Webb Therapy Uncategorized Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

Despite significant advancements in political and health initiatives by governments and non-governmental organisations, shame, stigma, and internalized stigma continue to profoundly impact millions of lives worldwide. These negative perceptions and self-judgments can lead to feelings of worthlessness, self-blame, and social withdrawal, which in turn hinder access to services and participation in treatment.

Shame and stigma are particularly prevalent among individuals with substance use disorders, mental health conditions, and those experiencing psychosis. For instance, internalised stigma can lead to low self-esteem, depression, and hopelessness, which significantly impede recovery and emotional well-being. Even with the implementation of cognitive therapy and other supportive measures, the battle against internalised stigma remains ongoing in a similar fashion to intergenerational trauma, as though it has been built into human DNA.

Political and health initiatives have attempted to be instrumental in addressing these issues. For example, the Australian Government Department of Health and Aged Care has launched numerous programs aimed at improving health outcomes and reducing stigma. These initiatives focus on health promotion, early intervention, and disease prevention, aiming to create supportive environments for those affected by stigma.

However, the persistence of shame and stigma highlights the need for continued efforts to combat these issues especially in the workplace and within individual families. Addressing stigma therapeutically, promoting empathy and non-judgmental attitudes, and supporting individuals to view themselves beyond their conditions are crucial steps in mitigating the negative impacts of stigma.

Helping someone with a substance use disorder (SUD) while protecting yourself and your family involves a delicate balance of support and self-care. Here are some steps you can take:

1. Educate Yourself

Understanding SUD and its effects can help you make informed decisions and provide better support. Reliable sources include medical professionals, reputable websites, and support groups.

2. Set Boundaries

Establish clear boundaries to protect your well-being. This might include rules about substance use in the home, financial support, and personal interactions. Boundaries help prevent enabling behaviours and reduce stress.

3. Practice Self-Care

Taking care of yourself is crucial. Engage in activities that bring you joy and relaxation, such as exercise, hobbies, or spending time with friends. Self-care helps you maintain your mental and emotional health.

4. Seek Support

Join support groups like Al-Anon or seek therapy to process your emotions and develop coping strategies. Connecting with others who are going through similar experiences can provide invaluable support and understanding.

5. Encourage Professional Help

Encourage your loved one to seek professional help, such as counselling, therapy, or medical treatment. Treatment programs often include individual, group, or family therapy sessions, which can be beneficial for everyone involved.

6. Detach with Love

Detaching with love means setting emotional and psychological boundaries while still offering support. This approach helps you avoid becoming emotionally drained and allows your loved one to face the consequences of their actions.

7. Be Patient and Compassionate

Recovery is a journey that takes time. Be patient and compassionate with your loved one and yourself. Celebrate small victories and stay hopeful.

8. Avoid Judgment

Avoid being judgmental when discussing substance use. Offer support and understanding instead of criticism, which can help reduce feelings of shame and stigma.

References

Al-Anon Family Groups. (n.d.). Al-Anon and Alateen. Retrieved from https://al-anon.org/newcomers/what-is-al-anon-and-alateen

Australian Government Department of Health and Aged Care. (2024). Initiatives and programs. Retrieved from https://www.health.gov.au/about-us/what-we-do/initiatives-and-programs

Australian Institute of Health and Welfare. (2024). Health promotion and health protection. Retrieved from https://www.aihw.gov.au/reports/australias-health/health-promotion

Australian Government Department of Health. (2019). Alcohol and other drugs – Information for families. Retrieved from https://www.health.gov.au/resources/collections/alcohol-and-other-drugs-information-for-families

Mental Health Foundation. (2016). How to cope when supporting someone else. Retrieved from https://www.mentalhealth.org.uk/publications/how-cope-when-supporting-someone-else

Morrison, A. P., Birchwood, M., Pyle, M., Flach, C., Stewart, S. L. K., Byrne, R., Patterson, P., Jones, P. B., Fowler, D., & Gumley, A. I. (2013). Impact of cognitive therapy on internalised stigma in people with at-risk mental states. The British Journal of Psychiatry, 203(2), 140-145. https://doi.org/10.1192/bjp.bp.112.112110

National Institute on Drug Abuse. (2020). Family support in addiction recovery. Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/family-support-in-addiction-recovery

Substance Abuse and Mental Health Services Administration. (2015). Substance use disorders. Retrieved from https://www.samhsa.gov/find-help/disorders

Wood, L., Byrne, R., Burke, E., Enache, G., & Morrison, A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Retrieved from https://repository.essex.ac.uk/21927/1/woodpr2017.pdf

Your Room. (2021). Shame and self-stigma. Retrieved from https://yourroom.health.nsw.gov.au/whats-new/Pages/Shame-and-self-stigma.aspx

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“I’m just lazy.” It’s one of the most common things we say about ourselves, and it’s almost always inaccurate — or at least, it’s not the full story. “Lazy” is a character judgement. It implies a fixed trait, a moral failing, something the person simply is. In reality, what looks like so-called “laziness” from the outside is usually a specific, nameable process happening underneath: low energy, fear, overwhelm, disconnection from meaning, or a nervous system that’s stuck.

Swapping “lazy” for “unmotivated” is a good first step, but it can still flatten quite different experiences into one vague label. Below are some more precise alternatives, what they actually describe, and examples of how they show up in real life.

When the problem is getting started

Low activation
This describes difficulty initiating action even when the desire is genuinely there. The want exists; the ignition doesn’t turn over.

Example: Someone wants to reply to a mate’s text, has wanted to all day, keeps thinking about it — and still hasn’t opened the message by evening. It’s not that they don’t care.

