There is a well-established hesitancy surrounding giving financial support to people with addiction. Families and communities often wrestle with the fear that if they give their loved ones money or material support it will “enable” their substance use disorder. This mindset has become a mainstay in how we treat people who use drugs: We remove financial support from family members, restrict charitable giving, and recoil at investing in programs that uplift people with addiction. But this can have serious consequences.
The premise for cutting someone off from financial or material support can be a simple equation. Drugs cost money, so if I take away someone’s money, they can’t access drugs. Right? It’s not that simple.
Money is only one of the currencies used to sustain drug use. People with SUD who become financially disenfranchised may instead turn to more risky means of financial support such as selling drugs, engaging in transactional sex, or operating on credit with their dealer.
The link between substance use disorders and spending is complicated. Some research has documented increased spending on drugs and increased risk of overdose after windfalls of cash, such as government checks. But other studies have also described an opposite trend, that increased cash payments don’t increase drug use but do increase spending on necessities such as food and housing — suggesting that when you take away resources from people who use drugs, you’re also restricting access to means of survival.
Having an addiction is a financial strain. It’s often accompanied by the loss of critical resources such as employment, financial support, and housing. Reacting to someone’s drug use by “cutting them off” reinforces, and sometimes even starts, a cycle of poverty and homelessness.
A “tough love” approach is widely circulated, sometimes by seemingly credible sources. Partially because it resonates with families and people impacted by addiction, it fosters a curative belief that consequences can correct addictive behaviors. In some cases, it might. But in many if not most cases, this strategy runs against the very definition of addiction — continued drug use despite negative consequences — and can cause lasting and deadly harm.
Alicia Ventura, the director of special projects and research at Boston Medical Center Office-Based Addition Treatment Program, works with families who are struggling with how best to support their loved ones who are addicted. She recounts that “when families find out that a loved one is using alcohol or other drugs, it’s impossible to protect them from myths related to how they should approach their family member who’s using. Myths around ‘enabling’, ‘codependency’, the ‘need to hit rock bottom’ are ubiquitous in society.”
Ventura goes on to describe how many families feel pressure to “cut off” their loved ones from financial support or to take away resources like cell phones, cars, or housing. “These myths can be used to shame families who support their loved ones who are dealing with substance use,” Ventura says.
It’s unsurprising that families are conflicted; the message to cut off people with addiction is everywhere. It’s baked into federal and state policies, such as welfare and SNAP benefits, and even advocated for by some treatment centers. Meanwhile, loved ones are left to deal with the hurt and worry of watching a family member as they plunge into a deadly disease without support — to say nothing of the pain of people with addiction who experience it firsthand.
Engaging in the assumption that people with SUD will simply waste all their money on drugs contributes to a cultural stigma that can be damaging to them. The nuance demonstrated by current research and the spending choices of people with SUD seems to be absent from much of the public debate on how to help people in our community who use drugs. We must start calling the notion of “cutting off” someone who uses drugs from their resources what it is — a risky intervention that can have huge negative consequences.
Advocates and treatment centers that peddle this notion as a wide-scale solution to substance use cannot remain unchallenged. When necessary, pursuing financial estrangement should be handled with extreme care. All told, we must evaluate the way that we think and talk about people with SUD in regard to their finances. The belief and, I would argue, the lie we tell ourselves is that we are helping people by not helping people. We cannot continue to tout financial stability as a mechanism for recovery while turning a blind eye to the routine financial disenfranchisement of people with substance use disorders.
Alex Woodruff is a health science specialist at the VA Boston Healthcare System and the Partnered Evidence-based Policy Resource Center.