Feb. 16, 2010 -- It happens to the wealthiest of families -- Casey Johnson, an heir to the Johnson and Johnson fortune, battled drug addiction.
It happens to the most political of families -- former presidential candidate George McGovern cut off his alcoholic daughter, Terry, who later died at the age of 44 after falling into a snow bank and freezing to death.
And it happens in Hollywood -- Martin Sheen's son Charlie Sheen arrested for cocaine use.
One Family's Struggle
Karen Franklin feared it would be her family's story, too.
She watched helplessly as her teenage daughter, Lauren, descended into a methamphetamine addiction.
Franklin took the door off Lauren's room and even moved her furniture out on the patio. "It did help change her behavior for a brief time," Franklin said.
But Lauren was not getting better. Karen finally kicked Lauren out of the house, terrified for her daughter's future.
How 'Tough Love' Works
The 'tough love' approach took off in the 70s and 80s: when all else fails, crack down. It can work, but experts caution that, if handled wrong, tough love can also do harm.
"We found that the major impacts of treatments that involve a lot of confrontation and tough love are to drive people away from treatment," said Richard Rawson, associate director of UCLA Integrated Substance Abuse Programs. "It's exactly the opposite of what we want to do."
Experts say the key is balance. Parents should insist the addict change behavior, stop using drugs and get treatment. But the family should still be willing to offer some lines of support. Also importantly, loved ones should get good advice and not try to go it alone.
"We don't want them to bottom out," said Tom McLellan, deputy director of the White House Office of National Drug Control, said. "They've lost when they've bottomed out."
Many clinicians believe tough love is still a useful tool because a lot more is known today about addiction.
"What I see in our field is an evolution taking place," said Maureen Canning, clinical consultant for The Meadows Rehabilitation Center in Arizona. "A little bit more sophistication in exploring the bigger picture with the individual, and in so doing, I think we are able to set limits and boundaries as opposed to erect walls around the individual."
Even with tough love, most experts now believe families are far better off staying connected, no matter how bleak life becomes.
"It is an act of love to monitor and make strong contingencies because you can," McLellan said.
Author Maia Szalavitz, a recovering addict herself, says cutting all ties should be a last resort.
"If the person is stealing from you or if the person is engaging in behavior that's hurting you, you may have to cut them off for your own good," Szalavitz said. "But don't think that that's going to fix them either."
Getting the Help
For Karen Franklin's daughter, Lauren King, now 30, the tough love approach worked. She's been clean for 12 years now. Franklin says she followed advice to never completely shut the door on her daughter.
"She didn't just throw me out and not offer me a solution," Lauren said. "But there was something waiting for me if I did decide I was ready to get help, and I was ready for a change."
Getting an addict like Lauren to be open to change is the first step, but certainly not the last. McLellan says regaining a loved one from the depths of addiction is possible, and should be the goal for all families.
"Recovery is not just not using drugs or alcohol," he said."Recovery is sobriety, coupled with a changed way of life to make somebody more personally healthy and a more responsible citizen. Exactly the kind of neighbor you want to have, exactly the kind of guy you want to marry your sister."
Karen Franklin and Lauren King's book about their family's struggle is called "Addicted Like Me: A Mother-Daughter Story of Substance Abuse and Recovery."
Ten Important Questions to Ask a Treatment Program
From Drug Strategies, a nonprofit research institute that promotes more effective drug abuse prevention, education and treatment. Visit drugstrategies.com for more information about their questions.
1. How does your program address the needs of adolescents?
2. What kind of assessment does the program conduct of an adolescent's problems?
3. How often does the program review and update the treatment plan in light of the adolescent's progress?
4. How is the family involved in the treatment process?
5. How do you engage adolescents so that they stay in treatment?
6. What are the qualifications of the program staff and what kind of clinical supervision is provided?
7. Does the program offer separate single sex groups as well as male and female counselors for girls and boys?
8. How does the program follow up with the adolescent and provide continuing care after treatment is completed?
9. What evidence do you have that your program is effective?
10. What is the cost of the program?