Why Compassion Is Stronger Than Tough Love for Substance Use Treatment

Caring about someone who struggles with substance use can bring up various feelings—devastation, helplessness, fear, anger, confusion, even annoyance. Perhaps you’ve been advised to try tough love?

Forging the right path is never simple, and doesn’t often have an obvious road map to follow. 

Most people in this situation have the best of intentions, but little clarity about what to actually do.

This is often complicated by external forces such as shame, stigma, and poor advice. 

Figuring out how to support and care for someone struggling with substance use can become a struggle in and of itself. 

The advice given most often—by both lay people and professionals—falls along the lines of tough love.

The biggest problem with tough love, though, is that it’s just not usually effective.

First, let’s explore what tough love is, and then we can look at an alternative path: compassion for those in substance use treatment.

What is tough love?

While there’s no singular definition, tough love in this context tends to involve confrontational interventions and ultimatums for the person with the substance use issue. 

Failure to choose the “correct” path on the ultimatum then involves withholding of love, support, financial help, or even being able to be a part of the family.

 In the tough love method, there are typically two primary goals: ensuring the person makes a swift move to abstinence, and ensuring the person administering the tough love is not guilty of enabling or codependency.

Understanding enabling, codependency, and detachment

Unless we’re obtaining substances on their behalf, we don’t really enable someone’s use. 

The addictive process is something that occurs inside people and is rarely appreciably minimized or accelerated by strictly external factors.

However, according to the Hazelden Betty Ford Foundation, the mere act of caretaking for someone struggling with addiction is enabling. 

In contrast, I would argue that loving them, providing shelter, staying in contact with them, making sure they eat, or driving them home when they are too intoxicated to drive themselves isn’t actually enabling. It’s kindness. It’s life support. 

Simply being in a relationship or staying connected with someone with a substance use disorder doesn’t imply codependency. 

It’s also worth noting that codependency isn’t a professional diagnosis—it makes no appearance in the DSM. 

The failure to administer tough love doesn’t prove that someone is behaving in a codependent manner. 

Well-meaning professionals get this wrong—often with dire consequences.

A lot of providers will often provide the loved ones of a person with substance use issues referrals to Al-Anon as a means of support and guidance. 

People often find great solace in being able to meet others in similar situations, and it can be a valuable resource. 

However, it’s also important to note that Al-Anon promotes the concept of detachment, which has several components, one of which states: “Not to prevent a crisis if it is in the natural course of events.”  

Intentionally allowing a crisis to occur is rarely helpful and can lead to even worse outcomes. 

Experiencing crises like car accidents, overdoses, and job losses often drive people deeper into substance use due to the shame and trauma they experience as a result.

These concepts, while popular, do little to help people struggling and don’t consider systemic implications as well as cultural differences.

The importance of compassion in recovery for substance use treatment

All too often, we reserve compassion for those who have overcome their substance use. 

For those in the midst of their struggle, we often condemn them and feel they are unworthy of love and support. We label them: sick, diseased, dirty, addicts, and alcoholics.

On the other hand, when we’re compassionate, we see suffering as a human condition.

“We have to recognize that people who use drugs need compassion, not contempt,” says Maia Szalavitz, author and harm reduction proponent. 

Mental health professionals don’t promote the withholding of love and connection for issues such as eating disorders or someone in an abusive relationship—so why are we doing it with substance use disorders?

The role of connection in substance use treatment

At our core, we’re social beings. And although we know this, this fact is often at odds with our individualistic culture. 

Studies have been highlighting the very real effects that loneliness and isolation have on our mental and physical health. 

In Lost Connections, Johann Hari writes, “Being lonely can raise cortisol levels as much as being punched.” 

Feeling isolated can weaken our immune system. Loneliness is not merely a side effect of depression, but loneliness can lead to depression. 

Healthy relationships and love cannot “cure” addiction, however love and compassion are absolutely core components of recovery, safety, and hope. 

The importance of boundaries in substance use recovery

Moving beyond tough love doesn’t mean that one’s life must become overrun by the needs and the whims of the person with addiction issues. Quite the contrary. The antidote isn’t to swing the pendulum all the way to the other side. Rather, it’s to establish boundaries.

A key note we can explain to our clients is that boundaries aren’t about what they think will change someone. 

According to Brené Brown, boundaries should be about what is and what isn’t okay with them.

Boundaries should reflect what your clients need to feel safe and respected, and take their own needs and values into account. 

Part of the fallacy of tough love is that it’s routinely used as punishment for failure to change. This can lead to resentment on both sides. In boundary setting, your clients aren’t trying to change anyone’s behavior—they’re asserting themselves and setting limits on what works for them.

For example, someone throwing their son out of the house for continuing to use drugs would be an example of tough love. 

However, telling the son that when he’s high, his younger siblings are frightened and don’t feel safe would be an example of boundary setting. The focus isn’t on whether the person is making choices that please us, but rather how their actions impact the needs and safety of other people. 

When people are unclear of their motivation, you can encourage your clients to ask themselves: Am I setting reasonable limits, or am I trying to control another person’s behavior? 

If the answer is the latter, it can be helpful to reframe the ask in a more productive way. 

How to help loved ones with recovery from substance use

Just as there are many paths into and out of substance use disorders, there are varied and nuanced ways that loved ones can be a source of support while still keeping firm boundaries. 

Within the helping professions, it’s important that we avoid latching onto labels and approaches that often don’t value other peoples’ perspectives, cultures, and beliefs. 

Tough love approaches often pathologize care, concern, and compassion. 

We don’t help people by blaming them and judging them. 

As helping professionals, we’re at our best when we listen and help our clients gain clarity on what they need and how they feel. In striving to empower people to make the changes that have meaning to them, we are doing our most important work—helping people be well. 

Love doesn’t have to be tough. It can just be love.

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