Does “tough love” in residential addiction rehab centres work?

Should families use tough love with alcoholics and addicts?

At The Haynes Clinic, the majority of the daily telephone calls that we receive are from family or friends asking for advice on how to help or how they should behave with someone with an addiction.  Loved ones can not comprehend how someone with an addiction will continue with their destructive behaviour, potentially losing everything from a job to their relationship, resulting in separation or divorce from their wife or husband and also not being allowed to see their children; it also amazes them how someone in their 20s can ruin their life. How is it that someone will put alcohol, drugs, or gambling, for example, before their family unit?  These are some of the questions we frequently are asked.

Generally, as part of our response, we will try and encourage the caller to be more challenging towards the person with the addiction and particularly about their behaviour not being acceptable. If they are allowed to continue with their addictive thinking and behaviour, unchallenged, then family members and friends are “enabling” the addict  to continue unchecked and unquestioned. This means that the behaviour will continue longer than is necessary before they seek help and stop – possibly by getting admitted to a rehab clinic or addictions treatment centre

When Resident in a Rehab Clinic, Addicts will make excuses for their addiction

Any alcoholic or addict will know that they have a problem but they will try and deflect the real source of the problem on to another life area. At the end of the day, though, the solution will not be alcohol, drugs, gambling or even their behaviour around eating. This will just make their problems a thousand times worse. Part of the addictive thinking and behaviour will be dishonesty and that dishonesty is also part of our own denial of the extent of the problem; we will try and find something else to justify our behaviour.  Family and friends challenging us will help to expose our denial and hopefully in turn lessen the time that we then take to seek help. 

Fear of confronting the alcoholic / addict

Although we will encourage a more direct approach towards the alcoholic and addict, invariably our advice is not carried out as family members have told us that they have thought that this sudden direct approach could make the situation worse – or they may be afraid of what will happen if they adopt a tough stance (a violent or aggressive reaction, for example). In the end, though, the addiction has to be confronted at some point. It will not go away on its own.  Any addiction is a progressive downward spiral so our being direct with an addict will not be the reason to create a more negative result. It may just hasten the inevitable.

A residential detox in a Rehab Centre only helps with the physical addiction, not the mental obsession and behaviour

When an alcoholic or addict does get to residential addiction rehab, they will generally be administered a medicated detox overseen by a GP and the clinical team.  However, that in itself is not sufficient to get well. Therapy, an understanding of the 12 Steps of Recovery and a willingness to make changes are the key. 

Addictions counsellors in Rehab Centres can usually see the truth behind our denial

The vast majority of addictions therapists in an alcohol rehab or residential addiction clinic are in “Recovery.”  This means that they have been admitted into treatment for any form of addiction and are now working a very stable programme of Recovery and have chosen a path of getting qualified and helping others. 

rehab group session

Whilst it may be very easy to fool those close to us, it is nigh on impossible to fool a therapist that has been in a similar situation as someone who is now in treatment. ‘You can’t kid a kidder’. At The Haynes Clinic, during the recommended 28-day residential treatment period there will be a structured timetable that will include daily group therapy and the structure of the therapy sessions can be challenging.

Clearly, whilst in residential addictions treatment, the drug of choice has been removed.  However, what is left is still our addictive thinking.  This is what will be challenged during these therapy sessions. Many people come into addictions rehab in denial about the extent of the problem: their life is good, their families are happy, they still have a job, friends etc. The reality is very different and it is the therapists’ job to challenge them with ‘the truth’. This can be with the help of information provided by the family.

Exposing the reality of someone’s addiction can appear to be quite harsh: for example, they may be saying their drinking is ‘normal’ and their wife and children are not affected by their behaviour. Their peers may believe this and be wondering why they are in an addiction rehab clinic. Then the family information comes out, detailing their addictive behaviour and saying how worried, angry and devastated the family are. This can be quite shocking to hear but no longer can the individual pretend that their behaviour is acceptable and affects no one. This can lead to the individual feeling a great deal of emotional pain. It can even lead to tears. This is not about being ‘reduced to tears’ – it is about feeling how we should be feeling – guilty and ashamed of our behaviour. Only if we feel deeply that our behaviour is wrong is it likely to lead to our commitment to change it.    

Many people going through residential rehab treatment will suddenly tell the therapists and their family that they now have everything “sorted’ and are ready to go home. They know what they need to do and do not need to remain in residential addiction treatment for a moment longer. In reality, it is just nonsense for them to think that they are suddenly “fixed”; sometimes their desire to escape the addiction clinic is because they can see that they are going to have to face some unpalatable and painful truths and they do not want to face these. 

The therapists will challenge this irrational thought process and invariably the individuals do not like it. This “tough love” approach is not about shouting at people, it is simply about showing them a path to changing their behaviour which will only happen when they change their thought process.  This challenging is coming from therapists who can see through the denial and blocks to Recovery that are being put up.  This pulling apart of the addictive thinking will come across as not being empathetic when in fact that is exactly what is being shown – understanding of the nature of addiction and the truth.

In order to get well and lead a life of Recovery, we need to change and specifically change within ourselves. We find it very hard to comprehend that others see us in a different way to the way in which we see ourselves. In therapy,  areas that could lead to a relapse are pointed out to us. However, there needs to be a building of trust between the therapist and the person in treatment so that when a “tough love” approach is used, the person doesn’t feel ridiculed and then chooses to close up / shut down as they feel that they are just being told off (some people are very proud and have a big ego, making the challenges particularly difficult for them).

It is also important that within a group therapy session, facilitated by a qualified therapist, that feedback from other members of the group is of a structured and helpful nature. Challenging our old addictive thinking can be particularly powerful and insightful when coming from our peers. Learning together about ourselves and our addictions – seeing other people’s truths and recognising how they apply to us as individuals – is the most insightful and effective way of learning.  

Helping family members show ‘tough love’.

At The Haynes Clinic we also help family members to gain more of an understanding of addiction and the Recovery process.  Family members also need support and may for the first time be willing to take more of a “tough love” approach, especially with support from the clinic.  Certainly, following treatment, the individual will now be aware that there can and will be consequences for their actions and behaviour and that going back to it is inadvisable for many more reasons than they could have imagined before coming into treatment.