Questions to Ask and Answer to Reduce Substance Use

Humans have used substances for over 12,000 years in ways that are meaningful to them. Between 70-80% of people who use drugs do so without issue. When people find themselves engaging in unintended use or overuse, particularly if use results in harm, their brains may have developed what’s termed “brain automaticity,” i.e. action without thought. Brain structures and functions involved with bonding, attaching, relating and loving are also involved. When this occurs, the terms “substance use disorder” and “addiction” are applied.

In the U.S., an estimated 1 in 10 who use drugs develops a substance use disorder, usually preceded by trauma and/or mental illness. Although chronic cases exist, most people with substance use concerns recover on their own without treatment. If substance use concerns do not resolve on their own, research suggests a three-pronged approach: 1) medical care, 2) skills-focused, cognitive theory-based counseling, and 3) connection and support.

However, if people are required to, or choose to, reduce substance use or abstain from substance use, what does research suggest is helpful on a practical level?

When people lose something or someone important to them, they have to both endure the loss and find adequate replacements. They have to accept that a one-to-one correspondence will likely never exist between what’s lost and what approximately fills the space. People who have lost loving mothers, fathers, grandparents, first loves, and dear pets know this. They are loved and will be loved again. However, it will never again be in that way.

So it is with mandated or chosen reduction in use or absence of use of substances. Substances take the human brain where it normally can’t go on its own. That’s why humans have used substances for 12,000 years. Their absence can be a one-of-a-kind loss.

As Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, puts it here, “If addiction resides in the parts of the brain involved in love, then recovery is more like getting over a breakup than it is like facing a lifelong illness. Healing a broken heart is difficult and often involves relapses into obsessive behavior, but it’s not brain damage.”

After substance use, our own brains and our own lives are, essentially, cornered into a no-win scenario. Life is expected to make a better offer than substance use. Life can’t? Well, why stop then?

How does one create a life to which substance use would add insignificant value? How might one evolve from ambivalence to indifference about substance use?

At essence, to taper from, reduce, or eliminate use, a person would need to regain autonomy over automaticity. After first seeking medical care, a person would painstakingly discover and identify specifically what substances do for them and use their own hearts, minds, and actions to provide, as best they can, what substances did.

A very tall order.

Below are questions a group of people experienced with using research-backed methods to address substance use concerns concluded might be helpful. Beneath each question is related, simply-stated guidance.

Begin, however, with self-kindness. Although current social norms may judge substance use, human history does not. Embrace yourself and begin to help yourself with this challenge.

What do substances do for you?

Find legal alternatives that provide similar, adequate effects.

When the longing for a substance arises, what feelings do you wish were different?

Identify the feelings and attempt to help yourself reduce the volume on their intensity. Rather than attempt to unsuccessfully suppress the unsupressible, counteract automaticity. Consciously use your attention as a muscle and shift your attention to your interests, preferences, and priorities.

What are the problems that arise which create a longing for substances?

Identify those problems and seek solutions, including identifying health conditions and seeking medical care and medications for them.

What are the rituals associated with using?

Find alternatives that provide similar, adequate effects.

With whom are you mostly likely to use substances?

Negotiate with those individuals a no-use policy when you’re together. At the same time, find others to be with who do not use.

What beliefs do you hold about using? Examples: “I can’t take what’s happening without using!” or “It might help if I have more” or “If I don’t use, I won’t belong.”

Consider this fill-in-the-blank: “If I use substances, I have/receive __________. If I don’t have/receive this, that means __________.”

Are the answers facts or beliefs?

Challenge beliefs with facts and questions. Examples: “I have made it through challenges before.” “It might help if I have more but it also might hurt.” “Does the group I want to belong to hold my values and priorities?” “Might I want to look at the ways I am thinking about things?”

What do you not know about substance use, the substance(s) you use, and evidence-based treatment for substance use disorders?

Find out. Educate yourself. Find or get recommendations for research-backed, self-guided therapy workbooks and complete them.

What have you found that substances do and do not give you? Did you get what you thought you would? Does the inner narrative of anticipated results match real results?

