3 Myths About Substance Use Treatment
/According to the U.S. Department of Health and Human Services, 46.3 million people met DSM-5 criteria for a substance use disorder in 2021. And yet, only 6% of these people received substance use treatment. One possible reason for this could be the stigma and mystery that still surrounds substance use disorders and their treatment today.
Here are some of the common myths surrounding substance use and its treatment:
MYTH 1: Achieving abstinence is the only option for recovery
FALSE. Many individuals assume that abstinence - that is, avoiding all drugs and alcohol entirely - is the only approach to substance use treatment and recovery that works. This is due in part to the success of 12 step programs such as Alcoholics Anonymous (AA) and the AA model, which now extends into narcotics, overeating, gambling, and compulsive sexual behavior. Even if you’re not familiar with the AA abstinence model and principles from everyday life, you’ve probably come across it in tv, movies, and popular culture: “Hi, my name is X and I’m an alcoholic,” or, “the first step is admitting you have a problem.”
While AA and its sister 12-step fellowships have been enormously successful and helped scores of individuals, its abstinence-model is not the only option for treatment and abstinence may not be the right approach for all clients. A powerful alternative to the abstinence-only model is the harm reduction model, which can include abstinence as a goal while also allowing for a wider range of treatment objectives. Harm reduction focuses on meeting patients where they are at and, in doing so, offers individuals the chance to personally tailor their treatment choosing the goal that would work best for them. These goals could include simply focusing on identifying and reducing the negative consequences of a substance use – for example, someone might use the harm reduction model to prioritize using clean needles to avoid infection. Or, they may work with their therapist not to cease use altogether but to moderate it, for example by decreasing the number of days/week that they use or deciding not to use some substances while continuing to use others. Finally, some individuals may decide to pursue complete abstinence.
Ultimately, harm-reduction can offer a more personalized, wider ranging, and more manageable substance use treatment plan for many individuals.
MYTH 2: If I’m ambivalent about treatment, I’m not ready
FALSE. Ambivalence - or being “on the fence” - about change is not only a normal part of substance use treatment, but it is often a normal part of any therapy. Change is hard (if it weren’t, us therapists would be out of a job!).
Understanding and working through one’s ambivalence about substance use is typically the first stage of treatment. As an individual begins work with their therapist, they may want to start by exploring why they use substances, acknowledging the pleasure substances bring them, and imagining how their lives would change (for better and worse) if they changed their relationship with substances.
Throughout all of this work, ambivalence, doubt, and uncertainty are totally normal parts of the process, and ones that therapists are used to exploring in session. Feeling conflicted isn’t a sign that you aren’t ready for substance use treatment; it may actually be a sign that you are ready to begin.
MYTH 3: I should be able to handle my substance use on my own
FALSE. Needing help for substance use doesn’t mean an individual is weak. Using substances can be pleasurable, comforting, fun, and enjoyable for many reasons. But substances can also be powerful self-soothing tools, temporarily masking underlying issues, such as anxiety, depression, or trauma, that can then be exacerbated in the long term with continued use. Furthermore, substances often have a powerful biological impact on how our bodies and minds function, so that sheer willpower to stop or change one’s use is often not enough, and at times can be medically dangerous.
A therapist can use their expertise to help you to explore and understand your substance use in a curious, non-judgemental, and non-shaming way. Often this leads to greater insight and awareness of the why and when of substance use, which can allow you and your therapist to collaboratively design a better relationship with substances in a way that makes sense for you. This work takes a great deal of courage, but you do not need to do it alone.
Here at Therapists of New York we understand that everybody’s relationship to substance use is different. If you are interested in better understanding and managing your unique relationship to substances, click here to make an appointment.