Shame pain and addiction
All four phases are both causes and effects. Meaning that each of them can be the gate to the addiction cycle or just a consequence of addiction. Some people will thus enter the cycle through shame that leads to isolation, suffering and drug addiction. Some people will enter through drug taking, ie. those who are prescribed strong painkiller medications or people who are somehow forced to take drugs don’t develop shame as a response to the personal choice of drug taking.
This is probably a protective factor for people who are prescribed painkillers by a physician, but who would not use drugs a coping strategy. When new statistics show that an increasing number of people do become addicts after taking strong pain medications, it might reflect that an increasing number of people feel ashamed about their health situation, their lack of performance or their need for sedation. An extreme case of someone clearly not ashamed of his heroin addiction is Conan “Popeye” Doyle from the French Connection. As he is forced into physical dependence without any personal choice, there is not shame in connection with his predicament. And that makes it relative easy to get out of the addiction as he only has to overcome the physiological cravings, not a intrapsychic condition.
When the fashion in US torture techniques is to incorporate as much choice into the suffering as possible is it undoubtedly to spike the physical pain with shame. What they might have found is that while pain is more acute, shame will run deeper and do more damage to the psyche of a person than physical pain.
Physicians could do well by never letting their patients have any choice in what level of pain medication they are subjected to as this would serve to protect to some degree against shame.
The shame might very well be specifically connected to the choice of dealing with personal suffering instead of the objective situation that is the cause of the suffering. Which is to say that the choice of opting for emotion focused coping (drugs, sandbagging, pain medications, comfort eating, shopping on credit) instead of dealing with the objective life situation might be a potent cause of shame in itself.
On a rational level we can recognize a difference between coping with emotions and coping with objective causes of suffering. It is more effective in the long run to cope with objective problems as they have a tendency to repeat their effects toward suffering. Alleviating pain directly has less chance of correcting a problematic life situation. So in most cases you will have to repeat the emotion focused solution while coping with objective problems has the potential of being permanent solutions.
But apart from a rational preference for problem focused coping there is the swarm of emotional derivatives that makes up the personal meaning of drug abuse as an emotional crutch. The personal meaning of emotion focused coping might run deep and involve existential choices, lack of trust and lack of love. When you choose to self soothe through comfort eating or self administration of heroin you have given up hope. Specifically you have given up hope that other people will make the choice for you, show you love and understanding and help you cope with pain and suffering either by comforting words or by prescribing pain a medication. You have thus broken the trust between yourself and the people that you rely on for love and understanding. You have done that. Your choice. By which you lose your citizenship in the community of love and understanding that you don’t trust to care enough for you.
I am not saying that this is a sane or sound way of thinking. But I am saying that dynamics like these are hard to avoid for any sane and sober person, let alone someone in agony over a mix of physical pain, bad life choices and withdrawal symptoms.