When You’re Sick or Incomplete, Open Up Your Heart

Research shows that empathy, not "tough limits," is a more effective approach to help loved ones with substance use disorder.

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Contrary to what some critics say, empathy doesn’t enable substance use or make the person sicker.

Tough love. Hard boundaries. Ultimatums. Many families use “tough love” to “help” loved ones with substance use disorder. However, research shows that empathy, not isolation, punishment, or tough limits is a more effective approach.

NPRAccording to NPR, studies show that a compassionate approach and voluntary treatment work better than tough love. Kindness and empathy engage people in active addiction and can keep them alive and connected to their support network. For parents, whose support often comes from other families of people in recovery, empathy is a key ingredient. Some parents describe a sense of shame when they help their sick children by offering a hot meal or a place to stay; others say they’ve been ostracized by their ‘support’ groups when they refused to set zero-tolerance boundaries with their children.

Some of the programs that support parents, families, and loved ones are parent support network Learn to Cope, the parent coaching program through the Partnership for Drug-Free Kids, and Community Reinforcement and Family Training (CRAFT).  

Nora Volkow, director of the National Institute on Drug Abuse told NPR that, in this era of fentanyl, the old ways may not be worth the risk. The bottom is much closer, and the person’s next use could be their last. She said, “The concept of letting their children hit bottom is not the best strategy. Because in hitting bottom they may die.”

There is no uniform path to healing for the drug user or parents, and no widespread agreement on the best approach for families. Empathy-based programs help support people switch from enforcing family consequences, like kicking a family member out of the house, to supporting them as they face other challenges, like losing a job because of substance use or mourning friends who have died of the disease.

It also helps families heal and come through the storm of addiction in one piece. Empathy helps maintain trust, which is essential. Asking for help from someone who’s been consistent in their love and support is much easier than going to someone who takes a punitive approach. Families are affected by addiction as well: the feelings of guilt or loss when a loved one or family member has a recurrence of use or struggles with substance use can have a profound effect on their mental health, too.

Michael Botticelli, who served as drug czar in the Obama administration, told NPR, “They don’t call this a family disease for no good reason. The whole design of these services [is] to promote tools and information for families, so they know how to approach a situation and can heal.” If a child had cancer, he said, parents “wouldn’t disengage with them or be angry with them. So I do think it aligns our scientific understanding that addiction is a disease and not a moral failure.”

Recovery can be a family solution to a family disease. Contrary to what some critics say, empathy doesn’t enable substance use or make the person sicker. “That’s a misconception,” Fred Muench, president of the Partnership for Drug-Free Kids, told NPR. “CRAFT is authoritative parenting, creating a sense of responsibility in the child, and at the same time saying, ‘I am here for you; I love you; I’m going to help you; but I can’t help you avoid negative consequences if you’re not looking to do that on your own.’”

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