Guides for People with Substance Use Concerns

People use substances for reasons that are meaningful to them.

Society’s view of substance use changes.

When first produced, Coca-Cola contained caffeine and cocaine. Maia Szalavitz writes in Undoing Drugs, “The penalty for coffee possession under the reign of Sultan Murad the IV of the Ottoman Empire in the 17th century was beheading.” Public over-consumption of ethyl alcohol, a known neurotoxin, is celebrated in America’s tailgating culture. The frequency of physical assaults, sexual assaults, arrests, and hospitalizations associated with tailgating does not diminish ethyl alcohol’s popularity or legality.

Abstinence from substances is a current social construct. Humans have used substances for over 12,000 years. Currently, between 70-80% of people use substances without issue. Nearly 99% of Americans use some combination of the legal, experience-altering substances alcohol, nicotine, and caffeine.

Drugs – substances – don’t cause addiction. If drugs caused addiction, since 99% of us in the U.S. use substances, we would all have addiction. Addiction, at essence, is defined as a learned behavior that achieves desired ends but persists despite negative consequences. Babies can’t be “born addicted” because they haven’t learned anything yet and don’t have the developmental brain capacity to know what they desire or how to get it.

If people use substances for reasons, and people decide they wish to reduce use of a substance, logic suggests that if they discover the reasons for use, and help themselves with those reasons, use will be reduced. Risk-informed skilled use and/or abstinence may be options.

“Drugs are not good or bad. They are simply morally neutral tools which can help or hurt, depending on context. Even the most stigmatized drugs can be helpful or even lifesaving – just ask chronic pain patients who rely on opioids, or people with ADHD who take stimulant medications. Dismissing certain drugs as ‘all bad’ or ‘all good’ ignores the complexity of reality as well as the importance of context.”
– M. L. Lanzillotta

Substance use can be problematic when overuse persists despite the individual’s volition and/or experience of negative consequences, including relational, parenting, school, work, and/or legal problems.

If people wish to reduce use of substances and find this difficult, brain automaticity may be a factor. “Automaticity” is a facet of the human brain allowing it to learn to act without thinking, e.g. automatically putting on the car’s brakes when a child’s ball rolls into the street. Brain structures and functions involved with bonding, attaching, relating and loving may also be involved.

Logic suggests that, with research-informed medical care to ease conditions that may be causing stress to one’s physical and/or emotional well-being, self-kindness, awareness, and practice, brain automaticity may be transformed into conscious choice. Periods of risk-informed, skilled use and/or abstinence become possible.

Crucial exceptions to this logic include untreated trauma, untreated mental illness, inadequately treated physical pain, and/or overuse of opioids. Research-informed medical care, including medications, and research-backed, cognitive behavior therapy-based counseling protocols are usually needed for these conditions. When opioids are used in large amounts, intermittently, over time, irreversible brain changes may occur. The treatment for this medical condition is medication. The only treatments known to cut death rates from opioid use disorder by half or more are the medications methadone and buprenorphine. Denying people with opioid use disorder medications can cause their deaths.

Other than “addiction,” these terms were purposely not used in the above text: addict, alcoholic, substance abuse, substance use disorder, drug abuse, alcohol abuse, disease, willpower, sober, clean. These terms and others related to substance use are used in stigmatizing, inaccurate, often dangerous ways. A comprehensive list is here.

Much of this content has been co-created with clients and community members. I am deeply grateful to them for their bravery, insights, and determination. Their generosity and humanity in finding their own insights, helping me create these materials, and their permission to share their wisdom is boundless.

Questions to Ask and Answer to Reduce or Eliminate Substance Use

Guide to Requesting Research-Informed Care

Guide to Requesting Medical Care for Substance Use Concerns

Research-Backed Ways to Reduce or Eliminate Substance Use: 
Learn Evidence-Informed Skills to Address Substance Use Concerns, a free, online course for people with substance use concerns. Here’s an introduction to the course and here’s the direct link.

Help That Helps: A Kind, Research-Informed, Field-Tested Guide for People with Substance Use Concerns, by Anne Giles, M.A., M.S., L.P.C. and Sanjay Kishore, M.D., July 2019

Help that Helps is a self-guided program for people with substance use challenges to use in tandem with medical care. Self-help is not an evidence-based treatment for substance use disorder.

Here’s an overview and introduction to Help That Helps.

Additional posts:

For people with loved ones with substance use concerns:

The most thoroughly-researched writing on substance use is done by neuroscience journalist, Maia Szalavitz. Recommended reading by Maia Szalavitz includes Unbroken Brain: A Revolutionary New Way of Understanding Addiction, 2016, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, 2021, and her articles.

In this 19-minute interview on 2/6/22, Maia Szalavitz states succinctly the science of substance use and addiction. Maia Szalavitz engaged in workshops and community conversations in Blacksburg, Virginia in August, 2016.

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Most supplements to Help That Helps have been grouped and organized here:

Additional Awareness Skills

You are invited to create an individualized supplement to Help That Helps. Here are the related materials:

We are developing an Awareness Skills Curriculum to accompany Help That Helps.

An earlier version of the guide, which used to reside on this page, has been moved here.

. . . . .

I am attempting to distill research, work collaboratively with clients, and derive a manualized, brief protocol to assist people in achieving remission from substance use disorders. I am hoping researchers will be interested in our case study outcome data and begin to design research trials to test the protocol’s efficacy.

If you’re interested in learning about our process, here’s what I’ve published online so far:

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.

Last updated 7/11/22