The Hidden Struggle: Understanding Shame in Addiction

There are many causes and effects of addiction. One approach to understanding the struggles individuals experience is through the lens of affect psychology, where the underlying emotions that motivate addiction behaviors are explored.

In many psychological conditions, including addictions, shame responses often form the core of distress or pathology, yet shame is often hidden or remains unacknowledged (Kelly and Lamia, 2018). Rather than recognize shame, attention is drawn to defensive and coping responses to shame that appear as primary rather than secondary. These include attacking others, attacking the self, withdrawal, and avoidance.

Responses to Shame

As with other emotions, shame is fleeting, although it may be repeatedly activated to produce a mood or state that may appear to be a personality trait. For example, we may misinterpret an attack other response to shame as a person’s need for anger management, since individuals prone to use this response tend to lash out at others or blame others to hide what they feel. Attack self shame responses direct anger toward the self, appearing as self-loathing or self-injurious behaviors. Withdrawal may be misunderstood as depression or isolation. Avoidance responses may appear as denial since they remove intense feelings of shame from conscious awareness.

Some therapists misinterpret defensive and coping responses to shame, seeing them as a maladaptive component of their patient’s personality. For example, the psychoanalyst Otto Kernberg (2007) asserts that alcohol and drug abuse or dependency in patients with personality disorders may express severe and relentless self-destructiveness as a life goal—a motivation deserving the designation “death drive.” Thus, he contends, repeated periods of detoxification and rehabilitation demonstrate their uselessness and the prognostic gravity of the case. In some cases of narcissistic pathology, Kernberg assigns a much better prognosis to patients whose addictions, he contends, serve to rationalize failures in work or a profession that might otherwise threaten their grandiosity.

An attitude on the therapist’s part that people suffering from addictions are motivated by self-destructiveness, a death drive, or rationalizing failure will likely create more shame in the patient. Understanding that shame may be both the initial motivation for the addiction and the result of it permits the therapist much more room for empathy and eventual reduction of the shame.

Avoidance and Addictive Scripts

Shame avoidance and reduction may be the most common motivator of addictive symptoms and behaviors, whether the addiction has to do with alcohol, substances, gambling, food, or the conspicuous consumption of goods (Nathanson, 1992). Reduction of shame—and with it the simultaneous reduction of distress—leads to a form of emotion management behaviors that Tomkins (1991) described as “sedative scripts” (p. 537). A sedative script addresses any problematic scene through escape, which attenuates or reduces the negative emotion that the scene has evoked (Tomkins, 1995).

People with high levels of shame, distress, or fear are especially prone to the development of addictive scripts where the sedative script has increased in frequency and power and “transformed a sedative into an end in itself” (Tomkins, 1991, p. 104). That is, once a drug, alcohol, cigarette, gambling, or sexual addiction begins, shame or other negative emotions are mostly avoided and replaced by feelings—both positive and negative—associated with cravings for the sedative substance(s) or acts. Conscious awareness that the desire to reduce feelings of shame is the motivation for the addictive behavior becomes buried in the scripted behaviors. In addition to the serious side effects of addictive substances and behaviors, the addictive scripts that arise from shame avoidance are essentially flawed in that they can never successfully prevent shame.

Further, psychological addiction is masked in drug addiction by the presence of biochemical addictive tolerance, thereby explaining the resumption of addictive dependency following years of abstinence and illuminating psychologically addictive phenomena such as compulsive gambling, eating, and risk-taking (Tomkins, 1991). Since scripted responses are based on what we have learned from past experiences when similar emotions were triggered, we cannot necessarily undo or erase them along with our emotional memories, but we can learn further from them and modify our responses.

The shame of addiction and the anti-social behaviors that accompany many addictions ultimately increase the amount of negative emotion driving the addiction Alcohol and substances permit temporary avoidance and denial of shame by physiologically reducing the emotion through the stimulation of the neurotransmitters dopamine, norepinephrine, and serotonin (Kelly & Lamia, 2008). All addictive behaviors create a difficult-to-break cycle of shame that creates further shame unless explored in a way that allows learning to take place. When individuals can identify the emotion that preceded an episode of behavior, they can group the experiences of that emotion and then find systems of modulation to help them cope in a healthy way (Nathanson, 1994).

Learning from Shame

Perhaps greater than any other emotion, shame motivates learning, growth, and a desire to change the self (Lickel, et al., 2014; Nathanson, 1994). Whereas regret motivates interest in mentally undoing the past and mending harm done, experiencing shame alongside the belief that change is possible can be a potent motivator for initiating contemplation about change (Lickel, et al., 2014). “Shame is a teacher,” asserts Nathanson, “often drawing us within ourselves to think deeply about the self” (1992, p. 211). Although the emotion of pride serves to disguise shame, rather than eliminate it, any improvement we can make in our lives may ease the agonizing effects of shame enough to look at ourselves rather than respond with avoidance or withdrawal.

Shame Essential Reads

“Cringe” and New Online Forms of Shame

Shame (in Moderation) Is Good

The voluntary exposure of shame-based vulnerabilities is one of the most effective methods of reducing its negative impact. The success of 12-step programs involves an important antidote to shame: Individuals can expose their experiences of shame and, as a result, receive acceptance and support from the community. Through intimate connection, and developing our ability to tolerate distress when shame directs us to avoid, withdraw, or respond with anger toward ourselves or others, we can truly learn what shame can convey and enable it to dissolve (Nathanson, 1992).

Excerpted in part from my co-authored book The Upside of Shame: Therapeutic Interventions Using the Positive Aspects of a ‘Negative’ Emotion.