Article

The Specter of Shame in Substance Misuse

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Abstract

This article provides an introduction to the concept of shame as it relates to substance misuse. Empirical research on shame and addiction and the theoretical and operational definitions that underpin them are discussed. Potential areas of further inquiry are highlighted. Implications for clinical practice are discussed.

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... Shame typically involves internalized global and persistent painful feelings about the self being flawed. Shame can evolve to become part of a person's identity and how they 1 view themselves (Wiechelt, 2007). As shame negatively affects a person's core sense of self and is often linked with depression (Kim, Thibodeau, & Jorgensen, 2011), it often results in selfdefeating and negative affective mood states and corresponding cyclical substance use in an attempt to negate painful emotions (Potter-Efron, 2002). ...
... As shame contributes to the development and maintenance of addiction, it should be addressed in rehabilitative and recovery programs (Potter-Efron, 2002). While there is a lack of psychosocial research concerning interventions targeting shame (Randles & Tracy, 2013), addressing and treating shame for people with SUD can help improve quality of life and the ability to change addictionrelated behaviors (Wiechelt, 2007). ...
... Further complicating treatment and research, shame can be an elusive construct to address and objectively measure. Treating shame can be perceived as confrontational (Wiechelt, 2007) which is contraindicated in SUD treatment (Potter-Efron, 2002). Moreover, shame constitutes a painful of experience often accompanied by hiding, avoidance, and escape (Tangney, Burggraf, & Wagner, 1995). ...
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Background: Resultant of engaging in behaviors outside of their value systems to maintain addiction, many people with substance use disorder (SUD) feel shame and guilt. Although shame, guilt, and pride do not represent traditional dependent measures in SUD research, experimental studies targeting these constructs are warranted. Objective: The purpose of this study was to determine the effects of a single songwriting intervention on state shame, guilt, and pride with adults with SUD on a detoxification unit. Method: Participants (N = 118) were cluster-randomized to songwriting or control conditions. To avoid testing fatigue in this single-session study, experimental participants received a group-based blues songwriting protocol targeting state shame, guilt, and pride and then completed the questionnaire. Control participants completed the questionnaire before receiving an intervention. Results: While there was no significant between-group difference in state shame or guilt, there tended to be slightly lower mean scores in the experimental condition. There was a significant between-group difference in state pride (p = .012), with experimental participants having higher mean scores than control participants. Conclusion: Although only the state pride measure reached significance, shame, guilt, and pride represent consequential constructs for people with SUD. As addressing shame and guilt can be perceived as confrontational, group-based blues songwriting may represent a positive, engaging, and creative intervention to target these challenging but important topics. Implications for clinical practice, limitations, and suggestions for future research are provided.
... Participants described their feelings of shame and guilt as consequences of their risky sexual behaviors, which they attributed to their meth use. Our participants' attribution of shame and guilt to sexual behavior induced by substance use, as opposed to substance use alone, distinguishes our results from prior studies linking low-guilt and/or high-shame proneness to substance use (Bradshaw, 2005;Dearing et al., 2005;Fossum & Mason, 1989;Meehan et al., 1996;O'Connor et al., 1994;Tangney & Dearing, 2003;Tangney, Mashek, & Stuewig, 2007a, Tangney, Stuewig, & Mashek, 2007bWiechelt, 2007) (Fig. 1). ...
... Interestingly, in the few instances participants implicated meth use in their feelings of shame and guilt, it was to blame meth use for the risky sexual behaviors that led to the consequences over which they felt ashamed and guilty. The emotional toll of the consequences stemming from meth-induced sexual risk behaviors, particularly shame and guilt associated with loss of meaningful relationships and self-respect over multiple-partner sex history, may provide an opportunity for meth use recovery intervention, as indicated by our results and prior research (Potter-Efron, 2002;Wiechelt, 2007).While research is limited in this area, other studies have shown that women and some men regretted their participation in sexual activities while under the influence of meth (Bourne, Reid, Hickson, Torres-Rueda, & Weatherburn, 2015;Iritani et al., 2007), further supporting others' findings that shame and guilt are important factors in substance addiction and addiction recovery (Dearing et al., 2005;Gueta, 2013;Potter-Efron, 2002). ...
... Individuals experiencing shame may feel powerless, whereas individuals experiencing guilt may feel motivated to change their behaviors as a means to seek forgiveness or otherwise cease actions they deem unacceptable by moral standards (Tangney, Stuewig, & Hafez, 2011Tangney et al., 2007aTangney et al., , 2007b. To break the shame/avoidance cycle of substance abuse (Wiechelt, 2007), prior research advocates for interventions designed to convert shame into shame-free guilt (Tangney et al., 2011;Wiechelt, 2007) or to convert avoidance of assessing one's behaviors into approaches to addressing one's behaviors. Guilt, specifically shame-free guilt, is associated with adaptive behaviors (Lickel et al., 2014;Tangney et al., 2011), while shame is associated with avoidance behaviors-i.e., minimization, anger, and blaming others (Lickel et al., 2014;Nathanson, 1994;Tangney et al., 2007aTangney et al., , 2007b. ...
Article
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Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users’ sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types—including meth use, and shame and guilt—few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.
... Ayıp ettin, bunları yapacak insan mıydın, kendini beş paralık ettin, gibi düşüncelerle hasta kendisini değersizleştirir ve zaten ne işe yararsın ki, işe yaramayan aşağılık bir insansın, senin hiçbir şeye hakkın yok gibi düşüncelerle acımasız boyutlara taşır (31). Bu sonuçlar da bireyin yaşadığı olumsuzluklardan duyduğu suçluluk, utanç duygusunu ve kaygıyı azaltma isteğiyle alkol kullanımına teşvik eden durumlar haline gelir (6,22,32). ...
... Ancak giderek artan bir suçluluk ve utanç duygusu gösterirler. Böylelikle birey, bu duygularını bastırmak için daha fazla içer, sonucunda da birey de anksiyete ve depresyon başlar ve sürekli alkol tüketir (22,24,27,32,33). Bilişsel kurama göre; alkol alma davranışında, işlevsel olmayan inançlarının rol oynadığı bilinmektedir. ...
... Bununla birlikte, bireylere baş etmeleri için çeşitli aktivitelere katılma gibi alternatif baş etme yöntemleri öğretilmelidir (41,42). Ayrıca, kliniklerde suçluluk ve utanç kavramına bağlı alkol kullanımını içeren kısa bir özbildirim ölçeği klinisyenler için yardımcı olabilir (22,32). ...
Article
Internalized stigmatization; is the cognitive and affective internalization of the patient's who stigmatized by society. The individual begins to see himself/herself as if he/she is stigmatized by others, and causes guilt, shame, feelings of inferiority, deterioration in family and friendship relationships and a decrease in self-esteem. Negative emotions are occured in person who internalized the stigma. The more important of these emotions are guilt and shame. Individuals who live with feelings of guilt and shame tend to drink alcohol as a way of coping with these emotions. After consuming alcohol, person experiences the feelings of guilt and shame again. This vicious circle, adversely affects the treatment of patients and increases relapse. Therefore, coping with these emotions, specially guilt and shame, are important component for alcohol addiction treatment. In the light of these information, the aim of this article is to take an attention the importance of internalized stigmatization, guilt and shame in alcohol addicts. ÖZET İçselleştirilmiş damgalama; toplumun damgalamasını hastanın bilişsel ve duyuşsal olarak içselleştirmesidir. Artık birey kendisini, diğerlerinin onu damgaladığı gibi görmeye başlar ve bireyde suçluluk, utanma, aşağılık duyguları, aile ve arkadaş ilişkilerinde bozulma ve benlik saygısında azalmaya neden olmaktadır. Damgalamayı içselleştiren bireylerde olumsuz duygular oluşmaktadır. Bu olumsuz duyguların en önemlisi suçluluk ve utanç duygusudur. Suçluluk ve utanç duygusunu yaşayan bireyler yaşadığı bu duyguları hafifletmek için bir baş etme yolu olarak alkole yönelmekte, alkol tüketiminin sonucu yaşanan suçluluk ve utanç duygularını tekrardan yaşamaktadır. Bir kısır döngü olarak devam eden bu girdap hastaların tedavisini olumsuz etkilemekte ve nüksü artırmaktadır. Bu yüzden alkol bağımlılarında, suçluluk ve utanç duyguları ile başetmek tedavi için önemli bileşenlerden olmaktadır. Bu bilgiler ışığında bu makale alkol bağımlılarında içselleştirilmiş damgalama, suçluluk ve utanç duygularının önemine dikkat çekmek amacı ile yazılmıştır.
... This suggests that SUDs develop from a need to escape personal deficits and failures, as well as one's negative self-judgment (Potter-Efron 2002). Individuals who develop SUDs discover that they may hide their shameful emotions through the use of substances (Wiechelt 2007;Potter-Efron 2011;Flanagan 2013). Shame motivates isolation, withdrawal, and avoidance; for shame-prone individuals, having a relationship with substances can replace interpersonal connections (Potter-Efron 2011; Randles and Tracy 2013). ...
... Potter-Efron (2011) described the shame-SU relationship as reciprocal and interdependent, where either factor can potentially start or fuel the cycle. Unfortunately, as the "shame-SU spiral" grows, the SU becomes more powerful and a goal in itself, rather than a coping mechanism to reduce shame (Wiechelt 2007;Potter-Efron 2011, 221). ...
... In summary, research findings support the notion that individuals with SUDs might be attempting to regulate negative emotions, such as guilt and shame, by using substances. However, as the "shame-SU spiral" grows, the substance becomes more powerful and a goal in itself, rather than a coping mechanism to reduce shame (Wiechelt 2007;Potter-Efron 2011, 221). Given that that acceptance may be a mechanism for alleviating shame and guilt (Randa 2011;Schneider 2006), it is suggested here that acceptance is an underlying behavioral mechanism that actually promotes a process of LTR from substance dependence. ...
Article
Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs. ARTICLE HISTORY
... Recent longitudinal daily process studies found that negative affect predicted substance use over time (Harder, Ayer, Rose, Naylor, & Helzer, 2014;Mason, Hitch, & Spoth, 2009). In particular, sadness was found to be a significant mediator of stress-related drinking (Dermody, Cheong, & Manuck, 2013) and shame was suggested to contribute to the development and maintenance of substance us related problems (Wiechelt, 2007). Furthermore, the experience of shame in the context of interpersonal trauma might involve a higher risk for substance use because of the trauma association and therefore the potential trauma-triggering effects (Wilson, Drozdek, & Turkovic, 2006). ...
... In addition, emotion regulation of shame may be more demanding than emotion regulation of sadness because shame might play a more salient role after traumatic events (Lee et al., 2001;Wilson et al., 2006). Consequently, the risk of developing substance use disorders may be higher as response to shame than sadness for individuals with childhood abuse and neglect (Wiechelt, 2007). ...
... This differential effect of intense shame for healthy individuals with experience of childhood abuse and neglect can be explained by the cognitive-affective process model of posttraumatic shame (Wilson et al., 2006). According to this model, the perception of shame may automatically trigger trauma-associated memories that are often accompanied by intrusions and flashbacks in individuals who experienced childhood abuse and neglect, and this may contribute to the development and maintenance of substance use (Wiechelt, 2007). Against the background of the recorded emotional experiences, our results suggest that the association between childhood abuse and neglect and substance use disorders can be explained through emotion regulation processes of specific intense negative, trauma-related emotions. ...
Article
Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.
... Most importantly, it has been substantiated that shame is not only correlated to addiction, but it is also a risk factor for developing addiction. In particular, it was found that individuals with higher levels of shame are more prone to addiction problems (Cook, as cited in Wiechelt, 2007) and also that fifth graders prone to shame are more likely to use psychotropic drugs by the age of 18 than their less shameprone peers (Tangney & Dearing, as cited in Wiechelt, 2007). ...
