This mixed methods study explores the effect of shame on opioid dependence and considers whether shame and opioid dependence should be treated as comorbid. The participants in this study are females ages 18-45 identified as either with opioid dependence (OD) and without opioid dependence (non-OD). Each study participant completed the quantitative phase of the study in which they responded to the Internalized Shame Scale (ISS) and the Compass of Shame (CoSS) to determine the level of shame present and defense style used against shame. Five participants from each group were randomly selected to participate in a qualitative interview to provide a clearer understanding of shame and its influence on the participants. Data from the ISS were analyzed using a Spearman’s rho correlation. A strong correlation was found between opioid use and dependency status ( r=.710, p<.01). A strong correlation was found between the shame style and dependency status. The CoSS was analyzed using chi-square and the percentage of women experiencing shame varied based on the shame experience and the dependency status of the women was X²(3, N=100) = 16.83, p<.01. According to this analysis more women in the OD group utilized the attack self defense style, while women in the non-OD group reported using the avoidance defense style. The qualitative and quantitative phases of the study provided complimentary findings for descriptions of shame experiences, and how shame style and level of shame related to key constructs such as dependence status. Shame experiences reported by the women in the OD group appeared more intense and debilitating than for the non-OD group, in which reported shame experiences were uncomfortable, but controllable. These same patterns were seen not only on the level of the self, but in the reports provided by the participants on their parenting interactions. The results of this study accent the influence of shame on opioid dependence, and the development of self in women and how this may relate to parenting. Thus, it is important to emphasize the issue of shame and consider its influence on the self when treating women with opioid dependence, especially those who are mothers.