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Is shame a barrier to sobriety? A Narrative Analysis of those in
recovery
Francesca Sawer1, Paul Davis1 and Kate Gleeson1
School of Psychology, University of Surrey, Guildford, U.K1
Email addresses: [email protected]
[email protected]; [email protected]
Telephone for all authors: 01483 300800
Postal address for all authors: School of Psychology, University of
Surrey, Guildford, U.K
ORCID ID for Paul Davis: orcid.org/0000-002-9796-4601
Abbreviated title: Shame and recovery from alcohol disorders
Word count: 4718
Correspondence to: Paul Davis, School of Psychology, University of
Surrey, Guildford GU2 7XH, UK. E-mail: [email protected]
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Is shame a barrier to sobriety? A Narrative Analysis of those in recoveryAbstractAims
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.
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Is shame a barrier to sobriety? A Narrative Analysis of those in
recovery
Introduction
The UK alcohol industry is now worth an estimated £39.9 billion
(International Wine & Spirit Research, 2016) and alcohol is often marketed as a
glamorous product and one that tempts consumers into purchasing. Drinking to excess
on a night out is also a popular recreational and social activity for many in the UK
(Watts, Linke, Murray & Barker, 2015), however there is a very fine line between the
credibility associated with drinking and the negative public perception of the
behaviour of those who drink excessively. Media campaigns targeting ‘problem-
drinking’ tend to have shaming messages attached to them (Watts et al., 2015). Whilst
not everyone who drinks becomes addicted, there is stigma associated with those who
cross the boundary from ‘drinking to excess’ to having an ‘addiction to alcohol’
(Schomerus et al., 2011).
Some psychological theories of alcohol dependence suggest that drinking is a
method of self-medicating to cope with negative emotions (Gelkopf, Levitt & Bleich,
2002), including the emotional pain associated with shame (Potter-Efron, 1987).
Shame is a self-conscious emotion, which typically arises when a person evaluates
themselves through the eyes of another (Lewis, 1995). Shame contributes to feelings
of inferiority and worthlessness (Ramsey, 1987). When a person experiences shame
they perceive themselves as bad, thus the attribution is internal and global and the self
is judged negatively. This contrasts with guilt where a person perceives their
behaviours as bad, thus the behaviour rather than the self is negatively evaluated
(Kim, Thibodeau & Jorgensen, 2011). As such, guilt may motivate reparative actions
including seeking support (Baumeister, Stillwell & Heatherton, 1995), whereas shame
inhibits this and therefore is more frequently linked with psychological distress and ill
health (Gilbert, 2006).
In addition, it is acknowledged that sociological perspectives on shame are of
relevance here. Shame can be viewed as a ‘social emotion’ that arises through
interactions with others and their social worlds (Scheff, 2000) and as such may be
imposed on others, especially already marginalised groups (Chase and Walker, 2013).
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Regardless of the aetiology of shame, however, research suggests that shame
increases vulnerability to developing an addictive behaviour (Tangney, Wagner &
Gramzow, 1992) and higher shame levels have consistently been reported in those
with drug addictions when compared to other population samples (Meehan et al.,
1996; O’Connor & Weiss, 1993). Higher shame has also been found in people with
anxiety and depression who report using alcohol as a coping strategy (Treeby &
Bruno, 2012).
Evidence also suggests that those who experience shame may experience
anger and depression, in particular self-directed aggression, which can present as the
dangerous use of substances (Tangney, Stuewig, & Mashek, 2007). This may impact
negatively on recovery because drinking is a strategy that temporarily relieves shame,
therefore upon abstinence becomes overwhelming, leading to relapse. 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. Luoma, Kohlenberg, Hayes and
Fletcher (2012) showed that when participants were given strategies for managing
shame and the perceived judgments of others (in an Acceptance and Commitment
Therapy group), self-reported levels of shame reduced at a four-month follow up.
Therefore, at present there is a paradox in the literature; feelings of shame might be a
hindrance to recovery and are related to relapse, yet a specific focus on managing or
coping with shame can have a positive impact on recovery. It seems that we could
benefit from further exploration of how and why people in recovery from alcohol
dependence experience shame, as this may provide further understanding of how
health care professionals can work effectively with shame in recovery.