... Most importantly, it has been substantiated that shame is not only correlated to addiction, but it is also a risk factor for developing addiction. In particular, it was found that individuals with higher levels of shame are more prone to addiction problems (Cook, as cited in Wiechelt, 2007) and also that fifth graders prone to shame are more likely to use psychotropic drugs by the age of 18 than their less shameprone peers (Tangney & Dearing, as cited in Wiechelt, 2007). ...
... For instance, O'Connor and colleagues (1994) suggested that confrontation-a technique with wide acceptance in addiction treatment, aiming to encourage assuming responsibility-may conjure up or maximize shame. Wiechelt (2007) discussed the need for clinicians to identify shame as well as those therapeutic techniques that evoke it, to appropriately modify them. Such understandings regarding the role of rage and shame in addiction, which were also highlighted in our findings, can be useful to practitioners working with people confronting the challenges of substance abuse and dependence. ...
Article
The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.
... Conversely, individuals with greater alcohol and drug problems are less likely to accept negative emotional states without shame, leading to more alcohol and drug use and problems, likely as a function of self-medication of these aversive emotional states. A propensity for shame is significantly related to substance use problems and can negatively influence treatment outcomes (Dearing, Stuewig, & Tangney, 2005;Wiechelt, 2007). This cyclical relationship between shame and substance use problems has been supported in research, such that shame increases vulnerability to addiction problems, which may in turn create shame as a result of the disorder (Wiechelt, 2007). ...
... A propensity for shame is significantly related to substance use problems and can negatively influence treatment outcomes (Dearing, Stuewig, & Tangney, 2005;Wiechelt, 2007). This cyclical relationship between shame and substance use problems has been supported in research, such that shame increases vulnerability to addiction problems, which may in turn create shame as a result of the disorder (Wiechelt, 2007). ...
Article
Impulsivity and distress tolerance (DT) have been implicated as key features in development and maintenance of substance use disorders. This study expanded on previous research by exploring the four factors of DT (Absorption, Appraisal, Regulation, Tolerance) and their interaction with impulsivity in relation to substance use. Participants were 105 men and 150 women who completed measures of impulsivity, DT, and substance use. Results indicated that Appraisal DT was a better predictor of substance use problems over and above overall DT or other DT factors. Mediation analysis indicated that Appraisal partially mediated the relationship between impulsivity and DT. Results suggest that DT, particularly Appraisal, plays a role in substance use problems, specifically in the relationship between impulsivity and substance use problems. Treatments emphasizing DT skills, particularly the appraisal of aversive emotions, may be useful to employ when attempting to reduce harmful drinking or drug use behaviors.
... Yet, the relational pathways to substance misuse and drug-related offending discovered in this study are similar to qualitative findings by Leverentz (2006). The proposed model is also supported by the wider literature on trauma, attachment, substance misuse, shame, and offending (e.g., Cook, 1991;Dearing, Stuewig, & Tangney, 2005;Golder, 2005;Matos, Pinto-Gouveia, & Costa, 2013;O'Connor, Berry, Inaba, Weiss, & Morrison, 1994;Padykula & Conklin, 2010;Potter-Efron, 2006;Wiechelt, 2007). The findings lend some support to relational theory's notion that relationship disconnection or violation may be central to understanding (some) women's substance misuse and criminal justice involvement (Covington, 2007;Covington & Surrey, 1997). ...
... Shame has been implicated in both the onset and maintenance of addiction (Wiechelt, 2007). Higher levels of shame have been found in substance misuse treatment and recovery populations than in general populations (e.g., O'Connor et al., 1994), and shame but not guilt has been associated with more problematic alcohol use, increased risk of relapse and relapse severity (Randles & Tracy, 2013;Wiechelt & Sales, 2001). ...
Article
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Dysfunctional relationships are highlighted as a potential mediator between women's substance misuse and offending, but few studies have explored how. This qualitative study explored the role of interpersonal relationships to substance misuse and offending in women, and underlying psychological processes involved. Seven women offenders in community treatment for heroin dependence were interviewed. Data were analyzed using social constructivist grounded theory. A provisional model was constructed of the interconnection between family disconnection, dysfunctional intimate partner relationships, loss of children, and substance misuse and drug-related offending, within the context of complex trauma, insecure attachment, and shame. The potential significance of shame to women's substance misuse and offending has had little prior investigation. Interventions for women offenders with heroin addiction may need to consider all these relational psychological processes to adequately address recidivism risk. © 2016 International Association of Forensic Mental Health Services.
... According to the 'Affect Theory', shame is an adaptive emotion that aids in the regulation of behaviour and only becomes problematic when the experiences of shame are intense, longlasting or frequent. As a result, shame stops acting as a self-regulatory affect and is instead internalised into one's self-concept (Wiechelt, 2007). Wiechelt (2007) describes the experience of shame as "emotionally and psychologically painful" (p.401), resulting in strong feelings of vulnerability, isolation and loneliness. ...
... As a result, shame stops acting as a self-regulatory affect and is instead internalised into one's self-concept (Wiechelt, 2007). Wiechelt (2007) describes the experience of shame as "emotionally and psychologically painful" (p.401), resulting in strong feelings of vulnerability, isolation and loneliness. ...
Thesis
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This qualitative research aims to explore and understand the stigma and possible barriers to reintegration experienced by problem drug users in Malta. In-depth interviews were held with four (2 male, 2 female) recovered problem drug users in order to gain their own point of view regarding the situation. The interviews followed Wengraf’s Single Question aimed at inducing a Narrative (SQUIN) which aimed at eliciting the various sources of stigma and how problem users negotiated their stigmatised identities that were imposed on them. The data was analysed using the constant comparative method of data analysis and emergent categories and themes were identified. Findings indicate that stigma is present within society in varying degrees. Some sources of stigma such as family were found to be subjective to the individual’s experience, while stigma from other sources such as agents of social control was encountered on a wider scale. However, the main concern for all participants was the lack of knowledge the rest of society possesses regarding the challenges faced by recovering drug users. While coping mechanisms varied, the participants’ narratives emanated a strong will and positive outlooks towards life. The study concludes with recommendations for future research, policy and practice
... Feelings of pride ). Feelings of shame (Wiechelt, 2007). ...
... Problematic shame develops when individuals are exposed to frequent, long-lasting, or intense shaming experiences. Shame is internalized and becomes part of the identity rather than a self-regulatory affect (Wiechelt, 2007). ...
Thesis
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􏰏􏰅􏰕􏰕􏰐􏰂􏰒􏰄 The mind altering and regulative effects of substances affect the caregiver incompatible with sensitive caregiving. Thoughts and emotions often circle around substances and substance-related physical symptoms instead of attending to the emotions and practicalities of childcare. The parent becomes unpredictable and “out of sync” with the infant in ways that potentially threaten child development and secure attachment. This dissertation was motivated by a search for better preventive strategies for children-at-risk because of parental problems of substance addiction. The overarching aim was to investigate how the parents themselves, based on the assumption that understanding the parental perspective is necessary in any intervention, experienced parenthood and addiction. The work is grounded in the philosophy of science of critical realism. The parents’ experiences are discussed from a psychodynamic, an ethical, and a gender perspective. Sixteen women and eight men participated in focus group discussions and interviews. The qualitative data have been analysed according to Interpretative Phenomenological Analysis (IPA) (Eatough & Smith, 2008), resulting in four papers based on the following four questions: 1. What kind of theoretical framework can support a study of parenthood and addiction, bearing the child in mind? 2. How does substance abuse influence the mental preparation for motherhood during pregnancy? 3. How do women with addiction experience mandatory placement during pregnancy, and what ethical dilemmas do their experiences expose? 4. How do men with drug addiction experience fatherhood? Paper I, “Minding the baby”, outlines the theoretical and conceptual framework of the dissertation. The mentalizing theoretical model, rooted in several scientific disciplines and traditions, is seen as an integrative theory with explanatory power of problems of addiction, the psychology of parenthood, and child development. The clinical adaptations of the mentalizing theory added to the perceived usefulness of this framework. However, to grasp the complexity of the issue under study, sociocultural theory supplemented the conceptual framework to account for the role of participation in developing caregiving competence, and to give due attention to structural and cultural influences. Paper II, “Mental preparation for motherhood”, describes the subjective experience of the “journey” through pregnancy towards the role of a mother. A prominent finding was that awareness of the symptoms of pregnancy was often delayed and distorted. Also, being high and occupied with drugs and drug-related problems, and fear of not living up to the expectations of the professionals, influenced the psychological preparation. In some of these women, severe feelings of guilt, which otherwise serve to adjust negative behaviour (Elvin- Novak, 1999), contributed to continued use of substances. The experience of ambivalence runs like a red thread through the findings. Ambivalence as a clinical issue is discussed. Paper III, “Pregnancy and substance use – the Norwegian § 10-3 solution”, uses two cases to discuss ethical dilemmas in interventions that involve elements of coercion. The § 10-3 of the Municipal Health and Care Services Act give access to incarceration of pregnant women when intake of substances are seen as a serious threat to the foetus. The findings confirm those of Paper II in terms of a surface adaptation and fear of the evaluations of the professionals, which might compromise the preparation for the caregiving role. The bioethical principles of autonomy, beneficence, non-maleficence, and social justice (Beauchamp & Childress, 2009), come up short as a tool to solve the many dilemmas of the situation. A more relationally oriented framework based on mutual respect and trust, and interpersonal and communicative competences, is suggested as an alternative. Paper IV, “The good, the bad, and the invisible father”, describes how men with problems of addiction think about themselves, and how they find themselves mirrored as fathers. A common experience was being the weaker parent and left out of the child and domestic sphere. Gendered roles in the family, a feminized social service, and more sceptisism toward men’s motives and their ability to change are described as obstacles to a present and participating fathering role. The findings are discussed in relation to two opposing discourses of modern fatherhood, the present and the absent father. Fathers’ experiences of being weak and/or invisible call for more attention to the fathering role of men with problems of addiction. The four papers illustrate how parenthood and problems of substance addiction collide and result in a dominant experience of ambivalence. Parents feel pulled between hope and despair, between the forces of addiction and the wish to be a good parent. Ambivalence is further strenghtened by professional and sociological ambivalence. This, together with a sense of insecurity from being under critical examination can result in surface adaptation and endanger the mental preparatory work to support parenthood and caregiving. The unique opportunity for change during early parenthood is threatened by the dynamics of addiction, impingemements on supportive relationships, stigma and social exclusion. A familyoriented approach where the professional helping relationship is used to enhance sensitive caregiving and parental mentalizing is suggested to facilitate healthy child development as well as parental sobriety. The findings indicate a need to further thematize and support men ́s development of caregiving competence. Finally, parenthood and addiction requires a complex explanatory model with generative mechanisms at several domains and levels: biological, psychological, relational as well as the larger social, political and structural conditions.
... The person drinks to escape shame but unfortunately finds self in even more shame because he has been drinking out of control. This cycle keeps on repeating & causes great harm to the person & society [66][67][68][69][70]. ...
... As pointed out earlier by researchers [64][65], lack of coping skills & repeated failures or situational helplessness from chronic stressors was the reason seen for the never stopping vicious circle of addiction in our cases. In accordance with the literature data [66][67][68][69][70] we found our patient's attempting hard enough to avoid drinking, but always landing up drinking more which caused them more shame than before & thus the vicious cycle of addiction kept on repeating. Here it can be hypothesized that the occurrence of ACEs contributes to the adoption of maladaptive psychological and behavioral coping mechanisms, which makes that individual vulnerable to unhealthy behaviors such as substance abuse. ...
... 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]. ...
... 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]. ...
Article
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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.
... (Wiechelt & Sales 2001;Dearing ym. 2005;Wiechelt 2007;Reenkola 2018.) Alkoholismista toipuneiden äitien kokemuksia väitöskirjassaan tutkinut Tiina Törmä (2011, 86) kirjoittaa naisten kokemuksista siitä, miten juovalla naisella ei ole ihmisarvoa ja jopa eläimiin sekaantujien katsottiin pääsevän vähemmällä moralisoinnilla. ...
