Yeah, this shame angle is offensive. My 80 year mom, who was strongly against drugs, died an addict because the pharm industry got her hooked on pain killers. Because of shame, her kids didn’t even know until she was an addict until she was almost dead.

I’m really sorry about your mom.

Your story is a good example of how shame can be harmful, it may have kept her from seeking help. That is certainly a negative effect of shame as a behaviour moderating factor, and I’m sorry that it affected your family in the way that it did.

I think your response is the only valid counterpoint I’ve seen here, since most people seem to think I was talking about shaming people or that shame would somehow prevent addiction… none of that was my point. But your story is a good example of how exactly what I was talking about can also have harmful effects, and that is an excellent point.

People should never be led to believe that seeking help is shameful.

This is shockingly common in the aging population, and no one really thinks to look at Grandma baking cookies as a potential addict quietly suffering

Ironically the shame is what hides this too. The Grandma trying to hide her shameful addiction. The part of her family that takes care of her shamefully hiding it from the rest of the family, for fear that they would not be seen as good care takers despite doing their best. The shame of the others that see it but pretend they don't, because they themselves don't want to admit that grandma is an addict. Justifying it away. No, the junkies on the street are different, they chose that life, but grandma is a victim. While yes, there can be people who made those poor choices, if grandma is a victim, then why should it surprise anyone that there are others. Others who are less fortunate, who's children aren't as responsible and loving as you.

My mom died of cancer in her 40's. My mom also died an addict. Two of her sisters also had cancer, found because of her diagnosis. Both became addicts as well. I don't see how they couldn't have. Chemo is rough. It is a long and painful treatment that we _should_ be giving painkillers to those receiving it. But it is shame that makes it difficult for people to get treatment. It is shame that prevents people from even admitting they need treatment in the first place.

The hard truth is that grandma is an addict and she needs to be unashamed of going to the methadone clinic.

Precisely. I grew up in an odd town on Lake Erie. On the coast there were the Cleveland Clinic millionaire surgeons, NFL, MLB, and NBA players. On the west side of town a Ford plant and some low income housing, same income and housing on the east side. Middle bit was mostly solid middle class with a couple small higher income enclaves (CEO of a Berkshire Hathaway division, for instance).

So it was truly, truly all income levels interacting in our public schools (which are pretty highly rated).

I graduated in 2009. Close to 10% of my graduating class (~400), all income levels, died of opioid overdoses or suicide. The shame of talking about our town's problem and wanting keep up appearances killed scores of people.

BBC did a documentary on our town, called Smack in Suburbia, focussed on my age group. 30 minute watch, but, it really drives this point home https://www.youtube.com/watch?v=j7ynJ5S9c58

All of this tragedy was the direct consequence of shame as public health policy.

For an example of how shame can be useful in discouraging bad choices, look at cigarettes. They're legal, but society and government have successfully campaigned to publicize their negative effects, to shame smokers and to praise quitters.

You're so close. Tobacco companies used to be allowed to actively advertise their product as healthy and employed statisticians and doctors to publish fake science in order to do so. Cracking down on Tobacco advertising has nothing to do with shame. On the other hand, people with a nicotine addiction are encouraged to seek treatment in order to quit. Again, this is the exact opposite of using shame to discourage "bad choices".

Perhaps if you thought about it just a little bit more you'd understand that treating addiction and substance abuse as a normal medical problem as opposed to a shameful sin to be hidden actually results in positive outcomes.

Hell, look at Indonesia, a nation which has a huge amount of shame-based societal pressures including the death penalty for drug smuggling and in some places corporal punishment for sex out of wedlock. They have one of the highest rates of smoking. Want to guess why? Thats right, Tobacco companies have practically zero restrictions in terms of who and how they market, including to children.

How about instead of shaming people we treat public health issues as health issues and stop allowing corporations to subject millions of people to catastrophic addictions.

