I don’t know what we should have done differently”: A qualitative study on the dilemmas of tough love and toxic drugs in British Columbia, Canada

Date: Tuesday 12th May 2026: 08.00 Vancouver time; 16.00 UK; 17.00 Western Europe; 18.00 Finland

Title: “I don’t know what we should have done differently”: A qualitative study on the dilemmas of tough love and toxic drugs in British Columbia, Canada

Presenters: Jennifer Hawkins, Amy Salmon, Steve Esau, Daniel Snyder & Mike Sikora

Centre for Health Evaluation and Outcome Sciences / School of Population and Public Health, University of British Columbia / Department of Psychiatry, University of British Columbia/ Pacific Community Resources Society / Lookout Health & Housing Society / City of Abbotsford, Department of Housing & Homelessness

Chair: Dr. Anja Bischof, Universität zu Lübeck

Description: This presentation shared findings from a qualitative study examining affected family members’ (AFMs) perspectives and approaches surrounding the concept of “tough love” in the Fraser East, a culturally conservative, semi-urban and rural region in British Columbia. British Columbia is currently the epicentre of the toxic drug crisis in Canada, where unregulated drug poisonings have become the leading cause of death for individuals aged 10–59.

We conducted 22 semi-structured interviews with AFMs about their perceptions and experiences during the toxic drug crisis, with particular attention to how “tough love” constructs shaped their relationships with, and responses to, loved ones at risk. Within the context of the current crisis, AFMs described facing agonizing decisions about how to offer support.

Answering the basic question — “What do I do?” — involved complex negotiations mediated by three main factors:

1. Perceived potential outcomes across various and competing harms.
2. Beliefs, attitudes, and values concerning love and compassion, the nature of drug use, and personal agency.
3. Available personal assets or social capital.

Participants frequently expressed significant uncertainty and regret, often unsupported and sometimes exacerbated by co-dependency theory–derived dichotomies of “tough love” versus “enabling.” Within the highly pressurised context of a toxic illicit drug supply, normative language and “rock bottom” narratives shaped and complicated relational negotiations.

We concluded that AFMs require nuanced and robust frameworks to support decision-making within both moral and pragmatic limits. The presentation featured specific stories and examples, and the discussion will explore “rock bottom” narratives, common governmental approaches, and the nature and function of potent opioids.

Due to a technical problem beyond our control, the recording of this Webinar was faulty. The presenters hope to be able to re-record it and we will then add that to this page as soon as we can.