Stigma: Shame & Guilt Prevent Treatment and Recovery

Stigma, causing shame and guilt, attached to substance use prevents people from asking for professional help. Guilt says “I am doing something terribly bad and deserve to be treated badly.” Shame says that “I am a bad person and do not deserve anything good in life.” When these two beliefs are combined, it becomes almost impossible to admit to others or to ourselves that we have a health condition causing use of drugs or excessive drinking. The same for family members. When families feel guilty or shameful about the substance use of someone they care about, they often deny the seriousness of the problem and don’t reach out for help.

Family members often believe their behavior causes their loved one to use. They believe if their behavior or attitude were different, the family member would stop using. When change does not happen, they feel that there is something wrong with them (shame). They try harder to behave in a way that will help, usually with no professional guidance. The addict will blame the family member. The family member will believe his or her own behavior, rather than substance use, is the problem (guilt). It is a never-ending cycle of shame and blame until qualified help is accepted.

Making the stigma worse, people often believe addiction and alcoholism are “moral” problems rather than a disease or health condition. Others might see the substance user as just a bad or a sinful person. Until substance dependent people and families understand that addiction is a physical, emotional, spiritual, and social disease, they likely will not stop feeling guilt and shame.

Does a family feel guilt and shame when a loved one develops diabetes or heart disease? In many ways, substance use is similar to these diseases. Diabetes and heart disease are physical diseases that require a treatment. People must change their behavior and attitudes to recover from any disease. Some recoveries, such as diabetes, require a lifetime of maintenance. There is usually some relapse involved in all chronic conditions.

This is true of addiction. If a diabetic chooses to eat sweets, he will have a “relapse.” An addict chooses to pick up a drug of choice. There is little difference. Why do families get angry when an addict relapses, but not if a diabetic or heart diseased person relapses?  How would you feel if the person with diabetes or heart disease constantly sneaked the wrong foods, or failed to take medications as prescribed? If you drove the person with the illness to the doctor and dropped them off time and time again, only to find out they didn’t go to the appointment, took the money provided for medications but instead bought foods that would kill?

Those families would become upset. However, because there is no “stigma,” attached to diabetes, heart disease and other chronic illnesses, they would not feel so ashamed or guilty. A “stigma” is created by a large number of people making a judgment that certain behaviors are bad or morally wrong. This reinforces people feeling ashamed and guilty when they become addicted to alcohol or drugs.

When people feel guilty and shameful, they will not reach out for help until there is so much pain that they can no longer take it; often it is too late. When an addict feels shame and guilt, only one thing will relieve it – using drugs or alcohol. Then, when the “binge” is over, there is more shame and guilt, the need to eliminate the feeling returns. To relieve it substance are used and the cycle continues.

When family members feel shame and guilt, they try harder to keep the addict or alcoholic from using. The family is usually not open to making real changes.  Without professional guidance, they seek short-term solutions, such as making excuses for the addict, helping pay bills, providing food, etc. These “solutions” keep the problem alive. Until the system of addicts, families, and significant others accept that it is a treatable condition, there will likely be no solution.

The best solution is treatment for both the family and the substance user. A few hours of brief treatment rarely resolves the problem; it takes months, sometimes years. For the addict, this may include inpatient and/or outpatient treatment. Recovering patients feel, look and function much better within a few weeks, but that is just a beginning. It takes months of constant work for deeper change to occur that will resolve the condition resulting in alcohol and/or drug use.

The 12-step programs such as Alcoholics Anonymous, Cocaine Anonymous, or Narcotics Anonymous are viable long-term support programs. Family, counseling and 12-step programs such as Al-Anon, Co-Anon, or Nar-Anon can help the family understand behaviors and relieve guilt and shame. The solution is simple, but until people break through the denial caused by shame and guilt, little will change. Deep change takes time and effort.

Henry Tarkington, MSW, LCSW, LCAS, CCS

“After 3 ½ years of sobriety, I relapsed; part of my recovery and turn to a life of sobriety was to seek help from First Step Services. During my time at First Step, I was impressed with the professional atmosphere and the group atmosphere had a major impact on my treatment. I have a renewed sense of responsibility for my recovery. First Step helped me realize the shame I was carrying about my actions. First Step has also given me strong tools to handle my guilt, find how to move forward in my life without substance abuse. I have great appreciation for all I have been able to accomplish with my time with the staff and other group members at First Step Services.” Anonymous

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