I agree that addiction should be treated like a medical issue, but I also think shame plays a role. We're social creatures, after all. Sometimes, the fear of being shamed can deter bad behavior. It's not about using shame to punish addicts, but about recognizing its part in our social dynamics.

Also, I'd suggest a friendlier tone in your discussions. Being condescending can push people away, even if you have great insights. Respectful communication can make a big difference.

There is nothing friendly or respectful about suggesting that people are becoming slaves to addiction and dying destitute in the streets of the richest goddamn nation on earth because of a lack of shame. I'm simply returning the courtesy and it happens to be one of the most well-received sentiments in this miserable thread. If you don't like it, well shame on you I guess.

I understand you're passionate about this issue and rightfully so. But the point isn't to shame addicts—it's to acknowledge that social factors like shame can influence behavior. It's a piece of the puzzle, not the entire solution.

I also want to emphasize that we're all here to discuss and learn. Just because a view is well-received doesn't mean it's the only valid one. Everyone's perspective adds to the conversation. This isn't about who's the center of the universe—it's about discussing solutions to a complex problem together. No need to take it personally.

I don't think it's been empirically demonstrated that shame-based public information campaigns contributed to the drop in smoking as much as tax increases, bans in restaurants and other semi-public spaces, and changing preferences (eg, adoption of ecigs and marijuana products). At least for personal health risks like drug addiction or obesity, pretty big mounds of evidence do exist that shame is mostly ineffective for changing behavior. Here's one analysis for example: https://www.sciencedirect.com/science/article/pii/S027273581...

What? You're telling me that you're denying the overwhelming evidence of the success of Nancy Regan's Dare program!? It's overwhelmingly uncommon to see anyone smoking weed, which we know is just a gateway drug to harder things like crack and heroin. Gen Xers and Millennials, who grew up under this program, are overwhelmingly known to be anti-pot and similarly just last week HN cheered about MasterCard's decision to deny service to dispensaries, which are also uncommon and no state would legally allow them. Similarly, you don't see the overwhelming evidence of abstinence based contraception? I mean how many Catholic girls get pregnant? Who needs a coat hanger abortion when you have Jesus? There is undeniable evidence that shame, fear based education, and harsh punishments stop these kinds of immoral behavior. (If for one moment anyone thinks I needed to add a sarcasm tag, please reevaluate your perception of the world. This is as obvious as it gets)

It wasn't shame. It was age restrictions, banning smoking in most public spaces, addiction acknowledgement and smoking cessation resources, public health awareness campaigns, and increased taxation. "Shaming" smokers was just the cultural byproduct in the change in smoking, and arguably a negative one.

In Australia at least there's been a government sponsored advertisement campaign "Every cigarette is doing you damage" that rather obviously conveys smoking as an unpleasant "shameful" habit, while graphically describing the health impacts. I very much doubt the "shaming" part of the campaign would work on its own, but whoever made the ads were obviously attempting to make cigarette smoking look as unappealing as possible. More importantly, given the article this thread is supposed to be discussing, I'd be wary of assuming what works in helping reduce the usage of a "soft" drug like nicotine by a significant percentage of the population would work with hard drugs used (and abused) primarily by marginalised individuals. In fact we have had similar advertising campaigns against heroin/ice etc. (*) but I'm not aware of convincing evidence that they've really done all that much to help reduce problem usage.

(*) https://youtu.be/jxOlwO_WHrg

> They’re legal, but society and government have successfully campaigned to publicize their negative effects, to shame smokers and to praise quitters.

I dunno, seems to me the effective thing wasn’t “shame”, but:

(1) Making it progressively more difficult for tobacco companies to recruit new customers by prohibiting many forms of advertising/marketing and forcing countermarketing about harms to be included in what marketing (including product packaging) is allowed, and

(2) Driving up costs with targeted taxes, and

(3) Prohibiting smoking in most workplaces and other public places, limiting environmental exposure to the addictive substances for people not actively choosing to participate and narrowing the contexts where people who do choose to partake are permitted to do so.