Method
Participants
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Participants were adults (aged 18+) who defined themselves as being ‘in
recovery’ from alcohol dependence. No minimum length of sobriety was specified,
however participants had to recognise their alcohol dependence, be currently abstinent
and be doing something they considered to be ‘recovery’. This was in line with the
AA philosophy of abstinence. Participants using other substances were not excluded
from the study, provided alcohol dependence remained primary. Participants were
five males and three females, aged 27-74, ranging from 21 months to 35 years in
sobriety. All participants were recruited from AA using a snowball sampling method
(Barker, Pistrang & Elliot, 2008).
Procedures
Ethical approval for the study was given by the University of Surrey ethical
review board. All participants were briefed about the study and gave written consent.
Narrative interviews aim to produce detailed accounts rather than brief answers
(Riessman, 2008), therefore an interview schedule was developed which encouraged
detailed stories to be told, rather than a question and answer approach. Prompts
regarding shame were not included in the interview although the participant
information sheet did prime people to the topic.
The interview consisted of one main question, “I would like you to start by
telling me about your personal story of recovery?” followed by additional prompt
questions; for example “Can you tell me about the best/worst times of your
recovery?”
Analysis
Narratives have been claimed to be the principal way that humans give
meaning to experiences (Murray, 2008; Rowe, 1989) and therefore a narrative
analysis was selected to allow for consideration of how participant stories were likely
to have been influenced by other people’s narratives.
A post-modernist position was adopted whereby each narrative was perceived
as a vehicle for participants to talk about their experiences. A structured five-stage
process was used during analysis as described by Crossley, (2000):
Step 1: Reading and familiarising- the first author transcribed all interviews before
familiarising and re-reading each transcript multiple times to gain an overview of the
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content and structure. Coding notes were then made in relation to general themes,
patterns and language.
Step 2: Identifying narrative tone- The authors reflected on the manner and
‘emotional flavour’ of how each narrative was told and assigned genres to each
narrative, in addition to creating detailed summaries of individual narratives.
Step 3: Identifying imagery and themes-The authors explored themes and images
across the whole narrative to consider changes as the narratives progressed. Any
disagreements between researchers were discussed by revisiting the transcripts and
data.
Step 4: Weaving a coherent story- Having summarised each narrative, narratives were
then put back into a coherent story rather like creating a biography of the participant’s
life, which was grounded in the data and used quotes to demonstrate interpretations.
Step 5: Cross-analysis- Once coherent stories were created for each participant, the
final stage involved looking for commonalities and differences across narratives by
synthesising salient themes, in addition to specifically looking at the ways that shame
was talked about within the narratives.
All participants were given pseudonyms and are referred to as Paula, Dianna,
Michelle, Gary, Raj, James, Matthew and Dean.
Results
In keeping with a narrative analysis and in answer to the first research
question “In what ways do participants tell their stories of shame?” the
results section will begin by describing the narrative techniques that
emerged across participants’ narratives. They will be explored in terms of
how they were understood as methods for talking about shame.
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To address the second research question “How is shame experienced
and/or understood by those in recovery from alcohol dependence?” a
narrative-thematic analysis is presented that elaborates the emerging
themes and how these relate to shame and recovery.
In what ways do participants tell their stories of shame?
Narrative analysis takes the view that stories are not created in isolation and
that the telling of one’s personal narrative is told and retold over time. It is
constructed and told like a story, which takes on a particular genre. When analysing
the narratives, they all fell into three discrete genres; melodrama, comedy and quest as
summarised in the table below:
Table 1 here.
Genre
In the genres we named melodramas and comedy, it was observed that the
tone was dramatic and detailed descriptions were used to draw the listener into the
story and take them on the highs and lows of the journey.
In Diana’s, Paula’s and Raj’s narratives, there was a high content of over-
exaggerated descriptions of the self, as if talking not about themselves, but a separate
person. This allowed for very honest and dramatic descriptions of memories of their
drinking in quite a sensationalised way that you may typically find in soap operas and
films. By externalising the shame and locating it in a dramatized character, this may
have allowed the participant to have some distance with their shame, separating
between their past and present self in order to disconnect with the emotion.
