Written By: Kenneth A. Hand, B.A.
“If you deliberately plan on being less than you are capable of being, then I warn you that you’ll be unhappy for the rest of your life.” –Abraham Maslow
Substance use disorder (SUD) affects over 1.1 billion people worldwide (Pinel, 2014, p. 369). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifies that a key component to SUD is an array of harmful physiological, cognitive, and behavioral symptoms in which an individual will persist administration of drugs despite the comorbidity of associated problems (American Psychiatric Association [APA], 2013). Furthermore, an addict who has abstained from drug use for many years is still susceptible to relapse even after all withdrawal and symptoms have ceased (Robinson & Berridge, 2008). While genetics and environment play roles in the generation of the disorder, they are not absolutes (Hand, 2019).
While the epidemic of addiction is not new to mankind, our understanding of it is. For many generations, drug addicts were seen through archaic eyes that viewed their affliction as a moral deficiency. Modern research has transitioned by attributing substance use addiction to a combination of neurobiological dependence and an assortment of Pavlovian conditioning (Pinel, 2014).
With these definitions in mind, it raises questions about why some people continue to shame addicts. The disease model of addiction has existed for about a century, but there is still an overwhelming amount of stigma. Let’s take a gander at this story…
Written by Larry M. Lake for Slate
When my wife was diagnosed with breast cancer, we ate well. Mary Beth and I had both read the terrifying pathology report of a tumor the size of an olive. The surgical digging for lymph nodes was followed by months of radiation. We ate very well.
Friends drove Mary Beth to her radiation sessions and sometimes to her favorite ice cream shop on the half-hour drive back from the hospital. She always ordered a chocolate malt. Extra thick.
Our family feasted for months on the lovingly prepared dishes brought by friends from work and church and the neighborhood: chicken breasts encrusted with parmesan, covered safely in tin foil; pots of thick soup with hearty bread; bubbling pans of lasagna and macaroni and cheese. There were warm home-baked rolls in tea towel-covered baskets, ham with dark baked pineapple rings, scalloped potatoes, and warm pies overflowing with the syrups of cherries or apples.
Leftovers piled up in the refrigerator, and soon the freezer filled up too, this tsunami of food offerings an edible symbol of our community’s abundant generosity.
Although few said the word breast unless it belonged to a chicken, many friends were familiar with the word cancer and said it often, without flinching. They asked how we were doing, sent notes and cards, passed along things they’d read about treatments and medications, emailed links to good recovery websites and the titles of helpful books, called frequently, placed gentle if tentative hands on shoulders, spoke in low and warm tones, wondered if we had enough food. The phrase we heard most was: “If there’s anything I can do …”
In the following months, after Mary Beth had begun speaking in full sentences again and could stay awake for an entire meal, the stored foods in the freezer ran out, and we began cooking on our own again. Our children, Nick and Maggie, sometimes complained jokingly about our daily fare. “Someone should get cancer so we can eat better food,” they’d say. And we actually laughed.
Almost a decade later, our daughter, Maggie, was admitted to a psychiatric hospital and diagnosed with bipolar disorder, following years of secret alcohol and drug abuse.
No warm casseroles.
At 19, she was arrested for drug possession, faced a judge, and was placed on a probation program. Before her hearings, we ate soup and grilled cheese in a restaurant near the courthouse, mere booths away from the lawyers, police officers, and court clerks she might later see.
No scalloped potatoes in tinfoil pans.
Maggie was disciplined by her college for breaking the drug and alcohol rules. She began an outpatient recovery program. She took a medical leave from school. She was admitted to a psychiatric hospital, diagnosed, released. She began years of counseling, recovery meetings, and intensive outpatient rehabilitation. She lived in a recovery house, relapsed, then spent seven weeks in a drug and alcohol addiction treatment center.
No soup, no homemade loaves of bread.
Maggie progressed well at the treatment center. When the insurance coverage on inpatient treatment ran out for the year, she was transferred to a “partial house” where she and other women slept at night then were returned by van to the facility for full days of recovery sessions, meals, volleyball games, counseling, and horticultural therapy. This daughter who once stayed as far away from my garden as possible lest I catch a whiff of my stolen whiskey on her breath was now planting a garden herself, arranging painted rocks around an angel statue donated by a counselor, carrying buckets of water to nurture impatiens, petunia, delphinium, and geranium.
Friends talk about cancer and other physical maladies more easily than about psychological afflictions. Breasts might draw blushes, but brains are unmentionable. These questions are rarely heard: “How’s your depression these days?” “What improvements do you notice now that you have treatment for your ADD?” “Do you find your manic episodes are less intense now that you are on medication?” “What does depression feel like?” “Is the counseling helpful?” A much smaller circle of friends than those who’d fed us during cancer now asked guarded questions. No one ever showed up at our door with a meal.
We drove nearly five hours round trip each Sunday for our one weekly visiting hour. The sustenance of food, candy, and fiction were forbidden as gifts to patients at the treatment center. Instead, we brought Maggie cigarettes, sketchbooks, colored pencils, and phone cards. Any beef roasts or spaghetti dinners we ate were ones we’d prepared ourselves or bought in a restaurant on the long road to the center.
Then, late one night in June, Maggie and another patient were riding in the treatment center’s van on the way back to their house after a full day of the hard work of addiction recovery. The number of patients in the partial house had diminished from six a few days before, after a scandal involving small bags of ground coffee some smuggled from the house to the center and sold as though it were cocaine to addicts craving real coffee. (The center, like many, served only decaf.) Dozing off and comfortable in the seat behind the driver, Maggie might have been thinking of those coffee dealers who had been returned to the main facility or dismissed. Or maybe she was thinking about the upcoming wedding of her brother, Nick. A light pink bridesmaid’s dress waited in her closet at our house. Her release from the center was scheduled for two days before she and Mary Beth were to fly to Wisconsin for the wedding.
That night, an oncoming speeding car hit the van head-on.
The medics radioed for helicopters, and soon the air over Chester County, Pa., was full of them, four coming from Philadelphia, Coatesville, and Wilmington, one for each patient. The accident site was soon a garish roadside attraction of backboards, neck braces, IV tubes, oxygen tanks, gurneys, strobing lights, the deep thumping of helicopter blades, and the whine of turbines.
A newspaper picture later showed five firefighters, all in full gear, lifting a woman from a van—only her feet and an edge of the backboard visible. The van’s roof, dark and torn and jagged in the picture, had been removed by hydraulic cutters while the huddled victims, Maggie unconscious among them, were carefully covered with blankets. One of her front teeth lay in a puddle of blood on the ground.
When we saw her in the hospital, her face was a swollen mass of stitches, bruises, and torn flesh. Brown dried blood was still caked in her ears. Mary Beth carefully cleaned it with a licked paper towel, as if she were gently wiping Maggie’s face of grape jelly smudges or white donut powder just before Sunday school. At first, Maggie only remembered headlights, but soon she would mention “a cute EMS tech waking me up,” and the muffled chattering of helicopters.
The day she was released from the hospital, Maggie insisted on returning to the rehab center to complete her program, a heroine in a wheelchair among heroin addicts and alcoholics. On the way there, we stopped at a restaurant for lunch, where Maggie ate mashed potatoes, a little soup, and sucked a mango smoothie through a straw held carefully where her tooth was missing. Back at the center, we rolled her out to see her garden.
While Maggie was in the hospital, cards and letters filled our mailbox at home. For the two weeks that Maggie remained in rehab, and even while she flew to the Midwest, then wore her pink dress at Nick’s wedding and danced triumphantly with her cousins, offers of food crackled from our answering machine and scrolled out on email: “If there’s anything I can do … ”
Larry M. Lake is a writing professor at Messiah College in Grantham, Pa.
“Life doesn’t make any sense without interdependence. We need each other, and the sooner we learn that, the better for us all.” –Erik Erikson
If someone has a physical ailment or a disease, it is likely that people will ask about it, talk about it, and do what they can to try and help. When it comes to mental health there seems to be a societal misunderstanding or “hush hush” attitude. When someone is in pain, and it is relatable and understandable, we often see compassion and a willingness to help. Then why is it when it comes to addiction, people shy away, and even cause turmoil with stigma, stereotypes, ignorance, and shame the addict for their affliction?
External Shame, caused by morals set by society and culture, as well as harmful perspectives on addiction, make it plausible that a person living with substance use disorder would be likely to experience shame. To define shame, it is also important to define guilt.
Guilt, according to Merriam-Webster, is feelings of deserving blame especially for imagined offenses or from a sense of inadequacy, or a feeling of deserving blame for offenses.
Shame, in turn, is defined as a painful emotion caused by the consciousness of guilt, shortcoming, or impropriety.
It is easy to see how guilt and shame play major roles for a person living with substance use disorder, both during active addiction and in recovery.
Highlighting the disease model of addiction is valuable as it changes the conversation around addiction and encourages a healing perspective that assists in treatment, by making it clear that addiction is not something someone can choose, or something you can simply decide not to do.
“Who looks outside, dreams; who looks inside, awakes.” Carl Jung
“Battling addiction is like climbing a mountain carrying a bag of rocks that you don’t need. The rocks are guilt, shame, resentments, anger, trauma, faulty perceptions, and self-hatred. You will not make it up the mountain unless you start dropping some rocks.” – Kenny Hand
It’s never been solely about the drugs or alcohol. So how do we start treating shame?
Healthy Shame: A self-regulating coping skill that acknowledges limits, monitoring of oneself, understanding infringements on one’s values, identifying inappropriate treatment of self and from others, and overall developing a consciousness through recognizing shame as a transitioning distressful emotion (Weichelt, 2007).
Problematic Shame: Is a process in which shame becomes part of one’s identity through frequent, long-lasting, and powerful experiences that has been associated with symbolism, dialogue, or scenarios that trigger shame-inducing feelings (Weichelt, 2007). In this definition shame is not a self-regulating emotion that is also fleeting but rather becomes a detrimental long-term construct of oneself (2007).
Treatment of Shame:
Treatment centers with licensed staff trained in identifying shame can help work with shame-prone people on how to dimmish shame and be able to manage it in therapeutic relationships (2007).
“Supporting people in recovery requires forgoing attitudes and practices of retributive blame directed towards them in relation to their addiction. This recognizes the fact that others can play an essential role in modeling more constructive practices. (Snoek, McGeer, Brandenburg, Kennett, 2021).”
“A key aspect of this shift involves investing oneself with the power to effect lasting changes in one’s life, not just in behavior, but more deeply in one’s attitudes and dispositions. It involves seeing one’s dysfunctional attitudes and dispositions as malleable, not fixed in stone, not the inevitable result of past circumstances and events, not the defining feature of one’s identity. But, more deeply than this, it involves reawakening one’s own sense of agency as instrumental in effecting such changes, in part by understanding one’s own agential role in maintaining a dysfunctional lifestyle via persistent condemnatory self-blame. In effect, it involves coming to see oneself as the author of the “condemnation script” one is no longer doomed to carry out, but rather instead can use one’s agential power to rewrite. (2021).”
Treatment that addresses the faulty perceptions of causality resulting in experiencing shame and guilt rather than the traditional confrontational approach may attenuate an irrational sense of responsibility (Meehan et. Al., 1996).
The overall consensus of research is to view shame as an identifying emotion that leads to self-reflection and a motivation to live more aligned to one’s own beliefs, values, and morals. This process of changing the narrative, letting go, healing, and interpersonal growth can occur with a range of therapies including:
- Art Therapy
- Dialectic behavioral therapy
- Cognitive-behavioral therapy
- Trauma therapy
- Eye movement desensitization and desensitization therapy
- Rational emotive behavioral therapy
- Healthy coping skills
- Behavioral therapy
- Community-Based programs
- Sharing, understanding, and accepting that we are not alone in our shame and that shame does not identify us as who we are
“People are just as wonderful as sunsets if you let them be. When I look at a sunset, I don’t find myself saying, “Soften the orange a bit on the right-hand corner.” I don’t try to control a sunset. I watch with awe as it unfolds.”
― Carl R. Rogers, A Way of Being
Freedom looks like
- Healing from past transgressions
- Resolving inner conflicts
- Understanding addiction
- Removing blame from oneself and others
- Letting go of perceptions, thoughts, and behaviors that do not help us climb the mountain of recovery
- Being released from the slavery of addiction
- Having free time for self-care and having fun
- Positive self-talk
- Ability to achieve goals
- Having meaning and purpose in life
- Having meaningful and long-lasting relationships
- Inner peace
Oregon Trail Recovery is an addiction treatment center with a multi-modal approach to treatment enhancing the self-efficacy of clients to promote probabilities of long-term success. Our clinicians are certified, educated, licensed professionals with shared life experiences who are qualified navigators in the field of substance use disorder. Through multifarious methods, it is inherent to provide interpersonal growth leading to enhanced self-efficacy. Uncovering and understanding shame from multiple perspectives leads to many resolutions and thus towards the path of emotional freedom.
Meehan, W., O’Connor, L.E., Berry, J.W, Weiss, J., Morrison, A., Acampora, A. (1996). Guilt, Shame, and Depression in Recovey From Addiction. Journal of Psychoactive Drugs, 28(2), 125-134.
Scheff, T. (2005). Shame and the Social Bond: A Sociological Theory. American Sociological Association, Sociological theory, 18(1), 84-99.
Snoek, A., McGeer, V., Brandenburg, D., Kennett, J. (2021). Managing Shame and Guilt in Addiction: A Pathway to Recovery. Addictive Behaviors, 120. Doi.org/10.1016/j.addbeh.2021.106954.
Johnson, L. (1990). Creative Therapies in the Treatment of Addictions: The Art of Transforming Shame. The Arts in Psychology, 17, 299-308.
Pinel, J. (2014). Biopsychology. University of British Columbia (pp. 369-390). (9th ed.). New York: Pearson’s.
Robinson, T. E., & Berridge, K. C. (2008). Review. The incentive sensitization theory of addiction: some current issues. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 363(1507), 3137–3146.
Hand, K. (2019). Nuerobiological Theories on Substance Abuse Addiction. Senior Seminar, Flagler College.
Lake, L.M. (2013, Nov. 8th). No One Brings Dinner When Your Daughter is An Addict. Families Dealing With Mental Illness Need Support, Too. Families dealing with mental illness need support, too. (slate.com).
Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35(1), 217.
Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35(1), 217.