Consider this fill-in-the-blank: “On the one hand, substances and/or substance use do give me __________. On the other hand, I had hoped substance use would give me __________ but it has let me down.”

Another possibility: “I just did it to __________. I didn’t mean to end up here.”

Practice self-kindness, self-empathy, and self-compassion. Embrace yourself, your disappointment, and your sorrow. Acknowledge that you did – and continue to – wish the best for yourself.

What outside support do you need?

Practice self-kindness and self-care. Reach out for medical care, agency support, and professional care. Seek the support from safe, non-judgmental people that you need.

. . . . .

To gain insight into answers to these questions, completing these exercises may be helpful.

  1. Self-Care Checklist
  2. Awareness Skills Self-Assessment
  3. Checklists to Assess Needs, Wants, Strengths and Preferences
  4. Values and Priorities Exercises
  5. Other posts in the Guide category.

Other guides on this site may be helpful:

Research-Backed Ways to Reduce or Eliminate Substance Use is a free, online course I have posted on Udemy for people with substance use concerns. Here’s an introduction to the course and here’s the direct link.

With any questions at all, please do contact me.

Image: IStock

Last updated 3/7/21

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Now Might Be a Good Time to Learn Mandarin Chinese

Why might now be a good time to learn Mandarin Chinese?

  1. We may be able to directly and indirectly contribute to world peace.
    Peace in any relationship – whether personal or international – depends upon being able to talk. Given current tensions between the U.S. and China, we, literally, need to speak each other’s language to gain deep, mutual understanding of each other’s needs and wants, feelings and thoughts.
  2. We can share the responsibility for communicating.
    According to research company Ethnologue, languages with the most native speakers in the world, in order, are Mandarin Chinese, Spanish, then English. Of languages with the most speakers, English is first, followed closely by Mandarin Chinese, then by Hindi. According to Wikipedia, 10 million people in China have acquired English as a second language. In contrast, an estimated 30,000 to 50,000 people in the U.S. are studying Mandarin Chinese.
  3. Logic suggests that, to solve the globe’s main problems, we need to speak the globe’s main languages.

I turn 62 at the end of this month. I have become aware that now might be a particularly good time for older adults to learn Mandarin Chinese. Why?

  1. We join the team.
    Perhaps, in human history, now is not the time for older adults to retire. Among the acquisition difficulty rankings of languages by the U.S. Department of State, Mandarin Chinese is ranked as a Category IV language, among the very hardest to learn. Although human bodies normally and naturally lose functioning with age, our brains gain complex cognitive abilities, unless afflicted with neurocognitive diseases. Might our mature brains now be optimally wired for efficient and effective learning? Might our mature brains be untapped resources to assist scholars, scientists, policy-makers, and members of our communities? Might now be the time for us to take this challenging task on – in service to all of us, for the sake of all of us?
  2. We may be putting our mature human brains to optimal use.
    The findings of neuroscience contradict the myth that second language learning is ineffectual in adulthood. In fact, with assistance with intermittent, short-term memory challenges, the intricately and deeply networked mature adult human brain may be particularly primed for second language acquisition.
  3. Learning Mandarin Chinese may be a way to covertly protest and change aging in the U.S.
    The process of aging and dying in the U.S. has become so lonely and bleak that guides like this one and this one have to be written about how to deal with it all. The primary challenges? Loss of purpose and meaning, cognitive decline, and social isolation. Triumphantly, learning Mandarin Chinese has no less than world peace as its mission, neuroscience backs it as a potentially enhancing, improving, even restorative cognitive endeavor, and connection with instructors and people with whom to practice are available online, 24-7.

Want to experiment with seeing if learning Mandarin Chinese might be a fit for you?

Through 5 months of literature reviews of research on second language acquisition, extensive testing of apps and materials, and difficult trial-and-error learning, these are the steps and resources I suggest:

  1. Download and use the Hello Chinese app. Early learning features are free; premium subscriptions start at $8.99 per month. Hello Chinese is beautiful and beautifully coded, offers enough explanation to keep moving but not too much to get discouraged, and blends learning with gamification in engaging and appealing ways.
  2. Download and use the Skritter app to become familiar with Chinese characters.
  3. Watch some episodes of Happy Chinese on YouTube.
  4. Listen to some episodes of the You Can Learn Chinese podcast.
  5. Once you know what “Nǐ hǎo” is, and way before you feel ready, do this anyway: Listen to their video introductions, make a selection, and book a session with one of the nearly 800 online teachers of Mandarin Chinese on italki.

