We often have habits in our lives that feel compelling, offer relief for intense emotions or boredom, and are reached for without much thought. Sometimes these behaviors are connected to processes such as scrolling social media, playing games, or gambling. Other times they involve alcohol and drugs. While not everyone who engages with substances identifies with the concept of addiction, I will be using that language as a basis for exploring the support and resources available for substance use challenges.
Recognizing that you’re struggling with compulsive behaviors around substance use can feel vulnerable and confronting. It can be easy to compare yourself to others. The inner critic (and outer judge) often go wild, stirred up by shame, stigma, and cultural mixed messages about substance use and addiction. Talking to friends and family can be challenging. It can feel isolating when others don’t understand or can’t relate to the compulsive nature of addiction, or when they project their own feelings about substance use.
Regardless of the nature and extent of your challenges with substances, wanting to reach out for support is a powerful and protective instinct. I often meet clients who want to work on their relationship with alcohol or drugs. I like to spend time with people to learn what role the substance or behavior plays in their life. Questions to explore might include: What types of stress and pressure are you under? What is your self-care and support system like? How does the substance or behavior benefit you? What do you like or cherish about it? What type of harm are you experiencing from the substance or behavior? How has your relationship to the substance shifted over time and what do you want it to look like in the future?
Traditional talk therapy can be a great place to start processing and exploring substance use and compulsive behaviors. Once there’s a clearer picture of the dynamic and goals, it can sometimes benefit clients to participate in a more structured approach to healing. There are many programs, schools of thought, and opinions about how to engage with addiction recovery. I want to discuss two of the big ones: abstinence-based 12-Step programs and harm reduction.
Harm Reduction
Harm reduction is a recovery method and movement that originated in the United States in the 1960s and 70s. It also has roots in Buddhist and other contemplative practices. Rather than focusing solely on abstinence, which means to stop use of the substance or behavior entirely, harm reduction emphasizes intentional ways to make substance use safer by changing behaviors and focusing on overall quality of life. The Illinois Harm Reduction and Recovery Coalition website states, “Harm reduction recognizes every individual’s dignity and prioritizes bodily autonomy, choice, and safety” (https://www.illinoisharmreduction.org/).
In therapy this might look like getting very mindful and curious about your relationship with the substance or behavior. A harm reduction approach often begins with tracking usage habits before deciding on specific changes. Once patterns of use are observed, choices can be made on how to be intentional with use and practice mindfulness. This can include exploring sensations of satiety, or satisfaction, and practicing moving away from the substance or habit once that state is reached. Strengthening skills for self-observation, self-compassion, and mindful decision-making are important practices for harm reduction, as is connecting with supportive habits and communities. A harm reduction approach can be helpful if you aren’t ready or wanting to be completely sober and if you want to explore substance use from an anti-carceral and intersectional perspective.
Harm reduction acknowledges the contexts that can make total abstinence from substances unrealistic and focuses on decreasing the negative impact of use. People with a history of serious opioid use might require medication-assisted treatment to help minimize harm. Harm reduction initiatives focus on ways to make drug use less dangerous and deadly, including clean syringe exchanges, substance testing kits, and access to naloxone, a life-saving opioid overdose reversal drug. In therapy, we might look at ways to reduce the physical impact of the substance or behavior, such as using filters if you smoke cannabis or choosing alcoholic beverages with a lower ABV.
Local harm reduction resources include:
- Illinois Harm Reduction and Recovery Coalition
- The Chicago Recovery Alliance
- National Harm Reduction Coalition
12-Step Recovery
Alcoholics Anonymous, the first 12-Step program, began in the United States in the 1930s. While it has origins in the disease model of addiction, many modern practitioners view it through a biopsychosocial lens, acknowledging that recovery is influenced by a complex interplay of biological, psychological, and social factors. This perspective emphasizes that total abstinence is often the most effective way to stabilize these various areas of life. There are 12-Step programs for numerous substances and compulsive habits, including narcotics, cannabis, cocaine, and gambling. There are also 12-Step groups that support relationships and emotional healing, including the Al-Anon group for family members of addicts and alcoholics, groups for codependent relationship dynamics, and recovery for adult children of dysfunctional families.
12-Step meetings are peer support groups, meaning they are led by volunteer group members. Meetings help people connect with others who are experiencing the same struggle and work together on a united goal of sobriety or abstinence. The steps are a sequence of statements and practices to explore. 12-Step members connect with a peer sponsor within the group to help guide them through the steps. The steps focus on the experience of addiction and personal relationship with self, higher power, and others. 12-Step groups do not require members to be Christian or believe in a specific god but ask that members conceptualize what a supportive higher power might be to them.
Meetings happen regularly throughout the day, both in-person and virtual. There are meetings specific to demographics, such as LGBTQIA+, BIPOC, and gender-based. During meetings people celebrate their wins by sharing sobriety day counts and anniversaries, study 12-Step learning materials, and share about their daily victories and struggles. Meetings offer opportunities for connection and service, both of which can counter the isolating nature of addiction. 12-Step recovery might benefit people who want or need to be completely abstinent. It can also be powerful and supportive to participate in a community with decades of culture and traditions.
Local 12-Step resources include:
People with a serious history and physical dependency on substances may require a higher level of care at first, such as an inpatient rehabilitation or treatment center. The Illinois Helpline is a good place to start for connecting to resources for substance use and recovery. They can also be reached at (833) 234-6343.
Written by:
