Empathy and Accountability
A person holds another person's hands in a show of support.

When we think about people who have a substance use disorder, there are two dominant perspectives that drive our worldview and shape our thinking. One is focused on empathy– rooted in the ability to understand and share the feelings of another person. We recognize and appreciate the person’s emotional state and perspective, and imagine what they might be experiencing. Based on that understanding, we then try to respond with sensitivity and care. Empathy allows us to connect with others on a deeper emotional level, fostering compassion and improving communication and relationships, and this shapes our response.

The second approach is largely rooted in accountability. We focus on accepting responsibility for one’s actions and decisions, and their consequences. When we think about people using drugs, our response is less rooted in understanding, and more rooted in a desire to see that person face up to the problem. Accountability involves being answerable to ourselves and to others for performance and outcomes, acknowledging mistakes, learning from them, and making amends where necessary.

While these two approaches are particularly easy to see when it comes to our approach to people who use drugs, the worldviews from which these perspectives spring apply broadly. Often, it feels like these world views are in conflict. The problem is either we need to care more (because the world is not caring enough), or the problem is people need to take more responsibility, because they are behaving in ways that are irresponsible. Push a little bit harder on this construct, and the empathy-based view says “it’s not your fault” and the accountability based view says “it’s all your fault.”

These different perspectives play out in public policy, in parenting, in relationships, and in our workplaces. These perspectives may feel incompatible, but they are both are important, and we suffer when we let one or the other dominate our perspective.

When we emphasize accountability without empathy, the balance needed for effective and compassionate interactions is disrupted. Rigid and punitive environments can emerge, where people are held to strict standards without consideration for their personal circumstances or challenges. Without empathy, demands for accountability from others can make us feel unseen; the rigidity of these demands can create an atmosphere of fear rather than one of encouragement and growth. In such settings, morale and motivation can plummet as we feel our struggles are neither understood nor valued; disengagement and apathy follow. Without empathy, demands for accountability from ourselves can make us feel inadequate and a failure.

Empathy turned inward is needed because we are human, and we sometimes fall short. Empathy turned outward is needed for trust, which is the basis of strong relationships and cohesive communities.

Trust erodes when we perceive the world as uncaring or unjust, and this lack of trust weakens relationships, institutions, systems, and relationships. Conflict and resentment rise. Without empathy, misunderstandings and hostility thrive, stifling open communication and cooperation. Accountability without empathy also inhibits personal growth, as outcomes, rather than the learning process, is all that matters.

However, empathy without accountability also creates problems. When we do not take responsibility for our actions, we arrive at a place where mistakes and failures are excused without efforts to correct or learn from them. Ironically, this lack of responsibility also stunts growth. Goals go unmet and performance suffers when we have no real accountability for what we do or how we perform. Without internal accountability, we feel apathetic, and we stagnate. In our relationships, empathy without accountability creates imbalanced dynamics where one person accommodates the other’s needs, or problematic behaviors remain unaddressed and proliferate. This imbalance strains relationships and lead to resentment. External accountability drives high standards and excellence— without it, these erode as poor performance or behavior is excused (because of understanding), leading to a decline in quality and integrity.

Empathy without accountability often results in short-term solutions that address immediate emotional needs but fail to tackle underlying issues. Without clear expectations for change, problems are likely to recur. Additionally, inconsistent consequences (because of empathetic understanding) can create confusion and undermine the credibility of leadership or authority figures, as people remain unsure of what is expected of them.

When it comes to recovery from substance abuse, both empathy and accountability are critical. As is true more broadly, empathy and accountability must travel together, and when either dominates, we suffer. When done with care and understanding, accountability (either of ourselves or another) is an empathetic act, creating an opportunity for growth, and because happiness cannot exist without accountability, the empathetic response often requires accountability.

Are these in balance for you? If not, which do you need to grow?


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