(To select teachers on italki, I begin by filtering the search results through “Availability.” I am an early riser and take a break around 1:00 PM. So I look for teachers available for 5:00 AM and 1:00 PM sessions. italki makes this easy by displaying results filtered through the user’s time zone. Before your session on italki, you’ll have the opportunity to message your teacher that you’re a beginner.)

5. Savor the heart-pounding, nerve-wracking awe and excitement of waiting to attempt to speak another language with a complete stranger in another part of the world. When your instructor’s face appears on the screen, say, “Nǐ hǎo” and see what happens after that.

If you have an experience similar to mine, the first teacher wasn’t exactly a fit but the longing to learn Mandarin Chinese began. And, the belief that it was doable began as well.

Here’s a video of my progress after 4 months of independent effort supported, all online, by my italki teachers, my local teacher, members of our Mandarin Chinese Conversation Club, and fellow learners on My Language Exchange. I’m very excited to begin to supplement my work through formal instruction with AllSet Learning, founded by John Pasden, co-host of the You Can Learn Chinese podcast, and co-author, with Jared Turner, of the Mandarin Companion graded reader series.



If you find the video somewhat excruciating to listen to and watch, that’s okay, ’cause I do, too. I don’t speak very well yet! I laugh near the start because I realize the teacher has asked me about the weather and I replied with a date. Mostly I feel joy, however. I, too, started with “Nǐ hǎo.”

Please do contact me if you have any ideas, suggestions or feedback on learning Mandarin Chinese.

Updated 12/13/20

I am a beginning student of Mandarin Chinese and also a counselor, able to provide services only to residents of Virginia, U.S.A. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Is Online Cognitive Processing Therapy for Trauma a Fit for Me?

At essence, Cognitive Processing Therapy, CPT, is a way to use one’s own heart and mind to help reduce the impact on one’s brain of having experienced trauma. Designed to be a brief protocol, CPT has over 25 years of research to back it and is recommended by the Veterans Administration and the American Psychological Association (APA).

Cognitive Processing Therapy for PTSD ManualI experienced such significant trauma symptom reduction myself from being taken through the protocol by clinical psychologist Stephanie Fearer, Ph.D., that I trained in providing the CPT protocol so I could pass this relief forward to others. I provided individual and group sessions in CPT in my private practice’s counseling office until March, 2020. Since then, we have been conducting individual and group CPT sessions online.

Numerous research studies report the effectiveness of online vs. in-person counseling, including for CPT.

The CPT protocol includes 12 sessions. These can be scheduled weekly, twice weekly, or at other intervals. The first 7 sessions are fundamental and the last 5 offer deeper insights. Some people experience noteworthy symptom reduction in a few sessions – “early responders” – and complete the protocol in fewer than 12 sessions.

Participants complete assessments prior to each session and plot them on a graph to track their progress. They complete daily homework between sessions.

Some people want to take their time and experience the comprehensive experience of the full protocol. Others, because of time and cost limitations, want to be early responders. In my professional experience, all who engage in CPT for any length of time are brave. Early responders tend to be those who 1) do the homework daily (not intermittently or all at once), and 2) do it thoroughly. In addition, women who identify as female and for whom attendance of our online CPT group is a fit may also respond quickly to the protocol.

The primary logistics challenge for conducting and participating in online CPT is distributing and using the handouts. When I had an office, I created a folder for each client and arranged a sequence of handouts in folders as if in a buffet line. Clients arrived, completed assessments, acquired the session’s handouts, and we were ready to begin in about 3 minutes.

