The most effective trauma resolution and addiction recovery work will not last if shame is bypassed during treatment. In fact, bypassing shame can often fuel an addiction, said Katie Thompson LPC, NCC, CEDS, at the National Conference on Addiction Disorders (NCAD).
Shame must be identified and addressed as one of the roots of addition, she added, and teaching patients shame resiliency will allow them to make better strides in treatment.
What is shame?
“Shame is the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging," said Thompson, who quoted Brené Brown, a shame and vulnerability expert.
Shame is often used in society as an agent of change without realizing how much damage it does, Thompson said. While everyone has healthy shame—an emotion tied to guilt that signals our moral compass and limits around right and wrong—there are types of guilt that aren’t healthy. Those include toxic shame, shame spirals and shame webs.
Toxic shame is believing that the whole self is fundamentally flawed and defective to the point were the self becomes an object of contempt. It's tied to all feelings, and the state of being “shame-bound” becomes an intolerable state of being for the patient.
Thompson likened toxic shame to a funhouse mirror, or the patient having an image of one’s self that is distorted by abuse and abandonment. Toxic shame is also highly connected to trauma.
A shame spiral is the recycling of toxic shame that’s difficult to step out of, and is often accompanied by a victim stance.
Shame webs are layered, conflicting and competing social expectations (who, what, how one should be). Entanglement in a shame web causes fear, blame and disconnection within a patient that creates shame.
Thompson said the most common shame categories are appearance and body image, money and work, motherhood/fatherhood, family, parenting, and mental and physical health—including addiction and surviving trauma—and the development and internalization of these types of shame must be understood.
Addiction as a mediator, false protector and prophet
Shame often functions to protect a person from the world witnessing their perceived defectiveness, she added, which acts as a barrier during recovery. When a patient has shame, they also often have no resolve reinforcement for breaking an addiction.
For a shame-bounded person, the addiction often "steps in" to protect them from the pain of cycling shame and numbs them to it, said Thompson. For example, the addiction can be used to guard the person’s truth about feeling defective, protect them from those beliefs, change their perceived "badness," hide their defectiveness, etc. And the behavior is cyclical. Like an overflowing bucket, the addiction produces more shame that gets added to the person’s reservoir that fills up and pushes the person into a shame spiral.
“While it protects, it simultaneously destroys,” she Thompson said. "The addiction only reinforces their original beliefs rooted in shame, and as a result, the person loses connection, is isolated and cannot function in life."
Resiliency in recovery
During recovery, patients typically have three layers: addiction (outer), shame (middle), and trauma (inner), she said, and the most effective trauma resolution will not last if shame is bypassed.
“It’s like attempting to consume the flesh of an apple first without consuming the peel,” Thompson said. Using basic dialectical behavioral therapy and bypassing shame actually made addiction stronger and had clients symptom swapping, she added.
This is where shame resiliency comes into play. According to Brené Brown, "It is the ability to recognize shame when we experience it and move through it in a constructive way that allows us to maintain our authenticity and grow from our experiences." It allows patients to avoid getting caught in a shame web.
Qualities of shame resiliency
Ability to recognize and understand shame triggers;
High levels of critical awareness of own shame;
The willingness to reach out to others; and
The ability to speak shame.
Thompson recommends asking clients four questions to kick-start resiliency:
Who do you become when you’re backed into the shame corner?
How do you protect yourself?
Who do you call to work through it?
What’s the most courageous thing you can do for yourself when you feel small and hurt?
Answering these questions, she said, allows patients to gain critical self-awareness that will enable them to cultivate hope, let go of powerlessness and numbness, and also step out of a victim stance. Integrating and applying these tools and skills day-to-day will help patients navigate recovery and beyond.
Shame resiliency also helps to stabilize addiction behaviors and process trauma in a more fluid manner, while also facilitating and reinforcing lasting recovery, she added. But patients must take ownership of their addiction for this to work. If they can't, Thompson recommends referring them to more intensive treatment.