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Is shame a proximal trigger for drinking? A daily process study with a community sample
Abstract and Figures
Between-subjects studies show that people with higher levels of shame tend to experience more negative drinking-related consequences than people with lower levels of shame. However, within-subjects studies of the association between daily fluctuations in shame and subsequent drinking have yielded mixed findings. This study aimed to resolve these inconsistencies by examining the association between daily fluctuations in shame, between-subjects differences in shame, and subsequent evening alcohol consumption in a sample of 70 community-dwelling drinkers. In addition, we examined whether the previous night’s drinking predicted shame the next day based on the theory that shame may operate in a cyclical fashion in some people to maintain problematic drinking patterns. Multilevel model analyses showed a cross-level interaction in which individuals’ average levels of ashamed mood moderated the effect of daily fluctuations in shame on solitary drinking. In contrast, previous day’s drinking was only weakly related to shame the next day. This study contributes to existing literature by refining models of negative mood-related drinking and further elucidating the patterns by which shame serves as a trigger for drinking, particularly among high shame individuals. The authors interpret results in terms of self-control theory and demonstrate the importance of disaggregating between- and within-subjects variance when examining longitudinal data.
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... The "shame addiction cycle" refers to a pattern of substance use to escape or avoid negative self-conscious emotions that paradoxically leads to increased shame related to the stigma of being a person who uses substances [7,19,20]. The experience of self-conscious emotions indicates social evaluative threat from negative appraisals by others, which may not only perpetuate substance use but also elicit physiological stress, including triggering the hypothalamic-pituitary-adrenal axis stress responses, such as initiating inflammation [21]. ...
... The first study identified that college students who described themselves as drinking more than their peers reported shame after drinking, which was then associated with increased drinking over the subsequent week [27]. The second study identified that higher levels of shame during the day were associated with higher likelihood of solitary drinking; however, level of drinking was only weakly related to shame the following day in a community sample [19]. While these two studies indicate that shame may be bidirectionally associated with alcohol use, no studies we are aware of have assessed bidirectional relationships between both shame and guilt and substance use beyond alcohol over time. ...
... Notably, these relationships were not attributable to depressive symptoms. While these findings are consistent with existing literature, indicating the perpetuating relationships between shame and guilt and substance use (e.g., [7,19,20]), they add to the existing literature by demonstrating that shame and guilt may be critical barriers for stimulant use recovery, beyond the previously identified relationships between depression and stimulant use. Further, while more work is needed, these nuanced results may be consistent with meta-analytic finding indicating that the likelihood of shame eliciting an adaptive rather than a maladaptive response is dependent on individuals' perception of their ability to repair a positive sense of self [10]. ...
Background
The bidirectional associations between negative self-conscious emotions such as shame and guilt and substance use are poorly understood. Longitudinal research is needed to examine the causes, consequences, and moderators of negative self-conscious emotions in people who use substances.
Methods
Using parallel process latent growth curve modeling, we assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. Emotions were assessed using the Differential Emotions Scale. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. Participants self-reported emotions and recent substance use behaviors over six time points across 15 months.
Results
Higher initial levels of shame were associated with slower decreases in stimulant use over time ( b = 0.23, p = .041) and guilt was positively associated with stimulant use over time (β = 0.85, p < .0001). Initial levels of guilt and alcohol use were positively related ( b = 0.29, p = .040), but over time, they had a negative relationship (β = -0.99, p < .0001). Additionally, higher initial levels of other drug use were associated with slower decreases in shame over time ( b = 0.02, p = .041). All results were independent of depression, highlighting the specific role of self-conscious emotions.
Conclusions
Shame and guilt are barriers to reducing stimulant use, and expanded efforts are needed to mitigate the deleterious effects of these self-conscious emotions in recovery from a stimulant use disorder.
... A recent systematic and meta-analytic review showed that shame seems to have both maladaptive and adaptive aspects (Luoma et al., 2019). Positive associations between shame proneness and addiction, both substance (Stuewig et al., 2015) and behavioral related (Bottera et al., 2020;Yi, 2012;Gilliland et al., 2011), were previously found, highlighting its dysfunctional nature (Yi, 2012;Luoma et al., 2018;Merrick et al., 2019;O'Loghlen et al., 2021;Wiechelt, 2007). Moreover, it has been reported that shame seemed to have been involved in behaviors, such as substance use and sexual risk conducts, that allow individuals to evade a sense of worthlessness and failure (Rahim & Patton, 2015). ...
