Chronic shame and unworthiness are common among people who struggle with addiction and are often magnified by societal stigmas attached to being an addict. Shame can create barriers to a healthy, values-driven life and make it difficult for people to maintain sobriety.
In their chapter about shame and stigma in the edited volume “Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions,” Jason Luoma and Barbara Kohlenberg suggest that working with shame can be helpful during treatment for those struggling with addiction.
“Early data seem to indicate that facilitating clients in recovery in relating to their shame and negative self-judgment with compassion and mindful awareness and turning their attention toward values-based action may be helpful to them,” write Luoma and Kohlenberg.
Not only does research suggest that substance users are viewed as lacking willpower, worthless, incompetent, unreliable, and untrustworthy, to name a few, Luoma also found through his own research that substance users were discriminated against in the realms of interpersonal relationships, housing, and employment (Luoma, 2011).
To add insult to injury, people with addiction issues also tend to struggle with self-stigma, the internalized negative attitudes from those around them.
Luoma and Kohlenberg present a model based on acceptance and commitment therapy’s psychological flexibility model of human behavior that aims to “lighten the burden of shame and stigma on those in recovery.”
They outline three contexts that shape the way shame and self-stigma function for people with addiction. The following has been adapted from their chapter in “Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions.”
The presence of shame, painful self-evaluation or fears about being stigmatized are not the root of the majority of the harm that comes from self-stigma. Actually, it is the attempts to avoid people, events and things that may bring on these experiences that come at the highest cost.
“A person in recovery might search for signs of being seen as immoral, resulting in interpersonal disruption. Or a person in recovery might give up parenting in part to avoid possibly confirming the stereotype of unreliability,” write Luoma and Kohlenberg
Of course, substance use itself may be a kind of experiential avoidance that is exacerbated by shame and negative self-evaluation.
But Luoma and Kohlenberg warn that clinicians should be cautious not to suppress shame; doing so can have adverse effects such as the continuation of substance use or deviant behaviors. Suppressing shame rather than working with it can mean violating personal values without feeling the shame that might otherwise deter such behaviors.
Conversely, a healthy expression of shame may help those struggling with substance use rebuild relationships and experience the benefits of social support.
“Rather than trying to avoid, suppress or otherwise change unwanted shame, self-devaluing thoughts or fears of enacted stigma, acceptance fosters the ability to compassionately notice difficult experiences, accept them as they are, and non-avoidantly shift attention toward values-based actions,” write Luoma and Kohlenberg.
When we fuse with the judgments and evaluations we create with our thoughts we aren’t able to clearly see that these thought processes are just that—processes—and not ultimate truths.
“Evaluations of self and others tend to be global and negative, undermining the ability to respond flexibly. When a person is fused with the thought I’m bad, that thought says little about what to do next,” write Luoma and Kohlenberg.
This is where the teachable process of cognitive defusion comes in. People can learn to notice their thoughts rather than immediately fuse with them as truths, which diminishes the thoughts’ ability to dictate over behavior.
When people who struggle with addiction are able to see their negative thoughts, evaluations and judgments as cognitive processes rather than ultimate truths, they are more able to engage in values-based actions.
It’s natural for us as human beings to want coherence in the stories we create about who we are and why we do the things we do. But this need for coherence in self-concept can cause problems when those views are negative or maladaptive. Behaviors that go against the things that matter to us can reinforce negative ideas we have about who we are, which tends to lead to further deviant behavior.
“People are often motivated to hide the “damaged” self in order to avoid rejection, leading to withdrawal and secrecy about their problems with addiction. Unfortunately, secrecy in the context of substance misuse has been related to poor outcomes and lowered social support,” write Luoma and Kohlenberg.
In the psychological flexibility model, clinicians would help those with addiction learn to hold less tightly to their rigid self-concepts in order to encourage more flexible responses and values-based choices. Like cognitive defusion, this allows people to step back from their negative self-evaluations and thoughts and foster a broader repertoire of behaviors that may or may not be consistent with their cognitions and existing story lines about who they are.
“We hope that this work can lead to more compassionate and effective treatments for people with addiction problems, freeing them from imprisonment by shame and stigma,” write Luoma and Kohlenberg.