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On Changing the Texture of Tough Love in Addiction

What if being kind is more effective?

Key points

  • How love and care are delivered is central to the impact they can have on those in our lives.
  • Families trying to support a loved one struggling with substance use often receive suggestions about how they should express love.
  • Evidence supports lifting the mandate on “tough love” and letting families deliver care in ways that maximize its positive effects.
Source: Kelly Sikkema/Unsplash
Source: Kelly Sikkema/Unsplash

Loving and caring for someone can be tough. It’s not always easy, nor is it always smooth. It can become even more complicated for families trying to support a loved one struggling with substance use and other mental health issues. Families in these situations often receive suggestions about how this should look in practice for them. However, what is common across different situations is that loving and caring requires emotional risk, being vulnerable, and accepting an invitation to open ourselves up to both the joy and the pain experienced by those we care about. Stepping towards this risk and vulnerability is not a one-time event. It is a daily ask of each person throughout the course of building and maintaining meaningful connections.

Yet how often do we consider how our love is delivered?

How love and care are delivered (and how it feels to receive them) is central to the impact they can have on those in our lives. Recognizing this nuance—the texture of love—is important. Studies of the relationship between texture and emotion have shown significant associations between the softness and smoothness of an object and how people experience interacting with it. We associate soft and smooth textures with pleasant emotions, such as happiness, and textures that are rough (e.g., acupuncture mats, sandpaper) with unpleasant emotions, such as fear and anger. In turn, emotional experiences can set the stage for wanting to move towards or away from the things we are asked to interact with.

However, does the texture of love impact the physical and emotional health of those that receive it? Kelli Harding shines a light on a body of work that provides a broad foundation for viewing the science of kindness in action and the importance of the quality of supportive relationships. Her writing captures a range of studies that demonstrate the way in which we interact and deliver care affects the health of those receiving it. The impact of texture cuts across a range of species. For example, how research staff interacted with rabbits in a study predicted which ones would eventually develop heart disease following an unhealthy diet. Rabbits that were regularly talked to, petted, and touched in a caring way demonstrated less heart disease compared to those rabbits that received less attention; all the rabbits had the same diet.

For humans, a wide range of studies highlight the positive impact of social support and touch on emotional and physical health, including the power of receiving hugs. Receiving hugs more frequently was associated with a reduction in the severity of symptoms individuals demonstrated after being exposed to a cold virus. These studies offer us a glimpse into the larger body of evidence linking our physical and emotional health with the texture of the social connections and support (i.e., love) we receive.

Unfortunately, it seems the science of love and kindness is lost when it comes to substance use disorders. Families looking for guidance on how to support a loved one who is struggling with their use of drugs or alcohol are told the most helpful texture of love should be a tough one, akin to the harsher textures associated with anger, unpleasantness, and fear. Tough love has been used as a rationale for recommending confrontation or withdrawing human interaction and connectedness. In its most extreme versions, it means removing all interaction and positive reinforcement until change happens (i.e., substance use stops). This tougher texture is frequently offered as the most effective way to address addiction and increase an individual’s motivation to change. The message is clear: individuals who use substances need to experience caring differently in order for relationships to be of any help.

The words and actions we use to help others matter. They are not experienced as neutral, and their texture directly influences how people respond to their presence. But what textures are helpful in the context of substance use? Must they be tough? Nora Volkow, director of the National Institute on Drug Abuse, spotlighted research that offers some insight. Animals trained to use substances, when given a choice between interacting with peers or substance use, overwhelmingly preferred social interaction. However, if the social interactions were delayed, or the bar to access them was raised, or they were associated with pain (the presence of a tough texture), drug use became the preferred option. These results align with studies supporting the importance of ongoing communication, the use of positive reinforcement strategies, and the continued benefit of family involvement when supporting those with substance use disorders. That is, allowing for accessible social support, positive reinforcement, and supportive interactions are important components of a comprehensive helping framework. This framework can increase treatment engagement and improve outcomes when individuals consider addressing their substance use.

So, while we acknowledge that loving someone and fostering social connection can be challenging and even tough at times, let's make room for different textures of love and support in the context of substance use disorders. Lifting the mandate that love and support must have a tough texture to be effective gives families permission to deliver care in ways that maximize its positive effects. It also offers families and friends a choice of the textures that best align with their values. Evidence supports this approach even when applied substance use.

References

Ariss, T., & Fairbairn, C.E. (2020). The effect of significant other involvement in treatment for substance use disorders: A meta-analysis. Journal of Consulting and Clinical Psychology, 88, 526-540.

Cohen, S., Janicki-Deverts, D., Turner, R.B., & Doyle, W.J. (2015). Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychological Science, 26, 135-147.

Fazzino, T.L., Bjorlie, K., & Lejuez, C.W. (2019). A systematic review of reinforcement-based interventions for substance use: Efficacy, mechanisms of action, and moderators of treatment effects. Journal of Substance Abuse Treatment, 104, 83-96.

Iosifyan, M., & Korolkova, O. (2019). Emotions associated with different textures during touch. Consciousness and Cognition, 71, 79-85.

Harding, K. (2019). The Rabbit Effect: Live Longer, Happier, and Healthier with the groundbreaking science of kindness. New York: Simon and Schuster.

Meyers, R.J., Roozen, H.G., Smith, J.E. (2011). The community reinforcement approach: an update of the evidence. Alcohol, Research, & Health, 33(4), 380-388.

NIDA. 2018, October 15. New NIDA Research Reveals the Power of Social Reinforcers. Retrieved from https://nida.nih.gov/about-nida/noras-blog/2018/10/new-nida-research-re… on 2023, February 22

Venniro, M., Zhang, M., Caprioli, D. et al. (2018). Volitional social interaction prevents drug addiction in rat models. Nature Neuroscience 21, 1520–1529.

Venniro, M., Panlilio, L.V., Epstein, D.H., Shaham, Y. (2021). The protective effect of operant social reward on cocaine self-administration, choice, and relapse is dependent on delay and effort for the social reward. Neuropsychopharmacology, 46(13), 2350-2357.

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