... Coherently, it has been formulated that childhood abuse, neglectful, and shameful experiences could overstimulate the threat system, promoting fear-based responses, such as flight (Bahtiyar & Gençöz, 2021;Gilbert, 2005). After a shame-eliciting situation, the desire to avoid and withdraw associated with shame could hesitate in the use of a substance or behavior to regulate the negative experience (Luoma et al., 2018;Wiechelt, 2007). ...
Adverse early interactions with parents deeply affect the socio-emotional development of an individual, leading to feelings of inferiority and negatively influencing the development of self-conscious emotions, such as shame. Moreover, dysfunctional parenting was found in the histories of people suffering from substance and behavioral addictions. In this context, there is currently no agreement in the literature regarding the role of shame proneness on the severity of the addiction. The present study aimed to evaluate the mediating (risk or protective) role of the two shame dimensions (withdrawal action tendencies and negative self-evaluation) in the association between dysfunctional parenting and the severity of addiction, testing two structural equation models (SEMs; for substance and behavioral addiction respectively). An online survey recruiting 710 Italian young adults was administered using the Measure of Parental Styles, the Guilt and Shame Proneness Scale, and the brief Screener for Substance and Behavioral Addiction. The SEMs confirmed the predictive role of dysfunctional parenting on the severity of the addiction. Moreover, two dimensions of shame mediated the association in opposite ways. The withdrawal action tendencies positively mediated the association between dysfunctional parenting and the severity of substance and behavioral addiction, potentially acting as a risk factor. Negative self-evaluation negatively mediated the association between dysfunctional parenting and the severity of substance addiction, playing a potential protective role. In a therapeutic context, the findings emphasized the importance of evaluating the different dimensions of shame experiences among addicted individuals and assessing the strategies used to withdraw from these experiences.
... После протрезвления они сожалеют об этом, возникает чувство вины. Стыд наутро после попойки -также частое явление (Luoma J.B. et al., 2018;Jargin S.V., 2020). Опохмеление временно устраняет субъективную симптоматику, которая позже возвращается с прежней или большей интенсивностью (Поттер-Эфрон Р.Т., 2014). ...
The full text can be downloaded here and is available at:
https://www.umj.com.ua/article/195838/pohmelnyj-sindrom-dopolnenie-k-obzoru
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... Shame, closely bound with drug use, is an aversive affective state associated with an inferior, defective, or unworthy selfimage (Cameron et al., 2020). Both research and clinical models have attempted to explain how shame and stigma contribute to SUDs (Luoma et al., 2018b). A recent meta-analysis revealed that many people do not seek help to manage their mental health due to the stigma and shame associated with psychological problems (Dobson et al., 2019). ...
ABSTRACT
Objective: This double-blind, parallel randomized controlled trial aimed to evaluate the effect of acceptance and commitment therapy (ACT) focused on stigma and shame as opposed to standard treatment (ST) in substance use disorder.Method: Participants with the main diagnosis of SUD were allocated through simple randomization to an ACT intervention or standard treatment. Primary measures, Substance Use Stigma Mechanism Scale and Other As Shamer Scale were employed to assess stigma and shame. Secondary measures assessed general health, quality of life, psychological flexibility, and multidimensional social support at pre, post, and 3 months follow up period.Result: Result of linear mixed-effects models showed that the intervention was efficacious in reducing stigma pre (M = 49.42 SD = 7.48) post (M = 23.97 SD = 6.52) and follow-up (M = 24.97 SD = 7.06). Significant decline in shame were also shown at pre (M = 26.17 SD = 5.72) post (M = 9.48 SD = 5.90) and follow-up (M = 10.62 SD = 6.93).Whereas slight differences were shown at secondary measures.Conclusion: It suggests that combined treatment with ACT was more effective than standard treatment for suds. This study could serve as a model for designing future RCTs with ACT-related interventions.
... The self-report measures of self-compassion and psychological flexibility tend to capture more cognitive constructs (e.g., ''Worries get in the way of my success''), whereas the mindfulness measure used in this study included aspects of LEOs' emotional experience, particularly in terms of self-criticism and judgment, which may be more relevant to alcohol use. 18 Additionally, MBRT emphasizes formal mindfulness training to a greater extent than self-compassion or psychological flexibility, and as a result a measure of mindfulness may be germane to the actual intervention being studied. ...
