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 "denial," "relapse," "codependency," and even the disease model itself, while still honoring the seriousness of addiction and the depth of people's 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 workHow Carrie's 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 lifespan—and why "lifelong relationship management" matters more than perfection. Do you have to be "in recovery" to help?The pressures clinicians face when they're asked, "Are you in recovery?" 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 that's honest, boundaried, and clinically useful. Rethinking 'denial' and harmful languageWhy words like "denial," "addict," "codependent," "chronic relapser," and "it's a slippery slope" can shut people down rather than open them up.A more curious approach: asking "What do you mean by that?" and unpacking the real story underneath labels.How language can either invite people into self-understanding—or reinforce shame, fear, and disconnection. Softening the disease model without minimizing the problemNuanced 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 line—and how accepting that can actually make care more effective. Relapse as an "old solution that once worked"Carrie's 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 "You didn't want it enough" and "Your brain reached for an old strategy that once helped you survive." The Invitation to Change Approach (ITC)The core elements of ITC:Motivational interviewing–informed 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 "wheel" of ITC lets people step in wherever they are—self-awareness, values, behavior strategies, or compassion—and build over time. Families, shame, and staying engaged without "tough love"Inviting family members to ask: "How does my loved one's behavior make sense?" instead of "What's wrong with them?"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 labelsWhy Carrie has never formally diagnosed anyone with "codependency."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 "codependent" erases nuance and blocks meaningful change. Neurodivergence, trauma, and substance use/eating behaviorsThe high rates of PTSD and ADHD among people seeking help for substance use—and why that matters for treatment design.Carrie's 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 superpowerCarrie's journey from skepticism ("this sounds too woo") 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 "tender" and "fierce" self-compassion to choose ...