Understanding Substance Use and Alcohol Therapy
A practical, compassionate guide for individuals and families
If you’re reading this, there’s a good chance something about drinking or substance use just doesn’t feel “normal” anymore — either for you or for someone you care about.
Maybe alcohol has shifted from social to necessary.
Maybe a prescription became something you rely on more than intended.
Maybe cannabis, stimulants, or other substances feel harder to control than you’d like.
Or maybe you’re simply noticing a quiet concern: “This is starting to run me.”
Let’s start here:
Substance use disorders are not a character flaw.
They are not a failure of discipline.
And they are not solved by willpower alone.
They are treatable conditions involving both brain chemistry and emotional coping patterns. With structured, evidence-based therapy, recovery is realistic — even when things feel complicated or entrenched.
What Is a Substance Use Disorder?
A substance use disorder involves a pattern of use that leads to:
Loss of control
Increasing tolerance
Withdrawal symptoms
Continued use despite consequences
Significant time spent obtaining, using, or recovering
It exists on a spectrum. Not everyone who struggles is drinking daily or using “hard” drugs. Many high-functioning professionals, students, and parents quietly meet diagnostic criteria without realizing it.
The clinical definition is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and recognized by organizations like the National Institute on Drug Abuse.
Common Substances I Work With
Alcohol
Increased tolerance
Drinking more than intended
Difficulty cutting back
Using alcohol to manage stress or sleep
Alcohol is socially normalized, which can delay recognition of a problem.
Opioids (Prescription Pain Medications or Heroin)
Escalating dosage
Physical withdrawal
Intense cravings
Medical risk if stopped abruptly
Medication-assisted treatment (MAT) may be appropriate in some cases.
Stimulants (Adderall, Cocaine, Methamphetamine)
Used for focus, productivity, or appetite suppression
Crash cycles
Irritability or mood instability
Increasing dependency
Cannabis
Daily reliance
Anxiety or irritability when stopping
Decreased motivation
Emotional avoidance
While legalization has changed cultural perception, heavy use can still impair functioning.
When Does Substance Use Become a Problem?
Here are subtle signs people often overlook:
Needing it to relax
Planning social life around it
Hiding quantity used
Feeling defensive when questioned
Failed attempts to cut back
Using to cope with difficult emotions
If you’re asking whether it’s a problem, that question itself is meaningful.
Why Substance Use Disorders Develop
There is never a single cause. Common contributing factors include:
Trauma
Chronic stress
Anxiety or depression
High-performance pressure
Social normalization
Genetics
Substances alter dopamine pathways — the brain’s reward system — which reinforces repeated use. Over time, the brain adapts, requiring more of the substance to achieve the same effect.
This is why stopping is not simply a matter of deciding to stop.
Co-Occurring Mental Health Conditions
Substance use rarely exists in isolation. Common overlaps include:
Depression
Generalized anxiety
PTSD
ADHD
Eating disorders
Integrated treatment is critical. Treating only the substance without addressing underlying drivers often leads to relapse.
For national mental health information:
Substance Abuse and Mental Health Services Administration – https://www.samhsa.gov
National Alliance on Mental Illness – https://www.nami.org
How Substance Abuse Therapy Works
Treatment begins with assessment:
Substance history and patterns
Withdrawal risk evaluation
Mental health screening
Risk assessment
Collaborative treatment planning
If medical detox is necessary, that is addressed first. Therapy begins once safety is established.
Evidence-Based Therapy Approaches
Different individuals respond to different methods. Effective treatment is personalized.
Cognitive behavioral therapy
Focus:
Identifying triggers
Interrupting automatic use cycles
Developing alternative coping skills
Relapse prevention planning
Motivational interviewing
Especially helpful when someone feels ambivalent about change.
Focus:
Exploring internal conflict
Strengthening intrinsic motivation
Reducing resistance
Dialectical behavior therapy
Effective when substance use is driven by emotional intensity.
Focus:
Distress tolerance
Emotion regulation
Reducing impulsive behaviors
Trauma-Informed Therapy
For individuals whose substance use began as a coping response to trauma, deeper trauma processing may be incorporated once stability improves.
What to Expect in Therapy
Early Phase (Weeks 1–6)
Stabilization
Trigger identification
Building alternative coping strategies
Possible harm-reduction planning
Middle Phase (2–6 Months)
Emotional processing
Addressing shame
Relationship repair
Strengthening relapse prevention
Later Phase (6–18+ Months)
Identity development without substances
Lifestyle restructuring
Long-term maintenance planning
Recovery is not linear. Slips can happen. What matters is building resilience and reducing severity and duration of setbacks.
Abstinence vs Harm Reduction
Not everyone begins therapy ready for complete abstinence.
Treatment may involve:
Gradual reduction
Structured harm reduction
Full abstinence
Medication-assisted treatment
The right approach depends on risk level, substance type, and client goals.
Levels of Care
Outpatient therapy
Intensive outpatient (IOP)
Partial hospitalization (PHP)
Residential treatment
Medical detox
Higher levels are indicated when withdrawal risk, severe impairment, or safety concerns are present.
A Final Word
Substance use disorders are adaptive coping strategies that eventually become costly.
They often start as relief.
They become routine.
Then they become necessary.
But recovery is possible.
With structured therapy, medical oversight when needed, skill development, and accountability, people regain control of their lives — not through force, but through sustainable change.
If something about your drinking or substance use feels off, you do not need to wait for it to become catastrophic before seeking help.
An assessment is simply a conversation — and sometimes that conversation changes everything.
