Episode 77

Shame and addiction cannot be separated.

The deeper someone goes into their addiction, the more things happen that they want to keep hidden. So many things are “normal” when a person is stuck in active addiction. Things that “normal” people who shake their heads about or even recoil in disgust. Shame is a huge part of why people don’t seek help. They don’t believe that they could ever be totally honest about what they have done. It takes a while for the whole truth to come out. It’s like they are breaking off a piece of shame at a time and bringing it forward. While they experience some relief, they still believe that they can’t share everything. Our role is to help them uncover shame and offer a place of openness and non-judgment. We cannot talk about shame without talking about Brene Brown. Links below will bring you to her work if you haven’t had the chance to hear her speak. 


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 77. We’ve been talking about starting the assessment and some of the things that get in the way. Some of those things could be on our side. Maybe we don’t feel like we know enough, or maybe we feel like we don’t know what questions to ask. Some of it is on the client side. Maybe they’re afraid of telling us things. Maybe they’re afraid that they’ll be judged.

We talked about fear and addiction and episode 74. Today, we’re going to talk about shame and addiction. Shame is a universal feeling, not just for people who are using substances, we have all felt the wash of shame. I have felt it when I’ve hurt someone I love with a careless comment, or when I realize I forgot to do something I said I was going to do for a client. I’ve felt shame when I remember things that I did or said that go against my own values. 

In some ways, I feel like shame is the biggest feeling we have.  I feel like shame is one of the biggest determinants of whether or not we’re going to tell the truth about something or whether we feel like we have to hedge our bets a little bit and keep back some of the truths. In a lot of places, shame is matched with the word guilt, as in someone’s feeling shame and guilt about something.

The idea here is that these are synonymous and in fact, they’re very different.  Before we start this conversation today let me clarify that the way I think about shame comes directly from the work of Brene Brown. Brene Brown is a shame and vulnerability researcher. She has been doing research for the last 20 years on these concepts and how they impact human behavior. So if the things I say sound similar to what she says, I want to honor her work and give credit where it’s due. Her views and research on shame were transformative for me in the way that I understand people, their motivations and vulnerability. 

We talked about minimizing as being one of the main difficulties to getting accurate information about substance use. My belief is that shame is underneath the minimizing that we do. I believe the reason that we don’t want to tell our doctor how much junk food we eat, that we don’t want to tell someone how much time we sit watching TV or Netflix or whatever, that the reason we don’t want to tell someone that we leave our house messy or don’t get certain things done is about shame. 

I had a supervisor who used to say that shame was paralyzing and that guilt is motivating. The idea put forth and that is widely echoed in the community is that  shame is not guilt. Shame is a focus on self. Guilt is a focus on behavior. Shame is I am a bad person. Whereas guilt is, I did a bad thing.

I believe that guilt can be motivating and that guilt can be very adaptive. The research bears this out. Shame however, is paralyzing and toxic and in no way adaptive. Shame tells us that we are bad, flawed, never going to be good enough. Shame is the voice in our heads that tells us that we’re an imposter, that tells us that we don’t belong in whatever space we’re in and that we should slink into the shadows.

Very often online in therapist’s groups I see the phrase imposter syndrome. The imposter syndrome being that they feel like they’re playing at being a therapist and being competent, but that they really aren’t and that why should people listen to them? That voice is shame. It’s coming from some place in them that’s telling them that they don’t belong there and they aren’t good enough. Vulnerability, as Brene brown says, is the antidote to shame 

Vulnerability can be a scary word for people. I know for myself it was. I grew up in such a way that I was always kind of large and in charge. Even as a small child, I did what I wanted, said what I wanted and generally was the first one to be willing to put myself out there. My mom used to say that I went through life like a Mac truck. Add to that, that I grew up in a family with both parents having been in the military and while they weren’t super strict militant parents, we did have a don’t show weakness sort of subculture. It was a, “you’re not bleeding” “you’re fine” sort of situation. . So showing vulnerability wasn’t something that I really had modeled for me. It also wasn’t something that I felt like was really safe.

I’ve always been really open and so people feel like they get to know me really well. What they didn’t know was that while they got to know me, If they pushed in a little farther, they would meet an extremely high and thick wall to keep people from seeing the soft side. In fact, I was so good at it I’m pretty sure that a lot of people weren’t certain I had a soft side.

It wasn’t until I went to graduate school that I learned the power of vulnerability for myself. I had a best friend and a roommate who was in graduate school with me. She had been raised more stereotypically for a woman to not speak up, to be nice, to be quiet, to be helpful, cheerful, all those sorts of things. That wasn’t how I was raised. I was raised to just be myself. My encouragement for her was always to say what you want, speak up, be yourself. 

