Shame & Guilt Prevent Treatment and Recovery

            Shame and guilt are two of the main reasons substance abusers and their families take so long to reach out and accept help. Guilt says "I am doing something terribly bad and deserve to be treated that way." Shame says that "I am a bad person and do not deserve anything good in life." When these two beliefs about ourselves are combined, it becomes almost impossible to admit to others or to ourselves that we are doing something wrong, like using drugs or drinking too much.

            The same thing goes for family members. When they feel guilty or shameful about the substance abuse of someone they care about, they will also deny the seriousness of the problem and not reach out for help.

    Shame and guilt often makes family members believe that their own behavior causes the substance abuser to use. They feel if their behavior or attitude were different, the addict would change. 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 the addict. The addict will then blame the family member, and the family member will believe his or her own behavior is the problem (guilt). It is a never-ending cycle until they accept help.

    Part of the problem is often people believe addiction and alcoholism are “moral” problems rather than a disease. Instead of seeing the problem as a disease, others often see the substance abuser as just a bad person or a sinful person. When chemically dependent people and families start to understand that addiction is a physical, emotional, spiritual, and social disease, they may not stop feeling the guilt and shame.

    Does a family feel guilt and shame when a loved one develops diabetes or heart disease? Chemical dependences is very similar to these diseases in certain ways. 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.

    This is just as 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 very little difference. Why do families get so angry when an addict relapses, but not if a diabetic or heart diseased person relapses? I'll bet they would if the behaviors were similar. How would you feel if the person with diabetes or heart disease constantly sneaked the wrong foods, or failed to take her medications when she should? If you drove him to the doctor and dropped her off time and time again, only to find out she didn't go to her appointment, and then she took the money for the medications and bought foods that would kill her?

Those families would become plenty angry, but because there is no "stigma," attached to diabetes and heart disease, they would not feel so ashamed or guilty. A "stigma" is when a large number of people make a judgment that a certain behavior is bad or morally wrong. That is part of the reason people feel so ashamed and guilty when they become addicted to alcohol or drugs.

When a person feels that way, he will not reach out for help until he is so much pain that he cannot stand it any more. 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 only much more shame and guilt, so he has to relieve it again and the cycle continues.

        When family members feel shame and guilt, they try even harder to keep the addict or alcoholic from using. They are not open to making real changes. They only want to look at short-term solutions, such as making excuses for the addict. These are not solutions at all, and in reality, help maintain the problem. Until the whole system of addicts, families, and others close to the problem accepts that it is a treatable disease, there will likely be no solution.

The long-term solution that usually works is treatment for both the family and the addict. For the addict, this may include inpatient and/ or outpatient treatment and 12-step programs such as Alcoholics Anonymous, Cocaine Anonymous, or Narcotics Anonymous. For the family, it probably includes counseling and 12-step programs such as Al-Anon, Co-Anon, or NarAnon. The solution is simple, but until people break through the denial caused by shame and guilt, little will change.

By Henry Tarkington, MSW, CSAC

Protected material -- do not reprint without written permission