... (Esim. Wiechelt & Sales 2001; Dearing, Stuewig & Tag- ney 2007;Wiechelt 2007.)38 Intervention taustalla on Brené Brownin (2006) muotoilema teoria nimeltä shame resi- lience theory (SRT). ...
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Naisten päihteiden käyttö ja siihen liittyvät sosiaaliset ja terveydelliset ongelmat ja riskit ovat lisääntyneet Suomessa. Päihdeongelmaiset naiset muodostavat heterogeenisen ryhmän ja heidän psykososiaaliset taustansa ovat moninaiset. Päihdeongelmat tuottavat naisten elämään hyvin kokonaisvaltaisia seura- uksia, jotka välittyvät muun muassa terveyteen ja sosiaalisiin suhteisiin. Lisäksi sosiaalinen stigma, leimautuminen ja häpeä estävät naisia hakeutumasta hoitoon. Vasta hiljattain on alettu kiinnittää huomiota sukupuoleen ja sen merkity- seen päihdeongelmille ja niiden hoidolle. On havaittu, että perinteiset hoito-ohjelmat eivät välttämättä ole soveltuneet naisille ja että ne on suunniteltu vastaamaan miesten hoidon tarpeisiin. Tätä taustaa vasten on pidetty tärkeänä kehittää erikseen naisille suunnattuja päihdehoitopalveluja, jotka vastaisivat nimenomaan naisten tarpeisiin ja edistäisivät naisen hakeutumista hoitoon ja hoidossa pysymistä. Tämä sosiaalityön väitöstutkimus tarkastelee naisten päihdehoitoa naiserityisestä näkökulmasta. Tutkimuksen aineisto on kerätty etnografisen kenttätyön avulla demokraatista yhteisöhoitoa soveltaneen päihdehoitolaitoksen naistenyhteisössä. Naiserityinen päihdehoidon interventio muodostuu seuraavista ulottuvuuksista: (1) naiseus ja sukupuolen merkitys; (2) kehollisuus ja traumati- soitumien (3) identiteetti, tunteet ja mielenterveys; (4) sosiaaliset suhteet; (5) päihderiippuvuus ja yksilköohtainen muutostyö. Analysoin näiden ulottuvuuksien ilmenemistä empiirisessä aineistossani terapeuttisen yhteisöhoidon kontekstissa. Yhteisö on tässä tutkimuksessa sekä yksilöllisen, tietoisen muutostyön menetelmä että hoidon rakenne. Tutkimuksen tulokset antavat viitteitä siitä, että naisten päihdehoidon kysymykset ovat monitahoisia ja kompleksisia. Tämän vuoksi myös hoidollisten jatkumojen varmistamista laitoshoidon jälkeen on kriittinen tekijä. Koska suhteisiin liittyvät tekijät ovat olennaisia naisten päihdeongelmille, on naisten toipumisen kannalta olennaista se, miten he pystyvät liittymään ja kiinnittymään yhteiskuntaan uudelleen. Avainsanat: naiset, päihdeongelma, naiserityinen interventio, yhteisö, etnografia
... In addition, shame and guilt-proneness have been found to be associated with different motivations for alcohol use (Treeby & Bruno, 2012). Consistent with the shame-alcohol use-shame spiral hypothesis (Bilevicius et al., 2018;Dearing et al., 2005;Hequembourg & Dearing, 2013;Potter-Efron, 2002;Tangney & Dearing, 2002;Wiechelt, 2007), Treeby and Bruno (2012) found that shame-proneness was positively associated with the motivation to consume alcohol as a means of down-regulating experiences of anxiety and depression. In contrast, guilt-proneness was found to be negatively related to the motivation to consume alcohol in order to down-regulate these negative affect states. ...
... The finding that alcohol use-related shame is associated with the experience of alcohol-related problems in academic and work environments suggests that neglecting responsibilities in these life domains has the potential to be shame-evoking for some individuals. The finding that alcohol use-related shame is positively associated with a loss of control over alcohol use is also consistent with the shamealcohol use-shame spiral hypothesis (Potter-Efron, 2002;Tangney & Dearing, 2002;Dearing et al., 2005;Wiechelt, 2007), which suggests that a loss of control over drinking may serve as an additional source of shame for some shame-prone individuals. ...
Article
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Background: The dispositional tendency to experience guilt is inversely related to disordered alcohol use, while dispositional shame-proneness appears to share a positive relationship with alcohol problems. Objective: In order to further research in this domain, a new measure of alcohol use-related shame and guilt is described. Methods: Using exploratory and confirmatory factor analysis (CFA), the psychometric properties of the Perceptions of Drinking Scale (PODS) were validated across two independent samples (Sample 1 N = 293, Sample 2 N = 429). Results: A four factor model of the PODS was identified in exploratory factor analysis. The hypothesized four-factor PODS model was validated in an independent sample using CFA (RMSEA = .046; CFI = .99; TLI = .99). Alcohol use-related shame and guilt were reliably differentiated, and test re-test stability, divergent and convergent validity was established. Alcohol use-related shame was not clearly related to taking action to address problematic alcohol use, but was positively related with measures of negative affect and using avoidance-based coping strategies. Conversely, alcohol use-related guilt was generally unrelated to measures of negative affect and was clearly associated with the taking of action to address problematic alcohol use. Conclusions: The Perceptions of Drinking Scale has good psychometric properties and also appears to reliably distinguish between experiences of alcohol use-related shame and guilt. Both alcohol use-related shame and guilt appear to be positively associated with the contemplation of changing one’s alcohol use-related behaviors. Only alcohol use-related guilt was clearly linked to the taking of action to address problematic drinking behavior.
... consequences for users and their close family members, are often seen as signs of incompetence, low morale, and weakness (Goffman, 1968;Livingston et al., 2012;Wiechelt, 2007). Patients with SUD often have experiences of being treated as untrustworthy and incapable of actively participating in their treatment planning, even by healthcare and social service workers (van Boekel et al., 2013;Welle-Strand et al., 2021). ...
... Nettleton et al. (2013), however, asserted that these expectations of "normality" may be perceived as constraints by people in recovery. The standards of "normality" are too difficult to achieve for many of them, and years of stigmatisation and marginalisation can hinder the development of a "normal" identity, which requires a far more diversity-oriented society than the one existing today (Livingston et al., 2012;Nettleton et al., 2013;Wiechelt, 2007). SUD treatment should probably, to a larger degree, take into account that a "normal life", with its expectations of zero substance use and participation and coping in all arenas in society, is not compatible with some individuals' aims for improved quality of life and well-being while still using substances . ...
Article
Background and aim: Substance use disorder (SUD) is multifactorial, complex, and involves the severe problematic use of alcohol, prescription drugs, and other substances. People with SUD have long histories of perceived stigma, marginalisation, exclusion, social isolation, and shame. Moreover, patients with SUD are often treated as untrustworthy and incapable of actively participating in their treatment planning, even by healthcare and social services workers. Methods: Through in-depth interviews with former patients who have undergone SUD treatment, we explored their reflections on the treatment content. Interpretative phenomenological analysis revealed that some informants experienced aspects of the treatment as valuable, whereas others considered the same treatment useless or harmful. Results: Essential aspects of treatment were developing self-esteem and optimism about the future, developing strategies for coping with stress and challenging emotions and situations, developing relationships with family and friends, and preparing for life after inpatient treatment. Relationships with staff were described as crucial in all parts of the treatment. Conclusion: In conclusion, we suggest that a transition to a more collaborative treatment philosophy would be ethically and professionally valuable for providing support and treatment and enhancing patients’ perceptions of empowerment, inclusion, participation, and well-being on their terms, in cooperation with supportive others.
... First, shame is a key element of morality signaling of wrongdoing without words or thoughts. Shame, as a healthy function, promotes the development of the moral conscience which serves to monitor and adjust behavior (Wiechelt, 2007). This form of healthy shame functions as a fleeting and temporary source of distress designed to adapt behaviors that may disrupt the social bond (Potter-Efron & Efron, 1993). ...
... This form of healthy shame functions as a fleeting and temporary source of distress designed to adapt behaviors that may disrupt the social bond (Potter-Efron & Efron, 1993). As shame also promotes awareness of mistreatment and indignities directed toward individuals, shame becomes unhealthy when these experiences are persistent and chronic (Wiechelt, 2007). ...
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Shame, originating from social threats to social bonds, self-esteem and/or social status, has been associated with poor mental and physical outcomes. Despite theoretical assumptions indicating shame as a prominent emotional response to social threats, limited research has examined the association between internalized shame and racism among African American populations. This exploratory study sought to investigate the relationship between racism, self-esteem, and internalized shame. College students who self-identified as African American or Black (N = 203) completed the Schedule of Racist Events and Internalized Shame Scale. Past year and lifetime experiences of racism were positively associated with internalized shame. Self-esteem and internalized shame demonstrated a significant negative association. Two hierarchical linear regression models were used to examine the effect of the frequency of racist events in the past year, over the lifetime, and self-esteem on internalized shame scores. Both unadjusted models for past year and lifetime experiences of racism significantly predicted internalized shame. Adding self-esteem significantly improved the regression models accounting for 36% and 63% of the model variance for internalized shame, respectively. Findings from this study warrant greater focus on the role of shame and self-esteem in understanding the impact of racism among African Americans.
... Several theorists have elaborated upon the hypothesis that shame-prone individuals drink alcohol as a means of downregulating and escaping the aversive experiences of shame and other negative emotions (e.g., Bilevicius et al., 2018;Dearing et al., 2005;Potter-Efron, 2002;Stuewig & Tangney, 2007;Tangney & Dearing, 2002;Wiechelt, 2007). This hypothesis is consistent with research indicating that drinking to cope with negative affect (e.g., anxiety and depression) is a commonly reported reason for consuming alcohol (Anker et al., 2016;Grant et al., 2007;Treeby & Bruno, 2012). ...
... Thus, and despite a self-reported motivation to drink alcohol to cope with anxiety and depression (Treeby & Bruno, 2012), shame-prone individuals appear to believe that this drinking-to-cope strategy is often ineffective and results in additional negative affect. This finding is notable as it provides empirical support for a component of the shamealcohol use-shame spiral hypothesis elaborated upon by Potter-Efron (2002) and other theorists (e.g., Dearing et al., 2005;Stuewig & Tangney, 2007;Tangney & Dearing, 2002;Wiechelt, 2007). More specifically, shame-prone individuals, who are prone to negative affect and report a tendency to drink to cope with anxiety and depression (Treeby & Bruno, 2012), also believe that alcohol results in the burden of emotional dysregulation and additional negative affect. ...
Article
Background: Whilst drinking to reduce negative affect (e.g., anxiety and depression) is a commonly reported motivation for consuming alcohol, minimal research has explored associations between shame proneness and self-reported outcome expectancies from alcohol use. The present study aimed to explore the relationship between guilt, shame and alcohol use-related expectancies in a predominately undergraduate, community sample. Methods: Self-report data was collected for measures of these constructs in addition to overall alcohol use from a sample of 281 individuals, mean age 22.22 years (SD = 7.83). Results: Overall alcohol consumption was associated with both positive and negative alcohol use outcome expectancies. Contrary to hypotheses, shame-prone individuals did not appear to have a particularly strong belief that alcohol is actually effective in reducing tension. However, shame-prone individuals may believe that alcohol helps serve to reduce physiological arousal and other anxiety-related phenomena experienced in social contexts, and possibly also in the lead up to and during intimate encounters. In contrast, guilt-prone individuals expect and believe that they are successfully able to avoid negative emotional experiences after having consumed alcohol. Conclusions: Findings are broadly congruent with research indicating that shame-proneness is associated with general emotion regulation difficulties, while guilt-proneness tends to be unrelated to such problems.
... Substance use in particular has been identified as one of the most stigmatized characteristics globally (Room, 2005). Further, the moralization of addiction, self-inflicted nature of addiction, and often-described cyclical relationship between shame and addiction (i.e., "the shame addiction cycle"; Frank and Nagel, 2017;Luoma et al., 2019;Wiechelt, 2007) may lead to the internalization of substance use stigma acting as a barrier to self-care behaviors. ...