The first day I saw her, my thought was she’s too perfect to be friends with. She saw me and thought she’s too scary to be friends with. What would happen over the next couple of years  is that we kind of rubbed off on each other. I helped her speak up for herself and feel good about it. And I think she made me softer. She was comfortable with vulnerability and with softness and with emotion.  I was comfortable with that in everyone else, but for myself, I just couldn’t do it. There wasn’t anyone I felt that was “safe enough” to be able to let my guard down.

I remember the moment that I experienced the power of vulnerability in a way that would stick with me. We were in my hometown, which is where our grad school was and in. a, park that I had gone to from the time I could remember as a child did brownies and girl Scouts and swim team at the pool. Here I am in that park, talking with her about some stuff that had gone on in my life when I was young. The story I was telling her, I had retold before, but I always held back one little piece of information.

It was this piece of information that I felt like was going to turn the listener against me. That my brain and the shame that I had was telling me that this was the reason that. I was to blame for all of the pain that I had experienced. I remember pacing back and forth in an empty parking lot on a cool evening and she was just leaning against the car, being silent, waiting for me to speak. I finally spoke the words and what I got back you won’t be surprised to hear, but I was. I heard her telling me that that didn’t change her opinion. That she still felt like I wasn’t in the wrong. That she still thought that I deserved compassion and grace. It sounds really simple, but it was profound for me.

And it was also like the breaking of a dam. I experienced more opportunities that year to be vulnerable and allow people to see what was happening inside and to let go of some of the things that I’d been carrying for a really long time.  It was transformative, freeing, liberating. It wasn’t easy. It didn’t feel good because being vulnerable is hard. It’s not something that we’re necessarily going to love, but the outcome of it was so worth it.

I never went back to that previous persona. I am fairly squishy inside, even though those around me might not always see that. You can still be a bad-ass and be soft inside. A client of mine and I were discussing this as she was trying to figure out how do you be a bad-ass woman and stand up for yourself and also remain soft. Later she had found a quote and she sent it to me and it said “Water is fluid, soft and yielding, but water will wear away rock, which is rigid and cannot yield.  There is another paradox. What is soft is strong”. 

Shame and addiction are intertwined. There will always be shame around addiction unless somebody is a true sociopath and incapable of feeling shame. Even the most confident people who present things as though they don’t give a fuck what other people think. Most of that is untrue. We all care. If we can release the shame and help them get vulnerable, it will clear the way for a lot of the work that they need to do and that we want to help them with. 

Shame and addiction can not be separated. Even the research tells us that shame is highly correlated with addiction, depression, violence, aggression, bullying, suicide, and eating disorders. Guilt on the other hand is inversely correlated with those things. 

Shame is that sneaking suspicion that if people knew who you really are, what you really think and what you’ve done, that they will never love you and that they would never want to be around you. Some of you know that all too well. 

The reason that groups like Alcoholics Anonymous even started, had to do with shame. When people go to meetings now, whether it’s AA, NA, Smart Recovery Life Ring, Recovery 2.0, She Recovers any of the groups that work on building a life of recovery the thing that people have in common is that they don’t have to feel ashamed because the people in the room virtual or otherwise have similar stories. 

There is a boatload of “normal” behavior for people struggling with addiction of all kinds. The stories that they tell are very similar. 

I thought I would tell you some of the things that are normal for people who are using. This isn’t an endorsement of these behaviors. I’m not saying that they’re right or moral or okay. I’m just saying that when addiction is involved, these things are normal.

It is normal to do whatever the behavior is in secret. It is normal to lie about where someone’s going or where they’ve been. It is normal to have two different lives. It is normal to lie. It is normal to steal. It is normal to cheat. It is normal to cover things like up. It is normal to plan elaborate ways to be able to do the thing that you’re struggling with. It is normal to think about it almost all the time and then when you’re doing it you don’t have not as much satisfaction as when you were thinking about it.

It is normal to do things you wouldn’t normally do. Like waking up next to someone you don’t even know. Sleeping with random people in order to get the thing that you need. Staying in a relationship because the person has money or a hookup or something along those lines. It is normal to use dirty needles. It is normal to steal from loved ones. It is normal to be around people that you would never think you associate with. It is normal to watch crimes happen and do nothing. It is normal to look the other way when something bad is happening. It is normal to miss family events. It is normal to not see your children. It is normal to make promises and break them.

