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.



Changing substance use means focusing on yourself and thinking about your moods, triggers, how you take care of yourself, and why you use. You might think of this as the set of your substance use: All those things that have to do with you, your identity, feelings, goals, health, and so on.


Set includes but isn’t limited to the following:

  • Identity, important affiliations, and perhaps occupation
  • Personality traits
  • Motivation for using and expectations about what’s going to happen when you do
  • Health: physical, mental, emotional, and medications


All of this will impact the experience that you have of using drugs (or watching pornography, for instance, with regard to sexual behaviors). So as Little and Denning point out, “Taking control of yourself is the first step toward controlling your drug use” (2017, p. 142).


As we’ll see in the next post, this is why understanding and managing your triggers is so important to changing substance use. It’s not an easy skill to learn, managing difficult feelings, especially when so many who use drugs problematically do so to self-medicate (I know I did).



Setting is where you use and with whom. Setting also includes current stressors and supports that are present in your life. Here’s the rundown:

  • Environment of use
  • Social contexts (family, other communities: are they accepting, supportive, critical, dangerous, etc.?)
  • People
  • Life stressors
  • Supports


Many people that I talk to drink or act out problematically in only one or two settings. That is, they may have a few drinks in a bar and be able to stop, but they have much more difficulty controlling their drinking at home. Another example: Watching porn usually isn’t an issue for those who struggle with it until they’re alone at home, perhaps coming from a stressful day at work.


As I mentioned, certain people can also be triggers. I can’t count the times I’ve heard people tell me that they’re triggered when they have a fight or difficult interaction with their spouse. Our partners are able to reopen our deepest wounds in ways few others can, wounds that then lead to painful feelings (set) and can trigger the desire to use.



When it comes to changing substance use and managing using the drug-set-setting model, “drug” may be the easiest to understand. But it also can be very complex. Here’s the skinny:

  • Drug used (alcohol, opioids, etc.)
  • Route of administration (oral, injection, etc.)
  • How much, how often, when
  • Legal status of the drug used
  • Drugs combining, if any (including prescription drugs)


Looking at that list, it’s pretty easy to see how some of the most dangerous risks of substance use are in this category. Common risks include accidents or overdose, disease transmission, stroke, infections, heart attacks, or other complications or even death. (Note that while some of these are related to physical health, they belong in the “drug” category as they’re the direct result of how much, how often, and when the drug is used.)


Harm from substance use can be significantly reduced even by small changes such as changing the route of administration (e.g., from shooting a drug to taking it orally). Alcohol users have all kinds of options in moderating their use; you might try eating before and while you drink, counting your drinks, having a glass of water between drinks, etc.).


We’ll get into how more about what all of this means for using more safely and managing your substance use in the next post. For now, remember that you’re at the greatest risk for overdose if you:

  • Mix drugs
  • Don’t pay attention to the drugs you’re using, the speed of their onset, when their effects peak, how the effects will change when mixed with other drugs, and the length of action
  • Use alone
  • Shoot drugs but don’t use your own shot or test your shot, especially with a new supply
  • Forget that alcohol poisoning can be fatal and try to sleep it off
  • Take drugs you don’t know about (Denning and Little, 2017).


Denning, P., and Little, J. Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. 2nd ed. New York: Guilford, 2017.


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Jeremy Mast

Jeremy is a licensed marriage and family therapist (CA LMFT90961) in private practice in Ventura, California. He helps those struggling with drugs, alcohol, and out-of-control sexual behaviors awaken to new possibilities for their lives. He lives with his wife, son, and cat in beautiful southern California.

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