Pain Is Inevitable; Suffering Is Optional

April 21, 2025

Ashley Coughlin, MD & Co-Author

Tom O’Connor, Co-Author & Publisher

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Recovery

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Topic

Pain is inevitable; suffering is optional. Pain is a natural part of life, but it does not have to rule it. Our thoughts and perceptions about pain cause suffering. People needlessly suffer for many years with substance abuse addiction. Unfortunate events, problems, and disappointments are the first arrows that cause pain. The second arrow may be self-deprecating thoughts, self-blame, or getting down on yourself. The key is not to grab a substance, alcohol, or drugs to heal the pain and suffering!

Ashley Coughlin, MD, is my co-author for this issue. She is a Double-Board-Certified and Yale Fellowship-trained Addiction Psychiatrist skilled at buprenorphine management. Ashley is certified in Accelerated Resolution Therapy (ART) and views treatment through a lens of Adverse Childhood Experiences (ACEs). She has contributed over a decade of clinical expertise to healthcare systems across Connecticut. 

According to Ashley Coughlin: 

My philosophy is harm reduction. As an addiction psychiatrist, I help meet people where they are on their journey to recovery, whatever that may look like. I am passionate about my work, patient care, and team unity. Furthermore, I appreciate people who are unafraid to recognize missteps, as mistakes help us grow. I tell my patients that they know themselves—both their minds and their bodies—best! They are the eyes and ears, and I offer them options and help monitor them, no matter what path they choose to optimize safety. It works best when we can collaborate as a team.

I do my job for the dopamine hit I get participating in recovery journeys, the lessons my patients teach me daily, and the intergenerational trauma I work to heal - I'll share some of why that probably came to be.

As an addiction psychiatrist, I’m no stranger to pain. 

Trust me when I say that I understand why people use drugs or alcohol to self-medicate their painful experiences. Some folks have argued with me that addiction is purely for fun or just to get a sexy dopamine rush, but I doubt it's just that. Looking more closely, I see how life circumstances can cut deeply. 

Many of us have scars from where we’ve been injured, some gnarlier than others. Being alive hurts. Addiction is not very fun at all. We try to escape the pain we feel at tremendous costs. Family culture impacts our coping capability, or lack thereof, in significant ways. Unlearning learned behaviors we've inherited can be key. In addition to medication and therapy, addressing underlying maladaptive coping skills and patterns of personal dysfunction is necessary.

Most importantly, look at how your survived traumas have impacted your nervous system. Hint: ACEs play a significant role. You might be surprised at what you find.

Ashley Coughlin’s Life

My maternal uncle was found deceased on the porch that belonged to a small town long-time career cop in Texas. He had been visiting family and had attended a party, which was a fatal mistake. The first autopsy report I viewed set my career trajectory in motion without me knowing it. It indicated facial and bodily injuries characterized as self-defense wounds in the setting of a blood alcohol level that was off the charts. It was deemed that he was left outside in the cold to die overnight from hypothermic injury. Based on a literature search fueled by my obsessive curiosity, this incident was not the first bout of foul play in that suspicious officer’s repertoire, and I doubt it was the last. A common denominator was that alcohol and violence were themes among his victims.

We can speculate that this was murder. That cop knew the right people in a tight-knit community familiar with burying justice and had sold a narrative of coincidence. After much deliberation, my aunt, a new widow, opted to forgo an investigation. Maybe she understood how things worked where there was a tradition of protection. Perhaps she was ashamed that alcohol was involved. Regardless of the rationale, my uncle’s death saw no retribution at that time. In hindsight, I was too stubborn to let my hope die with him then, but I was also too young to know how this would impact me in the long run. I desperately needed his loss to have meaning. Primarily, to honor his memory and better understand my own family, I studied human behavior meticulously. For reasons unbeknownst to me at that time, I was drawn to understand motivation, self-medication, pain, and denial. This obsession took me down a long, tumultuous road that eventually led to me gaining expertise in addiction psychiatry but also toward my recovery journey.

