Acceptance and Commitment Therapy Reduces Shame in Substance Users

Shame is an emotion that is exhibited by many people with addictions and substance use issues. “Shame is also the emotional core of self-stigma, which has been associated with treatment-seeking delays, treatment dropout, and poorer social functioning,” said Jason B. Luoma, of the Portland Psychotherapy Clinic, Research, and Training Center in Portland, Oregon. “Shame has long been seen as relevant to substance use disorders and their treatment, but the precise nature of the relationship and how best to address it clinically are controversial.” Luoma, lead author of a recent study, believes that Acceptance and Commitment Therapy (ACT) may be helpful in addressing shame for people struggling with substance use issues. “For substance abusers, acceptance and mindfulness might be adaptive responses to difficult internal experiences such as shame or negative self-judgment,” said Luomo, “In an ACT approach, rather than trying to reduce or eliminate shame, psychological acceptance techniques encourage participants to notice and experience shame and other difficult feelings more fully, while reducing their conditioned link to overt action.”

For his study, Luomo enrolled 133 adults in either an ACT intervention, or treatment at usual (TAU), as part of a 28-day in-patient substance use treatment program. Although the ACT group only attended three, two hour sessions, the intervention had a significant impact. “As predicted, the ACT intervention led to higher levels of outpatient treatment attendance during follow-up, which in turn were functionally related to lower levels of substance use,” said Luomo. “Across the board, participants in the ACT condition showed a pattern of continuous treatment gains, especially on psychosocial measures, rather than the boom and bust cycles seen in TAU,” said Luomo, referring to the gradual decreases in shame seen by the ACT group. He added, “It seems highly unlikely that a 6-hr group alone was responsible for the gains seen, but rather something in the 6 hours spent in the ACT group changed the overall effect of this residential program.” Luomo hopes these findings will expand the use of ACT for people seeking help with substance use. He said, “Results of this study suggest that acceptance and mindfulness-based interventions may help people to step out of a cycle of avoidance and shame and move toward a path of successful recovery that leads to more stable reductions in shame and to more functional ways of living.”

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2011, October 31). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0026070

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Shayne


    November 8th, 2011 at 5:13 PM

    As an addict I have to say that the path to recovery for me began not only when I was able to actyally acknowledge that I did have a problem, but when there was a point when I stopped living in the past/. I had to getover being ashamed of my actions of the past and move toward being a better person in the future. And I think that is where so many adidcts get bogged down. You constantly feel all of that guilt for the pain that you have caused in the past. But you have to get over that and move forward. You know you have to get past that and concentrate on making things right today.

  • miln3r


    November 9th, 2011 at 1:06 PM

    if you cannot forget something from your past then how do you expect others to??

    an addict may have it tough getting over things but really,that is an important step of also lets other people know that such a person has gotten over and that he needs to be taken seriously now!!

  • celestial


    November 9th, 2011 at 2:41 PM

    just remember that acceptance is no excuse for bad behavior

  • Rosemarie Collier

    Rosemarie Collier

    November 9th, 2011 at 7:49 PM

    Well you know what they say, the first step to resolving a problem is admitting it. If you can’t admit you have a problem, then you can’t do anything about it because you see no fault in what you’re doing, even if it’s ruining your life, money, and relationships. Feeling shame may only serve to drag you down, but it’s better than outright denial.

  • j.d. charles

    j.d. charles

    November 10th, 2011 at 4:00 PM

    Forcing feelings of shame on an addict isn’t going to help unless that’s you giving them a good reality slap and telling them that they have to clean themselves up. I’ve come to blows with some family members over their addictions, which is all part of growing up in a bad town, and I’ve told them to get into rehab or I’d kick them out of the house because I don’t want a livid drug dealer at my door.

  • Marcia H.

    Marcia H.

    November 10th, 2011 at 5:18 PM

    Doesn’t Alcoholics Anonymous’ 12 steps program have that as the very first step? I recall it being “We admitted we were powerless over alcohol—that our lives had become unmanageable.”, which is the most important step. Unfortunately steps 2, 3, 5, 6, 7, 11, and 12 are all linked to religious beliefs which alienates some. A Hindu friend of mine waved off the suggestion of AA when he was an addict because it was aimed too much towards Christians unfortunately.

  • A. Milton

    A. Milton

    November 10th, 2011 at 5:56 PM

    @Marcia H. : They do, and some AA groups avoid the religious side since many believe 1) that it’s rude to discuss religion and 2) that it’s unfair on, as you said, those who are not of the Christian faith. The emphasis on accepting that you have faults and can overcome them is what is important in getting people started on the road to recovery in the first place.

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