How to Heal and Recover from Shame

0:00:13 William Moyers
We know what happens to a woman or a man under the influence of a substance they cannot stop using of their own free will. The substance hijacks the mind and steals the soul. But there is much more to a substance use disorder than the substance. There are the emotions and the feelings, the actions, or the behaviors that go along with addiction and they often are as toxic as the substance itself. Welcome to Let's Talk, a podcast produced and brought to you by Hazelden Betty Ford. I'm your host, William C. Moyers. And today, to discuss shame and guilt with substance use disorders, is my guest and my colleague, Sarah Wicks. A Clinical Psychologist in mental health at Hazelden Betty Ford. Welcome, Sara. [nods, smiles]

0:00:57 Sarah Wicks
Thank you, William.

0:00:58 William Moyers
Tell me why do shame and guilt go along with substance use issues?

0:01:04 Sarah Wicks
They go hand-in-hand. The one cannot survive without the other, it's been said. Addiction and shame and guilt. Shame is one of the most universal human emotions, regardless of addiction or not, as well. It's been found across all cultures, around the world, and most of us have it to some varying degree or another. If you don't, that's probably an interesting other clinical issue. [Both chuckle] To not have it. [Moyers nods] But, the key is how do we work with it so that it doesn't control us. And that we can live with it.

0:01:40 William Moyers
And the guilt piece?

0:01:41 Sarah Wicks
Yeah. [nods] So, differences between shame and guilt. They're quite different actually. And shame is more along the lines of 'I am bad,' guilt is 'I did something bad.' Right? I mean, a lot of this stuff comes from Brené Brown, my personal hero when it comes to this, shame and guilt. And so the shame part, when you're stuck in shame, and feeling like a bad person, that's actually—there's a research correlating that with higher rates of addiction, depression, violence, bullying, even suicide. But the interesting thing is higher levels of guilt don't have the same effect on us. Higher levels of guilt actually promotes the ability to be more trustworthy to live with integrity and more empathy for others. When we are able to access some what I would call like a healthy level of guilt.

0:02:42 William Moyers
Mmm.

0:02:42 Sarah Wicks
So actually part of the work that we do at Hazelden and my personal work as a Psychologist is helping people actually transform their shame into guilt.

0:02:51 William Moyers
Ah.

0:02:51 Sarah Wicks
And my clients yeah I know they're like, 'Uh, excuse me, can't we just get rid of all of that?' [chuckles]

0:02:55 William Moyers
Right. Right.

0:02:55 Sarah Wicks
Right. But it—guilt is what allows us to take some accountability. For our actions.

0:03:03 William Moyers
Wow! I didn't realize that. I've always been told that shame is a result of a feeling, guilt is a result of an action. But it doesn't really matter where it comes from, it's that it's there, right?

0:03:17 Sarah Wicks
It's that it's there and that the shame is all-encompassing. Shame is a very social emotion as well. It's a feeling that's very primal and primitive that we will be rejected from the group. Which is—a feeling of belonging is just critical for us as human beings. Even though in modern times we may like to believe that we can be so self-sufficient and self-reliant, but it's such a critical emotional need to belong. And with shame, that's what feels threatened. With guilt, it's like well, I screwed up, I made a mistake, and I can work on this I can make it right, I can make some changes. Shame doesn't make a lot of room for change, guilt does. Gives us a path for change.

0:04:01 William Moyers
So shame and guilt are "natural" [uses air quotes] to the human species, of course—

0:04:06 Sarah Wicks
Mmm-hmm. Absolutely.

0:04:08 William Moyers
—We all have it. But when it comes to its intimate connection to a substance use issue, talk more about that.

0:04:20 Sarah Wicks
As addiction is progressing, what happens is the individual—it starts with, you know, some harmless intentions. Some fun, some, you know, drinking, drugs, it can feel good. Pleasure, sure. And then when it hits a certain point where this individual is engaging in behaviors over and over again that go against their core values—

0:04:43 William Moyers
Yes.

0:04:44 Sarah Wicks
—That's where the shame starts to build up. The farther and farther the person's behaviors get from their values. And that's where—and then actually using more of the substance to try to deal with that incredible pain of the shame, then keeps the vicious cycle going.

0:05:08 William Moyers
Yes. I see. And the substance might work quote unquote for a while but ultimately it doesn't.

0:05:14 Sarah Wicks
Yeah. That's the problem.

0:05:15 William Moyers
Okay. [nods]

0:05:15 Sarah Wicks
It works great in the moment—

0:05:17 William Moyers
Yes. Yes.

0:05:16 Sarah Wicks
—It takes away whatever's there, it's fun, I don't care anymore, or I'm high, I'm feeling something different so—and then the shame is just waiting for that individual after. And that's what—and that's where the worse that cycle gets, the stronger it gets, the more frequent, then we end up with this self-loathing they talk about.

0:05:33 William Moyers
Yes. Which is why in substance treatment, it's not enough to just address the use of the substance, you also have to address the feelings, the emotions, that go along with it—

0:05:47 Sarah Wicks
Mmm-hmm.

