"Kind Love" beats "Tough Love" – Top Doc explains why

Old 01-21-2013, 01:03 PM
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"Kind Love" beats "Tough Love" – Top Doc explains why

I ran across this article months ago, and then I read several books written by Dr. Gabor Mate. All were excellent and I would recommend. Since there has been some talk on the forum lately about “compassion” thought I would share. I found it very enlightening, and for those that question the benefits of tough love; this should serve as a reminder that there are many other methods being practiced in the real world, with positive results.

Treating Addiction: A Top Doc Explains Why Kind Love Beats Tough Love By Maia SzalavitzAug. 17, 2012 (Time Health/Family)


Dr. Gabor Mate is renowned in Canada for his work in treating people with the worst addictions, most notably at Vancouver’s controversial Insite facility, which provides users with clean needles, medical support and a safe space to inject drugs.

Canada’s Conservative government has tried to shut Insite down, but the country’s Supreme Court ruled late last year that doing so would contravene human rights laws because the program has been shown to save lives.
In Mate’s book In the Realm of Hungry Ghosts: Close Encounters with Addiction, which was a No. 1 bestseller in Canada, he advocates for the compassionate treatment of addiction, a position that is increasingly receiving international attention. Healthland recently spoke with Mate about the causes and consequences of addiction and what to do about the problem.

How do you define addiction?
Any behavior that is associated with craving and temporary relief, and with long-term negative consequences, that a person is not able to give up. Note that I said nothing about substances — it’s any behavior that has temporary relief and negative consequences and loss of control.
When you look at process or behavior — sex, gambling, shopping or work or substances — they engage the same brain circuitry, the same reward system, the same psychological dynamic and the same spiritual emptiness. People go from one to the other. The issue for me is not whether you’re using something or not; it’s, Are you craving, are you needing it for relief and does it have negative consequences?

Do you believe all addiction results from trauma?
I think childhood trauma or emotional loss is the universal template for addiction. It also depends on how you want to define trauma: if you want to define it as something bad happening, then it’s true that not every addict [has experienced trauma], in the sense of a death of a parent or violence in the family or child abuse, or any of the usual markers of trauma.
But there’s another [way to define it]. D.W. Winnicott [the late British child psychiatrist] said that there are two things that can go wrong in childhood: things that happen that shouldn’t happen — that’s trauma — and things that should happen that don’t happen. Children are equally hurt by things that should happen and don’t as they are by things that shouldn’t happen but do. If the parents aren’t emotionally available, [for example], no one will define that as trauma, but it will be for the child. If a mother has postpartum depression, that’s not defined as trauma but it can lead to emotional neglect and that interferes with child brain development.

It’s impossible for a parent to be emotionally available all of the time, however.
The parent doesn’t have to be perfect. In our society, it’s not [just] a question of whether parents are doing their best or love their kids or not, it’s that parents are often isolated and stressed or too economically worried to be there. What I’m saying is that early emotional loss is the universal template for all addictions. All addictions are about self-soothing. And when do children need to sooth themselves? When they are not being soothed.

You practice a harm-reduction approach to addiction, in which you provide clean needles and safe spaces for addicts to inject drugs. Americans have long tended to see this as “enabling” and typically view it as a bad thing because it doesn’t require addicts to be abstinent to receive care.
The question is, Is it better for people to inject drugs with puddle water or sterile water? Is it better to use clean needles or share so that you pass on HIV and hepatitis C? This is what harm reduction is. It doesn’t treat addiction, it just reduces harm. In medicine, we do this all the time. People smoke but we still give them inhalers to open airways, so what’s different? You’re not enabling anything they’re not already using.

Some critics claim that it prevents addicts from “hitting bottom” and getting off drugs entirely.
I worked for 12 years in the Americas’ most concentrated area of drug use, the Downtown Eastside of Vancouver. People live there in the street with HIV and hepatitis and festering wounds: what more of a bottom can they hit? If hitting bottom helped people, there would be no addicts at all in the Downtown Eastside. ‘Bottom’ is very relative, so it’s a meaningless concept. For me as a doctor, rockbottom might be losing my medical license, but what is a bottom for a person who has been abused all her life and lives on the street? It’s meaningless and false. People don’t need more negative things to happen to them to give it up. They need more positive things to happen. In 12 years of work on the Downtown Eastside, I didn’t meet an [addicted] woman who was not sexually abused as a child.

