A nuanced, non-judgmental look at substance use and how therapy can support meaningful, lasting change
Substance use is a complex and deeply human experience that exists on a wide spectrum. Substances such as alcohol, cannabis, opioids, stimulants, benzodiazepines, prescription medications, and other drugs can be used for many reasons, including social connection, pain relief, emotional regulation, curiosity, or survival during overwhelming circumstances.
Because substances affect the brain’s reward and stress systems, patterns of use can develop gradually and often unintentionally. Understanding substance use through a compassionate, evidence-based lens helps reduce shame and creates space for effective support and change.
Understanding Different Substance Use Patterns
Not all substance use is inherently problematic, and frequency alone does not determine whether there is cause for concern. Some individuals use substances occasionally without significant negative impact, while others may notice increased use during periods of stress, trauma, grief, chronic pain, or mental health challenges.
Patterns can include recreational or social use, situational use tied to stress or sleep, binge patterns, daily or habitual use, or reliance on substances to manage emotions or function day to day. These patterns often reflect attempts to cope rather than intentional self-harm, and recognizing this distinction is essential for effective intervention.
When Substance Use Becomes a Clinical Concern
Substance use becomes a clinical concernclinical concern when it begins to interfere with a person’s well-being, functioning, relationships, or sense of control. This may include difficulty reducing or stopping use despite intentions to do so, escalating amounts or tolerance, strong cravings, withdrawal symptoms, neglect of responsibilities, continued use despite negative consequences, or increasing reliance on substances to manage emotional distress.
Use may shift from being a choice to feeling necessary for relief or stability. Importantly, this does not indicate weakness or failure. It reflects changes in the brain and nervous system shaped by learning, stress, and lived experience.
Unfortunately substance use can worsen anxiety, low mood, emotion regulation, and trauma. While it might feel like a quick fix, substance use disrupts brain systems that manage stress, mood, and reward, making anxiety spike, sadness linger, and emotions harder to handle.
Sleep, focus, and emotional processing take a hit, and for those with trauma, substances may numb memories but actually keep the brain stuck in overdrive. In short, substance use and mental health issues can feed each other, showing why treatment needs to tackle both together.
Why a Shame-Based Approach Does Not Work
Historically, substance use problems have often been framed as moral or behavioural failures, which can intensify shame and secrecy while discouraging people from seeking help. Research consistently shows that shame increases avoidance and emotional distress, both of which can reinforce substance use.
Compassionate, evidence-based treatment focuses instead on understanding the function substances serve and supporting people in developing safer, more sustainable ways to meet their needs. When individuals feel respected and understood, change becomes more achievable and more enduring.
Evidence-Based Approaches to Treating Substance Use
Effective treatment goes beyond simply telling someone to stop using substances. While abstinence may be an important goal for some, others may begin with harm reduction, stabilization, or clarifying their relationship with substances.
Evidence-based therapy focuses on building insight, emotional regulation, behavioural flexibility, and alignment with personal values, all within a strong therapeutic alliance. Treatment is most effective when it is individualized rather than one-size-fits-all.
How Cognitive Behavioural Therapy Supports Change
Cognitive Behavioural Therapy helps individuals understand how thoughts, emotions, urges, and behaviours interact to maintain substance use. Clients learn to identify triggers, high-risk situations, and unhelpful beliefs such as “I can’t cope without this” or “I’ve already failed, so it doesn’t matter.”
CBT provides practical tools for managing cravings, reducing impulsive behaviour, coping with stress, and responding differently to internal discomfort. Over time, this increases a sense of agency and reduces reliance on substances as a primary coping strategy.
Acceptance and Commitment Therapy and Substance Use
Acceptance and Commitment Therapy offers a powerful alternative to control-based approaches. Rather than attempting to eliminate urges, cravings, or painful emotions, ACT helps individuals change how they relate to them. Internal experiences are treated as normal aspects of being human rather than problems to escape.
Therapy focuses on clarifying values, such as health, relationships, honesty, or self-respect, and supporting meaningful action aligned with those values even when discomfort is present. This approach is especially helpful for people who feel trapped in cycles of avoidance or who have struggled with rigid rules around substance use.
Understanding Substance Use Through Internal Family Systems
Internal Family Systems therapy recognizes that substance use often serves a protective role. Parts of a person may use substances to numb pain, reduce anxiety, manage trauma responses, quiet inner criticism, or create a sense of connection or relief.
Rather than trying to eliminate these parts, which fuels shame, IFS helps individuals approach them with curiosity and compassion while addressing the underlying wounds or unmet needs they carry. As self-leadership, emotional safety, and internal trust increase, the need for substances often decreases naturally.
What Effective Treatment Looks Like
When CBT, ACT, and IFS are thoughtfully integrated, treatment becomes both structured and deeply compassionate. Clients gain practical skills, emotional insight, and opportunities for experiential work that address underlying drivers rather than focusing solely on symptoms.
Evidence shows that outcomes improve when therapy is collaborative, tailored, and grounded in well-established modalities. Simply talking about substance use without addressing core emotional and behavioural patterns often leads to limited or short-term change.
A Hopeful and Individualized Path Forward
Change is rarely linear, and progress is not defined by perfection. Increased awareness, flexibility, self-compassion, and alignment with personal values are meaningful indicators of growth. Whether someone is questioning their relationship with substances, struggling with long-standing patterns, or supporting a loved one, understanding substance use through a nuanced and compassionate lens opens the door to healing and lasting change.
If you are ready to explore support that is evidence-based, respectful, and tailored to your needs, we invite you to contact us to learn how therapy can help.
