Changing Substance Use: Drug, Set, and Setting

changing substance useWhile most of the folks I talk to want to start changing substance use for themselves or someone else, they’re not sure where to begin. Whether it’s abstinence that you’re after, reducing your use, preparing to quit, or wanting to use more safely, you know that wanting to change is only the first step. Learning how to change your substance use is key.

 

Managing your substance use can help you moderate your use successfully. And implementing the model I’m going to talk about in this post can help you learn to quit. As you’ll see, if you’re struggling with sexual behaviors that are out of control, this model can also help you be aware of what makes you vulnerable to acting out and to observe yourself.

 

And learning to observe yourself is the key to successful change. Most of the harm that results from substance use comes from how, when, where, and how much you use. You need to become interested in your habit, its impact on your life, and why you’re using. So try to be honest with yourself and be willing to try new things.

 

In this first post, I’ll talk about the model of drug, set, and setting. Then I’ll talk in my next post about how to use it to change your drug use. But first, a few words of caution: This way of looking at your substance use can help you change, but it’s not a guarantee. I’m also not a doctor, so please don’t take this as medical advice. Also, many drugs are illegal. I can’t protect you from legal consequences of using, so please don’t take this as legal advice either.

Here’s What I Wish I’d Said on My Recent Podcast Episode

alcohol treatment familiesIn early May, I was in Phoenix for the annual symposium for therapists who treat individuals struggling with problematic sexual behaviors and their partners. I was presenting on harm reduction at the conference on a panel discussing alternative paths of recovery that may not include 12-step recovery groups. I was thrilled to bring harm reduction to the field of sexual addiction and recovery.

 

While I was there, I spoke further with Jackie Pack, the facilitator of our panel. She invited me onto her podcast Thanks for Sharing to talk more about harm reduction. A couple of weeks ago, Jackie graciously hosted me and we talked about harm reduction, its benefits and rationale, and how it can help those struggling with addictive behavior and those who love them.

 

We covered a lot of ground, but there are some things we didn’t get to or that I wish I’d said more clearly. Here’s the rundown.

How We Grow: The Stages of Change

stages of changeThis month was the 25th anniversary of the death of Nirvana frontman Kurt Cobain. I loved Nirvana as a teenager (sorry Mom) and still enjoy “Heart-Shaped Box” whenever I hear it over the airwaves. I remember his tragic end after a long bout with heroin use. It had been quite a while since I’d thought about his story.

 

Now, after all these years and working so closely with addictive behaviors and substance use, I felt sad as I read stories like this one about how loved ones tried to help him. They did their best, as we all do, in a difficult situation, and they were listening to the professionals guiding them.

 

Still, they can’t help but wonder today: What might they have done differently? How could they have reached him? How could they have helped? Could his story have ended in another way?

 

Of course, everyone affected by addiction—including those struggling with addictive behaviors and substance use themselves—asks similar questions not in retrospect but every day they live with their using or acting out.

 

Those struggling with substance use or problematic, compulsive sexual behaviors want to understand how they could possibly return to their addictive behavior of choice, sometimes even after a long period of abstinence. “Why do I keep doing this?” they ask. “And how can I change?”

 

Family and friends want to understand helpful ways to support their loved ones. They’re often desperate to help the loved one find healing and become hurt, angry, frustrated, and exhausted trying to understand his or her behavior.

 

A sound understanding of how people change can provide the foundation for answering both of these questions. If we understand the stages of change, we can give ourselves a bit of grace as we struggle with our addictive behavior. And family members can learn how to better support their loved ones and promote their healing.

Healing Shame with Self-Compassion and Connection (Part 2 of 2)

healing shame with self-compassionRecently, I’ve been wrestling with a business decision. I was unclear about what to do and decided to ask some trusted colleagues about their thoughts. So yesterday, I hopped on a phone call and talked for a few minutes about my quandary. I wasn’t ready for what happened next.

 

Because of the nature of the decision and my history with similar decisions, I felt very vulnerable. And to my colleagues, it seemed clear that my fears and “not enough-ness” was showing up in my waffling.

 

And suddenly, there is was. A big, fat helping of shame with a side of inadequacy.

 

It was like a sucker punch. I admire my colleagues and looked up to them, and suddenly I felt so small. I felt so foolish. So silly. So exposed.