Avolition
A more clinical term for a reduced capacity to initiate and follow through on goal-directed behaviour. It’s heavier and more diagnostic, yet accurate. It is commonly linked to major depression, bipolar disorder, and schizophrenia.

Example: A person who used to cook every night now can’t manage to put a frozen meal in the microwave, despite being hungry and having no external barrier.

Task paralysis / overwhelm-driven inaction
The task itself feels too big, too undefined, or too loaded, so the person freezes rather than starts.

Example: A person needs to “sort out their finances.” There’s no single first step, so nothing happens — not because they don’t want order, but because the whole thing feels like an unclimbable wall.

When the problem is energy or capacity

Low energy / depleted
Sometimes it’s simpler than motivation — the person is running on empty. This is especially relevant with burnout, chronic illness, or the tail end of a stressful period.

Example: A person who was previously proactive at work is now struggling to answer emails, not because the job has changed, but because they’ve been running on adrenaline for six months and have nothing left.

When the problem is avoidance

Avoidant coping
Here, the “laziness” is really a strategy — often an unconscious one — to dodge a task that triggers anxiety, shame, or fear of failure. The inaction is protective, not apathetic.

Example: A person keeps “forgetting” to start an assignment they actually care about, because starting means risking it not being good enough.

Procrastination
Useful when the issue is delay rather than total refusal — the person will eventually do the thing, but keeps pushing it to the edge. Procrastination gets treated like a single thing, but it’s usually a surface behaviour with several different engines underneath it. Here’s what tends to actually be driving it:

  1. Fear of failure (or fear of judgement): if the work is never finished, it can never be judged as not good enough. Delay protects self-esteem.
  2. Fear of success: less talked about, but real — finishing well can raise expectations, invite more responsibility, or change a relationship dynamic the person isn’t ready for.
  3. Perfectionism: not “I might fail” so much as “it has to be right, and I don’t yet know how to make it right.” The standard is so high that starting feels premature. Perfectionism is frequently a strategy for managing fear of judgement (and fear of failure), not a standalone driver in its own right. The logic is If I can make this flawless, no one can criticise it → if no one can criticise it, I’m safe from judgement → therefore I must make it flawless before I let it be seen. “It has to be right” isn’t really about the work — it’s a control mechanism aimed at the anticipated judgement. The satisfaction or reward is real too, but it’s often secondary. It’s a learned reward layered on top: the relief of having pre-empted criticism gets experienced as “getting it right” rather than “avoiding exposure.”
  4. Emotion regulation, not time management: this is the reframe from the procrastination research (Tim Pychyl, Fuschia Sirois) that’s shifted a lot of clinical thinking: procrastination isn’t primarily a planning failure, it’s an attempt to avoid a negative feeling attached to the task right now, at the cost of a bigger problem later. The person is regulating today’s mood at the expense of tomorrow’s outcome.
  5. Task aversiveness: sometimes it’s simpler — the task itself is boring, tedious, ambiguous, or otherwise unpleasant, and there’s no emotional complexity beyond “I don’t want to.”
  6. Temporal discounting: a cognitive-behavioural angle. Humans are wired to weight immediate rewards over future ones, even when the future cost is much larger. The person isn’t choosing badly on purpose; the brain is built to prefer now.
  7. Autonomy/control conflict: sometimes procrastination is a quiet act of resistance — doing the task on someone else’s timeline feels like a loss of control, so delay becomes the only lever the person has left.
  8. Low self-efficacy: the person doubts their ability to do the task well or at all, so starting feels pointless or exposing.

Example: A person always finishes reports the night before they’re due, every time, despite genuine intentions to start earlier.

When the problem is follow-through, not starting

Low follow-through / inconsistent follow-through
The person starts fine but struggles to sustain the behaviour over time. This is more behavioural and less about character, which tends to land better if you are already hard on yourself.

Example: Someone joins a gym, goes three times enthusiastically, then stops — not from laziness, but because the initial motivation (novelty, resolution energy) wasn’t backed by a system to sustain it.

Difficulty sustaining effort
Similar to the above, but useful when the task requires ongoing, low-grade output rather than one big push.

Example: A person can write a brilliant first page of a project but can’t sustain the plodding, unglamorous middle section.

When the problem is meaning or direction

Disengaged
This applies when the task doesn’t feel connected to anything the person actually values or wants. It’s not an energy or fear problem — it’s a “why would I” problem.

Example: A person who says they’re “too lazy” to network for a job they don’t actually want, in an industry someone else has pushed them into.

Ambivalent
Borrowed from motivational interviewing, this names a genuine internal split — part of the person wants to do the thing, and part doesn’t, and both parts are real and legitimate. It’s a particularly useful reframe because it doesn’t pathologise the resistance; it treats it as information.

Example: A person wants to leave a relationship and doesn’t want to leave it, in roughly equal measure — and the “laziness” they report about making a decision is really that unresolved tension.

Why the re-labelling matters

The value of a more precise term isn’t just semantic tidiness — it changes the intervention. “Unmotivated” invites a pep talk. “Avoidant coping” invites a conversation about what the task threatens. “Low activation” invites behavioural scaffolding (breaking things into smaller steps) rather than willpower-based advice. “Ambivalent” invites exploring both sides rather than pushing harder on one.

Rather than substituting one label for another, it can help to ask what’s underneath the “laziness” for them specifically. Low energy, fear of failure, unclear goals, overwhelm, and disconnection from meaning can look identical from the outside — someone just not doing the thing — but they call for very different responses. Naming the actual mechanism tends to land better than any single re-labelling word ever could.