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.