Emotional isolation was a familiar road to me growing up, and I was selectively mute for a lot of it. Alcohol and avoidance were embedded in the fabric of my family culture. For me, this felt cold. Lonely. Being brought up by traumatized parents left a significant deficit in my emotional world. Yes, they cared for my physical needs, and I am grateful beyond words. I shared how my mom lost her brother to suspected murder, but my dad also lost his sister to suicide. The trickle effect of grief weighed heavily on my family. We did not go to the doctor's unless we were physically sick. Psychiatry was not in my lexicon then, even though it should have been. But avoiding help did not work; the trauma still followed us. We couldn't escape it. The point is, my nervous system took many hits. 

Being meticulous about medical care now, as a psychiatrist, is likely a trauma response. Ironically, I navigated my heartbreak back then in solitude despite having an identical twin who was processing her grief in a parallel process, precisely what we were taught. Feeling lonely hurt me badly. Having others around physically but still feeling alone emotionally cuts the deepest. Once upon a time, I was even proud to bear the scars. Cultural and religious pressures encouraged this. The avoidance mechanisms passed down to me enhanced it. Don’t cry. Be strong. Bury your feelings. Be tough. Smile even though forced. Don’t burden others. Don’t ask for help. You cannot share family secrets. Pretend things are okay. I desperately wanted change, but shame and self-hatred seemed to be the themes preached, so for a while, I internalized them. 

Adverse Childhood Events (ACEs)

The literature is clear: traumatic events occur in childhood. Adverse childhood experiences (ACEs) can include violence, abuse, neglect, and growing up in a family with mental health or substance use issues. Prolonged exposure to stress from ACEs can affect brain development and also increase the risk of medical illnesses later in life. I inform my patients that ACEs serve as a way to quantify trauma. The Centers for Disease Control and Prevention (CDC) estimates that at least 1 in 6 adults has experienced four or more ACEs. Why does this matter? At least 5 of the top 10 leading causes of death are linked to ACEs. The painful beauty of this is that ACEs might be preventable. We may have more control over our health and wellness than we realize.

Intergenerational Trauma 

It took years, numerous epic failures of my own, feeling sick and tired of codependency, and hundreds of thousands of patient encounters to realize that I had inherited terrible coping skills. Most alarmingly, I could see more clearly my intergenerational trauma, and that I was destined to repeat it. I didn’t know what I was searching for, but I knew my life wasn’t aligned with how I wanted to live. I witnessed firsthand how trauma and untreated alcohol use could lead to death. But what if you don’t know that life can be any different? What if you don’t understand what 'better' looks like? Life can hit you hard and unexpectedly, incentivizing you to change. 

Alcohol Use Disorder (AUD)

I had been over-functioning at work when I discovered that my husband was drinking. The shame I felt was profound. Working as an addiction psychiatrist did not render me immune to the cycles of alcohol use. How did I miss this? I was hurt. I learned the hard way that denial doesn’t work long-term, and it doesn't work in isolation. Patterns emerged. I knew things could change, but could I? It wasn't easy, but I recognized how much I played a role. Mutual understanding of feelings was essential. I was partially responsible for the emotional shutdown in our relationship. We both needed to put in the effort.

Over time, I noticed that when feelings are honored, they become an essential treatment tool, like a barometer, guiding you down untrodden healing paths despite external pressure. I could no longer use work as an excuse to dodge my inner world. I chose honesty. Being neurodivergent with some inherent alexithymia of my own, it took a great deal of practice. I'm still learning. Generally, I had no trouble naming the feelings of patients I saw in the clinic, but I was left dumbfounded when identifying my feelings. Connecting with my sense of self required significant work and ongoing practice. 

In addition to regular supportive therapy, I underwent eye movement therapy called Accelerated Resolution Therapy (ART). This intervention calmed my nervous system to reduce my fight, flight, or freeze response. I could finally breathe. ART created a safe space for me to start loving myself. This was not easy; I'm still trying. There are times I feel frustrated, but that's okay. Over time, I began to see myself differently - as a remarkably flawed person on a mission to help others gently shovel their denial piles. Contrary to popular or internal belief, you matter. 

