Heroin abuse in the United States is reaching epidemic proportions.  According to SAMHSA, between 2007 and 2012, the number of Heroin users has doubled from an estimated 375,000 to over 665,000.  Additionally, in 2010, the number of deaths as a direct result of overdose surpassed auto accident deaths.

It is impossible to avoid the facts about heroin.  We are bombarded daily by the national and local media and extensive online resources.  So, is tough love the answer?  I recently met a family whose daughter is a client and whose son had recently died from a Heroin overdose.  The story they recounted was as follows:

The father told me, “we are here to get help for our daughter, she is a heroin addict.”  He went on to recount a story of “tough love” in regard to his son who died of a heroin overdose four months prior, at the age of 23.  Mr. Jones stated that his son had been admitted to 7 Florida drug rehab programs between the ages of 18 to 23 and the longest period of sobriety he was able to attain was 11 months clean.  He stated, “my son was plagued, he wanted to stop, he asked for help repeatedly and in the face of all the professionals, we continued to attempt to help.”  He went on to recount, “Finally, we gave in to the professionals and decided that ‘tough love’ was the answer and we would no longer accept our son’s phone calls, refuse to provide financial support and let him hit rock bottom.  The professionals told us this was the only way and we listened.  The result for us was that our son died of an overdose in a McDonald’s bathroom, alone.”

This is a story that I hear regularly.  Professionals recommend that parents “cut them off,” “let them find their own bottom” and tell them “you are killing them by helping them.”  I seriously struggle with this approach and I am personally ridiculed by the local treatment industry for going against the grain and what they term “clinically appropriate guidelines.”  I am termed “rouge” and “severely enabling” as well as, it has been stated, “He allows them to relapse and this is killing them.”   My response to this ridicule is to dig in and try to help individuals get well regardless of the theoretical approach.  My job is to help, not kick people to the curb.

Quite possibly, 40 or 50 years ago, waiting 10 to 20 years till an alcoholic hit his bottom was acceptable; however, today, 20 something heroin addicts will not live 10 to 20 years, much less 2 to 3 years.  For those espousing tough love, in essence, they are quite possibly sentencing an addict to death.  Obviously, the addict is responsible for his/her own recovery, but we have a responsibility to take the person where they are at and attempt to help if they ask.  Research in this area has demonstrated, in the legal system, that forced drug rehab vs. non-coerced treatment (tough love) yields no difference in terms of retention and outcomes (see below for citation).

Regardless of these observations, tough love does not work with an addict.  Anyone who has worked with this population would be hard pressed to report that an addict responds to tough love.  The opposite is true.  Without failure, every addict I have worked with wants to be loved and wants to feel loveable but none of them will tell me that because they believe if someone knows this, they will abandon them and see them as weak.  By modeling love and compassion, it provides the freedom to aggressively confront given the addict knows it comes from a loving place.

Addicts have been thrown to the curb (or felt as if they have) most of their lives.  The idea that a person is in pain because they are an addict rather than the pain they are in created an addict provides different solutions.  If a person is in pain because they are an addict, the rational solution would be to remove the drugs (through detox) and the problem should be eradicated; however, alternatively, if the pain created the addict, which I believe is the correct analysis, we need to address the problem, the internal emotional pain rather than modeling a means of creating more pain through tough love.

Mr. Jones finally stated “I blame myself for giving up on my son and I won’t make the same mistake twice.  I have to live with the consequences not the professionals who provide the same recommendations to every family.”

David Kolker is a licensed clinical social worker and is the clinical director and CEO, SLO Recovery Centers, Delray Beach, FL.

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