[Addicts] relationship to authority figures is one of fear and suspicion. How will it help if I punish them more? They need the very opposite. We end up punishing them for self-soothing. It makes no sense at all. Harm reduction is not an end in itself. Ideally, what it is is a first step towardsa more thorough-going [recovery], but you have to begin with where people are at.

When I’ve visited harm-reduction programs, it seemed that the clean needles and other tools weren’t the most important thing they provided. Rather, it was the message that ‘I believe you are worth saving, even though you are still using drugs.’ That touches people and opens doors.
That’s the key. Quite apart from clean needles and sterile water, the most important factor is for the first time saying to someone who has been rejected all their life, ‘We’re not going to judge you based on how you present your needs at the present moment.’ Harm reduction is much more than set of practices; it’s a way of relating to people. We’re not requiring you to stop using or do anything, we’re just trying to help you get healthier. At least you’re not going to suffer an infection of the bone marrow because you’re using a clean needle: is that not worth something? We’re here to reduce suffering. They may not get better in the sense of giving up the addiction, but that’s not a limit of harm reduction — that’s a limit of the treatment system.
[There are a lot of things] we can’t do in the context of a war on drugs. When people are attacked and stressed, we can’t hope to rehabilitate them [well]. That’s not a valid criticism of harm reduction; it’s a failure of the medico-legal approach we have right now to addiction.

People describe addicts as behaving compulsively in the face of negative consequences, but the same could be said of our drug policy.
It’s almost an addiction because we keep doing something with negative consequences and don’t give it up, and it gives a kind of emotional relief because people feel a lot of hostility towards addicts. Seeing someone jailed certainly provides some satisfaction and relief, but it’s not an evidence-based [treatment for addiction]. There are also a lot of other consequences we experience as a society by avoiding the connections between trauma and illness. Trauma is the basis for not just mental illnesses and addiction specifically, but also often for cancer and all kinds of other conditions [due to the effects of early childhood stress on the brain and immune system]. Society doesn’t look at it. We look at the effects and blame people for the effects but we don’t look at causes.

Why?
Because we live in a culture that promotes addiction, left, right and center. Addiction essentially is trying to get something from the outside to fill a gap and soothe pain. The entire economy is based on people seeking soothing from outside. The addict symbolizes all of our self-loathing.
The expression “the scapegoat” is very specific. The term in the Bible means a goat on whom the community symbolically imposed all its sins and then chases it into the desert. That’s what we’re doing with addiction. All the desperation to soothe pain and fill in emptiness from the outside that characterizes our culture, the addict represents. We hate to see that so we scapegoat them and think that way we are getting rid of our own sins.

So what can we do?
First of all, I would recommend that prevention has to begin at the first prenatal visit. Stress during pregnancy — contrary to the genetic view — has a large impact. Second, in the U.S., [you need] yearlong paid maternity leave. In other words, I would provide support and emotional nourishment for the child — and that comes from support for parents.

In term of addictions, first of all recognize that these people are traumatized and what they need is not more trauma and punishment but more compassion.

What most surprised you in working with some of the most severely addicted people?
What’s most astonishing is just how people survive, no matter what.
Even amid drug dealing and mutual ripoffs, there’s still a tremendous amount of caring. The same people who rip each other off would sometimes also go to great lengths to help each other. Despite all the pressure and suffering, to see people reach out to each other like that was the most astonishing thing I saw. When someone was sick, how people gathered around and helped, how they would share food with each other and some would volunteer and go at night and look after the young sex trade workers to make sure they were not getting hurt. There is that acceptance and community, and people need community. Especially for people who have not had emotional support, that community is very powerful

link: Treating Addiction: A Top Doc Explains Why Kind Love Beats Tough Love | TIME.com
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Old 01-21-2013, 01:59 PM
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I'm in favor of kind love plus tough love.

