Deeper Questions For Treating Addiction

To be human is to experience a wide range of messiness. Life is inherently complex, and our experiences and relationships are layered, shifting, and often contradictory. Real change becomes possible when we’re willing to make sense of these intricacies—when we get close enough to understand what’s actually happening inside. That proximity invites compassion, even for experiences we haven’t personally lived.

Addiction is one of the topics people tend to keep at a distance. Illicit drug use is something society prefers not to look at directly. Many psychotherapists and social workers, too, feel uneasy working with addiction—as if therapy and substance use must be treated separately, or that healing is impossible until the addiction is “fixed.”

The Shame That Surrounds Addiction

To suffer from addiction is to know shame—often a deep sense of self-disgust. Many people enter treatment feeling embarrassed, dysfunctional, or terrified of being seen. Families, frightened by the drug or by their loved one’s behavior, often try to monitor or control. Even in recovery, suspicion and vigilance can remain high. Ironically, this makes healing harder, not easier.

Early in my work with people struggling with addiction, I realized my own fear comes from not fully understanding. Once I looked more closely, I didn’t see “addicts,” I saw people in pain—carrying isolation, anxiety, trauma, depression, loneliness, and shame. Through that lens, the world of addiction becomes psychologically rich and deeply human. The patterns, triggers, and internal relationships inside a dependency reveal enormous information about a person. It made me wonder why we so often remain at the surface.

A System That Keeps Its Distance

Even before COVID-19, the opioid epidemic received only sporadic attention. In 2024 alone, over 80,000 people in the U.S. died from an overdose. Yet responses to the crisis were often band-aids—focused on symptoms rather than roots. That approach implicitly communicates that people struggling with addiction don’t deserve ongoing, consistent care.

When substance use is treated as something shameful or less-than-human, we draw an invisible circle around those who are suffering. That shame benefits no one—except systems of power that rely on misunderstanding to maintain control. As long as addiction is viewed through a moralistic or punitive lens, certain communities remain disproportionately labeled, stigmatized, and oppressed.

Shame on the Inside

When we’re ashamed of addiction, it’s often because we’re afraid that letting others see our survival strategies might lead to rejection. And when the larger culture also treats addiction as a defect, that shame only grows.

These internalized messages become subtitles: broken, flawed, defective.

If shame pulls someone into addiction, society’s view of addiction mirrors that shame, making recovery harder to reach. When people adopt these beliefs about themselves, seeking treatment can feel humiliating. It is incredibly difficult to ask for help when you believe you’re something that needs to be “fixed.”

The Missing Question: What Is the Pain?

Narrow views on addiction focus on the behavior and the harm of the drug. But that view erases the deeper story—the suffering underneath. It ignores what the substance provides: soothing, numbing, connection, relief. It overlooks the environment, the lack of resources, and the absence of models for tolerating emotional pain.

How using helps

In the addiction cycle, using occupies the “easy” side of the emotional ledger:
– relief
– comfort
– pleasure
– connection

For many, these states feel otherwise unreachable. Using temporarily dissolves isolation. It creates bonds with others who use. It softens the fear of vulnerability; it becomes a companion when no one else is available. Many people find it easier to expose their internal world while using—think of the classic drunk-dial confession.

How using harms

But eventually the destructive side emerges: loss of relationships, finances, stability, safety, freedom, even life. Some people reach a point where fear outweighs the relief, and something inside shifts. For others, an ultimatum pushes them toward treatment. Either way, walking through the door takes immense courage, especially when the coping strategy you’re surrendering is one society has already shamed you for.

What Treatment Needs to Hold

Addressing the physiological aspects—detox, withdrawal, medication-assisted treatment—is only one part of recovery. Stabilization interrupts the cycle, but it doesn’t touch the shame or the emotional landscape that fuels use.

Depth-oriented therapy for substance use recovery invites curiosity about the function of the addiction. Through open, nonjudgmental questions, we move closer to the heart of the struggle. And when we get close, our understanding is almost always widened.

Many treatment programs focus heavily on the destruction, hoping fear will motivate change. That may work short-term. But if we ignore the medicinal qualities of the substance, relapse becomes more likely. Without exploring the pain, the substance was soothing, we remain in shallow waters—always afraid of sinking back into the deep.

The Necessary Ambivalence

We hinder recovery when we refuse to acknowledge that using often feels good. Humans are ambivalent creatures. We know certain foods aren’t good for us, yet we still reach for them because they comfort us. Addiction is no different. The conflict between relief and harm is part of being alive.

Recovery requires anticipating this ambivalence, planning for it, and respecting its existence.

To be alive is to be torn between wanting to feel good and needing to survive our pain. People do the best they can with the resources they have. Some coping strategies are socially accepted; others are stigmatized. But each person’s relationship with a substance tells a story worth hearing.

When we approach addiction with curiosity rather than judgment, we finally get close enough to understand—and healing becomes possible.