For example, Diana portrayed herself as an emotional drunk similar to the
‘drunk stereotype’ depicted in films and soap operas, and her narrative was
accompanied by dramatic pauses and actions,
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‘…I’d ring his bell. He wasn’t answering, so I rang again…and I just
collapsed on the doormat, like nobody loves me’ (Diana)
Likewise, Paula’s story took the listener on a dramatic journey of highs and
lows, resembling an emotional rollercoaster, with the listener being drawn into a sense
of hope and then sadness.
‘…things got better and then it would all go downhill again, I would be
completely out of control. I would be drunk all the time’ (Paula)
Raj’s narrative was also dramatic; but his story was narrated as if an actor was
playing his role. This had the effect of allowing Raj to narrate humorous scenes and
then pause to invite the listener to laugh,
‘… I ascribed to God, the category of logical fiction. Namely that there had
to be a God, because if there wasn’t I was f***ed’ (Raj)
‘…I mean I went to my doctors…I was put in touch with some psychiatrist who
wanted me to go into some kind of group, but it was kind of a really weird kind of
group… you know he looked like Freud (//laughs) and he had a German accent
(//laughs), he had a bow tie and all the rest of it and he said tell me about your
mother, and I was just sort of like what you on about… so I just thought sod this ‘
(Raj)
In the narratives we called ‘quest’ the common theme was that the listener was
taken on the narrator’s journey of recovery and personal discovery. Whilst it had
lows, there was a sense that the story would have a happy ending as it was told with
hindsight, thus the memories felt recalled as a past event, rather than reliving them
through the story telling.
In contrast to highly emotive melodramas, the quest genres maintained a
reflective tone throughout, often talking from hindsight,
‘….look[ing] back I realise that I was actually using my knowledge of
alcoholism to deny the fact that I had a problem’ (Gary)
Whereas the melodramas were emotional, the emotional impact in the quest
genres were minimised,
‘…I mean obviously it’s difficult to recollect from that time just how I felt
internally, but I probably felt distant’ (James)
They were often matter of fact,
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‘I just realised that it’s either that or I die…and I didn’t want to die’ (Matthew)
In addition the quest genre showed contemplation about the future, leading the
listener to feel much more like the narrator was talking about themselves, rather than
another character
‘…maybe I’d not be in recovery now, without all these things …but I know
that I’ll make everything worse if I drink again’ (Dean)
Imagery
When analysing the narratives on a case-by-case level, a number of visual
images were created. It was understood that these images had the effect of assisting
the listener in visualising the participant’s shame, thus helping the listener to share
this experience and more full appreciate and understand the experience of shame. The
following images were created across all narratives.
‘Out of control train’
A repeated image “conjured up” was visualising the participant on an out of
control train. This image was powerful because it removed blame, giving the image of
desperation and lack of ability to stop, rather than a lack of desire,
‘…I just tumbled through life like that wing that tumbles with the wind and
then I get knocked up against the bush and stays there for a while, and then the wind
will blow the other way and I roll off down again’ (Paula)
The lack of control over one’s life was a source of shame in itself,
‘… I was ashamed of like my drinking and my behaviour and I didn’t
understand that once I had one drink I couldn’t stop’ (Michelle)
‘…the most shameful thing is admitting that you can’t deal with life without a
drink… Not being able to do anything unless I’d had a drink’ (Dean)
‘Being exposed’
Related to this came an image of people trying to become invisible. However
with this came shame with facing reality when they were exposed. The image of a
mask falling off and exposing vulnerability underneath was particularly strong in
James’ narrative,
‘… totally gone, totally disappeared…. I was exposed and there was no hiding
from it or pretending that it hadn’t happened. It had happened!’
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For Gary and Raj the realisation that someone had discovered their secrets was
shameful,
‘…I didn’t realise that my wife was stood behind me. And I said “gosh I’m
really sorry, I don’t know what came over me”. She said “I do”. I said “what?” She
said “you’re an alcoholic” ’ (Gary)
‘…when a four-year-old says that, you can’t hide away’ (Raj)
In both of these narratives the critical moment in recognising a problem and seeking
help came at the point where their secrets were exposed.
How is shame experienced and/or understood by those in recovery from alcohol
dependence?
