Research-Backed Ways to Reduce or Eliminate Substance Use
- By enrolling in the course, students acknowledge: 1) substance use disorders/addictions are considered complex medical conditions for which the first order of treatment is medical care, 2) the content of this course is for informational purposes only and is not a form of, or a substitute for, individualized care, and 3) students will consult qualified health care professionals for personalized, individualized health care.
If you have begun to drink alcohol or use other drugs more than you wish, have attempted to cut down, and had difficulty, I hope this course might be helpful to you.
Researchers have found that people use substances for very human reasons: to feel good, to feel better, to do better, and to connect with others. Humans have used substances medically, spiritually, socially and recreationally for over 12,000 years. Ninety-nine percent of Americans use one or more of these experience-altering drugs: caffeine, nicotine, alcohol, marijuana, and others.
When people find themselves unable to control their use of substances, the sense of shock and betrayal is palpable. Humans expect to be able to use their own volition to decide what they do and don't do.
Neuroscience researchers have found, however, that natural and adaptive structures and functions of the brain can become automated through the complex interaction of substances, substance use, and an estimated 100 billion neurons in the organ of the brain.
Addiction is defined as "persistent drug use or other compulsive behavior despite adverse consequences." Part of the beauty of being human, of course, is persisting through adversity more generally: caring for our young and our partners, even when we are tired; working hour after hour, day after day, regardless of the weather, perfecting a basketball shot; practicing cracking eggs into the frying pan until we can do it without thought and concentrate on our families; sheltering at home during a pandemic when we long for release.
This admirable quality of the human brain can become problematic if it is paired with substance use or other activities like gambling, Internet gaming, and other forms of overuse or over-doing.
The vast majority of people who use substances of any kind - 70 to 80% - do so without negative consequences. For those who have developed difficulty managing use, this is what researchers term "brain automaticity." Substance use becomes deeply intertwined with brain structures and functions involved with learning, bonding, and other fundamental functions.
Whether a person has become aware on their own that they have difficulty managing their use of substances, or they have received a diagnosis of substance use disorder or addiction, the challenges are similar: How do I help myself with something that has happened at the brain level?! How do I make conscious a process that has become automatic? Even if I can become aware of the process, how do I help myself through the distress that occurs when I try to alter the process?
Fortunately, research is clear on what is helpful.
The Surgeon General's Report, Facing Addiction in America (2016), urges people with substance use concerns to begin with medical care. For some substance use disorders, brain alterations are significant and may require lifelong medication to maintain health. A complete physical, including lab work and mental health assessments, are necessary to determine if any untreated physical and mental conditions are compromising stability.
Once people have received medical care, they can be ready to tackle the extraordinary challenge of wrestling with the functioning of their own brains.
This course is my attempt to offer a distillation and synthesis of what research-backed counseling protocols have to offer to people with substance use concerns after - and this is crucial - receiving medical evaluations and medical care. The content of the course is grounded in cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), and cognitive processing therapy (CPT). The content is similar to that presented in self-counseling workbooks but in an online course form. Students can do the course individually, work together in groups, or work with their mental health care providers.
If you like the content of this introduction, I continue in a similar fashion in the course's videos. I recorded the videos at my home as if we were seated together, usually on the first take, during the last troubled days of May, 2020. I tend to have a passionate, rather than polished, communication style. That may or may not be a fit for you. I include handouts in the Resources sections for you to use either with or without the videos. The content is presented sequentially but you can work in any order that seems useful to you.
I am grateful to neuroscience journalist Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Looking at Addiction, for consultation on this course.
Since substance use is moralized, stigmatized and criminalized, I cannot publicly give credit to the countless individuals who have field-tested the assessments and exercises included in this course. Many have participated in using these materials and our outcome data is on my website. I, they, and we are all rooting for you.
- Anyone who has begun to drink alcohol or use other drugs more than they wish.
- Anyone who is worried that overuse of substances may be causing harm to themselves or others.
- Anyone who has been asked to reduce use of substances and has had difficulty doing so.
- Anyone who works with people who have challenges with substances and wants to learn more about what can be helpful.