Objectives:
In the present study, we investigated the relative impact of improvements in mindfulness, self-compassion, and psychological flexibility in predicting decreased burnout and alcohol use in a sample of law enforcement officers (LEOs) participating in a mindfulness-based intervention (MBI).
Design:
This study is a secondary analysis of pre/post data collected as part of a larger randomized controlled trial of mindfulness-based resilience training (MBRT).
Subjects:
This secondary analysis comprises pre/post data from 28 LEOs recruited from a metropolitan area and its outlying regions in the Pacific Northwest.
Intervention:
MBRT is a MBI tailored specifically to the culture and needs of LEOs and other first responders.
Outcome measures:
All included data were obtained through self-report measures. Mindfulness was assessed by the Five Facet Mindfulness Questionnaire-Short Form, self-compassion was assessed by the Self-Compassion Scale-Short Form, psychological flexibility was assessed by the Acceptance and Action Questionnaire-II, alcohol use was measured by the PROMIS® (v1.0) Alcohol Use-Short Form, and burnout was assessed by the Oldenburg Burnout Inventory.
Results:
In the first regression, only increases in mindfulness significantly predicted decreased postintervention problematic alcohol use. In the second regression, only increases in self-compassion significantly predicted decreased postintervention burnout.
Conclusions:
This study builds upon a growing body of literature on the relative impact of mindfulness, self-compassion, and psychological flexibility in predicting outcomes among high-stress cohorts. Results suggest that different components of MBIs may be emphasized to achieve unique benefits. The Clinical Trial Registration number for the parent study is NCT02521454.
... The emotions of shame and guilt may contribute to addictive behaviors (7). The "next day shame from previous night's drinking" can be a consequence of problematic drinking patterns (24). All that, along with the coughing and unpleasant sensations in the oral cavity, would reinforce subjective hangover symptoms. ...
The full text can be downloaded here and is available at: http://www.e-discoverypublication.com/jsd-v4i2-20030/
RUSSIAN: https://www.umj.com.ua/article/195838/pohmelnyj-sindrom-dopolnenie-k-obzoru
https://www.researchgate.net/publication/351006696_Antialkogolnye_kampanii_Cui_bono
... Not surprisingly, guilt did not mediate the association between depression and alcohol craving. This result is consistent with literature that proposes that there is specificity of shame that drives depressed emerging adults to experience alcohol misuse (Treeby and Bruno, 2012;Bilevicius, Single, Bristow et al., 2018a;Luoma et al., 2018;Treeby et al., 2020). The differential findings between shame and guilt can be interpreted by understanding the fundamental differences between these two emotions. ...
Aims:
Comorbid alcohol use and depression have the highest prevalence among emerging adults and are associated with a number of consequences. Self-medication theory posits individuals with depression use alcohol to cope with their negative emotions. Preliminary work has investigated the social context of depression-related drinking and found that solitary drinking is a risky, atypical behaviour in emerging adulthood that is associated with alcohol misuse. However, it is unknown about what is unfolding in the moment that is driving depression-related drinking in solitary contexts. Accordingly, we used an experimental study to examine if shame mediated the association between depression and in-lab alcohol craving.
Methods:
Emerging adults (N = 80) completed a shame induction followed by an alcohol cue exposure in either a solitary or social condition. We used moderated mediation to test hypotheses.
Results:
Consistent with hypotheses, conditional indirect effects supported the mediation of depression and alcohol craving through shame among those in the solitary condition, but not in the social condition. There was no support for guilt as a mediator.
Conclusion:
Our study demonstrates that shame is a specific emotional experience that contributes to solitary drinking among depressed emerging adults. It is important to use these results to inform interventions that directly target solitary contexts and shame.
Introduction
Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems.
Methods
One hundred and eighty-four emerging adults (Mage= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses.
Results
In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use.
Conclusion
After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.
Guilt and shame, two negative self-conscious emotions, have drawn theoretical and empirical attention in studying self-control. Although a functionalist view suggests that their reparative tendencies would help combat self-control failures, the evidence is equivocal. In this review, we begin with a systematic analysis of how the context of self-control conflicts allows mood management to dominate reparative control as the primary means of regulating guilt and shame and, subsequently, sours the potential benefits of mood management. Then, inspired by the emerging literature of strategic indulgence and a multilevel perspective on self-control, we propose that people should adopt a tolerant view of indulgence at the behavioral level while channeling the reparative tendencies of guilt and shame at the strategy (behavioral plans) and the system (goal balance) levels. When appraising and regulating self-control, thus, focusing on the forest rather than the trees may help capitalize on the benefits of guilt and shame.