Understanding Addiction, Part 1: The Disease Model

understanding addiction“Why? Why do I keep doing this?” I get this question a lot, especially from new clients who are struggling to comprehend why they keep engaging in an addictive behavior they don’t want to keep doing. They struggle in understanding addiction.

 

I get it. I’ve been there. I wondered the same for a long time. I couldn’t understand why I continued to drink when I felt as ashamed about it as I did. Eventually, I came to understand why I started to drink and why I continued to need to drink.

 

Eventually, I came to understand that I drank to alleviate my own shame and anxieties. Understanding what alcohol was doing for me helped me learn to be more authentic and manage my feelings differently. When I didn’t need alcohol anymore, I spontaneously stopped when I got tired of how much it was taking from me.

 

Maybe you’re trying to understand your drinking, gambling, sexual behaviors, or other addictive behaviors. Really, you’re asking about what you don’t understand about yourself. That’s where looking at a few models of understanding addiction can help.

Treating Sex Addiction with Harm Reduction Psychotherapy

treating sex addictionThis week, I received the exciting news that I’ll be participating in a panel discussion about sex addiction, approaches to treatment, and how best to help clients needing support with these issues. I’ll be talking about treating sex addiction with harm reduction psychotherapy.

 

The conversation will take place at the conference for the International Institute for Trauma and Addiction Professionals in Phoenix in May. It’s going to be a great chance for mental health professionals on the front lines of out-of-control sexual behavior treatment to compare treatment options and philosophies.

 

Normally I don’t post too much about developments in the field of addiction, though I did give an update about sex addiction receiving a diagnosis last summer.

 

But this panel is so important and exciting because it’s evidence of a growing number of voices in the addiction field who think a bit differently about how to help those struggling with addictive behaviors, including sexual behaviors.

 

I thought I’d briefly compare the traditional approach and the harm reduction approach as I consider my remarks for the panel. I’m very much thinking out loud here as I continue to evolve and grow, so I invite you to be a part of the dialogue in the comments below.

Healing Shame (Part 1 of 2)

healing shameShame. Shame is pervasive these days, as are our attempts to banish shame from our existence. We try desperately to rid ourselves of shame and will sometimes to anything for a moment’s respite from that awful, heavy feeling.

 

Just for a moment, consider what comes up for you when you read this word.

 

Maybe you’re concerned about someone you love. Maybe you’re curious about your own shame and what to do about it. Maybe you’re even now trying to put out of your mind what you tell yourself when you feel shame so you can read this post.

 

If so, you’re not alone. Shame sucks. I would know; it’s a part of my story too. And I often get asked about how shame can be healed. It’s a good question, and one I’ve never quite felt I can answer fully in sessions.

 

While healing is never easy, finding your way out of shame is possible. Before we dive into that topic, though, we need to understand what shame is and how it affects us.

What to Do When Therapy Gets Hard

when therapy gets hardSo you’ve started therapy, and it’s actually going pretty well. Maybe you’ve been going for just a couple of months or a few years. You’re working well with your therapist feel you’re making good progress. The counseling seems to be helping. Things are humming along.

 

Then, whether gradually over time or all of the sudden, there’s a shift. Life gets really hard. Almost unbearable. And so does therapy.

 

Wait a minute. Weren’t things supposed to get better? Why now is the terde hitting the ventilateur?

 

It’s important to understand that I’m speaking in generalities here, and painting with broad strokes.

 

But often there’s a really good reason why therapy gets hard. It means you’re doing the work. Here’s what I mean.

Addiction and the Impact of Trauma

addiction impact of traumaIf you’ve read other blog posts I’ve written, you’ve probably learned by now that I think that people use substance and sexual behaviors in problematic ways because use these addictive behaviors often solve emotional problems. They help people feel better, or, as is often the case, to feel less.

 

For instance, problematic addictive behaviors can give people a break from their relentless, shame-driven inner critic. They can help chronically depressed people feel more expansive and alive. They can help people detach from feelings that are too painful to experience. The list goes on and on.

 

People use substances and sexual behaviors such as pornography and masturbation to address whatever personal vulnerabilities they have when nothing else seems to work. Often, they’ve learned through early direct exposure or modeling that porn, substances, or another addictive behavior can help.

 

But what causes these personal vulnerabilities in the first place (and we’ve all got issues, OK?)? Trauma.