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Substance Abuse
The topic of substance use, abuse and addiction is complex, and the media and society are full of many messages about this issue. Most people use and misuse substances because there is some physical, emotional or social benefit to doing so, at least at first. Individuals can become addicted to substances, and it can become hard to stop even when those benefits diminish or become overshadowed by the drawbacks of using. People typically seek help after they begin to experience difficulties resulting from their substance use. For example, someone experiencing substance dependence might seek a psychologist when their use: has become unsustainable or difficult to control; is placing them or others at heightened risk of harm or danger; and/or has started to cause significant problems in important life areas (legal problems, family functioning, mood changes, or work performance, etc).
The good news is that more than 30 years of research shows that substance addiction is clearly treatable! Working with a psychologist alongside other health professionals can be an effective aspect of treatment. A therapist is trained to work with (rather than ‘on’) an individual’s substance use; though therapy can sometimes feel like hard work, it should still be a supportive and collaborative experience. This means psychologists work at the individual’s pace, acknowledging the realities of drug use and challenges of overcoming addiction. Therapy for substance addiction is very broad and can differ according to many factors (such as substance type, frequency of use, the presence of other mental health concerns, available supports, and risk factors). Despite such differences, just about all treatments fundamentally aim to address the factors that maintain problematic drug use.
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One person's experience
Rachel, a 27 year-old woman, first began seeing her therapist for depression. It did not take long in therapy for Rachel to share with her therapist that for the past that for the past four or five years, she had fallen into a pattern of increasingly regular use of alcohol, pain medication, marijuana, and caffeine. “I guess it was really gradual, looking back. In my high school years, I tried pot and drank a little bit with friends in my last year, but not really anything like this now. I remember after school finished, I used pot a lot more, mainly just to block things out. After a year or two I got pretty serious about my job and tried to cut back on the pot through the week, and mainly just used it on weekends when with my mates. That didn’t really bother me – my family didn’t know, and my closest friends did it too. About five years ago though I was in a car accident and was prescribed pain killers. I lost my job because of how long the rehabilitation was taking (not that they’d ever tell me that’s why I lost my job), and I managed to stay on the strong stuff for my back and knee for a while and just sleep. I started doing pot on weekdays again like I used to just after school, and there was always something happening on weekends with booze there. The doctor took me off my pain meds, and after a few close calls going to different G.Ps for scripts, I just started taking the stronger over-the-counter stuff.
Looking back, I think the more I struggled to find work again, the more I tried to knock myself out with meds, pot and booze. And the more I did that, the harder it was to keep my friends as their friends, careers and relationships took them in different directions. I guess it was just easier to take something and sleep rather than deal with that whole hopeless cycle. About a year and a half ago, I got a job that I really wanted to keep – it was part-time, which meant I could do it without aggravating my injuries. I was waking up groggy from the meds, and from staying up late drinking and getting stoned, so I started drinking coffee. Eight, nine cups a day got me through work (with the occasional funny looks), but then I was too wired to sleep so I started taking more meds and drinking more.”
Rachel went on to describe the helplessness she felt in overcoming this cycle, and how isolating and stagnant she felt her life had become largely as a result of constructing her day around her substance use. She described her family’s growing concern for her declining health, and disappointment as she contrasted her own life with the lives of her former friends. Through therapy, she was able to look at which vulnerabilities and factors in her life had helped her become dependent on several substances, and her reasons keeping on using now. Over a number of sessions, she also learned how to begin breaking the cycle of substance use: armed with a fresh perspective on her substance use, she trialled new ways of improving her sleeping patterns and alertness at work, which in turn decreased her use of pain medication at night and coffee during the day. She also introduced other strategies to slowly decrease her marijuana and alcohol intake. When she felt solid and confident in continuing to self-monitor her decreasing drug use and independently adapt her newly-acquired skills, Rachel and her therapist decreased sessions to monthly, and then quarterly, before celebrating their combined efforts and finally parting ways.
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