It is normal to have suicidal thoughts. It is normal to use until you pass out just to avoid dealing with reality. It is normal to put whatever behavior it is above everything and everyone. That is the power of addiction. The shame that is associated with every single one of those things I named is incalculable.

People who are struggling with addiction know that they have done terrible things. They know they are so far beyond their own moral compass and the shame is real. When AA started, it was because Bill W and Dr. Bob were able to share their stories with each other. And in sharing, they heard that they had similar experiences and it lessened the shame. All the time. When people go to meetings or encounter other people who’ve struggled with the same thing, the shame lifts a bit.

I remember sitting in a group of women and  we were talking about what was normal in the life of addiction.  In this world, women have something that men want: their bodies. Most women I have worked with have either stayed with someone because they were able to get money or access their substance of choice or slept with someone for the same purpose. The shame associated with that is incredible. There’s a lot of judgment on people for doing that, even though lots of people sleep with random people just to feel better and just to feel desired for a moment. It’s the same behavior. Of course they feel shame about that too. We have this ideal about what behavior should be and what is good.

The ideal is to be good and kind, and honest and generous and successful and a productive member of society or whatever. Anything that falls short of that brings shame. 

The majority of the people that I have worked with and known in my life have secrets that they want to take to the grave. For you and me, the secrets may not seem like a big deal for them though they’re convinced that this secret is the thing that determines whether or not they deserve to be loved and cared for. That shame is so all encompassing.

Shame does present differently for men and for women. I want to take a second to say that the research that’s been done so far is primarily on people identifying as male and male assigned at birth and people identifying as female and female assigned at birth. So I want to acknowledge  that there’s much more complexity to gender and that for our conversation today I’m focusing on the two categories of men and women. 

For women the message is do everything, do it perfectly and never let people see how hard it is. This is career and being a mother and  being a sexual partner and being beautiful and looking the part. When a woman tries on a pair of jeans and the jeans don’t fit, she thinks my body is wrong. Or my body is the problem. When men try on a pair of jeans and they don’t fit very often, they think these pants are stupid. It is a very subtle change, but it is really real. For women shame is often about what they weren’t able to do, or people seeing the places they feel like that they have to hide or the ways they fall short of that perfection model.

For men, it’s different. For men, it is about not being weak. Be strong, be stoic, never show weakness, don’t show emotion. If you do, you can show anger, but nothing else. Shame keeps men locked up just as much as it does women, but in a different way. 

Brene tells the story in that 2012 video about a man at a bookstore. He came up and was talking about enjoying her work, but asked her why she didn’t talk about men. And she said, I don’t study men. And he said, that’s convenient. And she asked why, and I’m just going to read you the quote from the video just to make sure I get it just right.

“And he said, because you say to reach out, tell our story, be vulnerable, but you see those books you signed for my wife and my three daughters. And she said, yeah. And he said, they’d rather me die on top of my white horse than watch me fall down. When we reach out and be vulnerable, we get the shit beat out of us. And don’t tell me it’s from the guys and coaches and the dads because the women in my life are harder on me than anyone else.”  

She goes on to say. “So I started interviewing men and asking questions. And what I learned is this, you show me a woman who can actually sit with a man in real vulnerability and fear, and I’ll show you a woman who’s done incredible work.”

We are the safe place for vulnerability. That is our whole job is to be a safe place for people to be themselves. Much of what we do in building rapport, creating a relationship, holding space is about allowing that person to come in and to be fully themselves. It is a gift. It is a sacred gift that we give to people. When you ask someone about their substance use. They’ll be able to tell you about a little bit of it. They might even be able to tell you more than an average person might. 

However, there will be a moment where they take a sharp turn and stop being able to tell you the whole truth. They have to edit. They have to change what they’re saying, because the truth is too shameful for them to say out loud. 

In the 12 steps of AA and NA the fourth and the fifth step address this outright. The fourth step reads: made a searching and fearless moral inventory of ourselves. What this means is that a person who is working the steps writes down all of the things that they have done and things that they are ashamed of. Ways they have harmed others and themselves, and even people who were unknown. It is a purging of all of the darkness that they hide. All of the things that they never wanted to say to another human. The person then takes their fourth step as it’s called and they read it to another person out loud.

The fifth step says: admitted to God, to ourselves and to another human being, the exact nature of our wrongs. Let me clarify the 12 steps aren’t necessarily right for everyone. I’m not saying that the fourth and fifth steps aren’t perfect. I do believe that the spirit behind them is right. That we face the things that we feel ashamed of. That we find a safe person to share them with. And that they’re non-judgment of us; their acceptance of us is incredibly healing. 

