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Episode 259: Dr. Carrie Wilkens, PhD on Rethinking Addiction Without Shame
12/11/2025
Episode 259: Dr. Carrie Wilkens, PhD on Rethinking Addiction Without Shame
In this episode of the Food Junkies Podcast, Clarissa and Molly sit down with psychologist Dr. Carrie Wilkens to unpack what it really means to help people change without shame, stigma, or power struggles. Drawing from decades of work in substance use, eating disorders, trauma, and family systems, Carrie invites us to rethink âdenial,â ârelapse,â âcodependency,â and even the disease model itself, while still honoring the seriousness of addiction and the depth of peopleâs pain. Together, we explore how self-compassion, curiosity, and values-based behavior change can transform not only individual recovery but also how families, helpers, and communities show up for the people they love. In this episode, we explore: Lived experience & professional work How Carrieâs own long-term healing around food and her body continues to shape the compassion and curiosity she brings to her work. The idea that our relationship with food and our bodies changes across the lifespanâand why âlifelong relationship managementâ matters more than perfection. Do you have to be âin recoveryâ to help? The pressures clinicians face when theyâre asked, âAre you in recovery?â and how that question can be loaded with judgment and assumptions. Why personal experience with a specific substance or behavior is not a prerequisite to being deeply effective as a helper. How Carrie talks with clients and families about her own history in a way thatâs honest, boundaried, and clinically useful. Rethinking âdenialâ and harmful language Why words like âdenial,â âaddict,â âcodependent,â âchronic relapser,â and âitâs a slippery slopeâ can shut people down rather than open them up. A more curious approach: asking âWhat do you mean by that?â and unpacking the real story underneath labels. How language can either invite people into self-understandingâor reinforce shame, fear, and disconnection. Softening the disease model without minimizing the problem Nuanced ways to honor addiction as a serious, complex disorder without collapsing everything into a rigid disease frame. How fear (of overdose, loss, chaos, or death) drives a lot of rigid thinking in systems and professionals. Why behavior change is slow, non-linear, and rarely a straight lineâand how accepting that can actually make care more effective. Relapse as an âold solution that once workedâ Carrieâs reframe of relapse as returning to an old behavior that, at one time, made sense and worked on some level. How naming the function of a behavior (soothing, numbing, regulating, connecting) opens the door to new, less harmful solutions. The difference between âYou didnât want it enoughâ and âYour brain reached for an old strategy that once helped you survive.â The Invitation to Change Approach (ITC) The core elements of ITC: Motivational interviewingâinformed curiosity and ambivalence exploration. Acceptance and Commitment Therapy (ACT) and values-based living. A deep commitment to self-compassion as a foundation for behavior change. Why ITC was originally developed for family members and then adapted for people with substance use concerns themselves. How the âwheelâ of ITC lets people step in wherever they areâself-awareness, values, behavior strategies, or compassionâand build over time. Families, shame, and staying engaged without âtough loveâ Inviting family members to ask: âHow does my loved oneâs behavior make sense?â instead of âWhatâs wrong with them?â How this shift helps parents and partners move from fear and control into strategy, support, and skillful engagement. Concrete examples of how families can respond to return to use with curiosity, concern, and clearer communication instead of lectures or ultimatums. Codependency and other overused labels Why Carrie has never formally diagnosed anyone with âcodependency.â What often lives underneath that label: trauma histories, cultural norms, attachment dynamics, fear of loss, and learned survival strategies. How flattening all of that into âcodependentâ erases nuance and blocks meaningful change. Neurodivergence, trauma, and substance use/eating behaviors The high rates of PTSD and ADHD among people seeking help for substance useâand why that matters for treatment design. Carrieâs reflection on her own undiagnosed ADHD and how it likely drove much of her earlier eating disorder behavior. How binges, purging, and substance use can function as powerful nervous system regulators, especially for neurodivergent and trauma-impacted brains. Why we need more ground-up, neurodivergent- and trauma-informed approaches that focus on emotion regulation, executive functioning, and skill-building. Self-compassion as a behavior change superpower Carrieâs journey from skepticism (âthis sounds too wooâ) to seeing self-compassion as essential, research-backed behavior-change work. How self-compassion reduces shame, helps people tolerate slow progress, and makes it safer to look honestly at their own behavior. Using both âtenderâ and âfierceâ self-compassion to choose boundaries, seek support, and keep moving through discomfort. Reimagining âexpertâ roles and community care Why Carrie is skeptical of rigid expert hierarchies in addiction treatment. Inviting families, community leaders, and lay helpers into the work through accessible tools like ITC groups and trainings. The power of giving non-clinicians simple, evidence-based language and frameworks so they can respond with compassion instead of panic or shame. About Dr. Carrie Wilkens Carrie Wilkens, PhD, is a psychologist with more than 25 years of experience in the practice and dissemination of evidence-based treatments for substance use and post-traumatic stress. She is the Co-President and CEO of CMC: Foundation for Change, a nonprofit dedicated to bringing evidence-based ideas and strategies to families, communities, and professionals supporting people struggling with substances. Carrie is a co-developer of the Invitation to Change (ITC) Approach, an accessible, skills-based framework that helps families stay engaged, reduce shame, and effectively support a loved oneâs behavior change. ITC is now used across the U.S. and internationally in groups, trainings, and community programs. She is co-author of the award-winning book Beyond Addiction: How Science and Kindness Help People Change, which adapts the Community Reinforcement and Family Training (CRAFT) model for families, and co-author of The Beyond Addiction Workbook for Family and Friends, a practical, evidence-based guide for loved ones who want concrete tools to support change without sacrificing their own wellbeing. Carrie is also Co-Founder and Clinical Director of the Center for Motivation and Change (CMC), a group of clinicians providing evidence-based care in New York City, Long Island, Washington, DC, San Diego, and at CMC: Berkshires, a private residential program for adults. She has served as Project Director on a large SAMHSA-funded grant addressing college binge drinking and is frequently sought out by media outlets including CBS This Morning, the Katie Couric Show, NPR, and HBOâs Risky Drinking to speak on substance use and behavior change. Resources Mentioned CMC: Foundation for Change â Family-focused trainings, groups, and resources: The Invitation to Change Approach â (Book) (Workbook) The content of our show is educational only. It does not supplement or supersede your healthcare provider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.
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