Online, I have used a website page as a virtual table and made an ordered list of the materials participants need and the actions to take prior to each session. The give-and-take of quick questions that happens while seated in-person, side-by-side at a table doesn’t really happen in online sessions when one is, virtually, inches away from the other person’s face. There’s a focus and seriousness to it that, again in my opinion, might actually improve outcomes. That is hypothesis, not data. I’ve made a CPT glossary that covers the questions I was most often asked about terms and concepts.

Although a self-guided workbook is being developed, I encourage people to buy a copy of the CPT manual. I kept an in-house copy of the manual in my office so clients could follow along during each session. This was more efficient than attempting to page through copies of handouts in a folder or notebook.

If you’ve read this far, then you’ve answered the first question.

Is online Cognitive Processing Therapy (CPT) a fit for me?

1. Am I open to reading short passages of explanatory text at about the reading level of the text in this post?

2. Am I open to reading and following lists of directions primarily on my own and asking clarifying questions if I’m having trouble?

3. Am I open to doing daily homework? After the first homework assignment, which takes an hour, am I open to doing homework each day, maybe 20-30 minutes per day?

4. Am I aware that the primary symptom of trauma disorders is clinically – and somewhat uncharitably – termed “avoidance” but is my attempt to protect myself from emotional pain?

5. Am I aware that, paradoxically, the primary symptom of trauma disorders – avoidance – is the one that may get in the way of me getting help for it? If I do get help, am I aware I will, understandably, lean toward canceling sessions and not doing homework and lean away from attending appointments and doing homework? That I may find myself wanting to quit attending sessions at all?

6. Am I aware that a secret, fearful belief I have is that, if I engage in counseling for trauma, all my defenses and adaptations will shatter and I will be so raw and vulnerable that I will be unable to function?

7. Given all this, am I open to taking a chance on the protocol for about 20-30 minutes per day for up to 12 sessions, knowing I, truly, can stop at any time and use the manual on my own?

The start of any counseling process for any condition begins with self-kindness. Having questions and concerns like these makes complete sense. People who have trauma symptoms suffer. People who have been diagnosed with post-traumatic stress disorder (PTSD) have a condition considered a severe mental illness (SMI) for which they qualify to apply for disability benefits. This is serious business and deserves our attention and care.

If you are a Virginia resident and would like to consider Cognitive Processing Therapy, please fill out this contact form. (If you are not a resident of Virginia, here is a roster of other CPT providers.)

I will use your email address to send you the CPT contract and the .pdf of CPT worksheets for your review. If you decide you would like to engage in the protocol, I’ll send you further enrollment information and we’ll schedule a meeting to answer any questions you may have.  When we meet, we’ll schedule a set of 12 appointments together. Then we’ll begin.

With any questions at all, please do contact me.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

How Can Spoken Mandarin Chinese Be Learned in a Pandemic?

How can spoken Mandarin Chinese be learned in a pandemic?

“Not as well, perhaps, as when there is no pandemic.”

I felt so heartened and understood by Ralph Lake in his answer to my question on Quora.

Liu4 - six

Virginia began quarantining in mid-March, 2020. By late March, The Washington Post and other news media were suggesting using the long hours of quarantine to learn a second language. I studied Chinese history at Virginia Tech as an undergraduate and took a semester of Mandarin Chinese at the University of Connecticut in 1981. I decided to return to my studies.

For people who could no longer access counseling services for substance use concerns during lockdown, I created a no-fee, online course for Udemy in late March. That gave me the idea to search for courses in Mandarin Chinese. I found several fine ones, but when the learning is passive, I tend to endure courses rather than engage with them. I was able to find a local teacher and we have been meeting once per week via Zoom since March.

According to neuroscience studies on second language learning, people learn languages most efficiently through social interaction, particularly when it’s immersive for adult learners. During a pandemic, attending gatherings where Chinese is spoken and traveling to Chinese-speaking locations are impossible. How to simulate immersion? I  searched for online tutors, found italki, and have been working with Depeng and other instructors since July, 2020.

I have run into two surprising barriers to learning Mandarin Chinese during a pandemic.

Lack of materials for adult learners

Mandarin Chinese learning materials are created with classroom students in mind. I am 61 years old and have the particular needs of an adult learner. Confined primarily to my house and yard, I have very few classroom-related stimuli to prompt an internal dialogue in Chinese. From the confines of my home office, I stare at the table – 桌子 zhuōzi – across from me all day long. I can’t find much to say about it.

