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Options for Substance Users

Increase? Decrease? Solo? With support?

Lindsay Fox, Wikimedia, CC 2.0
Source: Lindsay Fox, Wikimedia, CC 2.0

When users of tobacco, alcohol, marijuana, and other mind-altering substances are honest with themselves, they’re aware that the liabilities outweigh the pleasure. Substances' dangers, including the surprisingly problematic marijuana's1, are becoming well-known.

Apart from the physical and mental health risks, too many users, often in denial, find that substance abuse damages their work life, relationships, and ironically, their overall happiness. And substance abuse causes crime, unwanted pregnancies and STDs, and vehicle accidents, causing pain and death to thousands of innocent people every year.

Research abounds on the negative effects of substance abuse. A Harvard/Northwestern study finds that even casual users of marijuana suffer significant brain structural changes, affecting motivation and emotions. That confirms what many of us have long suspected but we didn’t think casual use was so dangerous. Today, CNN reported government statistics that cited a major increase in marijuana-induced psychosis. A Mount Sinai School of Medicine study found that marijuana hurts brain development in fetuses. Kevin Sabet, the former Obama administration drug abuse advisor, reported on CNN that since legalization in Colorado, a pre-employment drug testing firm reports a 44 percent increase in the number of job applicants who tested positive for marijuana.

Alas, substance abusers have a hard time resisting substances' easy short-term feel-good, no matter the long-term liabilities. Perhaps one or more ideas here will help.

Substance abuse as a symptom, not the disease

Sure, some people experiment or occasionally use a mind-altering substance—that’s not abuse. But when a person has, for example, more than a couple drinks a night, vapes more than once or twice a week, or uses even stronger drugs, and tolerance and craving increase, the liabilities exceed the pleasure, and most abusers know it. The National Institute on Drug Abuse reports that a person who has used marijuana is 104 times(!) as likely as a non-user to go on to use cocaine. Might any of the following root causes apply to you or to a person you care about?

  • Stress. Instead of abusing a substance, do you want to try to reduce your life's stresses? For example, would it help to change your job or attitude at work so your boss gets off your back? Do you need to end a stressful relationship or find a calming one? Are you taking on too much of the stress of a family member's chronic illness?
  • Boredom. After work or on the weekend, it’s easy to fill time by getting high. Might you want to develop a habit of substituting healthier pleasures: movies, music, cooking, writing, video games, walking, a sport, being with friends (no, not abusers)?
  • Peer group. Some groups of friends, relatives, or housemate(s) are routinely under-the-influence. Want to try to find better friends?
  • Little to lose. This is the hardest cause of abuse to ameliorate. If you feel your life’s prospects are poor, it’s easy to think, “Why the hell shouldn't I get zonked? Getting high now would make me feel better now. So what if next year or decade I pay a price. I can’t think that far ahead.” Just maybe, might it help to force yourself to take baby steps to improve your work and personal life?
  • Illness. Of course, if you’re in severe chronic pain, especially at end-of-life, you can, without guilt, take mild-altering and pain-relief drugs perhaps including opiates, which hopefully will be made available to you by your physician despite the government’s crackdown.

Your options

Do any of the following options feel right for you or someone you care about?

  • Increase your use. Not only might increasing drug use be appropriate for a person with severe illness and/or pain, sometimes forcing yourself to take more can make you want to stop. That’s a psychological theory called paradoxical intention.
  • Status quo. Perhaps you’ve optimized the risk/reward ratio of your substance use, for example, deciding that vaping a bit twice a week gives you that pleasure when you most need it without your becoming a heavy user. And you're confident that you won’t increase your use or that it will be a gateway to even more dangerous drugs. Be careful though: Many people who have become heavier users and “graduated” to stronger drugs had insisted they wouldn't do so.
  • Reduce. Perhaps you’ve decided that you could achieve the aforementioned risk/reward optimization by cutting back to, say, once or twice a week of moderate use when you’d feel you most needed or wanted it.
  • Cold turkey. Some people don’t do moderation—That requires decision after decision: To do or not to do; that is the question. Rather, such people need to eliminate decision-making and decide to try to stop cold-turkey. Sometimes, a physician can prescribe medication to help.


  • Family and friends. Often, an abuser requires the support of a loved one, a team of family and friends. There are consultants such as SF Intervention, which help families, including imediating family interventions.
  • A counselor. For example, here are tactics I often use with clients but that you may be able to use yourself. I'll say something like, “Of course, you have the full range of options: increasing, continuing as-is, cutting back, stopping cold-turkey by yourself, or with a program’s help. As of now, which feels wise?” Sometimes the client says this isn’t the time to change. If so, I let it rest—pressuring probably won’t help.

When discussing options, I’ll usually say something like, “Do you want to write the baby steps to get to your goal?” Usually, they do. For example, they might write, “I have to get my girlfriend to agree to not do drugs, at least not in front of me. Then I have to toss my stash, and I need to find a substitute—play the guitar instead of getting high.” But as often, they’ll say that they just need to, ahem, just say no.

Then I’ll ask something like, “Imagine we were in Vegas. Should we bet that you would or wouldn’t do what you say are the next step(s)?” The clients are usually honest. If they say they'd bet against themselves, I ask, “What would make it worth betting on you?” One client said, only half-joking, “Having you stand in front of me 24/7 with an Uzi saying that if I pull out my vape pen, you’ll blow my brains out.” Often, the "What would make it worth betting on you" question unearths an underlying problem that need be addressed before the substance abuse can be expected to subside. For example, the client might say, “My life sucks. It doesn’t matter that I have a substance abuse problem.” We’d then dissect that and create baby steps to move up from there as pre- or co-requisite to addressing the substance abuse problem.

Some people are helped with cognitive therapy: correcting their erroneous thinking: e.g., "I'm more creative or likable when I'm high, "It so helps me cope with life that it outweighs drug use's liabilities," "My kids won't be affected," or, "I must satisfy my urge to feel good right now."Detox. In some cases, the withdrawal process is so psychologically or physically painful, marked by severe nausea, cramps, convulsions, and/or hallucinations, that the person requires a multi-day detox program.

Michael Edelstein, a Psychology Today blogger and San Francisco cognitive therapist who works with addiction problems, says that even successful "moderation usually requires abstinence for months, then moving to moderation, and defining in advance what moderation will consist of: e.g., only one drink per hour when out socially and none when alone."

Keep front-and-center the ways your life would be better if you stopped, and the price you've paid for your substance abuse. Edelstein recommends going further: "Five times daily, without fail, vividly read and write the pros and cons of kicking. And don't stop this when you're doing better."

Longer-term programs. The U.S. Substance Abuse and Mental Health Services Administration reports that "long-term drug use alters brain function and strengthens compulsions to use drugs. This craving continues even after drug use stops." So it's asserted that a long-term program may hold the best prospects for long-term avoidance of relapse.

  • Twelve-step programs help some people. Most likely to be helped are those who need structure, group support, and consider themselves religious or spiritual.
  • SmartRecovery is a global community of cognitive-behavior-therapy-oriented self-help groups.

The takeaway

Substance abuse is often a tough problem to solve, complex in etiology and treatment, often requiring long-term commitment and resilience in the face of relapse. So this article cannot be of sufficient value, but might it contain at least one idea that you or someone you care about sees as a step toward a life that's not weighed down by substance abuse?

For more help, here's a link to a wealth of resources.

I read this aloud on YouTube.


1 Replicated studies are finding that marijuana causes heart attacks and strokes, even among the young. This study was presented at the American Heart Association national meeting: This study was published in the Journal of the American Heart Association.

Here are more studies and literature reviews on marijuana's under-reported dangers: