Introspection can lead a person to look at the pluses and minuses of life. It will cause a person to look at things that have been done well and things that could have been done better. It can bring about growth through change. As a Lake Worth drug rehab, we have helped millions of people overcome drug and alcohol abuse, but it’s hard to say exactly how many people with the active addictive diseases are still out there.
With all of our experience, we know that the topic of “shame” comes up frequently. It comes up in the treatment setting and 12-step recovery meetings. Today we wanted to talk about eliminating shame in addiction recovery and how you could go about doing that as a recovering addict or someone close to one.
How We’ve Contributed to the Shame Cycle of Addiction
The first publication created by Behavioral Health of the Palm Beaches (BHOPB)’s Research Department was an outcome study published in 2006. At that time, the Research Department consisted of two people, myself and Dr. Donald Mullaney. Though making the phone calls was painstaking and tedious, it was at times very rewarding. As a result of those phone calls, a few people returned to our Lake Worth, FL, drug rehab for addiction treatment and got back on track.
We did the best we could. We had to trust in people’s honesty. It was often hard to track people down. The result was that 63% of the people remained substance-free one year after leaving residential treatment at BHOPB. We did an honest job. A 63% percent success rate seemed reasonable. We were pleased with ourselves.
“We never really paid attention to the finding that 37% of the patients we contacted were labeled ‘failures.’ You were either a ‘success’ or a ‘failure.’ There was nothing in between. After all, it was a study designed to determine our ‘success rate.’”
Creating “treatment failure” led me to start thinking about and paying attention to other ways that we may have unintentionally created shame. Unfortunately, I found a few.
We’ve all heard patients say, “I’ve been to treatment before.” Are they saying that they’ve failed before? It has to feel bad. It has to feel shameful. I wonder what it feels like to say, “I’ve been to treatment three times before.”
It makes me feel worse when I think about how many times I’ve asked a patient, “How many times have you been in treatment?” What am I really asking? The implication is, “How many times have you failed?”
Shame or the expectation of judgment will keep a person from returning for help if a relapse occurs. We may deny that this happens, but take a look at treatment plans for all patients who have returned to treatment multiple times. There’s always another first step and the telling of a story. There’s the assumption that a person who has relapsed didn’t get the first step. Where in the first step does it say anything about not drinking?
A person who has established a period of recovery is not the same as a newbie. A person who has experienced recovery has learned a thing or two. Likely, a return to social drinking didn’t work. That could be a lesson the newbie has yet to learn. A person coming back likely knows something about 12-step recovery, or maybe they know that trying to stay sober without support is difficult. These are valuable lessons.
The Language of Shame in Addiction Treatment
We tell our patients that they have a chronic disease, but we use acute care models. Acute care language has become the language of shame.
We convey the message that you better get well fast and in the way we want you to do it, or we don’t want anything to do with you. We have made statements like “come back when you’re ready” or “you need to do more research.”
I hate to admit that I have made similar statements to patients. What was I thinking? Would any one of us have made such a statement to a person with any other disorder?
Similarly, I’ve often heard the expression, “I’m not going to work harder on your recovery than you are.” On the other hand, we generally expect a patient to be in denial and ambivalent about recovery. So, do we expect a patient who is in denial of their disease and probably doesn’t want to be in treatment in the first place to work hard? We can’t have it both ways.
Traditionally, we’ve relied on one particular therapeutic skill to pull a patient out of their denial: confrontation. So if the patient is not shamed enough by this time, we yell at them. That may be an overstatement, but not always.
Another way that we create shame is through statements like “come back when you’re ready” or “you need to do more research.” As professionals, motivating patients is our responsibility. We can get better at motivating our patients, and we must. We can learn to use Motivational Interviewing and Motivational Enhancement to help the people we work with.
What we would never consider doing with other disorders, we should not do with addictive diseases, either. The therapeutic skills of addiction professionals have vastly improved from the days in which confrontation was the most frequently used counseling tool.
Let’s remember that treatment for addicts began with one person helping another. The people providing care were well-intentioned but untrained. Today therapists are mostly people with Master’s degrees and have been well trained in the use of therapeutic skills.
It’s important to remember, shamed or not, that a lot of addicts/alcoholics have gotten well because of devoted, well-intentioned people. We’re just trying to get better.
As a reader, you may not agree with every point, but I think that it’s hard to disagree with them all. It also seems possible to argue that developing a sense of humility is important in the process of recovery.
The line between shame and humility seems pretty blurry. Concepts like “powerlessness,” “unmanageability,” and “sanity” may be close to that line. Care needs to be taken when they are introduced.
It’s also important to remember that 12-step recovery is to be respected. We may have to teach patients how to cope with aspects of 12-step recovery that may not be working for them, but there is no support out there that approaches what 12-step recovery can do and has done.
Understanding Guilt and Shame in Addiction Recovery
But what exactly are guilt and shame in addiction recovery? While these words are often used interchangeably, there is a difference between guilt and shame. Guilt is a feeling you get when you do or perceive you did something wrong. Shame, on the other hand, is a feeling that your whole self is wrong and can be unrelated or related to a specific behavior or event, such as drug use.
When you feel guilty, you may feel remorseful or responsible for something you’ve done wrong or something you’ve perceived you’ve done wrong. Guilt usually relates to actions like mistaking, committing an offense, or hurting others, which is why it plays such a major role in addiction recovery.
Shame is also common in addiction recovery. It encompasses feelings of worthlessness, self-contempt, inadequacy, and feeling downright bad about yourself. Shame relates to our behaviors or self and other people’s opinions of us, not necessarily about a specific behavior or event.
Despite their differences, however, many recovering addicts experience both guilt and shame during treatment. And while many of us have unknowingly played a hand in perpetuating stereotypes, stigma, and shame, there are ways we can improve.
So How Do We Approach Shame and Guilt in Addiction Recovery?
Neither SAMHSA (2012) nor the American Society of Addiction Medicine (2013) includes abstinence from substance use as a measure of recovery. ASAM defines recovery as “A process of sustained action…in the direction of consistent pursuit of abstinence.” So, as long as a patient is still seeking abstinence, they’re still in the game. Why wouldn’t they be?
Diabetics who have unstable blood sugar levels that are still in pursuit of stability are never considered to be treatment failures. Only we do that! If perfect blood sugar was the criteria for the successful treatment of diabetes, almost every diabetic being treated would be a” failure.”
A similar argument could be made for the successful treatment of hypertension. Diabetics and people with hypertension are not considered to be “failures” as long as they’re treating their disease. Why not do the same for people with an addictive disease? It doesn’t have to be all or none: success or failure.
Shame in addiction recovery often stems from inner turmoil that can be traced back to one’s childhood and continuously fed through the person’s life. A victim of child abuse may nurse feelings of shame their whole lives and may even feel shame for not defending themselves more successfully. This leads to self-blame, self-doubt, mental distress, and eventually self-destructive coping mechanisms like drug use.
So what are some ways of dealing with shame in addiction recovery? Whether you’re the loved one of an addict or someone with a career in addiction recovery, below are some helpful tips you can follow.
- Recognize that these feelings are counterproductive
- Ask for forgiveness from those you’ve hurt in active addiction
- Let go of what you can’t control
- Be open with your counselors, sponsors, or addiction recovery advocates
- Focus on the positives: how have you improved?
- Be mindful of the language you use
- Remember that addiction recovery is an ongoing journey
- Forgive yourself
Eliminating Shame in Addiction Recovery as Specialists
It’s important to keep clients engaged in the process of getting well. We tell patients that we’re treating a chronic disease, but, traditionally, treatment has been heavily loaded on the front end.
We can learn something from how other chronic diseases are treated. Diabetics and people with hypertension will be monitored for their entire life. Can addicts have recovery check-ups with an addictionologist?
Check-ups could be quarterly or semi-annual, but it would keep addicts engaged in treatment. There wouldn’t be failures. There is something to be said for helping people in their “consistent pursuit of abstinence.”
With this in mind, our Banyan Lake Worth rehab offers alumni programs that provide clients with aftercare to help them stay on track after treatment. Because check-ups can make such a big difference in the longevity of a person’s recovery, we believe clients must become a part of our alumni program to receive continuous support as they transition to sober lifestyles.
The specialists at our BHOPB detox and addiction treatment center also believe that using the word “outcome” can be misleading. Now is when addiction is being recognized and treated as a chronic disease, which wasn’t the case in the past.
This means treatment for addiction needs to become more similar to the treatment of other chronic diseases, which recognizes that each disease has its characteristics. The intensity of care needs to match the intensity of the symptoms, which is why our facility offers various levels of addiction treatment, like inpatient and PHP. There should never be a time when an addict is not getting at least periodic recovery check-ups.
Additionally, if we’re treating a chronic disease, we’re not measuring an “outcome.” Rather we’re measuring progress at a given point in time. What a person has learned in the consistent pursuit of abstinence is important and needs to be taken into account when a patient with a history of recovery re-engages into a higher level of care (assuming that we consider that a patient has been engaged in a lifetime process).
It is true that within 12-step recovery, a patient would be encouraged to pick up another white chip signifying that the recovery process has begun again. Even within 12-step circles picking up another white chip has been referred to as “the walk of shame.” It is up to us to encourage a person to perceive it as a “welcome back” gesture.
We need to get better and take responsibility for motivating our patients. We don’t throw people away, and the progress they made in the beginning shouldn’t be dismissed if they relapse or hit a rough patch. As we’ve mentioned countless times, recovery is an ongoing process.
Addiction Treatment in Lake Worth
We understand the dangers of allowing guilt and shame to take over in recovery. Our specialists strive to create a safe and judgment-free space where clients can receive the treatment and support they need to overcome their addictions and achieve long-term sobriety. As we mentioned before, recovery is an ongoing process, and we meet you wherever you are.
If you or someone you care about is struggling with drug or alcohol abuse, call Behavioral Health of the Palm Beaches today at 561-220-3981 to learn how our addiction treatment in Lake Worth can help.