Guilt and shame don’t drive change, hope drives change

The Q&A below is transcribed from a phone interview with Dr. Kevin Baill, chief of the Intensive Treatment Unit at Butler Hospital, for Honest Conversations.

What is the greatest challenge in treating addiction?

Guilt. Feeling guilty about something that you’ve done doesn’t tend to drive change, and I don’t see it as something that’s beneficial. We’re looking to help somebody feel more hopeful about the future and when you feel guilty all the time about your relapse or the lies you’ve told, the people you’ve betrayed, the mistakes you’ve made, that leads somebody back to the bottle because they feel bad and then they go back to the thing they know will make them feel good. Guilt doesn’t drive change; hope drives change.

What do we know about the effects of substance use on the brain?

We’ve learned more about the brain and have been able to take highly refined images of the brain as a person is craving a drug or being reminded of a drug in some way. You can see unique neurological pathways that are present in a person who is dependent on substances that is not present in the general population. So we know that the architecture of their brain changes and continues to lead them back into behaviors they know are not healthy, that they know are not good for them. There’s a whole host of genes which are associated with our responses to substances of intoxication and there’s a whole bunch of vulnerabilities that are passed down through genes. We know that addictions are heavily loaded genetically and probably in very complex ways. It’s not a matter of one gene or two genes. There could be a family where one child develops an addiction and the other child develops depression and a third child doesn’t have either one because they got lucky and different genes mixed together in a way that they were spared.

How does this understanding help inform treatment and care?

We know that people can’t just walk away from an opiate addiction, and that their brains have changed. The only way they can feel healthy and normal again is with some sort of replacement therapy in a vast majority of cases. These replacement therapies are very safe and they relieve physical cravings and uncomfortable feelings of withdrawal that drive people back to using heroin or Percocet or hydrocodone or whatever opiate-related drugs they are using. They are able to take a medicine that doesn’t make them high, doesn’t make them want to steal all the money in their mother’s purse, doesn’t lead them into criminal activity or make them so drugged-up that they crash their car. But, it allows them to really get back on their feet and function normally.

What make addictions different from other illnesses?

Being able to put a label on a problem, especially in mental health or addiction, is hard. It’s very different from having a broken leg. You can point to your leg and say, “The rest of me is fine but my leg is broken so I need to see a doctor and get a cast on it.” But if you’re behaving in a way that you know is wrong but you don’t even know what can be done about it, you can’t really point to a place. Where would you point to? Addiction is something you do when you don’t even realize you’re doing it, like biting your nails.

Can recovery only happen after someone hits rock bottom?

Everybody’s story is unique and what their rock bottom is going to be. What we want to do as a health system is to create a place where whenever that person is ready to talk about it or ready to come in for help that we have the resources at our fingertips to provide that.

Butler Hospital’s Programs and Services

Butler Hospital is Rhode Island’s psychiatric hospital focused on treatments, teaching and research for behavioral health. Learn about our inpatient, outpatient and partial hospital programs.

View Our Programs

9 comments

Your email address will not be published. Required fields are marked *

  • Hi my name is sandy and i just want to say butler hospital is a wonderful place to b if your issues of all kinds they have the best staff and someone always to talk whatever it may b so please seek help for me especially 4 addition im not ashamed. Of that im proud to b part of such a great place like butler hospital God Bless

  • Butler hospital is the only hospital that has ever helped me. I’m very uncomfortable because people and mental health agencies now equate mental illnesses with substance abuse and have co-opted the term “recovery” The stigma of substance abuse is as bad, or even worse than mental illness. Who thought of this stupid concept anyway?

    • Victoria, you raise a good point about the stigma associated with substance abuse being as bad or even worse than the stigma experienced with other mental illnesses. We agree some feel there is a difference. The reality is that substance abuse and addiction, known as substance use disorder, is a type of mental illness, just like depression, bipolar disorder, and OCD, for example. Having open conversations such as this will change the perceptions and allow those suffering with mental health issues of all kinds feel comfortable asking for help.

  • Butler hospital is the only hospital that has ever helped me. I’m very uncomfortable because people and mental health agencies now equate mental illnesses with substance abuse and have co-opted the term “recovery” The stigma of substance abuse is as bad, or even worse than mental illness. Who thought of this stupid concept anyway?

  • Glad to see Dr. Baill speaking so passionately on the subject of opiate addiction and treatment with suboxone. I have had many friends and family members die from opiate addiction so I totally relate on this subject. I wish there were more understanding doctors out there
    Yay Butler Hospital! Yay Dr.Baill! This hospital’s reputation speaks for itself. I know many people that have gone there for different issues and received life changing treatment. If you or a loved one need help,

    • Joey, we are very sorry to hear you’ve experienced so many losses due to this illness, but we’re also very grateful to receive your input and support. Thank you for joining the conversation!

  • I’m on suboxen and I’m a recovering addict an a chronic pain patient its so hard to live like this!you really sounded like your very compassionate. Most actors don’t look at it the same way. Found it very interesting that I looked on my notifications and saw this! Maybe i was supposed to see this sincerely Patricia Allen

Butler Hospital

Dr. Kevin Baill

Chief of the Intensive Treatment Unit at Butler Hospital


Specializing in the treatment of severe mental illness and addictions, Dr. Kevin Baill serves Butler Hospital, its patients and the community in a variety of ways. As chief of one of Butler’s two inpatient intensive treatment units, Dr. Baill cares for some of the most acutely ill and vulnerable patients. Part of a multidisciplinary care team, he works with patients to treat and stabilize the symptoms and conditions that are impacting their quality of living. In a private, outpatient clinic, Dr. Baill has been an active buprenorphine provider for more than six years, working with patients battling opioid addiction.

Do you need help now? The Care New England Behavioral Health Services Call Center is available 24/7 at 1 (844) 401-0111 or view our services online.