I don’t know if everybody has to do that for their own recovery. I do know that in my recovery sharing those things was really important for me. Being honest about the things that I did while I was using was healing for me. It wasn’t about my relationship with the God of my understanding. It wasn’t about following the steps. It was about my own absolution, about showing my deepest and darkest places to another human and feeling acceptance and love. If done correctly, I have seen the fourth and fifth step be a breakthrough.

I have seen it be empowering in a way. I cannot describe. The feeling of knowing you have no more secrets is astounding. Being real about who you are at your base nature and accepting that that doesn’t make you a terrible person and that it is part of being human is transformative.

When I work with someone who’s deep in their addiction and I hear things that they’ve done for the most part, I’m not super shocked. Because the stories really do sound very similar. Places and people are different, but it’s pretty similar. Once in a while, there’s something that’s a little shocking and in my own heart, I know that if I were still using or if I picked it up again, that eventually I would be in that exact same place. 

Whether the details were exactly the same or not I know in my heart what I am capable of and it does not bring me shame. I accept the parts of myself, good and the bad and the ugly. And I work to be the best self I can be all the time. When I am wrong and I do something that hurts someone that is guilt and I apologize and I strive to do better. 

When I feel shame pop-up because of course I do. I’m aware of it for what it is. I hear that voice, that voice, that my friend Kelly coffee calls the beast. She and I did an interview back. I think it’s episode 15 and she calls it the beast, that voice in your head that says, who do you think you are? See, you haven’t changed. You call yourself a therapist or any other number of things. 

I recognize that for what it is and come back to what I know to be true about myself. That is the gift that we give to people. That is the work of what I do using EMDR to treat trauma. To help people dig out the roots of these negative beliefs that they have. Beliefs that say they’re unlovable, that they’re broken, that they’re hopeless, that they are bad and help them believe something new about themselves. 

We are the key in unlocking shame for people. Where else in their life do they have someone whose entire job is to reflect back to them unconditional positive regard.

When you are assessing for substance use, shame will pop up. Immediately the person’s mind will go to the bad experiences. That isn’t necessarily what they’re going to tell you. They’re going to tell you whatever it is they feel like will be most acceptable. It is practice that helps someone be honest about their history.

When I bring recovery stories to you, which we’ll have one next week, what the person is doing, who’s sharing their story is directly working against shame. They’re sharing stories that make them vulnerable in front of others and vulnerability is the antidote to shame.

Brene has said shame exists and grows exponentially when there is silence, secrecy and judgment. I think we can all agree that  in our therapy rooms, having to be silent about your struggle, having to keep secrets and being judged are not congruent with what we’re doing.

So when you set this conversation up, when you talk with the person about their substance use, be aware how insidious shame is and that the person might be telling you one thing, and that shame is active in the background, keeping them from telling you the whole truth. Recognize when they’ve given you something a little extra, they’re being a little more vulnerable, encourage and nurture that.

I have found over 19 years of doing this, that, that is an incredibly freeing situation for that person to be in. That once the shame has been loosened and no longer holds them, we can do incredible work. All of our assessment of substance use is to this end.

We want to find out what’s keeping this person stuck, how to help them move forward. This is just one more area that we’re assessing in order to help move them towards the future that they want. 

The commitment to being vulnerable is a daily one.  And sometimes even a moment to moment one. Vulnerability is something that we choose and that we have to keep choosing. Vulnerability is at the heart of true connection to another human being.  I truly believe that shame keeps people stuck and that getting rid of it, bringing it into the light is transformative. 

At the beginning of this month, we heard a recovery story of a man named Jonny. He talked about how he felt like he couldn’t be himself anywhere. Like he had to keep all of it inside. He was plagued by self-doubt and fear and shame.  When he finally was able to just be himself it transformed him.

If you haven’t had a chance to listen to Jonny’s episode, head over to betsybyler.com and it’s Episode 75.  Next week we’re going to be talking about getting started in the conversation about substance use with your client. I hope you’ll join me for that podcast. And until then have a great week.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links

https://brenebrown.com/videos/ted-talk-listening-to-shame/ Brene Brown from 2012

https://brenebrown.com/podcasts/ Two podcasts by Brene Brown

https://brenebrown.com/the-research/ The research that Brene Brown has done on shame and vulnerability 

Assessing Addiction: Concepts and Instruments

Clinical assessment of substance use disorders – UpToDate

The Clinical Assessment of Substance Use Disorders

Resources for Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA

NCDAS: Substance Abuse and Addiction Statistics [2022]

Free Treatment Planning Tool https://betsybyler.com/treatmenttool/