Article
Rationale Men who have sex with men (MSM) are disproportionately affected by HIV, substance use, and stigma related to co-existing or intersecting identities that are stigmatized or devalued by society (e.g., being a sexual minority male, a person living with HIV, or a person who uses substances). Evidence indicates that when stigma is internalized it may act as a barrier to engagement in self-care behaviors. Objective Gaining a better understanding of how intersecting internalized stigmas affect HIV self-care among MSM who use substances. Methods To investigate these relationships, we conducted semi-structured qualitative interviews until we reached thematic saturation (n=33) with HIV+ MSM who use substances and were sub-optimally engaged in HIV care. Interviews inquired about identity, internalized stigmas, substance use, HIV self-care behaviors, and interrelationships between concepts. Results Our sample was 63% African American and 76% reported annual incomes of ≤$20,000. Approximately half of the participants explicitly described how intersecting internalized stigmas impacted their sense of self and their behavior. The overwhelming majority conveyed that internalized stigma related to substance use was the most burdensome and was considered a barrier to HIV self-care behaviors. Participants also described internalized stigmas related to HIV and sexual orientation, as well as race, effeminateness, poverty, and housing instability, which together impacted their psychological wellbeing and HIV self-care. Conclusions Our results indicate a need for clinicians to consider and address intersecting internalized stigmas, particularly internalized stigma related to substance use, to reduce substance use and improve HIV self-care among MSM who use substances and are sub-optimally engaged in HIV care.
... Some authors see shame as a largely maladaptive, negative emotion, with little useful function [134]. Following similar reasoning, some therapy developers have suggested that shame should be directly targeted using shame reduction strategies [25,143]. Other authors have suggested that shame may serve a valuable function in regulating people's behavior through limiting deviations from accepted norms [29]. ...
Chapter
Stereotypes and judgments about people with substance misuse problems are extremely prevalent and negative. These negative evaluations are made not only by those who abstain from substance use, termed public stigma, but also by those who themselves use and abuse substances, termed self-stigma. While the exact form of discrimination may vary across different substances and social groups, research indicates that substance misuse appears to be at least as stigmatized as psychological disorders such as depression, schizophrenia, or borderline personality disorder. As used conventionally, stigma refers to an attribute or characteristic of an individual that identifies him or her as different in some manner from a normative standard and marks that individual to be socially sanctioned and devalued. This chapter outlines theories of stigma in relation to addiction. Types and levels of stigma are described, including structural versus individual stigma and public versus self-stigma. It is argued that stigma is a complex phenomenon that needs to be studied in context as its effects may vary across levels of analysis and across populations. Also outlined is the existing scientific literature on the impact of self-stigma, the role of stigma in the social networks of those with addiction, and the impact of stigma in treatment settings. Finally, interventions to reduce stigma are described and data on effectiveness are reviewed. Research on stigma in addiction is sparse, and much more research is needed to improve the effectiveness of these interventions.
... depression) to be private matters that one should manage on one's own, resulting in a reluctance to seek treatment (10). Acknowledging that one needs help to change an addictive behaviour like problem drinking may be particularly difficult among those who view seeking treatment as a sign of weakness, and feeling ashamed about needing help for substance abuse or other mental health problems is a known barrier to recovery from addiction problems among people of all ages (15). When alcohol problems are viewed as signs of personal weakness or failure, they are more difficult to talk about and therefore more difficult to diagnose and treat. ...
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Background: Although notable health disparities related to alcohol use persist among Alaska Native people living in rural communities, there is a paucity of research examining drinking behaviour in particular segments of this population, including elders. One explanation for this is the distrust of behavioural health research in general and alcohol research in particular following the legacy of the Barrow Alcohol Study, still regarded as a notable example of ethics violations in cross-cultural research. Objective: The present study reports findings from one of the first research studies asking directly about alcohol abuse among rural Alaska Natives (AN) since the study in Barrow took place in 1979. Design: We report findings regarding self-reported alcohol use included in an elder needs assessment conducted with 134 Alaska Native elders from 5 rural villages off the road system in Alaska. Data were collected in partnership between academic researchers and community members in accordance with the principles of Community-Based Participatory Research. Results: Findings showed very high rates of sobriety and low rates of alcohol use, contradicting stereotypes of widespread alcohol abuse among AN. Possible explanations and future research directions are discussed. Conclusions: This research represents one step forward in mending academic-community relationships in rural Alaska to further research on alcohol use and related health disparities.
... People who feel shame are typically dissatisfied with themselves and resort to obsessive-addictive behaviours to avoid and escape their self-hatred (Bradshaw, 2005). Likewise, most addictions, such as gambling, drugs and alcohol, are related to shame (Bilevicius et al., 2018;Bradshaw, 2005;Brown, 1991;Cook, 1991;Dearing et al., 2005;Shim, 2019;Wiechelt, 2007). According to previous research, shame also is a risk factor for Internet addiction (Craparo et al., 2014). ...
Article
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Internet addiction is an important mental health problem among university students. This study aimed to examine the relationship between shame and Internet addiction and investigate the mediating role of experiential avoidance in undergraduate students. A total of 307 undergraduate students (210 females and 97 males) were recruited. Shame was examined using the Self-conscious Affect-3 Test. Experiential avoidance was evaluated using the Acceptance and Action Questionnaire-ӀӀ (AAQ-II). Internet addiction was assessed using the Young Internet Addiction test (IAT). Findings revealed significant associations between shame, experiential avoidance, and Internet addiction. In addition, the results of structural equation modelling demonstrated the mediating role of experiential avoidance in the relationship between shame and Internet addiction. The results suggest that the experts working on Internet addiction consider the shame and experiential avoidance. Early discovery and intervention of shame and experiential avoidance can be incorporated into programmes intending to reduce the risk of Internet addiction. ARTICLE HISTORY
... The substances affect the brain's central functions, including dopamine production and executive functions, with a consequent craving for substances and impaired impulse control [47,49]. This may involve reckless behaviour that is often incomprehensible to other people and may lead to stigma and shame [16,18,48]. Mental health problems, such as anxiety and depression, may increase [29], and it may be difficult to maintain social relationships, everyday parenting responsibilities and work routines [18,34]. ...
Article
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This article concerns people who have developed a substance use disorder (SUD) and sought treatment. SUD is understood as a biopsychosocial disorder. People who want to stop using substances or wish to increase their wellbeing while using substances need to undergo a recovery process. We conducted qualitative interviews with 11 former patients four years after discharge from inpatient SUD treatment in the Tyrili Foundation to explore their experiences and reflections on SUD and the recovery process. The findings indicated that recovery processes are complex, and feelings of wellbeing and success vary over time. Several interrelated aspects of life were essential for seeking a better life: Understanding own substance use; Feeling safe; Understanding the impact of close relationships; and Perceptions of participation and belonging. The informants emphasised the need for access to professional and social support during the recovery process, which, for some, will last for many years. Receiving such support is not understood as a defeat, and each person’s resources and vulnerabilities should be recognized and acknowledged. SUD and recovery should be understood using the same coherent approach—as an interplay between biological and psychological factors and social, political and cultural contexts.
... Both mediation chains involving trait and state shame experience, i.e. the three-step, and two-step (without shame proneness) mediations represent important findings, given that significant evidence exists detailing the difficulties associated with shame not only for problem gamblers (e.g., Gainsbury et al., 2014) but also for those suffering from other addictions (e.g., Wiechelt, 2007). These findings suggest that even for shame-affected problem gamblers, interventions focusing on GRSE-related skills (and those parts of GRSE related to shame) could potentially reduce the damaging consequences of gambling that may affect other areas of their life. ...
Article
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Previous research has identified the benefits of increasing self-efficacy in problem gamblers, while other research has identified higher levels of shame and dysfunctional coping in problem gamblers. The primary aim of the present study was to examine the relationships between problem gambling behaviour, shame (as both a personality trait and an emotional state), gambling-related self-efficacy, and dysfunctional coping mechanisms. The sample consisted of 235 participants (172 male; mean age = 30.32, SD = 8.57), who completed an online, self-report questionnaire that assessed gambling severity, shame-proneness, post-gambling shame and guilt, and dysfunctional coping. Data were assessed using path analysis models. As hypothesised, more problematic gambling was significantly associated with dysfunctional coping. A pathway mediation model was determined and several mediator variables were found to operate in series, including: shame proneness, post-gambling shame, and gambling-related self-efficacy. This research supports and builds on previous research that has highlighted the detrimental effect of problem gambling and shame on coping mechanisms, and the benefits of gambling-related self-efficacy for subsequent coping. A limitation of the study was that 18.7% of the sample reported scores indicative of probable pathological gambling, while most of the remaining sample were representative of recreational gambling. Implications of this are discussed.
... Even if a person may have more than one disorder at the same time, mental disorders are complex phenomena made up of different components. At the core of every addiction are feelings of guilt and shame, which drive a destructive overall process [36]. These depressive elements cannot be separated from the addiction development. ...
... Within the literature, shame has often been proposed to increase a person's vulnerability to developing an addiction to substances (Dearing, Stuewig & Tangey, 2005) and our study would also suggest that shame is likely to play an important role in alcohol dependence. Unlike previous research, however, that has suggested that alcohol addiction is maintained because of the 'shameful' things one does whilst intoxicated (Wiechelt, 2007), our study found that shame was much more deep rooted. Shame was not about behaviour (feeling bad about something you did is guilt, not shame), but rather an internalised view of themselves as being unworthy, abnormal and inferior to others. ...
... If athletes follow the same pattern as recreational or habitual drug users, shaming may increase rather than decrease use. Dearing et al. (2005) and Wiechelt (2007) suggested that the use of shame reduction interventions might be a better prevention method to achieve a healthier outcome. ...
Article
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This article argues that Bowers and Paternoster’s emphasis on a moral community marks an important step towards a more ethical and effective approach to anti-doping. However, it also argues that the authors’ proposed strategies undermine their stated goal of effectively engaging athletes as partners in anti-doping efforts and raise ethical concerns. Their proposed emphasis on exploiting shaming as a punishment and their general view of athletes as adversaries fosters mistrust between athletes and those who enforce the anti-doping rules. Instead, this article describes a model for empowering athletes as stakeholders in anti-doping policy as a means to provide anti-doping rules with increased moral legitimacy among athletes.
... Hence, depression can make individuals more susceptible to experiences of shame (Whelton & Greenberg, 2005). Shame, in turn, may promote addictive behaviours in part through coping (Wiechelt, 2007) or negative reinforcement (Carpenter & Hasin, 1999). This suggests a potential causal chain between depression, shame, and problem drinking or gambling. ...
Article
Background Alcohol and gambling problems are common in young adults. Self-medication theory states that young adults with depression drink and/or gamble to escape negative emotions. Research shows that depression is a risk factor for drinking/gambling problems, but more work is needed to examine mediators underlying these associations. One potential mediator is shame. Shame is a self-directed emotion that follows a negative life event and is characterized by intense feelings of inferiority, worthlessness, and embarrassment. Depressed individuals are especially susceptible to shame (and associated emotions). Shame has also been implicated in risk for addiction. Accordingly, we predicted that elevated shame would explain why depression is associated with both alcohol and gambling problems. Methods A longitudinal design was used to examine this hypothesis. Undergraduates (N = 210) completed self-reports of depression at baseline (Time 1) and then completed self-reports of shame, alcohol misuse, gambling problems one month later (Time 2). Results Results showed that individuals with elevated depression at Time 1 endorsed high levels of shame at Time 2, which in turn predicted more gambling (β = .038, 95% CI [.010, .087]) and alcohol problems (β = .249, 95% CI [.123, .435]) at Time 2. We found that increased levels of shame explained the effects of depression on problem drinking and gambling. Conclusions Study findings improve our understanding of the depressive pathway to addiction by providing evidence for shame as a potential mechanism of this pathway. Impact Reducing shame can be a target of clinical interventions for young adults with depression and alcohol/gambling problems. https://www-sciencedirect-com.uml.idm.oclc.org/science/article/pii/S0306460318300881
... Moreover, prior research has highlighted the particularly potent impact of nonacceptance of emotions (e.g., Ostafin & Marlatt, 2008;Tull, Schulzinger, Schmidt, Zvolensky, & Lejuez, 2007) and shame on substance use (e.g., Cook, 1987;Luoma, Kohlenberg, Hayes, & Fletcher, 2012;Wiechelt, 2007). For example, in college students, nonacceptance of one's feelings significantly predicted ARP even when controlling for gender and general symptom distress and moderated the relationship between implicit urges and overt binge drinking (Ostafin & Marlatt, 2008). ...