I believe how we view and treat our addicted loved ones reflects how we view and treat ourselves.
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Old 01-21-2013, 04:10 PM
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thank you for the post
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Old 01-21-2013, 05:11 PM
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I defintiely believe in compassion and a no nonsense straightforward approach that says to the addicted "I believe in you. You are capable of ending your addiction."

As clearly stated in the article, harm reduction is not a treatment method for addiction. This will cut out certain risks from drug use, but it's harm reduction...there are still huge risks to an addict who continues to use, one being death.

I'm not a fan of harm reduction in terms of ending addiction. Yes, it will reduce the spread of diseases though.

In our society, it’s not [just] a question of whether parents are doing their best or love their kids or not, it’s that parents are often isolated and stressed or too economically worried to be there. What I’m saying is that early emotional loss is the universal template for all addictions.
Addiction has been a problem in all societies, across cultures and across the ages. There is nothing to back up that "early emotional loss is the universal template for all addictions". I'm sure there are parents on this very forum whose children became addicted despite them being more than adequate parents. Conversely, there are trillions who have suffered unspeakable pain and loss and never become addicted.

Tough love, kind love...in the end none of it matters until the addicted says so.
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Old 01-21-2013, 07:11 PM
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Great article.
I know in some areas there are free clinics that distribute viles of ... That drug that reverses an opiate overdose... Forgot the name but same idea. Harm reduction. But does it encourage people to use because they feel safer? Its easy to think yes, but I doubt it. A addict doesn't think about safety as priority.

The "kind love" I agree with. "the kid" that my husband and I took in, per request of his mom after she had enough. We did it to keep him off the streets, couch surfing with druggy friends. People said no, he needed that tough love; but you know we didn't agree in his case, and more important we could handle the emotional aspects of it. We encouraged him, provided him a safe, calm environment, food, and listened mostly, and he found his way back out from all of it. The living situation with his mom wasn’t good because she was emotionally not well herself at the time. He is now in his last semester of undergrad, and has applied to graduate school. He is still working part time at a company where my husband helped get him a job. The people there took him under their wing and gave him the opportunity to learn all aspects of the business. I should add, his father died prior to the start of all his troubles (like the article suggests, trauma but as a young adult).

If he had been subjected to “tough love”, I don't think he would be where he is today. Think he would have sank a lot lower and who knows maybe ended up being arrested, or into harder drugs. Long term could have been much worse for him.
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Old 01-21-2013, 07:46 PM
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Do you actually believe that I haven't shown kindness and compassion to my own child?

Do you actually believe that I CHOOSE 'tough love' because I just am too lazy or self-centered to show kindness and compassion for my own child???

Do you actually believe that tough love is easy for me in any shape, fashion or form???

Wow. Just wow.
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Old 01-21-2013, 07:53 PM
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I don't know that I like the term "tough love." It is misleading. Stepping out of the way of natural consequences of someone elses actions doesn't mean you aren't compassionate or that you aren't kind. To me, it means that you finally realize that continually cleaning up their messes is not helping the addict. Not only is it not helping them, it is dragging you down with them.

Allowing the addict to face their own consequences and being compassionate are not mutually exclusive.
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Old 01-21-2013, 08:05 PM
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Originally Posted by tjp613 View Post
Do you actually believe that I haven't shown kindness and compassion to my own child?

Do you actually believe that I CHOOSE 'tough love' because I just am too lazy or self-centered to show kindness and compassion for my own child???

Do you actually believe that tough love is easy for me in any shape, fashion or form???

Wow. Just wow.
no. I believe that you are compassionate and caring. we all love our children. when my MR son begins his negative stimms (strange behaviors like rocking and spinning and blowing raspberries are just wierd, but he grinds his teeth and bangs his head on the wall among other things) I ignore it, put his helmet on and walk away. I can't make him stop. I love him, but I accept that I cannot change him. I can control me. Im sorry I know it has nothing to do with addiction, but I want to say I might be able to relate to having a child in a situation that I can't change, and who I know will never ever be healed. at least in addiction there is always hope for healing. I think you are courageous to allow your son to clean up his own messes. truthfully.
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Old 01-21-2013, 08:07 PM
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Originally Posted by tjp613 View Post
Do you actually believe that I haven't shown kindness and compassion to my own child?

