Softening the disease model responsibly

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 work
• How 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 language
• Why 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 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 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 labels
• Why 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 behaviors
• The 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 superpower
• Carrie'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 boundaries, seek support, and keep moving through discomfort.
• Reimagining 'expert' 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 one's 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 HBO's Risky Drinking to speak on substance use and behavior change.

Resources Mentioned

• CMC: Foundation for Change – Family-focused trainings, groups, and resources: cmcffc.org
• The Invitation to Change Approach – Overview of the ITC model and its core topics.
• Beyond Addiction: How Science and Kindness Help People Change (Book)
• The Beyond Addiction Workbook for Family and Friends (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.