Article
Binge drinking (BD) and alcohol related problems (ARP) are highly prevalent among college students. However, current models examining ARP suggest drinking quantity only accounts for a portion of the variance, suggesting other variables contribute to ARP. Distress tolerance (DT), or the ability to withstand negative affect, is associated with alcohol misuse and may be an important mechanism related to ARP. However, studies have reported inconsistent findings on this association, which may be due to the use of only global scores to measure DT rather than specific DT components. Furthermore, the mechanisms underlying this association remain unknown. Drinking to cope with negative affect has been associated with both DT and ARP, suggesting it may be a mechanism explaining the relationship between DT and ARP. The current study examined the association between specific proposed DT components (i.e., tolerance, absorption, appraisal, and regulation) and drinking to cope and ARP in 147 college students who BD. A hierarchical linear regression was performed in order to examine which DT component best predicted ARP. Four follow-up mediation models were then tested to examine whether drinking to cope mediated the relationship between each DT component and ARP. Appraisal of DT was the only DT component that significantly predicted ARP, in the model controlling for drinking quantity and sex differences. Drinking to cope mediated the relationship between ARP and tolerance, absorption, and regulation, but not appraisal of DT. Implications for furthering our understanding of DT and treatment of BD as it relates to DT are explored.
... Given that shame and guilt are often encountered in treatment settings [40], a brief self-report measure that assesses the levels of shame and guilt an individual is experiencing is likely to have some utility for clinicians. For instance, if the measure reveals that a man is experiencing a significant level of shame, the treating therapist may need to focus on diffusing this aversive experience [18,41]. This is particularly the case given that experiences of shame are associated with a reluctance to disclose therapy-relevant material, which can impede the treatment process [42]. ...
Article
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Extant research points to shame and guilt as salient affective experiences for men’s mental health outcomes. As the constructs of shame and guilt gain increasing research attention in relation to at-risk men, including those with recent military combat experience, history of sexual abuse, substance misuse and suicidality, valid and reliable assessment is needed. The present psychometric validation study had four arms (Study 1a, 1b, 1c and Study 2) and aimed to validate a short-form of the Personal Feelings Questionnaire (PFQ-2) for assessing guilt and shame. Data were collected from four independent samples of men across community and clinical populations (total N=1042). In Study 1a (n=333) the factor structure of the original 16-item PFQ-2 was rejected. In Study 1b (n=332) a 7-item PFQ-2 Brief was calibrated. This was validated using confirmatory factor analysis in Study 1c (n=335; CFI=0.986, TLI=0.978, RMSEA=0.060, SRMR=0.026). Finally, PFQ-2 Brief properties were evaluated in 42 men attending outpatient psychiatric care (Study 2). The PFQ-2 Brief appears to provide a valid and reliable measure for assessing guilt – and shame-proneness in men and as such, should aid further investigations of the manner in which the two affect styles impact help-seeking, treatment engagement, treatment outcomes, and men’s overall mental health.
... Individuals identified as having substance-use problems are found to have higher levels of shame than individuals with other mental health problems and the general population (O'Connor, Berry, Inaba, Weiss, & Morrison, 1994). Individuals who experience these strong, negative evaluations about the self may use substances as an escape from the pain of their feelings (Adler, 2005;Cook, 1988) but, in turn, may experience increased feelings of shame with themselves for doing so (Cook, 1988;Wiechelt, 2007). This under scores the reciprocal relationship between shame and substance use. ...
Article
Inferiority feelings have been linked theoretically to substance use; however, an empirical definition of the construct is lacking in research. The purpose of this study was to examine the adequacy in defining inferiority feelings using the empirically established constructs of self-esteem, general self-efficacy (GSE), abstinence self-efficacy (ASE), and shame using a sample of 210 undergraduate college students. Results of the confirmatory factor analysis indicated that the overall model provided good fit for the data; however, self-esteem and shame loaded more strongly on the latent construct than did GSE and ASE. The results provide preliminary evidence for using these constructs to define inferiority feelings; however, future research is necessary to examine alternate constructs that may define inferiority feelings in other populations.
... The same kind of advice and help may be easier to accept for instance in a safe injection site than in medical facility, even if the personnel have the same training. Vulnerability that one may experience in losing control over one's drug consumption involves feelings of shame (see e.g., Wiechelt, 2007). These kinds of states are likely to make the individual with addiction even more vulnerable and further complicate addressing the problem and seeking help. ...
Article
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According to the brain disease model of addiction (BDMA), substance addiction is a chronic, relapsing brain disease. The BDMA is currently influential in informing addiction policy and the development of new treatments, but remains highly controversial across the addiction research community. We draw on resources from philosophy of science and applied ethics to re-examine the methodological and ethical implications of the BDMA and offer a new forward-looking and constructive conceptualization of the BDMA as a heuristic reductionist research hypothesis. We argue that this not only allows a sharper delineation of the empirical shortcomings of the BDMA, but also helps skeptical social scientists appreciate and incorporate the empirical successes of the BDMA to a broader, social understanding of addictions. We apply this view to the ethical implications of the BDMA, especially to the key concept of vulnerability. The BDMA states that it is the brain that has been hijacked by the drug and the brain thus compels the individual to act in ways that are often disastrous for the individual. The proponents of the BDMA ascribe “vulnerability” to multiple levels of organization, such as genes, specific neural systems, the brain, and the person, thus resulting in confusion and highly problematic ethical, social and even legal implications. The BDMA locates the vulnerability firmly within the individual and treats it as a matter of susceptibility to changes in brain chemistry. This may well be a part of the phenomenon, but the kind of vulnerability relevant for understanding and treating addiction is, however, embedded in normativity, as it concerns the agency of individuals with addiction. Agency is not simplistically reducible to the competencies of the individual, but rather it is also constituted in the interactions with their environment.
... Opplevelsen av å ikke ha blitt sett og beskyttet, ikke bare av foreldrene, men også av andre voksne, bidrar til å skape et negativt selvbilde, vansker med å knytte seg til andre mennesker og problemer med psykisk helse (Werner & Malterud, 2016;Wiig, Haugland, Halsa & Myhra, 2014). Flere studier peker på at skam og tabuer knyttet til rusmiddelbruk har vaert en tilleggsbelastning for barna, og at dette har medført en taushet rundt temaet (Delås, 2015;Kufås, 2015;Weston, 2010;Wiechelt, 2007). De barna som har blitt sett, beskyttet og snakket med, understreker viktigheten av dette (Backett-Milburn, Wilson, Bancroft, & Cunningham-Burley, 2008;Grove, Reupert & Maybery, 2015;Holmila, Itääpuisto & Ilva, 2011;Kufås, 2015). ...
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Barn som har foreldre med rusmiddelavhengighet er sårbare. Helsepersonell har plikt til å følge opp barn som pårørende til foreldre eller søsken med psykisk sykdom, rusmiddelavhengighet eller somatisk sykdom/skade. Syv foreldre/pasienter og 18 barneansvarlige ble intervjuet om erfaringer knyttet til barne- og familiesamtaler innenfor tverrfaglig spesialisert rusbehandling (TSB). Funnene viser at barrierer knyttet til både behandlerne, pasientene og organisatoriske forhold gjorde at pasientenes barn i liten grad ble invitert til slike samtaler. Funnene blir diskutert med utgangspunkt i teori om stigma og skam knyttet til foreldreskap og rusmiddelavhengighet.
... Given that women make up approximately half of the US population, increases in drinking represent a public health concern. Women experience more stigma related to problematic alcohol use and are less likely to seek services and support [64,65]. Women themselves face greater health consequences for drinking than men do, such as elevated risks of breast and cervical cancer, as well as other conditions like osteoporosis, and develop alcohol-related diseases at lower levels of consumption than men [66,67,68]. ...
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Background Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex. Methods and findings We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006–2018 waves of the cross-sectional National Health Interview Survey (NHIS, N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30–44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18–29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45–55) without children (odds ratio [OR] for heavy drinking each year = 1.06, 95% CI 1.02–1.10) and women ages 30–44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years. Conclusions This study demonstrated that trends in binge and heavy drinking over time were not differential by parenting status for women; rather, declines and increases over time were mainly attributable to sex and age. Women both with and without children are increasing binge and heavy drinking; men, regardless of parenting status, and women without children consumed more alcohol than women with children. Regardless of impact on child health, increased drinking rates in the past decade are concerning for adult morbidity and mortality: binge drinking has increased among both sexes, and heavy drinking has increased among older women. Men and women of all ages and parenting status should be screened for heavy alcohol use and referred to specialty care as appropriate.
... Further substance use may then subsequently function as a coping strategy to manage the negative emotions and distress resulting from initial substance use. Shame proneness has been associated with greater substance-use problems and userelated impairment (Dearing et al., 2005;Harper, 2011;Wiechelt, 2007), whereas addressing shame in therapy reduces substance use (Luoma, Kohlenberg, Hayes, & Fletcher, 2012). Thus, whereas religiosity and spirituality may be protective against high frequency of substance use, it may be that highly religious or spiritual individuals who do use substances perceive their use as contrary to their beliefs and in turn engage in more hazardous use as a maladaptive coping strategy in response to use-related shame. ...
... De plus, ces groupes se tenant pour la plupart en milieu de journée, la reprise des activités professionnelles des patients a également pu créer un frein matériel à la participation. Enfin, le sentiment de honte est central dans la maladie addictive, et peut constituer un obstacle au processus de soins [10]. Des épisodes de reprise de la consommation au cours de cette période peuvent avoir déclenché ce sentiment chez certains patients, entraînant un évitement des soins proposés. ...
... Specifically, the operationalization of the preoccupation dimension is highly consistent with empirical data on the meta-cognitive model of craving (i.e., desire thinking; Caselli & Spada, 2015). The use alone aspect captures the relationship between shame-proneness and the severity of alcohol and drugs use (e.g., Dearing, Stuewig, & Tangney, 2005;Wiechelt, 2007). The area concerning the use for rewarding effects overlaps with the neurobiological model of addictive behaviors, called "the reward deficiency syndrome" (e.g., Blum et al., 2000). ...
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Clinical trials on Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone intervention for alcohol use disorder (AUD) showed promising outcomes. Improvements in difficulties with emotion regulation (DER) played a mediating role on abstinence maintenance. However, the effect of DER, together with specific coping strategies, have not been considered yet in the treatment of clinical features associated to AUD and concurrent substance use disorders (CO-SUDs). The current study aims at investigating changes in the number of consecutive days of abstinence (CDA), severity of AUD and CO-SUDs (Shorter PROMIS Questionnaire; SPQ alcohol, prescription, illicit drugs subscale), DER (Difficulties in Emotion Regulation Scale; DERS) and coping strategies (DBT Way of Coping Checklist; DBT-WCCL) during a 3-month DBT-ST program for the treatment of AUD and CO-SUDs. Furthermore, four independent multiple parallel mediational models were estimated considering scores of CDA/SPQ, DERS and DBT-WCCL dimensions as dependent, independent and mediators variables respectively. One-hundred eight individuals with a primary diagnosis of AUD were consecutively admitted. The results showed significant and moderate to large improvements in CDA, severity of AUD, CO-SUDs and DER. The analyses detected significant improvements in the use of DBT Skills. The changes in DER predicted decreases in SPQ scores. The changes in DBT-WCCL scores were mediators of the previous relationships, considering SPQ alcohol and prescription drugs subscales. These findings support the implementation of DBT-ST as a stand-alone intervention for the treatment of AUD and CO-SUDs. DER together with coping strategies are relevant therapeutic mechanisms in the treatment of clinical features related to SUDs.
