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Compassion For Addiction When Contempt Causes Harm

November 2, 2018

The impact of shame and stigma For too long, people with addictions have been judged at face value. Shamed because they don’t have the so-called willpower to make better choices, shamed because they should know better. But what about the person behind the addiction? What about the adult who was once a child who didn’t know when their next meal would be? Or the child who was beaten by a parent, or sexually assaulted by a trusted relative? Or in adulthood, maybe they had a car accident that left them with serious injuries, or their life partner died suddenly, or they lost their job of 40 years. What about these people and their experiences? Sure, not all people who have adverse life experiences or trauma will go on to have an alcohol or substance addiction, but it is a very common path in trying to deal with the pain from the past. I see this in my work every day, and it’s my former client Melissa that comes to mind when I talk about shame and addiction. Melissa came from a wealthy Orange County family, and at face value, you would think she had everything going for her—money, resources, and opportunities. She completed her undergraduate education, and the future held many possibilities. Yet, she spent the next six years feeling completely and utterly lost. Melissa was using drugs regularly and also frequenting expensive rehabs, with little success. When I met her, her family had spent close to $1 million on her recovery. When she came to my IGNTD Recovery course, it was the first time she didn't feel shamed, judged, or blamed for her choices and her struggles. I talk about people like Melissa in my book The Abstinence Myth since her story is, unfortunately, not a unique one (her actual story I covered in an article here). All people with an addiction experience shame, no matter what their background.

How trauma can lead to addiction

A substantial portion of individuals who enter treatment for substance addiction report a history of trauma and mental health issues. Child abuse, violence, sexual trauma, and PTSD are the strongest, most reliable, risk factors predicting the occurrence and greater severity of addiction addiction later in life (as I talk about in the book). In my book, I explore the four camps (spiritualists, traumatists, biologists, and environmentalists) that explain addiction. Most relevant to this article is the traumatist camp which proposes that trauma (particularly childhood trauma) is at the root of all addiction problems. You may be surprised by the following statistics relating trauma to addiction:
  • Up to 75 percent of all people with a history of trauma have an alcohol use disorder.
  • Alcohol use disorders affect 52 percent of men and 28 percent of women with Post-traumatic Stress Disorder (PTSD).
  • Drug use disorders affect 35 percent of men and 27 percent of women with PTSD.
  • 27 percent of veterans with PTSD also have a substance use disorder.
  • People who score high on the Adverse Childhood Experiences Questionnaire are five times more likely to have an alcohol use disorder and up to 46 times more likely to use drugs.
Why does trauma play such an important role in mental health and the development of an addiction? There’s an abundance of research on the long-term effects of trauma on not only the psychological, emotional and social domain of development, but it also changes the brain. We know that early abuse and neglect affects how a child’s brain develops, specifically concerning brain chemicals like endorphins and serotonin. Early trauma may include being mistreated, sexually abused, neglected, the death of a parent, exposure to domestic violence, or having a parent with a mental illness. All of these circumstances can lead to increased levels of stress that hinder normal brain development. Often in these cases, the child's development is further impeded by the environmental and social impact of the trauma, for example, lack of familial support systems and a sense of security—which is essential for emotional well-being. This can increase their chances of self-medicating as an adult, to cope with negative thoughts and feelings that were not addressed in their early years. “Before you pass judgment on one who is self-destructing, it’s important to remember they usually aren’t trying to destroy themselves. They’re trying to destroy something inside that doesn’t belong.” —JM Storm

Is trauma to blame for all addictions?

Trauma is one of the contributing factors to alcohol and substance addiction, but it is not the only cause. It's a combination of the following: traumatic experiences, lack of healthy social support systems, mental health disorders, genetic predisposition, and the environment—all of which contribute to the development of an addiction. Sad woman sitting While the traumatists camp offers powerful support to recovery with a deep focus on talk therapy and cognitive exercise to understand one’s experiences, release shame, and address trauma triggers and emotional overload, on its own, it ignores the environmental and biological impact on an individual. That’s why it's so important to assess all camps when treating addiction.

What happens when we choose not to be compassionate?

When we choose not to be compassionate, we pass judgment. This perpetuates the cycle of shame and stigma, two of the reasons that hold people back from getting help. Contempt is not helpful to the individuals who are suffering, but it's also not beneficial for the community and society in which we live. The result of our anti-compassionate approach to addiction speaks for itself:
  • High incarceration rates in the United States (highest in the world), many of which are non-violent drug offenders
  • Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) each year in the United States from 2006 – 2010, shortening the lives of those who died by an average of 30 years.
In other words, punishing people with an addiction only makes the problem worse.

How can you help?

Addiction is not a choice or a moral failing. It’s not a lack of willpower. These beliefs cause addiction to continue, and so we have to change the way we think about addiction. We have to draw on compassion, instead of contempt. It's the only way to really understand the individual human experience of someone who has an addiction. When we are compassionate, we promote inclusiveness and safety, which are essential for successful recovery. So let's start using person-first, compassionate (like "person with a drinking problem" instead of "alcoholic") language and look behind the obvious behavior to see the person behind the addiction. If you want to deepen your understanding of all the variables contributing to addiction, you can read more about it in The Abstinence Myth. Not only will it change your perception of addiction, but it might just save someone’s life. "Shame and stigma can't coexist with compassion. If you can create a place for compassion, then you create the space where people can actually heal." —Vicky Dulai Author: Adi Jaffe Ph.D. Psychology Today LogoReferences
Centers for Disease Control and Prevention (2018). Retrieved from: Centers for Disease Control and Prevention (2018). Retrieved from: Foundations Recovery Network: Dual Diagnosis (2018). Retrieved from: Carter, A.C., Capone, C., & Eaton Short, E. (2011). Co-occuring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veteran Populations. Journal of Dual Diagnosis, 7(4), pp 285-299. Evergreen Drug Rehab (2018). Retrieved from: Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14, pp 245-258.
Original article here.

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