With Depeng, I have used the Kindle app, shared my screen, and read the story of Guo Guo – a nice little kid with a nice family – and we’ve looked at the story of Xiaoming – a pleasant young man who, when I glance at the end of the story, seems to make some interesting choices, limited as he is to HSK 1 vocabulary. (Here’s more about the Chinese proficiency exams, abbreviated “HSK.”)

But I’ll be 62 in December, am single – as are 45%+ of Americans aged 18 and older – and – as do 70%+ of American adults – I live without children.

I want to read about people to whom I can relate. What do adults who speak Mandarin Chinese do when they’re on their own?! I assume, as I do, they text, write emails, read stuff, watch stuff, make tea and coffee, decide what to eat, look out the window and think about the past, enjoy the moment, ponder the future? I’m guessing they’re not contemplating the meaning of 桌子. I would love to read their stories. I am slowly learning simplified characters, not traditional ones, so I need the text to include simplified characters, pinyin, and English, all three.

I don’t know how many English-speaking adults are currently learning Mandarin Chinese or if this is a market opportunity with the potential for the wild success of Charles Dickens, but I would gobble up a serial story about an adult written in HSK 1 and HSK 2 vocabulary, spiced up with pertinent, contemporary terms and a glossary.

Insufficient interactive speaking practice

When I speak even a single word in Mandarin Chinese, I go through such a laborious mental process. To achieve fluency, I need brain automaticity. That takes practice. Each week contains 168 hours. During those 168 hours, I currently speak Chinese during three of them, one with my local instructor and two with my italki instructor. The score for English hours to Chinese hours is an overpowering 165 to 3.

To achieve even a modicum of fluency, regardless of how many audios I listen to or videos I watch, I think I need to speak Chinese every day. Somehow.

I have proposed a Mandarin Chinese Conversation Group and three of us met yesterday via Zoom from different time zones. I felt quite moved to see three articulate people struggle to find words to say whether or not we had dogs or cats. We held the silence for each other to let our brains make the connections they need to make. All three of us leaned towards each other, albeit through screens, as if our very presences would help the other form the words. It takes bravery to be awkward.

A group member recommended Language Exchange and I will try this.

Learning the characters slows me down but learning pinyin without characters results, for me, in disambiguation. “Shi” – even with different tones – means a lot of things (scroll past the ads to see the results). I would love to start to learn to paint the characters via videoconference with someone in my time zone who speaks Mandarin Chinese. The other person doesn’t even have to speak English since “show, don’t tell” will work just fine. Wyzant looks promising but my funds, too, have taken a hit during this pandemic. I’m still thinking about this.

I welcome being contacted with ideas from others and with inquiries on joining the Mandarin Chinese Conversation Group for beginners.

And thank you, Ralph Lake, for helping me and others pioneer how to learn Mandarin Chinese in a pandemic.

Possible resources for adult learners of Mandarin Chinese during a pandemic

For the past 7 months, I have reviewed countless courses, websites, and apps. The resources listed below are ones I have found to be most helpful, most of the time.

Textbook for spoken Chinese

  • Basic Mandarin Chinese: Speaking & Listening (Textbook), Cornelius C. Kubler, 2017 | Accompanying audios/videos.Kubler is a stellar writer and teacher. From his introduction: “I should state here that the ultimate rationale behind the preparation of this course is to improve communication between Americans and the citizens of the various Chinese-speaking societies and thereby contribute, in however small a way, toward promoting understanding and peace between our peoples.”

[I have tried the textbook widely used in universities, Integrated Chinese, but the content is about students, the text is small and faint, there’s no Kindle version to enlarge the text, the web app doesn’t adjust line lengths to the screen, and characters were introduced faster than I could learn them.]

App for learning spoken Chinese

Learning characters

Other apps

Pronunciation

YouTube

  • Complete HSK 1 from Everyday Chinese (1:14:23) < — So grateful to find this. I can listen while I do chores.
  • HSK 1 Sample Exam
  • The Short Story of Charlie < — I enjoy this speaker very much. I listen every few weeks as a test of my learning. I understood 1% when I first heard it in March and now understand about 50%.

