Is shame a barrier to sobriety? A narrative analysis of those in recovery

Abstract

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.

Keywords:

• Shame
• recovery
• alcohol dependence
• narrative analysis

Introduction

The UK alcohol industry is now worth an estimated £39.9 billion (International Wine and 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, 1988). 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, 1988). 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 & Walker, 2013).

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

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 Alcoholic Anonymous (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 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.

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 Table 1.

Table 1. Genres identified.

Genre	Description	Participant
Melodrama	These were dramatic narratives with exaggerated characters and exciting events. Mostly high in emotion.	Paula and Diana
Comedy theatre	These were humorous narratives, often using dramatic irony to induce laughter.	Raj
Quest	Narratives that took the listener on a journey in search of something, often becoming lost in the process, but returning triumphant with new knowledge. Usually had a happy ending	Gary, James, Michelle, Dean, and Matthew

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,

…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,

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!

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)

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)

… 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 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,

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.

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 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; 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

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 statement

The authors report no conflict of interest.