Humans have used substances for over 12,000 years in ways that are meaningful to them. Between 70-80% of people who use drugs do so without issue. When people find themselves engaging in unintended use or overuse, particularly if use results in harm, their brains may have developed what’s termed “brain automaticity,” i.e. action without thought. Brain structures and functions involved with bonding, attaching, relating and loving are also involved. When this occurs, the terms “substance use disorder” and “addiction” are applied.
In the U.S., an estimated 1 in 10 who use drugs develops a substance use disorder, usually preceded by trauma and/or mental illness. Although chronic cases exist, most people with substance use concerns recover on their own without treatment. If substance use concerns do not resolve on their own, research suggests a three-pronged approach: 1) medical care, 2) skills-focused, cognitive theory-based counseling, and 3) connection and support.
However, if people are required to, or choose to, reduce substance use or abstain from substance use, what does research suggest is helpful on a practical level?
When people lose something or someone important to them, they have to both endure the loss and find adequate replacements. They have to accept that a one-to-one correspondence will likely never exist between what’s lost and what approximately fills the space. People who have lost loving mothers, fathers, grandparents, first loves, and dear pets know this. They are loved and will be loved again. However, it will never again be in that way.
So it is with mandated or chosen reduction in use or absence of use of substances. Substances take the human brain where it normally can’t go on its own. That’s why humans have used substances for 12,000 years. Their absence can be a one-of-a-kind loss.
As Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, puts it here, “If addiction resides in the parts of the brain involved in love, then recovery is more like getting over a breakup than it is like facing a lifelong illness. Healing a broken heart is difficult and often involves relapses into obsessive behavior, but it’s not brain damage.”
After substance use, our own brains and our own lives are, essentially, cornered into a no-win scenario. Life is expected to make a better offer than substance use. Life can’t? Well, why stop then?
How does one create a life to which substance use would add insignificant value? How might one evolve from ambivalence to indifference about substance use?
At essence, to taper from, reduce, or eliminate use, a person would need to regain autonomy over automaticity. After first seeking medical care, a person would painstakingly discover and identify specifically what substances do for them and use their own hearts, minds, and actions to provide, as best they can, what substances did.
A very tall order.
Below are questions a group of people experienced with using research-backed methods to address substance use concerns concluded might be helpful. Beneath each question is related, simply-stated guidance.
Begin, however, with self-kindness. Although current social norms may judge substance use, human history does not. Embrace yourself and begin to help yourself with this challenge.
What do substances do for you?
People use substances for reasons that are complex and dynamic. Discover these reasons and find legal alternatives that provide similar, adequate effects.
When the longing for a substance arises, what feelings do you wish were different?
Identify the feelings and attempt to help yourself reduce the volume on their intensity. Rather than attempt to unsuccessfully suppress the unsupressible, counteract automaticity. Consciously use your attention as a muscle and shift your attention to your interests, preferences, and priorities.
What are the problems that arise which create a longing for substances?
Identify those problems and seek solutions, including identifying health conditions and seeking medical care and medications for them.
What are the rituals associated with using?
Find alternatives that provide similar, adequate effects.
With whom are you mostly likely to use substances?
Negotiate with those individuals a no-use policy when you’re together. At the same time, find others to be with who do not use.
What beliefs do you hold about using? Examples: “I can’t take what’s happening without using!” or “It might help if I have more” or “If I don’t use, I won’t belong.”
Consider this fill-in-the-blank: “If I use substances, I have/receive __________. If I don’t have/receive this, that means __________.”
Are the answers facts or beliefs?
Challenge beliefs with facts and questions. Examples: “I have made it through challenges before.” “It might help if I have more but it also might hurt.” “Does the group I want to belong to hold my values and priorities?” “Might I want to look at the ways I am thinking about things?”
What do you not know about substance use, the substance(s) you use, and evidence-based treatment for substance use disorders?
Find out. Educate yourself. Find or get recommendations for research-backed, self-guided therapy workbooks and complete them.
- NIDA: Drugs, Brains, and Behavior: The Science of Addiction
- Outline of an Initial, Evidence-Informed Treatment Plan for Substance Use Disorder
- Guide for Clinicians to Initial Treatment for Alcohol Use Disorder
What have you found that substances do and do not give you? Did you get what you thought you would? Does the inner narrative of anticipated results match real results?
Consider this fill-in-the-blank: “On the one hand, substances and/or substance use do give me __________. On the other hand, I had hoped substance use would give me __________ but it has let me down.”
Another possibility: “I just did it to __________. I didn’t mean to end up here.”
Practice self-kindness, self-empathy, and self-compassion. Embrace yourself, your disappointment, and your sorrow. Acknowledge that you did – and continue to – wish the best for yourself.
What outside support do you need?
Practice self-kindness and self-care. Reach out for medical care, agency support, and professional care. Seek the support from safe, non-judgmental people that you need.
. . . . .
To gain insight into answers to these questions, completing these exercises may be helpful.
- Self-Care Checklist
- Awareness Skills Self-Assessment
- Checklists to Assess Needs, Wants, Strengths and Preferences
- Values and Priorities Exercises
- Other posts in the Guide category.
Other guides on this site may be helpful:
- If You Have Begun to Drink and Use More Than You Wish
- Insider’s Guide to Early Abstinence
- Help That Helps: A Kind, Research-Informed, Field-Tested Guide for People with Substance Use Concerns, co-authored with Sanjay Kishore, M.D.
- I Am a Person with the Health Condition of Addiction
- A Typical Day in the Life of a Person Practicing Evidence-Based Treatment for Addiction
- How to Help a Loved One with Addiction: An Evidence-Informed Approach
- How to Help People With Addiction Who Are Mandated to Abstinence
- Guide for Parents and Partners of People with Substance Use Concerns
Research-Backed Ways to Reduce or Eliminate Substance Use is a free, online course I have posted on Udemy for people with substance use concerns. Here’s an introduction to the course and here’s the direct link.
With any questions at all, please do contact me.
Image: IStock
Last updated 4/17/21
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