Do you actually believe that I CHOOSE 'tough love' because I just am too lazy or self-centered to show kindness and compassion for my own child???

Do you actually believe that tough love is easy for me in any shape, fashion or form???

Wow. Just wow.
NO!! Absolutely not tjp. Everyone knows any Mother on SR has done everything within their power to help their addicted loved one. Addiction is just that powerful.

Please take what you want and leave the rest.

:ghug3
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Old 01-21-2013, 08:14 PM
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when my MR son begins his negative stimms (strange behaviors like rocking and spinning and blowing raspberries are just wierd, but he grinds his teeth and bangs his head on the wall among other things) I ignore it, put his helmet on and walk away.
Yes, it is similar Lily1918, but society does not tell you that you contributed to his condition by your less than stellar parenting.

He is also not stealing your purse when you aren't looking.

Originally Posted by suki44883
Allowing the addict to face their own consequences and being compassionate are not mutually exclusive.
truth.
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Old 01-21-2013, 08:34 PM
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TJP, you are doing what is in your heart against every motherly bone in your body which wants to stop the bleeding. I understand.
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Old 01-21-2013, 08:55 PM
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I think you may have posted the wrong article with that title, no place in the article does it even use the words “tough love”.

This “top” doctor seems to place blame for addiction on mothers who did not nurture their children. This is the same “top” doctor that blames autism on “refrigerator mothers” (mothers that are cold and withholding of attention) though he admits that he has no proof for his theory.

In addition, this top “doc” was also threatened with criminal prosecution by Canada Health because he had his patients drink ayahuasca tea (a banned substance) to put them in a trance-like state as part of their therapy.
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Old 01-21-2013, 09:10 PM
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Tough love, kind love...in the end none of it matters until the addicted says so.
That very succinctly sums things up.

Thank you.

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Old 01-21-2013, 10:53 PM
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the article title is correct. I attached the link to the original article that was on posted on the website for Time Magazine; a respected news source.

As I stated, I have read several of the books written by this author. The one mentioned in this article was on the Best Sellers List; and while some people may not agree with his theories, he is still a respected doctor. The book also got very good reviews, and many people have found it beneficial. I would follow the rule and attack the argument, and not the person, if you disagree.




If the topic is an emotional trigger for some, then I would suggest they just avoid reading, or thinking about it. Personally, I do believe that things that happen/don’t happen to a person in their formative years can have an impact on things like substance abuse. I realize the thought of this may be painful for some who are currently undergoing a crisis, but it might be valuable information to others, who like me are parents of a young child and want to take in as much information as possible, make decisions on what we as individuals believe might be true, and then incorporate some of this into our parenting plan.

My husband suffered an addiction to pain meds, and it was long after he left his parent’s home, and we were married. We do not blame his parents for causing his addiction, nor do we think they failed him as parents. However, looking at his childhood from a place of honesty, there are things that he wants to do differently as it relates to parenting our child.

Tough Love, Kind Love are concepts. We are all free to incorporate these things into our relationships as we see fit. There are no absolutes, or guarantees where addiction is concerned. Take what you want and leave the rest.
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Old 01-21-2013, 11:08 PM
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I wonder what the recovery rate is for addicts that are taking his programs?

From what I understand (and I'm from Vancouver) the harm reduction programs are not about getting people off drugs. There's also a program in Van and Ontario that provides 12 hourly doses of alcohol (their choice of beer, vodka or wine) to homeless alcoholics as harm reduction because otherwise they'd be drinking rubbing alcohol and mouthwash which is more poisonous. But the intention is not to get them well, just keep them out of hospitals because these individuals typically are admitted very frequently to hospitals, and it's cheaper to give them safer booze than admit them to hospital so much.

I do like that the doc interviewed has compassion on his clients.
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Old 01-21-2013, 11:13 PM
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Originally Posted by h00ped View Post
I wonder what the recovery rate is for addicts that are taking his programs?

