You have seen many articles about how people who have a substance use disorder lie and manipulate others. These articles warn against trusting or believing a person with an addiction. This article will present a more compassionate viewpoint that pulls from many years of working as a counselor with very honest people who have suffered from and very frequently overcome serious substance use disorders. The images from Hollywood, in the media and in television often paint a bleak picture of substance use. Popular psychology self-help books tend to vilify and stigmatize those how have problems with substance use by perpetuating myths and presenting one dimensional characterizations of people with SUD. In over 20 years of experience working with individuals who use substances in a way that causes harm, most individuals I have known, abstaining or actively using, defy these stereotypes. This article focuses on the strengths of these individuals through the truths they tell. Many will achieve long term abstinence, some will moderate their use or learn to decrease the harm and some will continue to use or relapse to use frequently. Every person that I have worked with regardless of the level of interest in treatment or understanding of the problem are reflected in the following truths they tell.
- I know I have a problem with substances. Scratch the surface of denial and there it is. A truth well-known to those who struggle with substances. Denial is no more a part of the disease of substance use disorder than it is of other health conditions. The truth is that people may protect themselves from perceived weakness, the judgment of others and themselves by professing that they do not have a problem. Sometimes people who use will go to great lengths to explain why the problems they have are not related to using as often people with chronic health conditions go to great lengths to rationalize symptoms, avoid care, and avoid addressing or acknowledging the problem. Most people with a substance use disorder are aware that there is a problem and most people have at least some motivation to do something differently.
- I am sorry for the pain I cause others as a result of my substance use. For people who have lived with someone with a SUD for some time, you may question this truth. You may be saying, “if you are sorry, you stop doing what is hurtful”. Substance Use Disorders are disorders that have a biological basis. People are genetically more and less disposed to SUD and people who have mental health conditions or have experienced trauma have underlying brain changes that predispose them to reacting differently to substances when they are used. This is not to say that behaviors that are hurtful should be excused (see truth #9). If I have an SUD, I am most likely very much aware of how my use affects people around me and I feel guilty about that. I feel so guilty that I am likely to manage that feeling with more, not less, use.
- I have experienced trauma and have difficulty managing emotions. There are studies that show that people who have a substance use disorder are very likely to have experienced a traumatic event in childhood and the more trauma experienced, the more likely a person is to have a substance use disorder. Not everyone who has a SUD has experienced trauma, but if you have the disorder, you are far more likely than someone who does not have a SUD to have experienced trauma. Trauma has effects on the brain that may contribute to SUD and to other mental health disorders.
- I have tried to quit or cut down many times. Because I know I have a problem and I feel badly for my actions, I have tried to cut down or stop using many times. I have tried a lot of things and many of them have worked a little, others seemed to have actually made things worse. I am very upset about this and it adds to a feeling of weakness and maybe even shame which is likely to add to the problem if I cannot find better ways of coping with my feelings.
- I listen to your concerns when you express them. I know that you are aware that I have a problem. I may feel more comfortable avoiding conversations, especially if I do not feel ready or do not believe I am able to make changes in my using. I do listen to what you say and your expression of concern and especially specific communication about how you have been affected by my use have an impact in how I see my use. I may not make changes right away but your honesty and concern are likely to be something that will help me to resolve my ambivalence in the direction of making a change and may help me to get there sooner.
- I am scared to think about what life might be like without substances. I did not set out to develop a substance use disorder. I most likely started using substances as a teenager with friends to have fun. I responded to the substance differently than my friends did. I may have immediately felt a relief from negative feelings or an attraction I might describe as falling in love with the good feeling. So when most of my friends got interested in other things and let the use of substances fade in their life, for me, I continued to escalate my use and other things receded in importance.
- I have a lot of ambivalence about continuing to use. I may not even like using anymore but I have real difficulty imagining life without the substance. I may be afraid of withdrawal and the long period of feeling anxious or depressed that may come with abstinence or I may still associate using with fun. Either way, I see the substance as a big part of my life and no matter how much pain and sadness it has caused, I will experience a loss as I think about stopping use or even cutting back my use. I would like to think I can go back to using like I did at the beginning but I am pretty sure that will not work for me.
- I am embarrassed by what I see as a lack of strength or willpower. I see how people with substance use disorders are portrayed and I feel embarrassed because I also believe that my problem is my fault and that I should be stronger. I feel ashamed that you see me with my substance after our heart to heart where I promised I would change and that shame is likely to add fuel to urges to use more. This is a cycle I have trouble undoing (see #3, 4 &7). You react with disappointment and anger, and I feel the same way.
- I am responsible for my actions under the influence or sober and should be held accountable for them. There are lots of well researched reasons that I keep using in spite of my recognition that I have a problem and that I cause problems for others. This is a reason that you should feel compassion for me and my struggle. My behaviors are my responsibility and I realize I need to be held accountable for them. If I drive a car under the influence, hurt you, neglect responsibilities because of my use, I should expect the natural consequences of these behaviors and it is not your responsibility to save me from those consequences. I may feel scared and angry, I may blame others, but I know that I need to account for my behavior and that some of the consequences in pain to self and others is serious, sometimes tragic.
I have a disorder like any other medical disorder. Because I make decisions every day about whether to use a substance, there is a natural belief that I have the ability to choose not to. I react differently to the substance because of hereditary factors, experiences and mostly because I have used the substance and it has caused changes in my brain. Most people can relate to the difficulty of going on a diet or starting an exercise routine. There is a strong urge go off the diet (just for today),or to just stay in bed, multiply that by some magnitude and you will begin to understand what I am facing. I hope you will appreciate the millions of people who have been successful in overcoming a SUD. I think I will make it too. What I need more than anything is your compassion, your acceptance and support.