There’s one thing that has always struck me when working with patients struggling with addiction: they almost never come in because they haven’t tried anything—quite the opposite.

Most have already tried to quit on their own, set limits for themselves, removed bottles from their homes, uninstalled an app, and promised their loved ones that “this time, it would be the last.”

Some even managed to stay sober for several weeks, sometimes several months, but then their use returned. And with it, a thought that often comes up in sessions: “If I’m coming in for counseling, it’s because I’ve failed.”

I believe this is one of the most painful beliefs held by people struggling with addiction: asking for help would be tantamount to admitting that they’ve failed on their own.

In therapy, I never see it that way. Seeking help doesn’t mean you’re weak—it simply means that your suffering has become too great to bear alone. I believe it takes a tremendous amount of courage to take this step.

“Why am I so ashamed to ask for help?”

If there’s one emotion that comes up almost without fail in therapy, it’s shame. We see it in statements like: “I never thought I’d become that kind of person,” “I’m ashamed that I’ve ended up here,” “If my loved ones really knew…”

What’s striking is that this shame isn’t just about substance use—it’s also about the person’s self-image: a father who drinks in secret from his children, a nurse who is dependent on alcohol, a student who can no longer get through an evening without cannabis, a business executive who gambles online until the middle of the night. They all have different life stories, but many share the same thought: “I’m not supposed to be this person.”

It’s often not just the addiction that causes suffering. It’s the feeling of no longer recognizing the person you’ve become. Many patients tell me, in different words: “This isn’t me anymore.” This shame often leads to isolation. And the more they isolate themselves, the more that shame grows. This is probably one of the reasons why so many people wait before seeking help. They’re not just looking to overcome an addiction. Above all, they hope they won’t have to bear that shame alone anymore.

Shame doesn’t disappear just because we tell the patient they have nothing to be ashamed of:

At the start of clinical practice, we may tend to want to quickly reassure patients: “You don’t have to be ashamed.” However, despite our good intentions, we’re missing the point of what the patient is actually experiencing. Their shame is real; it deserves to be heard before it can be alleviated. It’s important to make space for it and to take an interest in what they’re sharing. How long has it been present? When is it strongest? What does the patient think I’ll think of them?

Very often, discovering that this shame can be expressed without provoking rejection is in itself a deeply healing experience.

“I feel like no one can understand what I’m going through.”

This statement comes up frequently in sessions because, before seeking help, many people have already tried to talk about their substance use with a spouse, a friend, a parent, or sometimes even a professional. Often, they come away with comments that hurt them more than they help: “Just stop,” “Everyone drinks a little,” “You’re overreacting,” “If you really wanted to, you could do it.”

I don’t think these words are meant maliciously. They’re often spoken by loved ones who are suffering too and don’t know how to help anymore. But when you hear them over and over again, it becomes easy to conclude that “no one can understand what I’m going through.”

When they come in for counseling, many aren’t initially looking for help. Above all, they’re trying to make sure they won’t be judged yet again. This distinction seems essential to me because, before someone can speak freely about their addiction, they often need to be sure they can do so without being reduced to it.

Before trying to understand addiction, let’s try to understand the person:

I’m often struck by one thing: you can never understand an addiction without first trying to understand the person suffering from it. These are two very different things. I don’t believe a patient expects a therapist to know everything there is to know about their substance of choice. I think they mainly expect the therapist to be curious enough to try to understand what they’re going through. Two people may engage in the same substance use without attributing the same meaning to it, which is why I think it’s wise to avoid jumping to conclusions too quickly. I prefer to let the patient show me, little by little, the role their addiction plays in their life story, and I often feel that it’s this sincere curiosity that allows trust to develop.

“Why is it sometimes easier to keep suffering than to ask for help?”

This question may seem surprising, and yet I think it sums up much of what people struggling with addiction experience. Over time, I’ve come to realize that many patients don’t wait to seek help because they aren’t suffering enough, but because they still hope they can get through it on their own.

