Shame and substance abuse | David Gregor De Bono

According to the National Institute on Drug Abuse, addiction is a chronic and recurring brain ailment characterised by the unmanageable consumption of a substance or the repetition of specific behaviours, such as gambling, even when faced with negative consequences. Despite experiencing a range of detrimental effects, individuals afflicted with substance use disorder (SUD) persist in engaging in irresponsible behaviour.

The widespread acceptance of the biomedical model can potentially be attributed to a tendency to provide biological explanations for human behaviour, even in cases where these explanations lack theoretical consistency or obvious empirical support. Multiple research studies have consistently demonstrated that individuals have the capacity to modulate and change their addictive behaviours merges with the biology and psychology of addiction. These findings suggest a dynamic interaction between volitional aspects and a significant social component that influences the origin and nature of addiction. Irrational behaviour and perceived lack of control can indeed be understood as motivated behaviour, ultimately prioritising immediate rewards over long-term advantages. It is only when the balance between the costs and benefits of substance use is altered that individuals may contemplate reducing or discontinuing their drug consumption.

One much-cited definition of shame confers it as an “intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging…shame creates feelings of fear, blame and disconnect” (Brown, 2006, p. 29). Shame has been labelled as the master emotion “because no other emotion plays such a central role in affective, cognitive, motivational, and behavioural experiences” (Turner & Schallert, 2001, p. 320)

Shame manifests itself in the intrapsychic, a feeling of being flawed, and in the relational, ‘the exposure of a flawed self’ (Wiechelt, 2007, p. 400) instilling the need to hide. Shame is the force that unites us as social beings, compelling us to reflect upon the social norms we have violated and urging us to restore our wounded sense of self. While profound shame can erode our very core, it also serves as a crucial motivating factor for addicts, compelling them to reclaim their lives, reconstruct themselves, and strive for personal growth. It ignites their desire to regain control.

While it is still not fully understood whether shame directly causes addictive behaviours (and/or vice versa), research indicates that individuals who experience high levels of shame are more prone to developing substance use disorders. The emotional baggage and negative self-talk that we carry from our early years can contribute to certain behaviours that provide temporary comfort and can lead to addiction. This creates a harmful cycle where active addiction triggers actions that evoke shame, causing one to increasingly rely on substances for short-term relief. Being ashamed of losing control or not meeting personal goals can drive individuals to hide their shortcomings. When societal shaming is added to the equation, the burden becomes overwhelming, leading to greater secrecy and dependence on substance use.

Despite a growing interest in that interface between shame and substance use, there is still a lack of comprehensive understanding when it comes to the complexities and nuances of shame. Whilst there are multiple viewpoints on shame that have yet to be explored through empirical research, little is understood on how individuals who engage in substance use perceive and grapple with shame. This gap in knowledge is particularly significant as well as problematic when one considers how therapists’ reactions can influence clients’ feelings of shame.

Concerned with such gaps and the dearth of research within the Maltese context, I am currently carrying out an M.Phil/Ph.D research that explores the ways shame effects persons who use drugs problematically could contribute to improving the quality of care provided to people using health services. Delving into and comprehending the real-life experiences of individuals affected by this phenomenon enhances our existing knowledge of the link between shame and addiction. The objective of this research is to assist practitioners when providing therapeutic support to these individuals with regards to the emotion of shame. Overall findings are expected to provide a more detailed understanding of shame related issues to addiction and its implication on addictive trajectories and desistance, as well as pave the way for the established use of shame resilience applications and further research in the subject, since there are existing gaps in knowledge in the Maltese context with regards to these issues.

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