Self-Priority

We are taught to place an oxygen mask on ourselves before assisting a seat partner on a flight, but aside from this, we are not necessarily taught the importance of self-priority. Your authenticity is what makes you great! After pushing things down or pretending to smile to mask the pain, it takes practice and patience to make amends. Also, take breaks; I cannot emphasize this enough. You can't hide or over-function in denial for long, not effectively. Trust takes time to rebuild, as does your life and your relationships. Getting in touch with your emotional world can improve things significantly. Additionally, show compassion to your inner child who didn't know better. Just make recovery a possibility.

Self-Medication

You can’t run and hide from feelings indefinitely without inflicting significant damage on yourself or others. Drug or alcohol use, over-functioning at your own expense, gambling, workaholism, overeating, and overspending when resources are limited, as well as non-consensual infidelity, might seem beneficial in the short term because they feel good at first. Still, ultimately, they won’t provide lasting satisfaction. Surviving the painful aftermath of financial ruin, unbearable loss, and self-hatred is possible, but it is incredibly challenging. It boils down to avoidance. The typical pattern I observe is that people attempt “self-medication” to find something missing or to fill a void that feels empty. 

Find and Protect Our Emotional Wellness

We may even create excuses to rationalize these hurtful behaviors. Often, in these situations, feelings are forcefully suppressed. I ask my patients, "Can you hold an inflatable beach ball under the water indefinitely without it bouncing back up?" No, you cannot. It will resurface, and the harder you struggle, the more forcefully it splashes out. Some helpful language I learned during my lifelong training is, “How do we find and protect our emotional wellness?” The actual depth of intimacy was unfamiliar to me for a long time. 

An emotionally neglected child may not initially understand what that means. Yes, I’m referring to your relationships with others, but your relationship with yourself is paramount. Intimacy occurs when you feel safe and free to be yourself, especially with someone else. It’s about connectedness. Self-love is the most essential ingredient; anyone seeking it can learn how. Trust me; it sounds simple, but it's not easy. I've realized it’s impossible to love others meaningfully if you profoundly hate yourself. Others sense it. They may subconsciously recoil or lash out in response. You might be oblivious, so listen carefully.

Being In Recovery

Recovery can be unfamiliar for those who have experienced trauma, particularly intergenerational trauma, where ongoing suffering creates an inability to pause and recognize what’s present. However, these confusing cycles don’t have to persist. Change can begin with you. Furthermore, how you choose to reinvest in yourself is significant. Avoid living on autopilot as a victim of circumstance; approach your life differently, and be intentional about the next chapter. You may discover more power than you realize is possible.

Being in recovery means something entirely different than simply going to rehab and emerging “clean and sober.” I put that in quotes because you were never "dirty." You were hurting. You tried to numb the painful void, but at a cost.

You needed compassion and one person to care about your emotional wellness. Pejorative language involving substance use terminology is harmful, so let's unlearn it. Positive and negative urine tests are more appropriate. You don't need more shame. Recovery is a mindset. It’s honesty. It’s a journey. It’s meant to be filled with successes and failures that lead to personal growth. That’s how we learn.

Adult Child Syndrome (ACS)

For me, the most powerful experience was releasing the grief I had bottled up long ago. When my uncle died, I read his autopsy report as if I were a medical professional, not just a grieving person. I'm still learning how to balance my life as an authentic human being with my profession as a physician. There are many opinions on this matter. We are often shamed for being open about our feelings. When it’s clinically appropriate, I share some of my weaknesses so others can find strength in my mistakes. This is tough stuff. Trust me, I'm not perfect; I still need to muster the courage to attend an ACoA meeting, which is a self-help group for Adult Children of Alcoholics and Dysfunctional Families.

The road I now choose to walk intentionally has changed the course of my life in remarkable ways. Those around me notice and are starting their wellness journeys as well. As they heal, they remind me to reassess my enabling tendencies, which I might inadvertently default to from childhood. As an adult, I have the opportunity to practice tolerating my vulnerability to codependency and channeling this into strengthening my collaboration as a team member. This is where I shine. 

Loneliness no longer suits me. I feel valued when I present my true self and am accepted by my peers. I love being part of teams and recognizing the value of mutual wellness. This way of living feels better and warmer; it is less lonely and more sustainable. It gives me an extraordinary dopamine boost to help patients recover when I work alongside a crew of compassionate clinical professionals who understand me and why I do this work. In recovery, “teamwork makes the dream work.”

