When you walk into a 12-Step meeting, one of the first things you may see is a sign that says, “We Care.” Though short and seemingly insignificant, this message highlights one of the components of 12-Step recovery that makes the program so effective: empathy.
What Is Empathy?
In its broadest sense, empathy is central to what it means to be fully human. It allows us to tune into how someone else is feeling and gives us insights into the thoughts, emotions and behaviors of other people.
Why do we have empathy? We know that empathy is associated with morality, altruism, pro-social behavior and cooperation. As humans evolved into tribes and larger social groups, empathy was a way of building social cohesion by helping us understand and sympathize with other people’s emotional states. It made us want to take care of them and treat them well, while allowing us to feel good about cooperating with one another.
Empathy is critical to moral development. If you don’t care about another person’s feelings, you’re not going to behave in a moral way to them. And probably the truest definition of evil is a lack of empathy. People can do horrible things to other people if they lack empathy.
Lack of Empathy Tied to Substance Abuse
One of the principal complaints of the family members and loved ones of addicts is that the addicted individual no longer cares. They have become completely self-consumed and lost all regard for other people’s thoughts and feelings, even the people they care about most.
Research shows this observation is a fairly accurate description of what happens during addiction. Although their true self still cares deeply for loved ones, their ability to care has been taken hostage by the disease of addiction.
There is a lot of evidence that empathy is impaired in substance abuse. Research shows that callous and unemotional children are at greater risk for conduct disorder, antisocial personality disorder and substance abuse. When these behaviors manifest early in life, they are significant risk factors for ultimately developing problems with alcohol and drugs.
Alcoholics face unique empathy deficits, often struggling to identify even their own feelings, let alone the feelings of other people. A psychological syndrome called alexithymia, which is the inability to identify and describe one’s own feelings, occurs in almost 40% of alcoholics, compared with only 5% to 7% of the general population.
In studies of alcoholics who have gone through detoxification or drug rehab, empathy is significantly lower than control groups. This means that in the acute period following detoxification, alcoholics are less empathic than other people.
Which Came First: Addiction or Lack of Empathy?
Is this loss of empathy that we see in alcoholism and other drug addictions a temporary state of being or a personality trait? Is it a response to becoming addicted or was it there before?
Many people would say that a diagnosis of alcohol dependence and other substance use disorders is intrinsically characterized by impaired capacity for empathy. In other words, lack of empathy is the result of alcoholism and drug addiction.
Why do people struggling with drug addiction seem to care less? First, as drugs become more and more important, the addict is less able to respect the feelings of others because their brain only wants one thing: more drugs. Their entire emotional state becomes focused on getting and using drugs.
Second, drugs create a pseudo-empathic experience among drug users. Although addicts have impaired abilities to relate to other people, they bond with one another in a unique way when getting high. Even though they are not really emotionally in touch with their fellow drug users, they have an experience of being closer to them as a result of sharing the experience of being high. In this kind of pseudo-empathic experience, drug users share a high but are not really in a relationship emotionally or psychologically.
And finally, empathy for others seems to suffer particularly as drug cravings and withdrawal dominate the addict’s emotional state. As they become more and more focused on trying to control the physical symptoms of withdrawal and the psychological cravings, their ability to relate to other people diminishes.
So which came first: addiction or lack of empathy? Research points in both directions. There is a great deal of evidence from studies of children who later become alcoholics that loss of empathy in many cases precedes drug use. There’s also evidence that this loss of empathy is made worse by becoming dependent on alcohol and other drugs.
Rebuilding Empathy Through Fellowship
Regardless of which came first, there is undeniable evidence that lack of empathy is tied to addiction. Just as addiction takes away an individual’s capacity for empathy, that capacity must be restored for successful long-term recovery.
This is where 12-Step programs and group therapy become essential components of a recovery program. Empathy is a skill that can be re-learned through education and hands-on application. Support groups provide regular opportunities for recovering addicts to hear each other’s stories and begin offering support and feedback.
In a safe and supportive environment, people in recovery can get honest about what the disease of addiction has taken from them and lay the groundwork to get it back. The process begins with empathy for oneself, forgiving the wrongs they committed while addicted to drugs or alcohol and releasing the shame that stands in their way of lasting recovery. Next, empathy extends to close family members and friends, and then to the community at large.
David Sack, M.D., is a board-certified addiction psychiatrist and CEO of Elements Behavioral Health, which owns Promises Treatment Centers in California, The Ranch in Texas, The Recovery Place in Florida, and The Sexual Recovery Institute.