To be human is to experience a vast array of messiness. Life is inherently complex, and experiences and relationships are varied and dynamic. It is much easier to affect progress and change when we make sense of these intricacies and complexities. It is with the understanding that we afford ourselves compassion for that which we don’t personally experience. We can’t change anything if we stay far away from it. We need to get up close.
The topic of substance use or addiction often turns people off. Illicit street drugs are a topic that most of society likes to avoid. It’s an area that psychotherapists and social workers tend to steer away from; many therapists feel they cannot conduct therapy until the addiction is resolved, as if they were two separate entities.
To suffer addiction is to experience shame- a sense of self-disgust. Individuals are often embarrassed to enter treatment, feeling embarrassed and dysfunctional while wrestling with their desire to recover. Families often feel frightened by the drug, or their addicted love one’s behaviors and try to cut off from or control their using loved one. In recovery, families may feel uncomfortable, maintain suspicion and distrust, and attempt to monitor their every move. Ironically, this makes it more difficult in treatment and recovery.
Very quickly after I began working with people who are struggling with substance use addiction, I realized that I was only frightened by something I didn’t fully understand. I saw humans who were suffering and trying to soothe emotional pain: isolation, anxiety, loneliness, trauma, depression, fear, and shame. Taken through a new lens, the complexities of substance use addiction are genuinely captivating. One could understand so much about a person if you looked into the relationships inside the dependency: the patterns, the triggers, the set, and setting. With a wealth of depth and psychological information, it perplexed me why so much of the subjective understanding of this population remains shallow?
Before the COVID-19, the major epidemic (defined as a sudden widespread occurrence of an infectious disease), the opioid garnered only some intermittent attention. In 2018, 67,367 drug overdose deaths occurred in the United States. People in leadership responded to the virus of the opioid epidemic with a band-aid solution, responding to the problem, instead of addressing the root issue. This response indirectly communicates that people struggling with addiction didn’t deserve consistent attention or help. Substance use and people who struggle with addiction are often treated less than humane, drawing an invisible circle of shame around the population.
The complexities and misunderstandings of substance use addiction limit the potential for positive change and outcomes. Due to the narrow views of addiction, devoid of curiosity, society stands far from the humanness of addiction—people in power and patriarchy benefits from limited understanding. As long as we view addiction in a shameful light, specific populations can easily target “addict” labels, maintaining their oppression. Negative views of addiction and illicit drugs keep the patriarchy going strong.
When we’re ashamed of addiction, it’s because we’re afraid to expose that we’re embarrassed about our way of surviving. We’re so scared others might not accept us if they knew the truth. What does it reflect about a society that so many people are currently struggling with addiction?
Internalizing the messages from society, those inside their addiction feel their shame magnified. Punitively labels affect individuals and their capacity to heal. It’s as if there is a subtitle that reads: flawed, broken, defective, or troubled. If shame brings someone into addiction, society’s view of addiction mirrors that shame, which makes it harder to get out.
When clients internalize the shameful stigma about themselves and adopt the beliefs of the people around them, seeking treatment is disgraceful, and people often try to avoid it. It’s hard to ask for help when you believe you need fixing and feel ashamed about it.
Narrow views on addiction focus on the behavior of the person and the harmfulness of the drug. This view leaves out a massive part of the story: the pain. This approach forgets to ask about how and what the substance was soothing. It neglects to consider the environment, lack of resources, and society’s failure in modeling how to tolerate painful emotions.
How using helps.
In the addiction cycle, the use plays the side that feels emotionally easy: soothing, relief, and pleasure, experiences the user believes are otherwise inaccessible in their current life. At its core, using drugs resolve the pain of isolation. Users can bond with other users to create a sense of connection. While the drug can also become the buffer to intimacy, blocking the relationship’s realness. When otherwise feeling hindered from self-exposure, using lets down our guards; Many people are more comfortable exposing their inner worlds through a substance. (See: drunk-dial confessions.) Using alone can feel soothing for one’s inability to regulate their feelings: without others to turn to, the drug becomes the console.
When using harms.
When the harmful side of use starts showing up: loss of finances, ruptured relationships, job loss, incarceration, violence, homelessness, and walking closer to the line of death, some people decide something needs to change. Afraid of their current life, they begin to want more for themselves. Some come in for treatment due to an ultimatum from another. It’s a humbling and courageous act to walk into treatment for addiction, recognizing that there might be a problem with one’s way of coping, especially if that coping mechanism is shamed by society.
Treatment
Treating the physiological aspects like withdrawal through detox or medication-assisted-treatment (MAT) is one part of the equation for recovery for opioid addiction. Stabilization temporarily manages the use-withdrawal spiral by interrupting the compulsive cycle to avoid withdrawal and the shame that arises once sober. Depth counseling for substance use recovery (whatever the substance: alcohol, sex, porn, cocaine, etc.) is an opportunity to develop more resources and dive into shame. With open and non-judgemental questions and curious listening, we’d bring ourselves closer to the struggle. From this stance, no matter what we get close to, our perception is often inclined to widen and to change.
Most treatment and recovery programs focus on the destructive ends and frighten people into making a lasting change. For a while, this may work. However, if treatment doesn’t address the medicinal qualities of the use, relapse is more likely. Without understanding the root of the drug use and addiction, we walk in shallow waters, always afraid to fall into the deep again.
We hinder recovery if we aren’t willing to look at both the benefits and consequences of using as a way to cope. In studying the deeper intricacies of the central tug-of-war, we might ask: How can this thing feel so good, and be so destructive? It temporarily makes life feel better, but, in the long term, ruins everything around me. How long can I resist such a thing that I know makes me feel so good? When you know something soothes, bring comforts and calms you, how do you give it up?
If our approach to anything centers on the harmful aspects, we miss out on understanding the ambivalence that is a natural part of being alive. We may know that something is dangerous or wrong for us, yet our bodies and minds may still seek the relief that the experience provides. We all know that certain food is not healthy for us, but we may again eat it anyway because it tastes good and will make us temporarily feel comforted. In recovery, ambivalence and conflict show up throughout: there is always a choice to make. By anticipating and planning for it, sustaining recovery is more likely.
To be alive is to be naturally torn, we crave feeling good, and yet life can bring incredible pain. We do what we need to do to get by with whatever resources we have; some of the ways that humans cope with surviving our lives are labeled better, and others are stigmatized. Each journey into addiction and recovery varies. The substances and the relationship the user has to them tell a vast story. We only need to be willing to become curious, and listen.
Musing on Life 
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