WHAT IS SUBSTANCE ABUSE & ADDICTION?
Substance abuse is a pervasive problem within our society with significant costs including people's lives. Because of this, most people have some experience with or exposure to substance abuse, but sometimes it can be difficult to differentiate between use and abuse. Substance abuse is distinguished from substance use by a problematic pattern, which leads to impairment in functioning and distress accompanied by experiences such as developing a tolerance, unsuccessfully cutting back, spending a great deal of time either obtaining substances or recovering from substances, cravings, recurrent use despite persistent problems in social, occupational, or recreational activities, and ongoing use despite health problems.
TREATING SUBSTANCE ABUSE & ADDICTION
Substance abuse can be very difficult to treat and requires a good deal of motivation and commitment on behalf of the client. Oftentimes, when people have substance abuse issues, there is some ambivalence about quitting: part of them wants to quit and part of them doesn't. For this reason, treatment often begins with what is called motivational interviewing, a therapeutic approach that can help people explore the impacts of certain kinds of behaviors, such as substance use, on their life. It also helps them explore their reasons for wanting to change and their reasons for not wanting to change. For example, a client might want to stop drinking because of the way it is impacting their marriage, but not want to quit drinking because alcohol helps them to manage their tension, stress, or anxiety. In this example, you might normalize the client's desire to experience relief from their stress while exploring the ways in which alcohol is likely increasing their stress over the long-term. It is very typical for addictive behaviors of any kind to provide short-term relief, while simultaneously causing long-term damage. This is what I like to call the cycle of addiction:
When a client is reasonably motivated and committed to either reducing their use or abstaining, more behavioral interventions come into play. For example, identifying what are commonly referred to as triggers, or things that often preceded substance use, and finding ways not to act on them. Triggers can be internal and external. Internal triggers include emotions such as anger or shame. External triggers include people, places, and things. While there are some triggers that you can avoid, which is a smart idea if possible, especially early in recovery (i.e., not going to a bar or party where people will be drinking), some, such as internal triggers, are unavoidable. This is where I like to use mindfulness and acceptance-based interventions to help people learn how to make room for their emotions, including inevitable urges and cravings, without reacting to them. I have also found compassion to be an incredibly important intervention for those struggling with addiction due to the shame people often carry as a result of their addictive behaviors.
One of my favorite workbooks for substance abuse is the Addiction Recovery Skills Workbook, which uses motivational interviewing and cognitive-behavioral therapy (CBT) in addition to mindfulness-based interventions. However, individual therapy is often not enough to address substance abuse. For this reason, I strongly encourage clients to consider attending Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery, which is based on CBT. I also encourage clients to look into Mindfulness-Based Relapse-Prevention (MBRP), which was developed by Sarah Bowen, Neha Chawla, and G. Alan Marlatt, to see if it is available in their area. Other resources include the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. You can also learn more about managing stress by purchasing my book.
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Please note that this information is intended for informational purposes only. It should not be used as a substitute for psychological or medical care. If you are looking for professional help, visit my resources page for guidance on how to find a therapist. If you are experiencing a mental health emergency, call 911 or go to the nearest ER.