- The Realities of Substance Use vs. What We've Been Taught to Believe01:51
- People Do Not Abuse Substances. They Use Them for Meaningful Reasons.01:57
- Medical Care First01:57
- Medical Care May Involve Medications00:48
- I, You, We01:16
- Substance Use vs. Substance Use Disorder/Addiction01:36
- Brain Structures and Functions Involved with Substance Use Disorders01:58
- Persistence Despite Adverse Consequences01:00
- Complex Brain Functions Are Interwoven with Brain Automaticity00:34
- "Substances Don't Cause Addiction. Trauma Does." Precursors to SUDs01:23
- Setting Goals Along the Abstinence/Harm Reduction Continuum00:42
- Components of an Evidence-Based Treatment for Substance Use Disorder00:37
- Sample Template for Setting Goals00:59
- Begin with Self-Kindness, not "Tough Love"00:30
- Let's Think About This Logically01:51
- Stability Helps00:53
- Stress and Distress Can Be Destabilizing.00:32
- Self-Care Helps with Stability01:13
- Self-Care Helps People Feel Better and Do Better01:10
- Becoming Aware of Needs and Wants and Ways to Meet Them00:49
- Ah, So These Are the Cards That Have Been Dealt00:24
- Identifying Needs, Wants, Strengths and Preferences00:35
- Awareness of Values and Priorities Offers Power and Momentum00:27
- Summary So Far00:47
- Awareness Skills Definitions00:34
- Awareness of Feelings and Thoughts Offers Access to Inner Wisdom00:31
- Powerful Attention Can Overcome Powerful Environmental Cues01:09
- The Importance of Attention00:31
- Acknowledging - Rather Than Judging - Attention00:23
- Awareness Skill #1: Attention Management00:27
- Work Attention As a Muscle00:26
- Work Attention As a Muscle 200:30
- Work Attention As a Muscle 300:36
- Work Attention As a Muscle 400:30
- Using Sensory Experience to Manage Attention00:43
- Taking a Sensory Tour of One's Surroundings00:50
- Awareness Skill #2: Awareness of Feelings00:37
- Having Feelings is Human00:30
- Helping with Feelings Helps with Thinking00:31
- Helping with Feelings Helps with Thinking 200:54
- Imagining an Inner Volume Dial on Feelings01:16
- Awareness Skill #3: Awareness of Thoughts00:21
- The Brain Is a Thought-Making Machine01:04
- Thought-Sorting 200:40
- Holding Onto Painful Beliefs00:50
- 70%+ of People with Substance Use Concerns Have Experienced Trauma01:28
- Cost-Benefit Analysis and Opposites Can Both Be True02:05
- Awareness Skill #4: Accessing Inner Wisdom00:56
- The Guidance of One's Inner Wisdom00:51
- Awareness Skills Summary: Fill-in-the-Blanks01:26
- What If?01:44
- Limits of Awareness Skills for Co-Occurring Disorders02:44
- All Deserve Evidence-Based Treatment04:00
- Bonus Lecture02:04
Anne Giles, M.A., M.S., L.P.C. is a Licensed Professional Counselor in the Commonwealth of Virginia. She specializes in offering kind, effective, research-backed counseling services for people with substance use concerns, including those with post-traumatic stress disorder and other serious mental illness diagnoses.
Through systematic literature reviews, consultations with experts - including neuroscience journalist Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Looking at Addiction - professional and personal knowledge and experience, Anne has developed and field-tested a brief counseling protocol to help people who need or want to reduce or end problematic substance use. Outcome data is available on her website.
Anne is licensed to provide individual counseling services to residents of the Commonwealth of Virginia.
Anne shares openly that she has been in remission from alcohol use disorder since 2012. She developed post-traumatic stress disorder, coupled with problematic alcohol use, after the Virginia Tech shootings, bookended by two incidents of student-on-teacher violence. She is an activist for evidence-based treatment for substance use disorders and is a contributor to Changing the Narrative, an initiative of the Health in Justice Action Lab at Northeastern University School of Law, a network of reporters, researchers, academics, and advocates dedicated to providing accurate, humane, and scientifically-grounded information on drug use and addiction. She is a rostered provider of Cognitive Processing Therapy for PTSD (CPT).
Anne lives in Blacksburg, Virginia, U.S.A. with four cats. She enjoys providing a home for international scholars visiting Virginia Tech. She loves partner dancing and is a beginning student of Mandarin Chinese.