Alongside the techniques used in telling their stories, the following themes emerged:
‘Addicted Parent’
Half of the participants in the study described having had parents with an
addiction, and it was elaborated that having ‘an addicted parent’ was a source of
initial shame for many, long before their own drinking started. For example, Matthew
witnessed how alcohol broke-up his parents’ marriage; he felt ashamed of his father’s
behaviour and did not want to be like him, thus later in his narrative experiencing
further shame when he followed the same path.
‘…I never thought that I would follow the same path as him’ [alcoholic father]
(Matthew)
Diana and Paula referred to feeling shame as a consequence of having ‘an
addicted parent’ and the impact this had on feeling normal and fitting in with peers,
‘…because of her addiction you know, I couldn’t bring people home…we
didn’t have the niceties of life’ (Diana)
‘I was ashamed of our home, I couldn’t take people home’ (Paula)
It was also suggested that the process of experiencing one’s parent as feeling
shame then contributed to oneself experiencing shame,
‘I had a lot of shame thinking about it….my mother had got divorced because
she had an affair with a man and when her husband was away she got pregnant’
(Diana)
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For others, family discourses about ‘inheriting’ the addiction were more
explicit,
‘….dad used to say to me it would never surprise me if you and your brother,
would end up going to AA meetings’ (Matthew)
‘Well my belief is that I was born an alcoholic’ (Paula)
Furthermore having ‘an addicted parent’ also caused ruptures in relationships
with parents, which then impacted on a person’s own sense of self,
‘… [Mums’] moods were really unpredictable; she could be really loving and
then really aggressive’ (Michelle)
‘…My mother didn’t protect me….decisions were not in [my] best interests
(Paula)
‘I know that he [father] instilled shame in me… unless your behaviour was
exemplary then you should be ashamed of yourself’ (Gary)
Therefore the theme of ‘addicted parent’ was embedded in a number of narratives and
appeared to be related to an early experience of shame. This was in terms of having an
addicted parent and having to hide part of their life from peers and also witnessing
one’s own parents experience shame.
‘Inferiority’ (Core Shame)
Inferiority was present across all narratives and referred to the experiences of
participants seeing themselves as different. For some, this was about not being
‘worthy’ or ‘up to scratch’,
‘…I had a lot of feelings of inferiority. I thought I was different to other
people. I thought that other people were better than me’ (Gary)
‘…I thought I was a bad person, I was always less… I don’t deserve to be
here’ (Paula)
Feelings of difference and inferiority were identified as a source of shame,
‘…I just had a sense of shame of who I was, I just didn’t think I was normal or
up to scratch’ (Michelle)
‘I knew that it was abnormal. I knew that it wasn’t what other people did and I
was ashamed of it.’(James)
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‘… I just had a sense of shame of who I was’ (Michelle)
Drinking was therefore identified as a method for ‘transforming’ feelings of
inferiority, perhaps a way of managing shame,
‘…I absolutely adored the feelings it gave me. It transformed me, changed me’
(Gary)
‘… alcohol just took the edge off of life you know’ (Dean)
‘…I saw it [alcohol] as a very positive thing because obviously it was
enabling me to do things which I couldn’t normally do’ (James)
Whereas previous research has focused on shameful ‘behaviour’ associated
with drinking, the way that participants spoke about inferiority suggested that shame
was not about ‘doing’ something embarrassing, but instead feeling as though there
was a fault with the self. This was magnified via comparison with others,
‘I knew that it was abnormal. I knew that it wasn’t what other people did and I
was ashamed of it’ (James)
‘I felt I was ashamed in my life’ (Paula)
Rather than being embarrassed by actions while drinking, the deeper rooted core
shame and feelings of inferiority seemed to trigger initial drinking because of the pain
it caused. It was as if feelings of shame hindered entry into recovery because of the
belief that there was something fundamentally wrong with the person that could not
be repaired, as suggested by Paula
‘…it was like bristles in my brain they hurt me so much, I had to drink to take the
pain away’ (Paula)
‘Giving Back’
Despite the varying lengths of sobriety, all but one of the participants were
still attending AA, which seemed to be significant in participant’s construction of
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their identity as a recovering alcoholic. Many participants specifically referred to this
as ‘giving back’,
‘…part of my recovery and staying recovered involves passing on and helping
others’ (James)
‘…I thought I would never get over that, but the years of doing things and
I’ve done a lot of service, I've given back’ (Paula)
Whilst the theme was primarily one of giving back and helping others,
continued service within AA also seemed to be related to dependency; a fear of what
could happen if one left the fellowship,
‘…perhaps I could remain abstinent for the rest of my life, I dunno perhaps I
could. But I’m not willing to try’ (Gary)
‘…I believe that if I did do [turn my back on AA] I would cut myself off from
the supply of whatever it is that is keeping me well’ (James)
In summary, participants’ continued commitment to AA appeared to serve as a
way of modelling to others how to be vulnerable and to provide support to others to
share their shame experiences.