When I read toxicology or autopsy reports, I care deeply about justice being served for those who deserve it. You know now how it's personal to me. If someone tests positive for drugs or alcohol, I see this as an indication that they need help. I’m there for them, no judgment. I will help hold them accountable, and they will tell me if medication is indicated.

Rather than continue down the painful road to almost certain death, anyone can take an alternative route toward healing. You, too, can look for opportunity - together, we can change. Let's say goodbye to hurtful language, shame, punishment, and fear - the annoying default strategies we probably learned young that simply don’t work. 

Society needs a paradigm shift. The evidence shows that positive reinforcement is effective, rather than subjecting ourselves to ongoing pain. Change is possible if you desire it. The level of suffering you endure may be optional. Discover your motivator(s) to inspire this growth. Cast a wide net to gather new ideas. Be prepared to feel uncomfortable at first. Find the right tools and teammates to reclaim the life you wish to live and allow yourself to love again. 

If the right people do not surround you, work hard to find them. Reward yourself for your successes. Be honest about what is and isn't helping you change. Don’t punish yourself for mistakes; just learn from them. Don’t give up—the key is to recognize when it's okay to pivot to a new path if the current road is unsuitable for your well-being. 

Don’t let your pain be in vain; channel it into building the best version of yourself. Sometimes, we get to pick the type of pain our journeys contain, so be selective. Sobriety can be uncomfortable, but continued use might hurt more. Keep trying. Keep remodeling. You can redefine yourself at any time. Practice patience. Pause to breathe. 

Don’t forget to have fun! This will support your nervous system's healing and reward you later. Consider consulting a professional for medications and therapy, as we never know when these treatment tools might be helpful. You are not alone; give yourself extra love, and don't hesitate to ask for help! The opposite of addiction is a connection to others, but now I also see it as falling in love with the best version of yourself.

Your Call to Action

According to Ashley Coughlin, MD:

• Mistakes are essential for learning. It may require significant unlearning if you weren't allowed to make mistakes in your younger years. Urine toxicology and labs serve as accountability tools to monitor sobriety progress. The most effective instrument in treatment is self-reliance. If you have relapsed or returned to use, please inform your treatment team. Develop a contingency plan and then take action!

  
  

• Accountability is important. Many treatment tools can assist. Learning to feel and trust yourself without allowing those feelings to disrupt your life or resorting to behaviors that suppress them, even when you hurt so deeply you feel like you might explode, is genuinely embracing recovery.

  
  

• Don’t navigate the path alone. Find a friend to help set your "beach balls" (feelings) free. Being new to feelings in sobriety can be especially painful. Loneliness exacerbates unhealthy coping mechanisms and stifles personal growth. Isolation prevents movement forward. It’s progress, not perfection, that matters. Keep practicing how to be present for yourself and others. Know when to decompress. Negative feelings will pass. Enjoy the positive ones you discover.

  
  

• You can externalize your feelings by participating in physical activities like running, pursuing a hobby you love, or building a meaningful friendship. However, exercise caution with romance until you prioritize self-love first.

  
  

• Seek employment to divert yourself from your cravings and build strategic relationships. Patients often tell me, "Vocational rehabilitation offers benefits. It works!”

  
  

• Seek your community. If the AA or NA meeting you just attended wasn't a good fit, look for another one. Avoid making excuses. Consider exploring SMART Recovery, The Phoenix, Women for Sobriety, Refuge Recovery, and many other supportive organizations.

  
  

• Establishing healthy boundaries with peers and loved ones and receiving therapy from a qualified expert has helped me navigate my honesty. I learned to say “no” firmly yet politely for self-preservation. Additionally, I utilized my treatment tools, sought out healthy mentors, and discovered when and how to trust my instincts. 

  
  

• Learn about ACEs. If we reduce the stigma surrounding seeking help and shift responsibility towards community-based healing instead of blaming individuals, we can prevent intergenerational trauma before it occurs. This offers every inner child the best opportunity to heal.