Videos

The accompanying image is a photograph of my attempt to use my watercolors to paint a lucky number and remind myself that 六 liu4 means “six” even though the character has five strokes. My house guest, a visiting scholar from Brazil who has been to China, asked about the difference between liu4 and ren2 and that’s why one 人 is painted, too.

Again, please do contact me if you have any ideas about learning to speak Mandarin Chinese during a pandemic.

Revisiting Values and Priorities in Challenging Times

Values

Please give yourself approximately 30 minutes for the values portion of this exercise.

Please print out the pages from the Personal Values Card Sort and use scissors to cut out the cards.

Place the three category cards in a horizontal row on a table: “Not Important to Me,” “Important to Me,” and “Very Important to Me.”

Try to be aware of both doing the exercise and observing yourself do it.

Sort all the cards into piles beneath each category. Take the cards you have sorted into the “Very Important to Me” pile and pick your top 10. Then rank order them. Then pick your top 3.

Staying aware of values and priorities

Please consider answers to these questions:

  1. What were your top 3 values?
  2. What did you become aware of during the values exercise?
  3. What insights did you gain from doing the values exercise?

Priorities

Please give yourself approximately 30 minutes for the priorities portion of this exercise.

Part 1.

Please take out a piece of paper or a pad of paper.

Using your own definition of the term “priorities,” please take 5 minutes to simply list any and all priorities that come to you, in any order, in any form, in any area on the piece of paper. It’s okay if you cry and it’s okay if you don’t feel finished in 5 minutes. You can noodle over this later and add items as they occur to you. For now, just give this exploration 5 minutes.

Part 2.

In times of uncertainty, people wish for certainty. If you could have certain answers to 3 questions, and you think the answers to these questions would help you with your priorities, what would those 3 questions be? Please write these questions at the bottom of your list or on a fresh page.

Part 3.

Using your own definition of the term “crucial,” when you look at your page of priorities, what is the crucial priority?

Part 4.

Please print out this priorities worksheet or sketch a copy on a piece of paper.
The handout is Steven Covey’s “four quadrant” model with the addition of “crucial” by Mike Vardy. The columns, left to right, are “Urgent” and “Not Urgent.” The rows, top to bottom, are ” Important” and “Not Important.“ In the center is a box labeled “Crucial.“

Please write your crucial priority in the center box. Based on your assessment of their urgency and importance, please add your priorities into the quadrants around the crucial priority.

Part 5.

Rank order the priorities in each quadrant, putting a “1” by the most important in that quadrant, and”2″ by the next most important, and so on.

Please consider answers to these questions:

  1. In addition to your crucial priority, what were your top 3 priorities in rank order?
  2. What did you become aware of during the priorities exercise?
  3. In what ways did your “certainty questions” or your view of them change?
  4. What insights did you gain from doing the priorities exercise?

Values + Priorities

When I feel lost and scattered and uncertain about what’s going on, who I am, or what I am doing, I can revisit my values, the top three of which are _______,_______, and _______.

My values remind me of my power.

Then I can become aware of my priorities. Among my priorities, I can decide what’s crucial, urgent, and important – and what’s not crucial and not urgent and not important.

My crucial priority is _______.

I can rank order my remaining priorities.  After my crucial priority, the top 3 remaining priorities that are urgent and important to me, in rank order are: _______, _______, and _______.

Awareness of my priorities gives me direction.

The photo accompanying this post shows paleontologist Matheus Denezine’s system for keeping his values and priorities foremost.

I can keep my values and priorities before me – in whatever system I devise – to power and guide me through challenging moments, days, weeks, and times.

. . . . .

Awareness of priorities and values is a skill taught through Dialectical Behavior Therapy (DBT), a form of cognitive behavior therapy invented by Marsha Linehan, Ph.D.

Of possible further interest

Addressing Unmet Needs During Social Distancing

Adeptly Shifting Priorities in Uncertain Times

What Still Makes Sense and What No Longer Fits

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.