Healing Through Hearing
All participants experienced AA as pivotal to recovery and it seemed that this
was as a result of hearing stories and normalising one’s own experiences. In hearing
stories, participants could make sense of and release their own feelings of shame.
‘There is no shame in AA, everyone has done much worse than anybody else.
You can just go and listen and nobody laughs at you’ (Diana)
‘…hearing other people tell their stories…it’s not just me that’s done that. It
doesn’t make it right, but it’s suddenly not as shaming’ (Matthew)
The process of making relationships seemed to be important for facilitating
connections with others,
‘I trusted the people and looking back that was a huge part’ (James)
‘I realised that was actually a vital point, having someone to talk to about
relationships and to pass something onto somebody’ (Raj)
Listening to others provided a forum that started a process of self-discovery,
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‘It’s a learning process really. It’s like going back to the beginning, apart
from I can talk and walk…. I feel a bit like I’m armed with everything I need in life
but I don’t really know how to use it’ (Dean)
Acknowledging Shame
Acknowledging shame so that you could stop it from having power over you
in addition seemed to be part of the recovery process.
‘Being able to talk about shame and articulate it… It releases it, it ceases to
have power over you’ (James)
‘….it’s like bursting a pimple and all this gunk comes out and then you clean it up
and you can start healing. But the gunk has got to come out’ (Diana)
A narrative within AA is that alcoholism is an illness that cannot be recovered
from and this narrative appeared to provide acceptance,
‘I wasn’t a bad person trying to get good, I was a sick person trying to get well’
(Michelle)
Discussion
Constructing a Shame Narrative
Narrative theory suggests that scripts about the self are continually redefined
to make sense of experiences (Morgan, 2000). This study suggested that a key
mechanism for recovery involved participants developing personal understandings of
their shame by sharing their stories with other people and creating a ‘shame-
narrative’.
Genres were identified as a technique for discussing shame and helped
narrators externalise shame, locating it outside of the self and in another character. In
doing this, the narrator could control the shame and how it was presented; this was
often achieved by turning shaming events into comical ones. White and Epston (1990)
suggested that externalising emotions removes blame from the individual and makes
the emotion less important, therefore it could be interpreted that shame could be
talked about when the associated emotions were minimised. The use of a narrative
methodology that encourages the listener to follow the storyteller’s journey “walking
in their shoes” may in itself invoke empathy in the listener.
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Brown (2012) proposed that in experiencing empathy we feel accepted rather
than judged, therefore perhaps this genre was a method of eliciting empathy, therefore
helping a person overcome shame.
How was shame experienced? (Foundations of Shame)
Participants spoke about shame as a deep-rooted view about themselves,
which we labelled as ‘core shame’. Core shame was spoken about in relation to the
theme of ‘inferiority’, which emerged in all narratives, capturing participant’s
experiences of feeling unworthy. Participants spoke about their feelings of difference;
alcohol being a method to elicit connection whereby feelings of inferiority could be
overcome. This would support Gilbert’s (2002) model of shame, who suggests that
humans have a desire ‘to belong’, with lack of connection being experienced as
rejection and subsequent shame. More recently Brown (2012) also suggested that
absence of connections leads to beliefs about being unworthy of belonging. Therefore
taken together with the interpretations from this study, it could be suggested that
‘inferiority’ prevents connection and this increases feelings of inferiority; thus
maintaining shame. Alcohol dependence could therefore be maintained in order to
manage these deep-rooted feelings of shame.
