If you or someone you love struggles with substances, how you understand the problem matters a lot! If you approach it from the perspective that substance problems are the result of a weak will, a shaky moral compass or an innate set of character flaws, you are going to face unnecessary obstacles like shame and a desire to isolate away from it all. Thankfully, over 50 years of scientific research and clinical experience have given us a new way to understand substance use problems.
Here’s what’s important to understand.
First, behaviors make sense, including using substances. What do we mean? We humans ALL engage in a variety of behaviors (like exercising, sleeping, drinking alcohol, taking pain pills, eating cookies) because we get something out of it. The behaviors we choose to engage in might help us feel good or reduce depression and anxiety. They might helps us feel accepted by our friends or be more focused or even stop nightmares and reduce pain. The choice to use substances is like any other behavioral choice we make, if we choose to keep doing it, it must be working in some way.
The second thing to understand is that one size doesn’t fit all. Instead of assuming “all addicts are the same” or that you are just “doing what addicts do”, work to understand why and how the behavior pattern came to be and then think through the why and how of the change process. Do you think the soldier with PTSD who drinks to cope with his nightmares is going to respond to the same treatment and supports as the insecure teen who is smoking pot to fit in with his peer group? Does the grieving 60 year old who lost her husband last year and is overtaking her xanax need the same helps as the firefighter who is taking more and more opiates to deal with his chronic pain from falling through a floor? The truth is, we are all different and we develop problems for different reasons and we change behavior patterns in different ways. Some people need to go to AA meetings every day, others need to see a therapist and work on their marriage. Some need to do both. It is important to think through what you may need, or the person you love and want to help may need, as you approach the change process.
Finally, change takes time and practice. Why? Because when we try to give up a behavior pattern that “works” in some way there is understandably “ambivalence.” Ambivalence is normal, and to be expected as part of change. When someone returns to an old pattern, like using, it does not necessarily mean they are “in denial.” The person may really know how bad using is for them, yet the pull to return to old, familiar patterns is strong because the new things (like exercise, meditation, meetings, connection) that they are trying to learn to replace the old behavior are not comfortable yet.
And, the new behaviors may not work as well as the original behavior. Meditation may be the perfect long-term antidote to a drinking problem that developed in response to anxiety, but it’s not going to work right away! Learning to meditate is actually pretty difficult and takes lots of practice and repetition. Picking up a drink is easy and works very quickly! So it’s hard to give up! If you or someone you love is trying to quit or reduce using substances, try to have compassion for the learning process. Learning not to use and learning to do something different to cope with the underlying reason for using takes time, repetition, and commitment.
All of these understandings are compassionate ways to approach the change process.
