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Understanding Substance Use

I have worked extensively with folks who have had chronic and severe mental health concerns, as well as heavy daily use of substances such as heroin, alcohol, crack, and crystal meth - to name a few - who are also marginalized in terms of housing and employment access. I have worked with folks from a variety of socioeconomic backgrounds and professions who have the benefit of stable jobs, housing, and social circles. What I have learned from witnessing folks seeking assitance in therapy for substance use is that 'traditional' approaches to addiction recovery and substance misuse counselling are highly problematic and yield very poor results.

People use any number of substances including sugar, caffeine, alcohol, tobacco, pot, heroin, cocaine/crack, crystal meth, and 'E' in everyday life for a variety of reasons. It is important to move away from seeing some substance use as socially acceptable while viewing other use as destructive and immoral.

A brief overview of history on the criminalization of substances reveals that marijuana was legal in Canada and the U.S. until the turn of the 20th century. At this time, despite several Royal Commissions to evaluate the harms of pot use and finding no drastic physical, psychological, or social health risks, the government was successfully lobbied to criminalize marijuana based largely on economic factors and racist fears (ex. see Chinese Exclusion Act).

Heroin was historically prescribed by doctors for pain management until the 1920s in the U.S. and Canada, and 1960s in the U.K. Cocaine was an ingredient in Coca Cola. Cigarettes were recommended by doctors. Prescription medication such as Valium (diazepam), Ativan (lorazepam), and Clonazepam are often abused and result in compounded anxiety, yet still, are widely and overly prescribed by physicians for mental health concerns. Painkillers such as oxycontin and percocet are also widely prescribed for issues often centered around anxiety, trauma and depression but for which physicians feel ill equipped to deal with, thus creating wide swaths of 'law abiding' citizens who are dependent upon painkillers for daily functioning.

Substance use as a form of mood alteration is but one avenue individuals use to manipulate themseves in relation to their surroundings and should be regarded as an individual discretionary choice with potential health impacts. Depending on how early one started using, their family situation and background, and how frequently and heavily they use - some folks who use substances may receive many benefits psychologically, physically and socially, while others notice more harmful impacts.

In providing support for folks who would like to reduce their use, I believe our medical and mental health systems are woefully inadequate for dealing with the holistic picture of one's health and recovery needs. Our systems are too focussed on shaming and incarcerating people, instead of providing a range of supports that increase housing stability, employment, educational access, and, in particular, providing social and relational support.

When substance use becomes harmful creating dependence, frequently, underlying themes of unadressed experiences of trauma, neglect/abuse and isolation are present.

In considering whether your substance use may be harmful to you, it is important to look at the bigger picture of your life, overall health, happiness and functioning. A therapeutic space may be helpful for you to explore your relationship to substances when there are the following considerations:

  • What coping strategies have you learned along the way that may no longer be serving you?

  • What is your relationship to your self, what messages did you absorb from early caregivers about your value, worth and capacities?

  • How did you learn to connect to and validate your emotions?

  • What automatic or learned thought processes are present?

  • How do you feel comfortable to relate to and connect with friends, lovers and family?

  • What is your level of emotional awareness, are you able to identify your feelings?

  • How is your communication? Are you able to express your thoughts and feelings in order to meet your needs and negotiate with others regarding their feelings and needs?

  • Do you have things that you do for yourself that cultivate a relationship to particular moods and feelings, a sense of joy, care and nurturing?

  • Are there ways in which using a substance is useful to you? Are there times, contexts, spaces, or moods that correspond to a desire to use?

  • Are there times when your use does not come with a harmful consequence?

A therapist who is flexible, non-judgmental, and who links to broader issues of health, wellness, and functioning can begin to help you explore more deeply whether your use is of concern to you. A greater awareness of your coping strategies and functioning can facilitate moving towards new strategies that may reduce risky behaviours, lessen harmful consequences, and improve your relationship with yourself and others.

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