... Although substance-related disorders are categorized as psychiatric disorders, society tends to view these problems more harshly than other forms of mental illness (Rasinski, Woll & Cooke, 2005). In addition, research has found that higher degrees of shame are experienced by individuals with substance-related disorders in comparison to individuals with other forms of mental illness (Wiechelt, 2007). Furthermore, the magnitude and duration of the effects of substance abuse stigma may last far beyond that of other disorders (Link, Struening, Rahav, Phelan & Nuttbrock, 1997). ...
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Purpose: This qualitative study examined the experience, manifestations, and impact of racial discrimination and substance abuse stigma, also known as a double stigma, among 10 African-American male substance users. Method: Interviews were audio-taped, transcribed, and analyzed for themes using Grounded Theory methodology. Results: Racial discrimination and substance abuse stigma were common experiences. In terms of a double stigma,interviewees perceived that their substance use problems were viewed differently, and less favorably, than the substance related disorders of non-minority clients. Spirituality also was an important aspect of coping for a majority of interviewees. Conclusions: This qualitative approach utilizing Grounded Theory was successful in collecting and summarizing the narrative experiences of double stigma among African American male substance users. A double stigma experienced by African-American males with substance related disorders may cause potentially harmful effects on treatment engagement and success. 10.5463/sra.v1i1.3
... Sanders (2011) found that shame caused distress for women entering recovery and that higher levels of shame were related to greater chance of relapse. Wiechelt (2007) has suggested that relapse triggers feelings of inadequacy, which intensifies feelings of shame, thereby perpetuating a vicious cycle where drinking relieves shame but also reinforces it. Gilbert (2009) suggested that psychological treatments for mental distress should support people to develop tolerance to shame. ...
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Aims: Experiencing shame can be a risk factor for relapse for people recovering from alcohol dependence, but for some it may act as a necessary protective factor for preventing relapse. Knowing how best to manage shame is therefore an important issue, yet the precise nature of the relationship between shame and alcohol dependence remains largely unexplored. Research questions: (1) In what ways do participants tell their stories of shame? (2) How is shame experienced and/or understood by those in recovery from alcohol dependence? Method: Eight participants were recruited from Alcoholic Anonymous (AA) groups and invited to tell their story of recovery. Stories were then analysed using a narrative analysis, focusing on how participants narrated their stories and made sense of their experiences of shame in particular. Findings: Participants spoke about an inherent deep-rooted negative view about themselves, which was present long before alcohol dependence developed. Alcohol served as a means of connection to others and a way of artificially relieving feelings of worthlessness. Recovery was about finding somewhere safe to talk about feelings of shame and make sense of these experiences. Conclusions: The results indicate that management of shame is an important component of recovery programmes for alcohol dependence.
... Noting the similarity between depressed patients' and defeated macaques' behavior, Price highlighted the evolutionary function of the behavioral and emotional reactions to defeat: anxiety, irritability, and depression are the emotional correlates of submissive behaviors necessary to maintain the hierarchical organization of the group. Moreover, other authors have pointed out how another predominant emotion among depressed patients, shame-which derives from the fear of losing one's social ranking-has an important adaptive value since it inhibits the aggressiveness of the dominant member within the group, and leads who feels it to avoid other potentially humiliating situations (Gilbert 1997;Kim et al. 2011;Wiechelt 2007). Later, Gilbert (2000Gilbert ( , 2005 has postulated four motivational systems (social mentalities): careseeking, caregiving, cooperation, and competition. ...
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Attachment theory is useful, but per se it may not be sufficient to understand the complexity of human relationships. For this reason, we believe that there is the need to refer to a broader (evolutionary theory of motivation; Liotti, Psychoanal Inquiry 37(5):319–331, 2017) that considers normal functioning as the result of the harmonious activation of various motivational systems, each aimed at achieving an objective of high evolutionary value (adaptive for the individual, the social group, and the species). In this approach, pathology results from the disharmonious and dysfunctional activation of one or more motivational systems. This leads to a theory of care aimed at modulating the maladaptive activation of motivational systems by recognizing each patient’s dysfunctional interpersonal schemas and restoring his ability to function in more flexible ways. Motivational monitoring allows us to recognize impasses/ruptures within the therapeutic alliance and effectively use interventions to restore it. It may enhance patients’ emotional regulation and the interpersonal attunement between patient and therapist, reducing the risk of dropouts and leading to better therapeutic outcomes.
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Previous researchers have established the relationship between substance abuse and shame and religiosity/spirituality and shame. This study investigated the associations among shame, religiosity, spirituality, and drinking behavior in a college student sample (N = 310). Participants classified as hazardous drinkers reported higher levels of shame associated with drinking behavior. Elements of religiosity and spirituality significantly explained state shame among hazardous drinkers. Implications for college counselors are presented.
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Although guilt and shame, on one hand, and spirituality, on the other, are known to relate to recovery from substance abuse, the connectedness of these emotions, spirituality, and recovery has hardly been touched in research. This study, drawing from rich qualitative data consisting of the interviews of 21 former substance abusers, each interviewed twice, targets this relationship and analyses how spirituality, in this case more precisely Christian faith, relates to guilt and shame during the process of recovery. Since self-conscious emotions are at least in part socioculturally constructed, Christian faith is seen as a cultural tool that is influencing the ways how to define and cope with guilt and shame in recovery. Both academic and practical conclusions are drawn from the data.
Chapter
Shame along with guilt and embarrassment, belongs to a family of emotions that have been called the self-conscious emotions. These emotions are known to make us inward focused, however, shame almost always occurs in the presence of the other or imagined other making us relationally focused. When appropriately experienced, shame can be a modulator of interpersonal relatedness, however, if it is denied in oneself or not accessed meaningfully, it can lead to disconnect in the emotional and relational realm. In psychotherapeutic literature, there has been a surge in clinical interest in shame and many of the problems of anxiety have now been reconceptualized as problems of shame. It has been found correlated with a host of psychiatric disorders like depression, suicidal ideation, anxiety, eating disorders, PTSD, and substance abuse. An appreciation of manifestations of shame in psychotherapy may greatly deepen our ability to connect with and understand our patients’ experience. This chapter will discuss the relevance of shame in therapeutic practice, the importance of assessing shame, identification of verbal and non-verbal markers of shame, role of shame in therapeutic alliance, and some principles a therapist should follow when treating shame.
Chapter
Self-stigma in addiction occurs when individuals with substance use disorders (SUDs) experience shame based on mythological stereotypes in public stigma, as well as from their own sense of what they take to be shameful about addiction. This process leads to changes in identity in line with negative stigmatising stereotypes. The main source of the shaming process comes from public stigma where powerful others impose upon the individual with SUDs a social world (an ambience) containing false and distorting attitudes and beliefs that are internalised and lead to harmful effects, including further substance use and self-sabotage. A second source of self-stigma is the private shame that individuals feel based on accurate recognition of their situation. This may generate the motivation to heal but typically only when it occurs in a supportive context where public stigma is absent and acceptance by others is present. With the barrier of public stigma removed, or at least lowered, the individual with SUDs will stop self-stigmatising based on the damaging mythology around addiction and so may be given the support he or she needs for self-compassion, and in particular self-trust, in order to recover.
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Individuals with negative feeling such as shame might be vulnerable to smartphone addiction. The present study aimed to explore the relationship of smartphone addiction with external shame and internal shame in a sample of Christian adolescents in Korea. The correlational and causal relationships between Korean Christian adolescents’ smartphone addiction and external shame-including others and God-and internal shame were examined. Through a correlational analysis, the study found that external shame-others, external shame-God, internal shame, and smartphone addiction were all highly correlated with each other. During causal and mediation analyses, it was found that internal shame mediated external shame-others and smartphone addiction and also mediated external shame-God and smartphone addiction. In addition, the study offers a discussion of its finding and suggestions for clinical interventions.
Chapter
The legal community has a complex relationship with individuals with substance use disorders (SUDs). The law punishes much drug use, of course, but it also simultaneously protects individuals with SUDs (through partial recognition of addiction as a mental disorder) and disadvantages them (through restrictions on when such a conception can be used as a legal defense). What is clear is that when it comes to treatment of individuals with substance-related charges, race matters. Within the law, there is racialized drug stigma. Beyond the criminal justice system, addiction stigma and the law collide in two important areas: one, societal treatment of individuals who were formerly incarcerated for drug offenses and, two, stigma against attorneys who struggle with SUDs. Much research in this area remains to be done, including the study of intersectional stigmas.
Article
This paper reports on data that is part of a wider evaluation of a small‐scale project that offers support to parents, children and families affected by alcohol and substance use. Using semi‐structured interviews and a focus group, the data in this paper explore mother's sense making of their substance use and their experiences of various professional interventions which have helped or hindered their personal journeys of recovery. Mothers' narratives suggested a self‐critical inner dialogue conceptualized as shame. Fear of stigma and a sense of shame derived from historical abuse and had a profound effect on how mothers perceived themselves and how they negotiated a web of professionals involved in their lives. Community projects with a focus on understanding mothers and their needs, and not the risk they posed to their children, were considered most supportive. Interventions working within a non‐judgemental and empathetic framework that fostered the importance of relationships and connection had a greater impact on mothers' long‐term recovery goals.
Thesis
Most individuals with alcohol use disorders (AUD) never seek or receive specialist treatment. However, much of what is known about addiction and recovery is based on pre- and postintervention studies with patients in specialist treatment settings who tend to have severe dependence. These studies often fail to capture the complex and circuitous nature of recovery, and findings might not be generalisable to most people with AUD. The work described within this thesis therefore aimed to: 1) gain an in-depth understanding of how those with a range of drinking patterns and treatment experiences, whose narratives are largely absent in the literature, conceptualise their relationship with alcohol, and 2) generate theory about processes and determinants of recovery. A mixed-methods constructivist grounded theory approach, comprising two separate but related studies, was employed. Study 1 involved in-depth telephone interviews with 31 members and browsers of a previously unresearched online mutual aid group (Soberistas.com) which resulted in the development of a theoretical framework of recovery entitled: ‘managing multiple facets of self’. This analysis highlighted important personal and social identity processes that appeared to underpin change. To advance the framework, a further two-phased study with a more heterogeneous population was conducted. During the first phase, an observational follow-up cohort study recruited 141 patients with AUD during their unscheduled attendance at a general hospital, and gained quantitative estimates of alcohol use, and related measures such as psychological dependence and readiness to change. Participants were re-interviewed six months later, and variables examined for change (or lack thereof). The second phase employed face-toface in-depth qualitative interviews with a sub-sample of the hospital cohort, purposively selected to be a maximum variation sample using quantitative data collected previously. Quantitative and qualitative data were synthesised to develop the final theoretical framework, ‘alcohol and recovery self-concept fluidity’, which illustrates the dynamic, fluid, and complex nature of living with, and moving beyond, a problematic relationship with alcohol. The theory posits that conceptualisations of problematic alcohol use and recovery are diverse and subject to constant (re)negotiation; individuals navigate numerous, and at times conflicting, explanatory frameworks, in order to make sense of their experiences and align themselves to an approach most suited to their needs at the time. This thesis contributes new understanding of how problematic alcohol use and recovery can be conceptualised, addressed, and researched, by gaining the perspectives of individuals whose voices are largely absent in the literature.