0:05:48 William Moyers
I.e., shame and guilt.

0:05:50 Sarah Wicks
Mmm-hmm. And so the first step in addressing it, I believe, is that the cure for shame is love.

0:05:59 William Moyers
The cure for shame is love.

0:06:00 Sarah Wicks
The cure for shame is love. Dr. Omar Manejwala I have to credit him for that, when he worked with Hazelden. [smiles, nods] Yes.

0:06:06 William Moyers
I know him, yes.

0:06:08 Sarah Wicks
He said it, really stuck with me, always has. And the thing about the initial stages of getting help for addiction is that the people that are closest to the person suffering from the addiction are not the best people to give unconditional love.

0:06:25 William Moyers
Ahh. Huh.

0:06:26 Sarah Wicks
They've been hurt, they've been probably betrayed, probably lied to. They're just not in a position to provide the love that's needed for somebody to kind of drop their shame or kind of ease their way through it.

0:06:41 William Moyers
Mmm-hmm.

0:06:42 Sarah Wicks
And so, it is important to actually get folks surrounded by other people who suffer with addiction. [nods]

0:06:49 William Moyers
Mmm-hmm.

0:06:49 Sarah Wicks
And build that sense of community independent from their closest family.

0:06:53 William Moyers
So group is a critical antidote to shame and guilt—

0:06:57 Sarah Wicks
Yes. Yes.

0:06:58 William Moyers
—What about Twelve Step facilitation or just the working of the program, if you will? How does the Twelve Steps work in dealing with shame and guilt?

0:07:08 Sarah Wicks
Well, so I'm a Psychologist—

0:07:09 William Moyers
Yes.

0:07:10 Sarah Wicks
So this is the background that I'm coming from.

0:07:11 William Moyers
Yeah. Long time, you've been around it a long time.

0:07:13 Sarah Wicks
And been at Hazelden a long time. And so, the way I view the Twelve Steps is kind of a recipe for how to come to terms with shame. And how to build an unconditional sense of belonging—that's how I see like the Higher Power relationship.

0:07:37 William Moyers
Mmm. Mmm-hmm.

0:07:38 Sarah Wicks
It's finding a source of unconditional acceptance, love, and belonging. Whatever that source may be.

0:07:44 William Moyers
Hmm.

0:07:45 Sarah Wicks
And I think that can really help reduce shame and help build a sense of self-acceptance. It's not about—in treatment and in Twelve Steps and in the meetings in the rooms—they're not trying to make everybody feel great about themselves all the time. It's more a culture of, 'You know what, we all screw up, and welcome to the club!'

0:08:05 William Moyers
[nods] Right, we're all imperfect!

0:08:07 Sarah Wicks
We're all in it together!

0:08:08 William Moyers
We're human! [smiles]

0:08:08 Sarah Wicks
[smiles] We're all in it together. Yeah.

0:08:10 William Moyers
Yes.

0:08:11 Sarah Wicks
And that is—it's not about like I'm great, I'm smart, you know, it's about like we are just all doing the best we can and we sometimes have good days and sometimes screw up. And we love you anyway.

0:08:23 William Moyers
[chuckles] What about the use of medications in the treatment and recovery process? Can a medication help to address somebody's shame and guilt? Or is it really gonna be about a therapeutic experience?

0:08:38 Sarah Wicks
So, shame can actually be so painful and unbearable to experience that we build walls around it. To protect ourselves from the actual experience of shame. And what do those walls look like? Anger, depression, social isolation, social anxiety. So, there're symptoms that can show up—not always as a result of a defense mechanism with shame. But sometimes as a result of that. And so the medications—there's no medication to treat shame directly—

0:09:11 William Moyers
Sure. Yes. Yes.

0:09:11 Sarah Wicks
—But, can treat or help with those symptoms. And then you can really kind of I like to talk with people new in recovery who just maybe recently started a medication. I'll say okay, let's figure out your baseline here.

0:09:24 William Moyers
Mmm.

0:09:24 Sarah Wicks
When you're sober, when you're not on the drugs and alcohol, and when you're taking prescribed appropriate medication, let's see what your baseline is. As far as how you feel emotionally, what's your relationship to yourself and your relationship to others.

0:09:39 William Moyers
Yeah. Yeah. What role does a Higher Power play in helping people to come to terms with their shame and their guilt?

0:09:49 Sarah Wicks
Well that's yeah what we touched on before with as a Psychologist, the way I see Higher Power is this source of unconditional love and belonging. And 'cause we're all gonna have times when we're lonely. And when we're alone.

0:10:01 William Moyers
Mmm-hmm. Mmm-hmm. [nods]

0:10:02 Sarah Wicks
We're all gonna experience rejection, failure, loss.

0:10:06 William Moyers
Mmm-hmm.

0:10:07 Sarah Wicks
It's sometimes my work with clients actually feels a bit depressing initially because I'm helping them accept the realities of this—

0:10:15 William Moyers
Yeah. Yeah.