> Its fucking wild that folks are advocating shame as a method for dealing with drug addiction in the year 2023.

It's also extremely divorced from reality. Even if you've never met an addict and seen how many want to get off the drugs (maybe you've met someone who is addicted to something else, like food, alcohol, or bad habits), but that the very fact that people don't flaunt it is proof of that shame. Now maybe some are unabashed now, especially in big cities, but similarly if you call someone "a fatty" enough they'll either: fix themselves (lol), hide their eating while trying to show effort or justify their weight, or just stop giving a fuck.

> people got hooked on legal prescription drugs

I want to address this, not because I think you're making this argument (your wording suggests not), but because it can be common. Many people set up the situation as if there are one of two directional graphs. Drugs -> homelessness or homelessness -> drugs (with variations on paths and some other nodes). But the effect in reality is coupled. Both can be true. It's a clique to drink your sorrows away and everyone knows the call of a stiff drink after a hard breakup or the call to eat a tub of ice cream. Of course losing your livelihood and having difficulties putting it back together can lead to that kind of addiction. But similarly we've seen people go off the deepend and take a bender too far, so of course that can lead to losing your livelihood. Most things in the world are not DAGs. There's lots of complex and coupled phenomena with feedback loops and many paths to reach certain steady state solutions. The danger is oversimplifying it and pretending these are trivial to avoid or trivial to escape. But the nature of their existence is proof of the lack of triviality, while a single counter example is not proof that they are.

Similarly it boggles my mind that a comment about shame is the solution. As if the Victorian times were well known for their safety and high prosperity. As if highly religious cultures have demonstrated exceptional prosperity (Christian, Muslim, Hindu, or whatever). That we're seeing similar comments about punishment, as if North Korea, Russia, and Iran are pinnacles of prosperity, wealth, and morality. How people are unabashedly hand waving away any nuance and pretending that the solutions are simple. But if they were then the examples before would be utopias, and that we'd speak of the many historical draconian eras in high regard.

Fwiw I actually wasn’t trying to advocate shaming people as a solution to drug addiction. At all.

I’m not even addressing addiction, but rather the socially disruptive manifestations of drug addiction related activities that are becoming increasingly common, especially in the United States.

Obviously my (now suppressed) comment was poorly written if it gave that impression.

I was suggesting rather that the disruptive social circumstances that we are seeing in the USA surrounding drug addiction are partly a result of people not feeling that they need to keep disruptive behaviours to a minimum out of a sense of personal discretion.

I have lived all over the world, and in many areas with serious addiction problems, but the kind of overt behaviour common in the last decade in the USA is uncommon in most of those cultures, and i posit that is a direct extension of the addicts themselves retaining a sense of personal dignity.

The idea of personal dignity and it’s corollary, shame, seems to be conspicuously missing in the subcultures where these kind of problems are recently erupting compared to subcultures with similar base problems where the public presentation tends to be more benign. But that is just my empirical observation from living amongst different peoples and cultures.

Furthermore, I think that replacing personal standards and self moderation with stronger regulations and reductions of civil liberties is a dangerous path that can jeopardise the functioning of a healthy democratic society.

In summary, I see shame ( not being shamed by others, but rather feeling shame in oneself) is an undervalued component in the moderation of behaviour and has utility that we ignore at our peril.

Some commenters have pointed out that shame sometimes prevents people from seeking help for addiction or other circumstances. I think that is an excellent example of where a usually useful thing can sometimes be tragically harmful. It’s an excellent counterpoint, though I never meant to suggest that shame was universally a good thing, only that it is often a useful thing. It’s definitely worth mentioning though, since my examples do tend towards being unreasonably rosy in that regard.

Personally, I strive to be able to look back at my actions and words of 5 years ago and feel a deep sense of shame- this is an indication that I have grown as a person and have transcended behaviour that I earlier would have thought of as being nominal. That’s just one example of how I find shame to be useful in my own growth.