Article
Background: The complexity of substance use problems is hard to understand, both for those who suffer from it and for their children. This study aimed to explore how people affected by it conceptualized and understood substance use problems. Methods: Seven young people with parents with substance use disorder (SUD) and seven patients in SUD treatment participated in in-depth interviews. Results: The analysis revealed that the informants’ narratives included a search for meaning about concrete experienced situations and behaviors connected to substance use, attempts to understand the development and maintenance of the problems and the nearby environments’ stances and attitudes toward people with substance use problems and their children. Conclusion: The findings are discussed in light of theory about the creation of meaning through narratives and theories about stigma and shame. The article concludes that psychoeducation and conversations with professionals may contribute to cope with the stigma and shame related to substance use problems.
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Child maltreatment is a prevalent societal problem that has been linked to a wide range of social, psychological, and emotional difficulties. Maltreatment impacts on two putative evolved psychobiological systems in particular, the attachment system and the social rank system. The maltreatment may disrupt the child's ability to form trusting and reassuring relationships and also creates a power imbalance where the child may feel powerless and ashamed. The aim of the current article is to outline an evolutionary theory for understanding the impact of child maltreatment, focusing on the interaction between the attachment and the social rank system. We provide a narrative review of the relevant literature relating to child maltreatment and these two theories. This research highlights how, in instances of maltreatment, these ordinarily adaptive systems may become maladaptive and contribute to psychopathology. We identify a number of novel hypotheses that can be drawn from this theory, providing a guide for future research. We finally explore how this theory provides a guide for the treatment of victims of child maltreatment. In conclusion, the integrated theory provides a framework for understanding and predicting the consequences of maltreatment, but further research is required to test several hypotheses made by this theory. © The Author(s) 2015.
Chapter
Previous literature has reported the relationship between shame and substance dependence. Some studies suggested that experiencing shame is a risk factor for relapse. Negative feelings of shame are temporarily relieved using substances therefore reinforcing use and maintaining addictive behavior. Consequently, learning how to cope with shame without the use of substances may improve recovery. In contrast, other evidences found that addressing shame may be helpful for developing reasons for stopping use and as a protective factor that helps prevent relapse. This paper describes some Islamic psycho-spiritual approaches and practices for transformation and alleviation of shame for Malay Muslims recovering from substance dependence. These include healing through the process of self-audit (muhasabah), repentance and forgiveness (tawbah), constructing new narrative of the self, and developing a stronger relationship with Allah (hablum min Allah) and other humans (hablum min annas) as the foundation for healthy recovery. It also covers the main areas of definition and prevalence of substance dependence in the Malaysian context as well as literature on shame from the perspectives of the Malaysian Muslim culture.
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This article examines the long-term sequelae of childhood sexual abuse in six areas: posttraumatic stress, cognitive distortions, altered emotionality, disturbed relatedness, avoidance, and impaired self-reference. It is concluded that childhood sexual abuse has a variety of long-term impacts and that the measurement strategies used to demonstrate these sequelae require further development.
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• Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods such as self-report scales, which allow the routine assessment of patient adjustment, are potentially useful. The derivation and testing of such a method, the Social Adjustment Scale Self-Report, is described. This scale covers the patient's role performance, interpersonal relationships, friction, feelings and satisfaction in work, and social and leisure activities with the extended family, as a spouse, parent, and member of a family unit. Self-report results based on 76 depressed outpatients were comparable to those obtained from relatives as well as by a rater who interviewed the patient directly.
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The links between shame and guilt and psychopathology were examined. In 2 studies, 245 and 234 undergraduates completed the Self-Conscious Affect and Attribution Inventory, the Symptom Checklist 90, the Beck Depression Inventory, the State-Trait Anxiety Scale, and the Attributional Style Questionnaire. Results failed to support Lewis's (1971) notion that shame and guilt are differentially related to unique symptom clusters. Shame-proneness was strongly related to psychological maladjustment in general. Guilt-proneness was only moderately related to psychopathology; correlations were ascribable entirely to the shared variance between shame and guilt. Although clearly related to a depressogenic attributional style, shame accounted for substantial variance in depression, above and beyond attributional style.
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The relations among 3 moral affective personality characteristics--shame-proneness, guilt-proneness, and empathic responsiveness--were examined in 4 independent studies of undergraduates. Results indicate that shame and guilt are distinct affective experiences that have important and quite different implications in the interpersonal realm. There was a substantial positive correlation between shame-proneness and guilt-proneness. Nonetheless, as predicted, other-oriented empathic responsiveness was negatively related to proneness to shame but positively correlated with proneness to guilt. In contrast, an index of more self-oriented personal distress was positively linked to shame-proneness. Taken together, these results add a new dimension to the ugliness of shame but suggest that guilt may not be that bad after all, at least in the interpersonal domain.
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Individual differences in proneness to shame and proneness to guilt are thought to play an important role in the development of both adaptive and maladaptive interpersonal and intrapersonal processes. But little empirical research has addressed these issues, largely because no reliable, valid measure has been available to researchers interested in differentiating proneness to shame from proneness to guilt. The Self-Conscious Affect and Attribution Inventory (SCAAI) was developed to assess characteristic affective, cognitive, and behavioral responses associated with shame and guilt among a young adult population. The SCAAI also includes indices of externalization of cause or blame, detachment/unconcern, pride in self, and pride in behavior. Data from 3 independent studies of college students and 1 study of noncollege adults provide support for the reliability of the main SCAAI subscales. Moreover, the pattern of relations among the SCAAI subscales and the relation of SCAAI subscales to 2 extant measures of shame and guilt support the validity of this new measure. The SCAAI appears to provide related but functionally distinct indices of proneness to shame and guilt in a way that these previous measures have not.
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Men and women in recovery from addiction were compared on levels of depression and self-conscious affect including proneness to shame, guilt, externalization, detachment, and pride. The sample consisted of 130 subjects (88 men and 42 women; mean age 33.04), 90 of whom were active participants in a 12-step recovery program, and 40 of whom were in a residential treatment community. Subjects completed The Beck Depression Inventory and The Test of Self-Conscious Affect. Significant differences between the sexes were found for proneness to shame, detachment, and depression. Women were significantly higher on shame and depression; men were significantly higher on detachment. The subjects were compared to subjects who were not chemically dependent. It was found that these recovering drug-addicted subjects scored significantly higher in proneness to shame and externalization and significantly lower on proneness to guilt. Treatment implications of proneness to shame in the drug-addicted population, and particularly in women, are discussed. The use of confrontational drug treatment strategies may be contraindicated.
Article
This article differentiates guilt and shame as aspects of each individual. It also discusses the relationship between shame, guilt, and alcoholism and chemical dependency. The Twelve Step Program of AA is identified as a resource for resolving guilt, shame, and alcoholism. The concept of AA as a caring community is discussed on the basis of how AA addresses issues related to shame and guilt.
Chapter
Research indicates that many forms of violence are prevalent in women's lives. Both physical and psychological violence can occur from perpetrators who are strangers, acquaintances, family members, or partners. These experiences exist throughout women's lives. They never outgrow their concerns, fears, and the need to cope with violence. Thus, fear of violence permeates the lives of all women, influencing their decisions, impacting their psychological and physical health, and limiting their options. Violence exists across cultures and women's perspectives of violence have been shaped not only by this widespread awareness of violence but also by historical events that continue to influence women's lives. Health care settings have largely been relegated the role of attending to the acute physical consequences with little involvement in prevention or intervention efforts. However, the health care system offers, potentially, one of the most powerful systems for implementing change. Violence remains one of the most important public health crises in many communities.
Article
describe the key phenomenological differences between shame and guilt / review the extant theoretical and empirical literature relating shame and guilt to depression / describe results from several independent studies bearing on the relationship of shame and guilt to depression study 1 demonstrates that the states of shame, guilt, and depression represent distinct phenomenological experiences / studies 2 and 3, however, indicate that a dispositional tendency to experience shame, but not guilt, is an important correlate of depressive symptomatology, above and beyond that accounted for by attributional style / [subjects were aged 17–64 years] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
An experimental scale to measure shame, the Internalized Shame Scale, is described with data on reliability and validity presented from a large nonclinical sample of college students and adults and a small clinical sample that included clients with alcohol problems. Implications from the scale for understanding the phenomenology of shame and its relationship to addictions is discussed.
This study compares the recovery experience of female members of Alcoholics Anonymous (AA) who reported a history of childhood sexual abuse (68%) with those who did not report experiencing childhood sexual abuse. A sample of 53 women was obtained from AA. A significant relationship was found between shame and two measures of difficulties in recovery-problems in social adjustment and relapse. Though the hypothesis that experiences of child sexual abuse predicted difficulty in recovery was not supported, these data suggest that shame may be an important variable in both the etiology and treatment of alcoholism in women.
Article
Thirteen subjects were administered the Internalized Shame Scale (ISS) before and after EMDR therapy to determine whether Eye Movement Desensitization and Reprocessing (EMDR) significantly reduced internalized shame and increased self-esteem as measured by the ISS. While the study did not control for alternative treatment effects, age, diagnosis, SES, or ethnicity of subjects; statistical analysis indicated a significant decrease in internalized shame subscale scores and a significant increase in self-esteem subtest scores following treatment with EMDR. These results support the hypothesis that EMDR is an effective treatment for internalized shame, even when shame is not the identified target of treatment. These preliminary findings suggest that future research is warranted to explore the efficacy of EMDR in the treatment of internalized shame.
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This article reviews some of the recent research concerning factors that contribute to the development of alcohol use disorders in females who were sexually abused as children. Issues pertaining to a possible history of childhood sexual abuse are often overlooked in treating adult females who have alcohol use disorders. Implications for assessment and treatment are discussed. It is recommended that mental health and substance abuse counselors become aware of strategies to detect the interactive effects of these two disorders so that a more integrated and effective treatment approach can be implemented.
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There has been increased understanding and recognition concerning the contribution of shame to chemical dependency problems. Twelve-step programs are considered to be important and helpful not only for sobriety, but in the processing through of shame-based conflicts. But for many recovering chemically dependent persons, shame-based conflicts will not be sufficiently addressed in 12-step groups. This article describes how shame can contribute to relapse for recovering chemically dependents and emphasizes the importance of resolving shame-based conflicts. A case study is presented.
Article
The author compares the experience of males and females with shame and guilt. Particular attention is given to the relation of these issues with alcoholism. Barriers to treatment are noted and the treatment of shame and guilt with women alcoholics is discussed.