From what I understand (and I'm from Vancouver) the harm reduction programs are not about getting people off drugs. There's also a program in Van and Ontario that provides 12 hourly doses of alcohol (their choice of beer, vodka or wine) to homeless alcoholics as harm reduction because otherwise they'd be drinking rubbing alcohol and mouthwash which is more poisonous. But the intention is not to get them well, just keep them out of hospitals because these individuals typically are admitted very frequently to hospitals, and it's cheaper to give them safer booze than admit them to hospital so much.

I do like that the doc interviewed has compassion on his clients.
There was a posting on the Alcohol Program on the Family side a while back, think they are called "wet houses" and are really for those alcoholics in last stages. You might be interested in reading that thread, it got kind of long too i think...seems like it was a few months ago. I found that interesting also, and had never heard of that type of program.
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Old 01-22-2013, 12:23 AM
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I wonder what the recovery rate is for addicts that are taking his programs?
I don't think recovery is the intent of the program from what I gathered from the article. It is a form of palliative care for late stage addiction. Aside from the author's inference that crappy parenting causes a child to become addicted (which is essentially offensive to any of the parents on this forum), just the thought of the need for palliative care for our loved ones brings to the surface our ultimate fear......their death from this disease. It messes with our hope that recovery is possible. Unfortunately, in some cases, it is a very sad reality.

Personally, I am very glad to know that there is someone with the compassion to provide this measure of palliative care to the terminally addicted. But there was a good portion of the article that I think was a bit of hooey. JMHO.

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Old 01-22-2013, 01:29 AM
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I must admit that the article made me want to run to my son and beg him to come home so I can show him how compassionate I am and how much I love him. Then I remembered that I did that for a long time. I tried unconditional love for a long time where no matter what he did, I showed him how much I loved him and that I understood and forgave him. All it did was lulling me in a false sense of security that my son was healing and the shock of discovering what he was up to was even bigger.

I do resent the fact that it is implied that an addict was not mothered enough. It sure feels like the blame is put back squarely on the mother. Having fought long and hard to overcome the intense guilt that I must have done something wrong, I am simply not prepared to contemplate that again. The doctor may not understand the fact that addicts will lie and put the blame anywhere else to protect their addiction. How does he KNOW they were al deprived?

Deuce, I have said it before and will say it again that I am happy everything worked out well for the kid. However, please understand that tough love is a process that you EVENTUALLY get to. Not one of us started off like that. What would you have done if he started stealing from you, if he became abusive, if he did nothing else but stay in his room all day playing computer games and getting high? What if, in spite of your best efforts, this carried on year after year after year? What if his behaviour affected the whole family and other children really badly? Would you have started contemplating tough love then? You were blessed and I am glad you blessed him by giving him a chance. However, please do not think that is all it takes for everyone.

I am glad that people are given clean needles and that someone tries to keep them healthy. That way, they have a better chance of staying alive and hopefully one day decide to get clean. However, the insinuation that anyone not showing more "compassion" doesn't care enough, is offensive.
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Old 01-22-2013, 07:39 AM
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I think dr. Mate proposes "the system" should treat addicts with compassion/ kind love.
Not that their homes/family didn't provide enough love and compassion.

I don't think that the blame is put on the mother, I would say it's put on circumstances.

This article reminds me that Alcoholism/addiction is a family disease. My mom was a
total codie from her dad being a total addict. I do not blame my mom, in fact I thank
my mom for being a loving person who welcomes new experiences and tries to find
solutions to any situations that arise. My mom was a really strong person. A good
person. But perhaps not really emotionally available?

I also worry that I might be raising a codie or an addict.

I really like that dr. Mate has worked with Ayahuasca and is at least interested in
********.
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Old 01-22-2013, 07:57 AM
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In 12 years of work on the Downtown Eastside, I didn’t meet an [addicted] woman who was not sexually abused as a child.
Personally, I do not find this credible at all. Based on I read about the "top" doc, I question his motives - compassion or $$$!! JMO!!
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