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The modern and ‘enlightened’ view of people who suffer from addiction is that they have a mental illness. Look in the Diagnostic and Statistics Manual (DSM-5) of the American Psychiatric Association and you’ll find Alcohol Use Disorder, Nicotine Use Disorder, Opioid Use Disorder, and so on for substances ranging from hallucinogens to cannabis, sedatives to stimulants. There are moves to make Internet Gaming a Disorder for inclusion in the next edition of that manual. No doubt excessive gambling, shopping, pornography viewing and social media involvement will be on the list in the future. And while not termed an addiction, people who compulsively eat, purge or restrict their eating to the point of poor health could equally well be said to fall into this category, and already appear in the DSM. So if you have any of these behaviors, you’re not bad, you’re just sick.
The less modern and enlightened view is that addiction is a moral failing. That was the general view regarding alcoholism up until the late 1940’s — the temperance movement that swept the world in the first half of the 20th century was very much focused on the “sin" of drunkenness. And even though the moral failing view of substance abuse is no longer the establishment position, and perhaps no longer politically correct, it’s very much in the minds of most of us. Just consider the moral judgments attached to stereotypes of substance abusers: We see them as lying shamelessly to enable their habit, stealing, breaking promises, ignoring the damage they cause, loving their substances more than their families, being irresponsible, endangering others and so on. When we meet someone who suffers from an addiction, we often feel pity, contempt, disgust and a sense of moral superiority.
The truth is that both these views are incorrect. Addiction is neither a moral failing nor a disease. It is, rather, a coping strategy. We use substances to manage our feelings, to deal with emotions that would otherwise be too painful and overwhelming. And in certain specific situations, few would argue with such a strategy. Who would criticize a widowed spouse for taking sleeping pills following his bereavement? Or a fired executive for getting drunk the night of her termination? Or a terrified student for taking a calming benzodiazepine the day of a critical exam?
For some, however, coping with painful and overwhelming feelings through substance use becomes a more long term strategy, perhaps because the negative feelings persist for a long time: Loneliness is a constant, retreating only under a flood of alcohol; anxiety makes life unbearable, and only cannabis brings relief; sadness is paralyzing, and lifts only with an infusion of narcotics.
Yet the use of substances in this way is deeply shameful. Consciously or unconsciously, users are aware of their emotional dependence on the substance in order to get through the days. They’re aware of the fact that they cannot cope with their emotions unaided. And sooner or later, the use of substances results in behavior that is shameful: missed appointments, failed exams, lost jobs, unpaid debts, broken promises, violence, accidents, and more. The shame about their use of substances is compounded by their shame about their behavior while using.
And then they are forced to cope with the views of society — that they are either sick, or that they are moral failures. Both drive down self esteem and any sense of autonomy they have. “You’re sick, you need help, you have a disorder, there’s something wrong with you”, they’re told, making them feel even more ashamed. Or “You’re weak, you're bad, you’re ruining your life and the lives of people around you”, driving the level of shame to even greater heights. It was once considered good technique to surprise a substance user with a confrontational gathering of friends and family in order to make the problem inescapably clear and shame the user into treatment.
What is the effect of this super-sized helping of shame? For someone who is already having trouble coping with painful emotions, it often makes things worse, far worse, thus increasing their desperation to numb themselves with substances again.
What does all this mean for those of us who are dealing with people who overuse substances? We can’t change how society as a whole treats these people, but we can do our best to reduce the amount of shame they feel. That means:
Remember that the person who is using substances is doing so in order to cope with overwhelming and painful feelings. They are self-medicating.
A person who overuses substances is not sick, nor are they morally weak. Their coping mechanism, which originally was probably quite effective and functional, has become a source of problems rather than a solution.
Regardless of what the user says, they are — either consciously or unconsciously — deeply ashamed of their behavior.
Confrontation and anger will only deepen their shame. That doesn’t mean that you can’t protect yourself and your other family members from the negative effects of that self-medication. It does mean that you should try to do so in a calm, assertive manner, rather than through anger and conflict — although this can feel impossible at times.
(For those interested in learning more, read Beyond Addiction: How Science and Kindness Help People Change)