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Tough Problems—Substance Abuse in the Time of Coronavirus

Five causes, each with its own approach.

U.S. Dept. of Defense, Public Domain
Source: U.S. Dept. of Defense, Public Domain

This is the latest in the Tough Problems series.

With more time on our hands and more stress in our lives, substance abuse is an increased risk, as when automotive plants shuttered, substance abuse increased.

There's no one-size-fits-all approach. As with a headache, the treatment depends on the cause. Of course, there can be more than one cause:

Boredom. Some of my clients conclude that boredom is a major reason they abuse a substance. That’s good news because that cause is relatively easy to address: We identify activities that could be more attractive than substance abuse. Often they’re addictive activites that can be done solo, because doing drugs can be done while alone. Some of the activities that my clients have successfully substituted include video games, binge-watching favorite TV, staying busy with work and family, and perhaps surprising, helping others. I’ve had clients volunteer at 7 Cups of Tea, a service in which anyone can volunteer to listen to callers' problems.

Anxiety. Some people abuse substances to self-medicate their anxiety, which is heightened today by coronavirus fears. My first-line approach is to ask the client such questions as, “Let’s assume worst case: How would you cope?" and “Let’s assume the most likely case. How would you deal?” I accompany such questions by encouraging distraction: “The moment you’re aware of the anxiety, redirect to something constructive.” That tends to atrophy the memory neurons associated with the anxiety." If such purely practical approaches are insufficient, cognitive-behavioral therapy may additionally help.

Addictive personality. Genes do predispose a person to addiction but life can be improved by substituting healthier addictions, perhaps plus cognitive-behavioral therapy or a 12-step program. A new metaanalysis has found 12-step programs to work well for many people.

Rebelliousness. Some clients abuse substances, at least in part because of rebelliousness against their parents, their partner, or the societal mainstream. Usually, they’ve been rejected by one or more of those and abusing substances, rejecting others' approach to life, is a way of preserving their self-esteem.

Rebellious people may manifest that not just in substance abuse but in unconventional appearance and in career or avocational choices. A client of mine comes to mind: Her hair has a purple streak, she has many piercings and tattoos. She’s “into” cosplay, sexual extremism, and brags that she has seen The Rocky Horror Show so many times that she knows many of its lyrics. Her favorite is “Planet Schmanet, which has lyrics such as, “Your apple pie don't taste too nice—A mental mind fu*k can be nice. Planet, schmanet, Janet!” I usually don't try to get such clients to be more mainstream but rather, invite them to channel their rebelliousness into something possibly more constructive than substance abuse, for example, out-of-the-mainstream politics, writing, or visual or performing art.

Hopelessness: Some people abuse substances because they feel their life is hopeless, so it’s not worth taking care of themselves—It feels better to just anesthetize. That is the hardest cause to address. We typically address it a bit at a time. I’ll ask the client something like, “Take the aspect of your life that you’re most motivated to tackle. Perhaps it’s something you deem easy: like cleaning one corner of one room. Or apologize to a loved one you’ve hurt. Or read an article on how to write a LinkedIn profile. When you’ve done one of those, try another. That may build momentum. As they say, an object in motion tends to stay in motion.”

Of course, it would be simplistic, downright Pollyannaish of me to assert that a short article can cure a person’s substance abuse, let alone amid the coronavirus’s added stress and home-boundness. But I hope you’ll find something here that offers a glimmer.

I read this aloud on YouTube.

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