Tough Love’ in treatment isn’t tough, it’s trauma

let’s look at the true cost of shame-based interventions

The last post highlighted the financial drivers behind the addiction treatment sector’s revolving door.

Today, let’s drill down into one of the most ingrained – and arguably most disastrous practices: the concept of ‘Tough Love.’

For the majority of clients, addiction is a trauma-driven survival strategy, a desperate attempt to regulate a system overwhelmed by past adversity.

Research from the foundational ACE Study (Felitti et al., 1998) shows a clear link between childhood trauma and high risk of ‘Substance Use Disorder’.

Yet, countless institutions still rely on shame, confrontation, and conditional care. This approach is not simply ineffective; it is actively re-traumatising.

The Neurobiological Problem
When a person with a trauma history is subjected to shaming or ultimatums, it doesn’t prompt self-reflection; it triggers the body’s nervous system reaction.

These tactics strip a person of their agency and safety, the very qualities they need to rebuild, mimicking the disempowerment of their earlier life.

As the body enters fight, flight, or freeze, the chance for true, integrated emotional learning disappears. We all know this.

We see outward compliance, the quick fix, but we deepen the underlying internal dysregulation.

This is why when people are traumatised, they take drugs to try and stabilise their bodies (van der Kolk, 2014), shame just destabilises them further.

other studies also show that high levels of shame are strongly associated with increased vulnerability to addiction and act as a barrier to long-term sobriety (Luoma et al., 2012).

By employing shame, the system inadvertently entrenches the exact emotional state that fuels the cycle.

The Systemic Failure – Compliance Over Healing

Traditional models favour tough love because it is fast, linear, and fits easily into short-term billing cycles.

They focus on the immediate symptom rather than the root cause.

Addressing the deep, chronic dysregulation requires:

– Time with non-punitive engagement.

– Relational Safety built on unwavering compassion.

– Somatic integration that often doesn’t fit a standard package.

But there is a caution even with trauma work itself…

We risk substituting the ‘addict identity’ with the ‘trauma survivor identity.’

Healing doesn’t stop at being a victim or a survivor; it’s about moving beyond any single identity completely.

The real goal is awakening, to a self not defined by the wound. We must facilitate true self-coherence, not just a new narrative.

(SAMHSA) advises that care must be trauma-informed, shifting the focus from ‘What is wrong with you?’ to ‘What happened to you?’

Could this shift be possible in a shame-based environment?

 

If you could banish one shame-based practice or piece of language from all addiction treatment centres today, what would it be?