out and only 15% of its participants stayed abstinent.
Maia Szalavitz, in Unbroken Brain, demonstrates how devastating these tactics are:
“While the 12-step approach is relatively benign when chosen, it can be devastatingly harmful when coercion enters the picture. Then, the need to hit bottom can be used to justify disrespectful and abusive tactics in order to prompt someone to feel powerless and desperate enough to try the steps.
Since humility is seen as critical to this process, humiliating participants is acceptable. Since pride and confidence are antithetical to surrender, attempts are made to suppress or puncture them. Since social support can aid resistance, people are cut off from access to friends and family and even to kindness from each other during periods of punishment, which often involve being silent and totally shunned.
Not surprisingly this does not empower patients. It is explicitly intended to do the opposite.”
Ideas about tough love—as benign as our own versions may seem—have their roots in this idea of hitting bottom.
Though many of the harsher treatment tactics are no longer as prevalent as they once were, today 80% of treatment programs use 12-step principles as a foundation. These ideas drive mainstream thought about what it takes to help people recover. Some of these powerful ideas have led people to recovery and saved countless lives. Others, like this idea of tough love, can cause great harm.
Why Tough Love Doesn’t Work
Most people would probably not consider going to the extremes that these programs employ. But it is extremely common for friends or loved ones to want to “call out” the person dealing with addiction and point out all the ways that person is hurting themselves and the people around them. People may be inclined or roused through emotion to give their loved on a list of demands or an ultimatum.
Research shows that tough love just doesn’t work. Reviewing over four decades of research, Bill Miller and Bill White found that not a single study supported the confrontational approach as better than kinder and less harmful treatments.
Instead, this review showed that these methods actually worsened addictions and increased treatment dropouts.
“If we step back and look at what’s happening to the person that’s struggling with addiction, they already have such a powerful internal tough love, negative voice that’s communicating to them how they are failing themselves and everybody in the world around them. If tough love would work, why wouldn’t that internal tough love work?”
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In fact, research has shown that people have a greater chance of recovery with more support. People are more likely to recover while they still have a job, a life, a network of friends, and family.
So, what can you do to help your loved one instead of using tough love?
Dealing with friends and loved ones who are struggling with addiction is hard. It can be frustrating and make you want to do something drastic. But maybe the next time you feel like you need to use some tough love, instead pause, take a breath, and empower your loved one to make a change.
Learn more about concrete ways to have tough conversations with your loved ones. Read “How to help a loved one who’s struggling with addiction.”
Alcoholics Anonymous, Alcoholics Anonymous (‘Big Book’), third edition (New York: A.A. World Services, (1976), 1-16, 171-81.
Fletcher, Anne. Inside Rehab. New York: Penguin, (2013).
C.E. Grella and J.A. Stein, “Remission from Substance Dependence: Differences Between Individuals in a General Population Longitudinal Survey Who Do and Do Not Seek Help,” Drug and Alcohol Dependence 133, no.1 (2013): 146-53.
White, W. & Miller, W. (2007). "The use of confrontation in addiction treatment: History, science and time for change." Counselor, 8(4), 12-30.
Szalavitz, Maia. Unbroken Brain. New York: St. Martin’s Press, (2016): 185-187.