Article
Investigated the relationship between childhood experience of incest and dysfunction of women in adult life, using 117 female participants in Alcoholics Anonymous. Ss completed self-administered questionnaires assessing history of alcoholism and sobriety patterns and Institute for Personality and Ability Testing anxiety and depression scales. 82 Ss did not report a childhood incest experience, 29 did (14 cases were with father figures), and 6 could not remember. Results indicate that posttraumatic stress disorder (PTSD) occurred in almost 40% of the Ss who experienced incest. There were no significant differences in the frequency of the occurrence of PTSD when father-figure incest victims were compared with other incest victims. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Suggests that when alcoholic women have experienced childhood incest, 2 basic components of recovery are required: (1) self-help (e.g., Alcoholics Anonymous) and (2) therapy or counseling. Resistance is likely to occur because the trauma of incest often creates characteristics (i.e., lack of trust, denial, shame, poor self-esteem) that exert their influence on therapeutic and other interpersonal relationships. Based on clinical experience, it is suggested that accurate assessment and diagnosis and the uncovering of a history of childhood incest are important in assuring a stable and productive sobriety. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Discusses links between affect theory and cognitive therapy (CTH) in the realms of the formal conceptualization of the patient, the nature of the therapeutic relationship, and the form of the therapeutic process. Affect, intentional behavior, and neocortical cognition are interconnected and influence one another reciprocally. CTH involves a focused attempt to identify and correct faulty information processing, maladaptive assumptions, and early negative schemas in order to alter the emotional aspects of experience, thus opening the way for new behavioral responses. Although the language and practice of cognitive therapy may appear foreign to those trained in other systems, it is affect theory that can offer a link to these other modalities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
study of shame experience and shame avoidance / gain increased sensitivity to the problems presented by patients in psychotherapy experience of shame is always related to the experience of pride / both emotions bring the self into awareness adult pride—what happens to joy / comparison / competition / affect theory / the mastery of shame through the illusion of pride / status / borrowed pride / the need for an inferior (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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[suggest that] reexamining what we know of trauma from the perspective of affect and affect theory can add to our ability to describe and understand the phenomena that comprise it / in an attempt to begin this task, this chapter briefly outlines a framework for considering the realm of affect / using the proposed terminology, we will then review the affective dimensions of existing descriptions of traumatic stress and the symptoms of posttraumatic stress disorder (PTSD)s / from the vantage point this provides, implications for assessment and treatment will be discussed / focuses [attention on] military veterans PTSD defined / alexithymia / dissociation and affect / assessment and affect theory / cultural factors / numbing / overload (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the relationship between violence and alcohol problems in women. Interviews were conducted with 472 women (aged 18–45 yrs) from 5 sources: outpatient alcoholism treatment programs (OATPs), drinking and driving classes (DDCs), shelters and support groups for women who have experienced partner violence, outpatient mental health centers, and randomly selected households. OATP Ss experienced higher rates of childhood victimization, significantly more severe violence by fathers, and more childhood sexual abuse than did DDC Ss and women in households. OATP Ss also experienced significantly more childhood sexual abuse than did Ss without alcohol problems in other treatment settings and significantly higher levels of violence by partners than Ss in the household sample. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In this chapter we use an epidemiological perspective to examine the comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUDs). Our primary goal is to present epidemiological evidence of the association between these disorders and potential causal relationships between them. To place these finding in context, we begin the chapter by discussing the unique advantages, as well as the limitations, of epidemiological investigations of the comorbidity between these two disorders. We also present basic epidemiological concepts to guide readers who are less familiar with research in this field. Finally, we address gaps in the epidemiological literature and propose future directions for research in this area. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
compares the ISS [Internalized Shame Scale] to other published shame scales and shows how [the author's] own understanding of his test has changed as he has mastered affect theory / review some empirical studies addressing shame, guilt, and pride—the so-called "self-conscious" emotions / the general frame of reference for most of these studies is the hypothesized relation of shame and guilt to psychopathology approaches to measuring shame and guilt / reliability and validity of the ISS and related scales / the shame–psychopathology connection / shame & dysphoria / clinical implications (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents prevalence and population estimates of alcohol (AL) abuse and dependence in the US for the year 1992. Definitions of AL-related disorders were based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria; data were derived from interviews with 42,862 adults (aged 18 yrs and over). More than 7% of Ss met DSM—IV criteria for 1-yr AL abuse, AL dependence, or both. Males were almost 3 times more likely than females to meet the criteria for AL abuse and/or dependence. The male–female ratio was lowest in the youngest age groups among non-African Americans (AAs), suggesting that non-AA females may be catching up. Male–female ratios for AAs decreased as a function of age. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Post-traumatic stress disorder is a legacy of the Vietnam War. Perhaps as many as a half-million U.S. veterans suffer from the problem to some degree. Hospitalized U.S. veterans, diagnosed as suffering from PTSD were given the Internalized Shame Scale, the Beck Depression Inventory, and the Rosenberg Self-Esteem Scale. Hospitalized veterans suffering from (1) depression and (2) substance abuse were also given these instruments and the resulting data were compared. Veterans suffering from PTSD scored higher on Internalized Shame and on Depression than did the Substance Abuse group and scored higher numerically on Depression than did the Depression group itself. All groups were compared on factors related to Shame, Inferiority and Alienation. Data indicated that the PTSD group scored numerically highest on both factors. Results are discussed in accordance with current Shame induction theory.
Article
Research based on attachment theory is reviewed for its relevance to the development of later addictions. The problem of internalized shame as an attachment related issue is discussed. Some original research into internalized shame using the Internalized Shame Scale is summarized. The relevance of this research and theory for family of origin based treatment of addictions is explored.
Article
Data are presented on social functioning derived from a self-report social adjustment scale (SAS-SR) administered to 774 subjects including a community sample and three psychiatric outpatient populations: acute depressives, alcoholics, and schizophrenics. This self-report scale derives from an interview form and was developed and tested on depressed outpatients. Since its publication, it has been used in populations other than depressives including other psychiatric patients, nonpsychiatric patients, and nonpatients. The purpose of this paper is to make data available to other investigators on results of this self-report social adjustment scale in a broad range of subjects and to describe further the psychometric properties, limitations, and utility of the scale. Findings show that the scale has wide applicability in a range of subjects but that certain cautions should be followed in using it with chronically impaired psychiatric populations who may not be involved in the major roles assessed by the scale.
Article
The relation of shame and guilt to anger and aggression has been the focus of considerable theoretical discussion, but empirical findings have been inconsistent. Two recently developed measures of affective style were used to examine whether shame-proneness and guilt-proneness are differentially related to anger, hostility, and aggression. In 2 studies, 243 and 252 undergraduates completed the Self-Conscious Affect and Attribution Inventory, the Symptom Checklist 90, and the Spielberger Trait Anger Scale. Study 2 also included the Test of Self-Conscious Affect and the Buss-Durkee Hostility Inventory. Shame-proneness was consistently correlated with anger arousal, suspiciousness, resentment, irritability, a tendency to blame others for negative events, and indirect (but not direct) expressions of hostility. Proneness to "shame-free" guilt was inversely related to externalization of blame and some indices of anger, hostility, and resentment.
Article
Although U.S. and Canadian surveys conducted over the past two decades have found little evidence of major changes in drinking levels or drinking problems among women in general, change may be occurring within certain subgroups of women, for example, based on age, ethnicity, employment, or marital status. Women's drinking behavior shows significant linkages to aspects of women's social environments, including gender of co-workers and drinking behavior of significant others. The greater complexity of recent findings reflects the increasing maturation of epidemiological research on women's drinking.
Article
In-depth interviews with 65 women in treatment contributed to a taxonomy of indicators of women's alcohol problems, with five major categories and numerous subcategories. The largest number of client indicators appeared in the Individual (psychological and behavioral) category. The Physiological category included unique indicators regarding physical appearance. Within the Social category, family/partner relationships were emphasized. The taxonomy can be useful in therapeutic assessments, to develop survey items, in comparative research, or in alcohol program development.
Article
This study examines the historical treatment of two phenomena that impact negatively on the lives of millions of women--incest and alcoholism--and explores the similarities in characteristics of alcoholic women and women with histories of incest. Prior to the early 1980s, incest histories were rarely mentioned in the literature on alcohol. Similarly, the literature on incest makes only passing references to alcohol abuse among adolescent and adult survivors. Hence, formal research comparisons between the alcoholic woman and the incest-surviving woman are lacking. The purpose of this study is not merely to illustrate the similarities between the alcoholic woman and the incest-surviving woman, but also to present a persuasive argument that multidisciplinary research efforts are essential in order to promote more effectively the identification, diagnosis and treatment of women who suffer both alcoholism and incest. To accomplish these goals, this study presents parallel reviews of (1) women and alcohol and (2) women and incest, then develops a comparative profile of the alcoholic woman and the incest-surviving woman. Additionally, the relatively sparse information on the alcoholic incest-surviving woman is reviewed. This study points to the need for further research in order to address the compelling question that emerges: Why do some incest-surviving women become alcoholic while others do not?
Article
Competence in treating the victims of sexual abuse and exploitation requires an understanding of shame, the complex and multilayered emotion triggered when we have been exposed or when our self-esteem has been reduced. The experience of shame is initially physiologic, involving a cortical shock momentarily halting higher cognitive function, but followed immediately by a host of associations to previous experiences of shame. Acutely, the affect itself impels hiding, while defenses against it include anger, humor, silence, and a wide range of behaviors. In our culture, all sexuality involves an interplay between exposure and privacy, between control and release. The sexual abuse of adults and the sexual exploitation of children must produce shame, study of the interaction between abuser and abused suggests that shame conflict figures prominently in the genesis of such activity. To the extent that psychotherapy itself involves exposure, it must trigger shame; thus, it is likely that the therapist unskilled in the recognition of shame in all its disguises will overlook or misunderstand many of the issues that should form the core of our treatment of those whose sexual selves have been abused or exploited.
Article
Women substance abusers usually labeled as treatment failures are described and case illustrations are presented. The role of sexual victimization in the substance abuse is considered, as is the use of substances to mitigate posttraumatic stress symptoms. Abstinence as a precondition of treatment is examined, and more objective case conceptualization and treatment planning advocated. Aspects of the long-term therapeutic relationship are discussed.
Article
The effects of childhood sexual abuse on the development of alcoholism in women were examined by comparing a sample of 45 alcoholic women selected from local treatment agencies and Alcoholics Anonymous groups with a group of 40 nonalcoholic women selected randomly from a household population. Face-to-face interview schedules were administered to both samples. Sexual abuse was defined as any unwanted sexual contact with a person at least five years older than the respondent, or with any family relative, regardless of age difference. Types of sexual contact included both nonphysical contact (e.g., invitations, exposure) and physical contact (e.g., fondling, intercourse). Results showed that alcoholic women were more likely to have experienced sexual abuse, had a greater number of different types of sexual abuse experiences, and endured sexual abuse over a longer period than the comparison group. The presence of any childhood sexual abuse experience was sufficient to discriminate between the alcoholic women and the comparison group, even controlling for demographic variables and the presence of a parent with alcohol-related problems. Although alcoholic women were more likely to report that a parent had alcohol-related problems, relatively few of the sexual abuse incidents were perpetrated by a parent. The data suggest that vulnerabilities to sexual abuse were attributable to environmental or psychological factors in homes in which a parent was reported as having alcohol-related problems.
Article
A history of child sexual victimization may be much more prevalent among substance abusers than previously suspected and may be commonly missed if not assessed directly in every patient. The rates of reporting child sexual abuse among inpatient substance abusers were compared before and after the question was routinely asked in a treatment program. Before routine inquiry, 4% of men and 20% of women disclosed such abuse but after routine inquiries began the rates for adult men quadrupled, up to 42% of the teenaged boys reported such abuse, about 75% of adult women admitted such abuse, and 71 to 90% of teenaged girls disclosed histories of child sexual abuse. Unresolved issues from childhood sexual abuse may be a hidden factor underlying much substance abuse and if not treated may lead to rapid relapse.
Article
The Childhood Trauma Interview, a new instrument for brief and comprehensive retrospective assessment of childhood interpersonal trauma, is presented with initial evidence of its reliability and validity. Drug- or alcohol-dependent patients (N = 220) were given the Childhood Trauma Interview and a questionnaire measure of child abuse, the Childhood Trauma Questionnaire. Convergent and discriminant validity for the Childhood Trauma Interview were tested by comparing correlations between analogous and nonanalogous trauma scales to those of the Childhood Trauma Questionnaire. Interrater reliability for the majority of trauma dimensions measured by the Childhood Trauma Interview was very high (63% had intraclass correlations above 0.90). Principal-components analysis yielded six rotated factors that accounted for 74% of the variance among scores: separations and losses, physical neglect, emotional abuse or assault, physical abuse or assault, witnessing violence, and sexual abuse or assault. Since these six factors exactly represented the areas that the interview was designed to assess, the construct validity of the Childhood Trauma Interview was supported. Without exception, convergent correlations were significantly higher than discriminant correlations, and convergence was improved when multidimensional variables from the Childhood Trauma Interview and their interactions were regressed onto Childhood Trauma Questionnaire scores. These initial findings suggest that the Childhood Trauma Interview is a reliable and valid method for brief assessment of multiple dimensions of six types of childhood interpersonal trauma.
Article
Scores on the Beck Depression Inventory for 23 alcoholic women (22 white and one Hispanic) who had been molested as children and 20 alcoholic women (17 white and 3 black) who had no memory of being molested as a child were compared. Significant differences showed the abused group scored significantly higher on the depression scale than the nonabused group. No significant difference was found on age at which the 2 groups began drinking regularly. The implications of these results are discussed.