Background and aims
Solitary drinking in adolescents and young adults is associated with greater risk for alcohol problems, but it is unclear whether this association exists in older demographics. The current paper is the first meta‐analysis and systematic review to determine whether adult solitary drinking is associated with greater risk for alcohol problems.
Methods
PsychINFO, PubMed, and Google Scholar were searched following a pre‐registered PROSPERO protocol (CRD42019147075) and PRISMA methodology. Following the methodology used in our recent systematic review and meta‐analysis on adolescent/young adult solitary drinking, we systematically reviewed solitary drinking measures/definitions, prevalence rates, and associated demographic variables in adults. We then meta‐analyzed (using random effects models) associations between adult solitary drinking and alcohol use/problems, negative affect, and negative/positive reinforcement‐related variables (e.g., drinking to cope or for enhancement).
Results
Solitary drinking was defined as drinking while physically alone in nearly all studies, but measures varied. Prevalence rates were generally in the 30‐40% range with some exceptions. In general, males were more likely than females to report drinking alone, and married individuals were less likely than unmarried individuals to report drinking alone; racial/ethnic differences were mixed. Meta‐analytic results showed significant effects for the associations between solitary drinking and the following factors: alcohol consumption, r=0.25, 95%CI [0.18, 0.33], k=15, I²=97.41; drinking problems, r=0.15, 95%CI [0.10, 0.21], k=14, I²=92.70; and negative reinforcement, r=0.24, 95%CI [0.14, 0.32], k=11, I²=91.54; but not positive reinforcement, r=0.02, 95%CI [‐0.06, 0.09], k=8, I²=76.18; or negative affect, r=0.03, 95%CI [‐0.02, 0.08], k=8, I²=52.06. Study quality moderated the association between solitary drinking and negative affect (β=‐0.07, p<0.01) such that lower quality studies were significantly associated with larger effect sizes. Study quality was generally low; the majority of studies were cross‐sectional.
Conclusions
Solitary drinking appears to have a small positive association with alcohol problems.
Background:
Empirical studies of the relationships between shame, guilt, and drinking are sparse and sometimes appear contradictory. However, a more coherent picture emerges when researchers differentiate between measures of experienced of guilt and shame (i.e., questionnaires that ask how often people experience thoughts, feelings, and sensations associated with the emotion) versus proneness to guilt and shame (i.e., self-report of likely responses to imagined situations) is understood.
Objectives:
Assess the extent to which experiential versus proneness measures of shame and guilt are associated with alcohol consumption and alcohol-related problems.
Methods:
Between 2012 and 2013, 89 community-dwelling non-abstaining adults were interviewed on a single occasion about their drinking and completed self-report measures of shame, guilt, and drinking-related behaviors.
Results:
Overall, shame and guilt were most strongly related to alcohol-related problems and not drinking amount per se, and shame was more strongly related to alcohol-related problems than was guilt. A measure of experienced shame, the Internalized Shame Scale, was the strongest predictor of drinking-related problems and predicted problems above and beyond other measures of shame and guilt. While guilt proneness was related to less problematic drinking, guilt experienced at the time of the assessment was related to more problematic drinking.
Conclusions:
Shame appears to be more central to the experience of problematic drinking than guilt. Results also support the idea that guilt/shame proneness is distinct from experienced shame and guilt. Incorporating this distinction appears to account for the inconsistencies in the literature regarding how shame and guilt are related to drinking.
This study tested within-person associations between intoxication, negative affect, and self-control demands and two forms of self-control failure, interpersonal conflict, and neglecting responsibilities. Effortful control was hypothesized to act as a buffer, reducing individual susceptibility to these within-person effects. In contrast, reactivity was hypothesized to potentiate the within-person associations. 274 young adults aged 18–27 (56% women, 93% white) completed experience sampling assessments for up to 49 days over the course of 1.3 years. Results indicated independent within-person effects of intoxication, negative affect, and self-control demands on the outcomes. Hypothesized moderating effects of reactivity were not supported. Effortful control did not moderate the effects of self-control demands as expected. However, effortful control exhibited a protective effect when individuals were intoxicated or upset to reduce the likelihood of maladaptive behavioural outcomes.