Some participants talked about their parent’s addictions and the impact this
had on feeling different from peers and the shame of this. Although not everyone with
alcohol dependence or who experiences shame will have an ‘addicted parent’, these
experiences for some could provide an explanation for how ‘core shame’ develops.
Those with ‘addicted parents’ not only felt differences with peers but also had
reduced opportunities to connect, due to fear of peers finding out about their parent’s
addiction. Jacobs and Jacobs (2015) suggested that in avoiding potential shame
associated with the ‘addicted’ family member, families become silent. This study
could suggest that whilst silence stops peers from discovering their ‘addicted parent’,
remaining silent ceases connections with peers, which actually reinforces shame.
Using Shame in Recovery
Acknowledgment was a theme to emerge across narratives. In recovery this
was often about developing a new narrative; moving from a place of seeing oneself as
inherently bad, to a narrative about oneself having done ‘bad things’. It may indicate
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the importance of being able to develop a compassionate narrative about the self
during recovery and more specifically how compassionate narratives may help to
alleviate shame (Gilbert, 2009).
‘Healing through hearing’ was a theme that captured participants’ experiences
of connecting to others during recovery. Listening to others may have provided a
template by which participants could talk about their own shame and facilitated
connections through having shared experiences and feeling ‘normal’ (Brown, 2012).
Bowlby (1980) suggested that responsive and sensitive caregivers who acknowledge
distress, assist children to develop secure attachments. Therefore, potentially AA may
provide a substitute secure attachment or a forum in which attachment security can be
fostered, thus promoting feelings of trust and safety to acknowledge shame and
manage the associated distress.
‘Giving back’ was another theme related to recovery. Helping others by
telling one’s own story and sharing the messages of AA is an important narrative
within AA, therefore it was unsurprising that this was dominant in participant’s
narratives. ‘Giving back’ helped participants to feel worthy of the support that they
had received, helped to challenge beliefs of inadequacy and inferiority and provided
opportunities to maintain connections and build new relationships.
Clinical Implications and Limitations
This study suggests that the assessment and consideration of shame in the
treatment of those who enter services for alcohol dependence is crucial, yet often
missing. ‘Cost-effective’ treatments for Alcohol Use Disorders are often time-limited,
usually 6-12 sessions (NICE, 2011), however this only allows for a limited time to
develop a trusting therapeutic-relationship. As this study implies that trust and safety
is necessary prior to exploring issues of shame, it is possible that therapy effectiveness
is compromised in time-limited treatments, especially in patients who feel shame.
An important clinical implication of this research is that it indicates the
importance of being able to develop a compassionate narrative about the self during
recovery (as in the therapy intervention described by Luoma et al., 2012) and more
specifically how compassionate narratives may help to alleviate shame (Gilbert, 2009)
and help prevent relapse.
This study implies that those who experience shame may feel threatened by
the thought of someone judging them. This will only perpetuate feelings of inferiority;
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and therefore reducing shame and stigma about alcohol dependence within society
could help to make accessing treatments easier. For example, recently ‘sobriety tags’
have been introduced in some areas of London. These tags monitor alcohol
consumption in those who drink and offend, with the person being brought back to
court should they drink whilst wearing the tag. Whilst it is acknowledged that they
have been reported to reduce drinking (Lockhart-Mirams, Pickles & Crowhurst,
2015), this study would argue that such interventions are also likely to reinforce
shame associated with alcohol dependence within society and make a person feel
worse about themselves.
This study would also bring into question the effectiveness of public health
campaigns that use humiliation and shame as a deterrent for drinking alcohol and
instead would indicate the dangers that reinforcing shame in those who already have
alcohol dependence.
One limitation of this study is that AA members are not necessarily
representative of the population of recovering alcohol dependent people and thus the
results may not apply to other groups. Further research is needed with other groups as
well as validation of these findings using quantitative methods with a larger sample.
Acknowledgements, Funding and Authors’ notes
We are grateful to the participants for giving up their time for this study. This paper is
based on work submitted by the first author in partial fulfilment for the Doctorate in
Clinical Psychology at the University of Surrey and was internally funded.
Disclosure of interest
The authors report no conflict of interest.
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