What Really Helps Someone Change their Substance Use

Changing your relationship with substances is no small feat. Traditional approaches to substance use problems have primarily focused on altering consumption behaviors—setting goals for abstinence or moderation, managing cravings, and developing refusal skills. While these methods are crucial, they often miss addressing the root causes of substance use. Many people are left managing symptoms rather than making more lasting changes. This resource explores a more holistic approach that delves into understanding and addressing the underlying needs met by substances. 

Why Addressing the Root Cause Matters 

The critical question is, why do people use substances to begin with. If you stop and think about it, most people don’t use substances just because they enjoy the taste of alcohol or the smell of cannabis. Instead, they often turn to substances to meet certain psychological and emotional needs. These needs are normal, understandable, and important. If you can figure out what needs you might be seeking to meet through substances, and then find other ways of meeting these needs that don’t involve drinking or using, you can change your relationship with substances.

Strategies to Identify Underlying Needs 

Let’s explore some strategies to help you identify the needs that substances might be meeting. These approaches can provide clarity and insight into why you use substances. 

1. Direct Contemplation: One straightforward, yet sometimes challenging, method is to directly contemplate your substance use. Take some time and ask yourself the following questions: 

• What is my understanding of the function of my substance use? 
• Why do I do it? 
• What do I get out of it? 
• What needs might substances be meeting for me? 

This reflection can offer valuable insights into your motivations. 

2. Analyzing Feelings: Substances are mood-altering chemicals. People take them to change the way they feel. Typically, people use them to either feel something they otherwise don’t (like happiness or confidence) or to avoid feeling something they typically do (like depression or anxiety). Ask yourself: 

• How do I usually feel before I use substances? 

• How do I hope to feel or expect to feel once I consume them? 

The difference between these two emotional states can indicate what you are seeking through substance use.

3. Considering The Costs and Benefits: Evaluate the benefits of using substances and the costs of giving them up. What do you gain from using substances? What would you lose or miss out on if you stopped? Understanding these trade-offs can help you recognize the needs substances are meeting.

4. Asking “Why the Pain?”: Gabor Maté, a renowned addictions physician, suggests asking, “Why the pain?”. He recognized that all substances reduce pain in the body and work not only on physical pain, but psychological and emotional pain. This might help you consider what pain or distress you might be medicating with substances.

5. Identifying True Cravings: When you crave a substance, it’s often not the substance itself but what it can give you. Ask yourself, “What am I really craving?” This can help you identify the deeper needs you are trying to fulfill.

6. Viewing Substances as Solutions: Sometimes, substances are solutions to other problems in your life. Ask yourself, “What problem is my substance use solving?” This can reveal the underlying issues that may be fueling your substance use.

7. Mindfully Not Using: Temporarily stop using substances and carefully observe your thoughts and feelings. These emotions and thoughts can provide clues about why you use substances. 

8. Common Reasons for Substance Use: Consider common reasons people use substances, such as unhappiness, anxiety, stress, loneliness, boredom, or grief. Reflect on whether any of these reasons resonate with you. 

Developing Alternative Strategies 

Once you understand the needs met by substances, the next step is to find other and healthier ways to meet those needs that don’t involve drinking or using. There are many ways to do this. However, because so many people use substances to manage uncomfortable feelings, two common strategies for addressing these needs are to (a) reduce the incidence of uncomfortable feelings and (b) find alternative ways to manage these feelings when they do arise. 

As one example of this, let’s say that you use substances to manage feelings of social anxiety when you’re around other people. Specifically, you feel people are judging or criticizing you, which creates anxiety, and you use substances to cope. A first alternative way of addressing this need is to seek to understand why you feel social anxiety to begin with. Often, the reason people feel that others are judging or criticizing them is because they have felt judged or criticized before in their lives, often in their childhoods, not necessarily because they are being judged or criticized in that moment. Recognizing that one’s feelings may have very little to do with the present situation, and may simply be carryovers from experiences long ago, can help a person to feel less socially anxious eventually. 

A second way of dealing with these feelings is to find other ways of managing them when they do arise. For example, if a person felt socially anxious at a party, they could step out to get some air, take a walk to help to ground themselves, reassure themselves with positive self-talk or phone a supportive friend. Each of these ways may help them feel less anxious without having to resort to substances.  

Addressing the Right Need 

There is an old adage which states: “A problem well-defined is half-solved.” In finding alternative ways to address the needs met by substances, it is important to address the right need. For instance, if you use substances to give you energy because you are constantly tired, it is important to understand where your fatigue comes from. It could be a medical condition, such as fibromyalgia, a mental health issue like depression, or life circumstances. Each of these underlying causes may require different strategies to address. Considering the root cause of your needs can lead to more effective solutions. 

One technique which can help you to address the right need is called the “Five Why’s” Technique. This technique involves asking “why” multiple times to drill down to the root cause of a problem. For example, if you feel lonely and use substances to cope, ask yourself: 

• Why am I lonely? Because I have no friends. 
• Why do I have no friends? Because I never pursue relationships. 
• Why don’t I pursue relationships? Because I don’t think anyone will like me. 
• Why don’t I think anyone will like me? Because I don’t like myself. 

In this case, low self-esteem is actually the problem. Loneliness is just the symptom.  

Changing your relationship with substances requires understanding why you use them in the first place. By identifying the underlying needs you are using substances to meet and finding healthier ways to address those needs, you can address the root causes of your substance use — not just the symptoms — and cut off consumption at its source.  

Craving change? ALAViDA offers a wide range of support options to help you change your relationship with alcohol and other substances. Access this link to find out more. 

About the author:

A. Paul Singh is a virtual health coach at ALAViDA Substance Use, a product of LifeSpeak Inc. He has over 25 years of experience in providing alcohol use counselling and has worked as a therapist in virtually every part of the continuum of care, including detox, outpatient, and residential treatment programs.

Featured speaker at several national conferences, Paul has delivered 1000+ presentations across Canada and the United States on mental health and substance use issues. Paul holds a bachelor’s degree in psychology from Cornell University, a law degree from New York University School of Law, and a master’s in social work from the University of Chicago.