Loneliness is a well-known indicator of relationship deficits, with potentially severe consequences on health and well-being (Perlman & Peplau, 1981). Research has used cross-sectional methods to examine behavioral consequences of loneliness (e.g., Cacioppo et al., 2002). However, within-person associations between daily fluctuations in loneliness and subsequent behavioral outcomes have yet to be explored. Using a sample of community-dwelling adults, the authors examined associations between daily loneliness on daily time with others, and subsequent context-specific alcohol consumption (i.e., social and solitary consumption), and individual differences in these patterns of behavior. Daytime loneliness significantly and uniquely predicted patterns of social behavior and context-specific consumption; time with others mediated loneliness-social consumption associations, but not loneliness-solitary consumption relationships. These findings contribute to existing literature by demonstrating the unique properties of solitary versus social consumption as behavioral responses to loneliness, thus addressing inconsistent findings regarding the effects of loneliness on alcohol consumption.
© 2015 by the Society for Personality and Social Psychology, Inc.
This research tested a multilevel structural equation model of associations between 3 aspects of affective functioning (state affect, trait affect, and affective lability) and 3 alcohol outcomes (likelihood of drinking, quantity on drinking days, and dependence symptoms) in a sample of 263 college students. Participants provided 49 days of experience sampling data over 1.3 years in a longitudinal burst design. Within-person results: At the daily level, positive affect was directly associated with greater likelihood and quantity of alcohol consumption. Daily negative affect was directly associated with higher consumption on drinking days and with higher dependence symptoms. Between-person direct effects: Affect lability was associated with higher trait negative, but not positive, affect. Trait positive affect was inversely associated with the proportion of drinking days, whereas negative affectivity predicted a greater proportion of drinking days. Affect lability exhibited a direct association with dependence symptoms. Between-person indirect effects: Trait positive affect was associated with fewer dependence symptoms via proportion of drinking days. Trait negative affect was associated with greater dependence symptoms via proportion of drinking days. The results distinguish relations of positive and negative affect to likelihood versus amount of drinking and state versus trait drinking outcomes, and highlight the importance of affect variability for predicting alcohol dependence symptoms. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Understanding why people drink alcohol and in some cases develop drinking problems has long puzzled researchers, clinicians, and patients alike. In the mid-1940s and early 1950s, experimental research began to systematically investigate alcohol’s hedonic properties. Presumably, alcohol consumption would prove reinforcing as a consequence of its capacity either to relieve stress or to brighten positive emotional experiences. This article reviews experimental research through the years examining the impact of alcohol on both the relief of negative affect and the enhancement of positive affect. It covers initial accounts that emphasized direct pharmacological effects of ethanol on the central nervous system. These early studies offered surprisingly tepid support for the premise that alcohol improved emotional states. Next, studies conducted in the 1970s are considered. Informed by social learning theory and employing advances derived from experimental psychology, this research sought to better understand the complex effects of alcohol on emotion. Coverage of this work is followed by discussion of current formulations, which integrate biological and behavioral approaches with the study of cognitive, affective, and social processes. These current perspectives provide insight into the particular conditions under which alcohol can boost emotional experiences. Finally, future research directions and clinical implications are considered.
This article extends current discussion of how to disaggregate between-person and within-person effects with longitudinal data using multilevel models. Our main focus is on the 2 issues of centering and detrending. Conceptual and analytical work demonstrates the similarities and differences among 3 centering approaches (no centering, grand-mean centering, and person-mean centering) and the relations and differences among various detrending approaches (no detrending, detrending X only, detrending Y only, and detrending both X and Y). Two real data analysis examples in psychology are provided to illustrate the differences in the results of using different centering and detrending methods for the disaggregation of between- and within-person effects. Simulation studies were conducted to further compare the various centering and detrending approaches under a wider span of conditions. Recommendations of how to perform centering, whether detrending is needed or not, and how to perform detrending if needed are made and discussed. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
The role of reference group norms in self-regulation was examined from the perspective of transgressions. Results from four studies suggest that following the transgression of a reference group's norms, individuals who strongly identify with their group report more intense feelings of guilt, an emotion reflecting an inference that "bad" behaviors are perceived as the cause of the transgression. Conversely, weakly identified individuals reported more intense feelings of shame, an emotion reflecting an inference that "bad" characteristics of the person are perceived as the cause of the transgression. The studies also explored the differential relevance of the reference groups when assessing transgressive behaviors, the counterfactual thoughts individuals have about possible causes for the transgressions, and the motivational outcomes of guilt and shame using behavioral data. Results of the studies offer insights into self-regulation, maintenance of group norms, and offer implications for alcohol consumption interventions, such as social marketing campaigns.