0:10:17 Sarah Wicks
—We like to pretend as a society that if I'm doing all the right things, I can be happy and comfortable at all times. Just not true.

0:10:26 William Moyers
Right.

0:10:26 Sarah Wicks
So, how do we get through the hard times? How do we deal with our own mistakes, our own failings? I think that's where a Higher Power can come in.

0:10:37 William Moyers
Mmm-hmm. Mmm-hmm. And I think what you're also saying is that putting down the substance—the marijuana, the cocaine, the opiate—and beginning the recovery process, that's an important start. But that the process of dealing with guilt and shame is not gonna just come and go as soon as you put the substance down—

0:10:57 Sarah Wicks
No. No.

0:10:59 William Moyers
—It takes time.

0:10:59 Sarah Wicks
It takes time. And usually, there's other ways of hiding the shame from yourself that will show up. Maybe other compulsive behaviors—

0:11:08 William Moyers
Ah, yeah.

0:11:09 Sarah Wicks
—Maybe judgmental attitudes towards other people.

0:11:11 William Moyers
Uh-huh.

0:11:11 Sarah Wicks
This is where the ego can come in. So it really is not just abstaining from the substance, but building a program of recovery is an entirely different kind of undertaking.

0:11:23 William Moyers
Yes.

0:11:24 Sarah Wicks
I just love people—helping people do that. Because it can be so transformative.

0:11:28 William Moyers
It's a journey, not a destination.

0:11:31 Sarah Wicks
Exactly. Always.

0:11:32 William Moyers
You've gotta tell me about this term Self-Concept Yogi.

0:11:35 Sarah Wicks
[laughs] Okay. So Self-Concept Yogis come from—I completely made it up.

0:11:41 William Moyers
Really? [grins]

0:11:42 Sarah Wicks
Yes. But, there's some good basis to it. [Moyers laughs] There's some good scientific background to it. I made up the term, but it comes from my background working with acceptance and commitment therapy. And my own yoga practice and being a lifelong athlete and yoga whatever.

0:11:59 William Moyers
Yeah.

0:11:59 Sarah Wicks
So, Acceptance and Commitment Therapy Act is six core processes of change. One of which is called self as context. And so, this goes back to the thing I was talking about before where self as context means that I'm not trying to feel great about myself at all times, I'm trying to be open and flexible and accepting of whoever I am, however I show up, on any given day.

0:12:29 William Moyers
Mmm-hmm.

0:12:30 Sarah Wicks
Knowing I'm gonna have better days and some bad days. And I'm gonna have some successes and failures.

0:12:35 William Moyers
Mmm.

0:12:35 Sarah Wicks
And so, the yoga practice physically involves balance, flexibility, tuning in to yourself, and in knowing when you can stretch yourself to your limits and when you need to take it easy on yourself. And it's all with the physical body. And I propose that [Moyers chuckles] we do the same thing mentally. And that's really a recipe for a pretty great way to live.

0:13:02 William Moyers
And it works!

0:13:03 Sarah Wicks
Mmm-hmm. It does. [nods]

0:13:04 William Moyers
But it takes time.

0:13:06 Sarah Wicks
Oh yeah.

0:13:06 William Moyers
It takes practice.

0:13:07 Sarah Wicks
Oh yeah.

0:13:07 William Moyers
It takes community.

0:13:09 Sarah Wicks
Mmm-hmm.

0:13:10 William Moyers
Nobody overcomes shame and guilt on their own. [Sarah shakes head.] But they have to be part of the process of change.

0:13:18 Sarah Wicks
Well and they have to have the courage to be vulnerable.

0:13:20 William Moyers
Ahh. The courage to be vulnerable.

0:13:22 Sarah Wicks
If you're not vulnerable, if you're not honest and open, you're not giving anybody a chance to show you love.

0:13:28 William Moyers
Yeah. Well, we really appreciate you being here today and showing us the way to love. And showing us the way to how we're all in this together.

0:13:38 Sarah Wicks
Yeah.

0:13:38 William Moyers
Because, you know, we often think about shame and guilt as being intimately personal, and it is, but we're all intimately personal with shame and guilt. And you don't have to have a drug or alcohol problem.

0:13:49 Sarah Wicks
No.

0:13:50 William Moyers
For it to be debilitating. In terms of shame and guilt.

0:13:52 Sarah Wicks
Right. Right.

0:13:54 William Moyers
So, recovery is all about people trying to improve themselves overcoming their shame and their guilt whether they have a substance use issue or not.

0:14:03 Sarah Wicks
Yeah. Exactly. [nods]

0:14:04 William Moyers
Yeah. Well thank you for bringing that great credibility that you have through your own commitment, your own clinical expertise, your passion for helping people to change. Sarah Wicks, thanks for being with us today. [Sarah smiles, nods]

0:14:16 William Moyers
[turns to camera]
And thanks to all of you for joining us, for tuning in. And remember, if you or a loved one need help for addiction, don't wait! Ask for help, it is available. Treatment works and recovery is possible. We'll see ya again.