They tell themselves: “Just a little more willpower and things will get better,” “This time, I’ll be able to control it,” “I’ll wait until this difficult period passes.”

These thoughts are understandable because they allow them to hold onto the hope that the situation remains manageable. Asking for help sometimes means accepting that this is no longer the case. This idea is difficult because it forces them to let go of an illusion they’ve often clung to for a long time: the belief that they can handle everything on their own.

I’ve also noticed that there’s another, more subtle fear. Some patients dread what might happen if they stopped using, because they’re no longer quite sure how to live without it.

After several years, substance use has sometimes become ingrained in every moment of daily life: to relax, to get through a difficult day, to sleep, to go out, to calm an emotion, or simply to stop thinking. The idea of giving it up can therefore be as unsettling as it is reassuring. It’s important to be able to say this without being judged.

When “I want to quit” and “I can’t live without it” coexist

One of the most surprising things about working with patients struggling with addiction is their ambivalence. In fact, the same patient might say, in a single session: “I really want to quit,” and then, a few minutes later: “But I can’t imagine living without it.” This reflects an internal conflict. One part of the patient sincerely wants to change, while another deeply fears what that change entails. This ambivalence isn’t a sign that the patient doesn’t want to change. It often reflects an inner conflict: one part of them sincerely longs for a different way of life, while another continues to rely on addiction to cope with what still feels unbearable. It is precisely this conflict that therapy seeks to understand. Trying to resolve it too quickly risks missing what is really at stake.

What helps the most isn’t always what we imagine:

When you’re struggling with an addiction, you sometimes imagine that the therapist has all the right answers—that they’ll tell you what to do, how to stop, or how to quickly regain control. In reality, I believe that what helps the most is often much simpler: meeting someone in front of whom it finally becomes possible to stop pretending. To stop downplaying things. To stop making excuses. To stop hiding. Over the course of the sessions, patients begin to share things they’ve never told anyone before. Not because I ask them extraordinary questions, but because they gradually discover that they can speak without fear of being reduced to their substance use. This is probably one of the most important moments in therapy.

Once a person no longer needs to constantly protect themselves from the gaze of others, they can finally begin to view their own suffering in a different light.

How do you choose a therapist when you’re struggling with an addiction?

There’s no single answer to the question of whether a psychologist, psychotherapist, or psychoanalyst is qualified to treat an addiction. Of course, their training, clinical experience, and interest in addiction are important factors. But if I had to give just one piece of advice to someone looking for a therapist, it would be this: after the first few sessions, ask yourself one question. Did you feel understood? Behind this question lie many others: did you feel heard? Did you feel that the therapist was trying to understand your story rather than immediately giving you advice? Were you able to speak freely, including about the things you’re most ashamed of? Did you feel welcomed as a person… or merely as someone who uses substances?

It seems to me that these are the essential questions. I don’t believe a good therapist is someone who has all the answers; I believe they are someone who remains curious enough never to assume they already know the story of the person sitting across from them.

That’s also why I consider continuing education and supervision to be essential parts of my practice. They allow me to keep questioning my own perspective, to avoid becoming complacent in my certainties, and to offer each patient a space for reflection that remains dynamic.

In conclusion, I believe there’s a notion that does a great deal of harm to people struggling with addiction: the idea that they should be able to pull through on their own. This belief often fuels shame, silence, and isolation. It causes some people to wait months, sometimes years, before daring to ask for help. Yet, behind this hesitation, I rarely find a lack of willpower. Most often, I meet people who have already tried so hard, felt so much guilt, and often suffered greatly in silence. In my view, asking for help isn’t an admission of failure. It’s a decision that you no longer want to bear this suffering alone. It’s a step that requires tremendous courage. Ultimately, even before they need to stop using drugs, many people first need something much more fundamental: to meet someone in front of whom they no longer need to hide what they’re going through.