What Addiction Experts Would Never Do

Addiction is a terrible disease that affects almost 50 million people in the U.S. — as well as their family members, friends and other loved ones. When we talk about addiction, alcohol and drugs may be the first things that come to mind, but people can also be addicted to behaviors or processes, such as gambling or exercise. Very few people, if any, will go their whole lives without being affected by addiction in some way.

If you or someone you know is struggling with addiction, or you want to avoid it, the next steps — like learning more and getting help — can be scary. You, or your loved one, may have even had a bad experience with an addiction expert, and so now you feel reluctance or discomfort at the idea of trying again.

With that said, there is hope. Many addiction experts and clinicians have the right idea about how to support people, as evidenced by what they say they’ll never do:

By far, the most common response from addiction experts and therapists was this: They won’t judge or shame someone who struggles with addiction. It’s just not helpful, nor is it based in truth.

“Addiction, as we know, is a complex disease that affects the brain and behavior, and it requires empathy and understanding to effectively support someone in their recovery journey,” said Ashley Hall, the drug and alcohol director at Singing River Services in Mississippi. “Judging or shaming someone can create feelings of guilt and worthlessness, which can hinder progress and make it more difficult for individuals to seek the help they need.”

Many people who don’t live with addiction believe that the disease is something a person brings upon themselves, and so it’s also something they can simply snap out of. But this is a complete misunderstanding of how addiction works.

If you’ve struggled with addiction and been shamed or judged ― even if it was unintentional ― you’re not alone.

“Historically, people experiencing addiction have been stigmatized, even within the field of medicine and mental health, which can discourage them from seeking treatment and feeling devalued,” said Dr. Ryan Wade, a psychiatrist and director of addiction services at Silver Hill Hospital in Connecticut. “Shame can be dangerous to mental health, so as an addiction professional, I focus on helping patients work through it, not reinforcing it.”

Dr. Arthur Robin Williams ― a double board-certified addiction psychiatrist and chief medical officer at the New York-based Ophelia ― adheres to this no-shame framework by practicing what’s known as motivational interviewing. Essentially, this counseling method centers on strengthening personal motivation for positive change — with compassion.

“MI was developed to try to retrain clinicians to support patients with addiction the same way they might work with patients with other chronic disorders or problems in life: encouragement and inspiration rather than condemnation,” he explained. “In particular, MI emphasizes open-ended questions, affirmations, reflections and summarizations that help elicit change talk among patients.”

It’s worth emphasizing, again, that addiction is a disease, not a choice or a character flaw. Keeping that in mind ― and being aware of the factors that can contribute to addiction ― is another way to build empathy for people struggling with it.

“In every case I have worked with, the addiction is a response to one of two things: a concretely traumatic experience, or an ongoing misalignment between the person and their environment,” said Renée Zavislak, a licensed psychotherapist with extensive experience working with addiction.

Further, if a person is struggling with addiction, you should remember that this isn’t their only trait. Viewing a human being simply as their addiction can lead to feelings of shame, self-consciousness and hopelessness. And defining or describing someone in terms of what they struggle with may make them lose connections to other parts of their personhood that can help them feel whole and recover.

“By labeling those who struggle with addiction as ‘addicts’ and pushing them to surrender to the idea that they are powerless, we only encourage them to over-identify with their trauma and lose contact with their power to heal,” Zavislak said.

Eliminating shame around struggling is the first step to addressing the problem, but experts also personally recommend avoiding:

The idea that everyone who struggles with addiction looks the same, or has the same background, is harmful and untrue. According to a 2020 study in the journal Substance Abuse Treatment, Prevention, and Policy, substance use stigma has detrimental effects on treatment outcomes, policies, and society as a whole. So it’s important to address biases and lay assumptions aside.

The author Chimamanda Ngozi Adichie put it well in her 2009 TED Talk, “The Danger of a Single Story.” “The single story creates stereotypes, and the problem with stereotypes is not that they are untrue, but that they are incomplete,” Adichie said. “They make one story become the only story.”

This reminder is important to Brittany Cilento Kopycienski, a nationally certified counselor and certified advanced alcohol and drug counselor. “As an addiction expert, I would not assume I understand or know the person’s history and unique experiences before listening to what they have to share,” she said. “I have learned during my own professional journey [that] every individual’s journey with addiction is unique, and invalidating or assuming their feelings or experiences can be deeply damaging.”

Another ethical principle for counselors is to respect a client’s autonomy, which means the counselor must put their assumptions and personal beliefs aside.

“Allowing each individual to share their own story, without drawing conclusions on what they’ve been through and what they may have experienced, focuses on empowering the individual and honoring their individual’s autonomy,” Kopycienski said. This can be good to keep in mind when talking to loved ones, too.

There’s research to back up the effectiveness of some forms of addiction treatment, such as group counseling, motivational interviewing and relapse prevention strategies. But that doesn’t mean there’s one model that works for everyone.

Just like general mental health treatment looks different for everyone — different medications, different styles of therapy — so does addiction treatment. What one person with an addiction needs, or how they recover, will look different from the next person.

This is important to keep in mind for two reasons: It may address some of the bias mentioned above, and it’s a reminder that how you support one friend in recovery may not be how you support another. Attending to each individual’s needs is vital.

“Addiction treatment is very personal, and not everyone follows the same path of recovery,” said Karen Wolownik Albert, the CEO at Recovery Centers of America in St. Charles, Illinois.

Examples of this might include going to AA or NA meetings a few times a week and finding a sponsor there, as well as talking to a doctor about taking methadone to reduce cravings.

For people going through recovery, addiction experts also recommend regular exercise, getting enough quality sleep, engaging in meditative practices, continuing to learn about addiction and educating others, establishing healthy boundaries, seeking out nurturing relationships and dropping unhelpful labels. Finally, and most importantly, they hold on to hope that change and recovery are possible.

Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.