Addiction Therapy
Discover the larger story of your life.
Addiction is incredibly complex because it has biological, psychological, and social factors. For that reason, I don’t believe in a one size fits all approach to treating addiction. I believe it’s more important to examine each factor and discover how it’s related to the larger story of your life.
The Three Factors
While there is no one specific experience universal to all who identify as LGBTQ+, there are often common themes woven throughout.
Biological
Substance abuse is believed to be inherited or passed on through families, making a person more likely to struggle with substances if there is a family history of abuse. This is true not only because of specific genetic markers, but also due to the environment in which each person was raised.
If alcohol or other substances were a regular feature in your childhood, they are more likely to make an appearance in your adult life as well. This is especially true when we lack role models that demonstrate healthy coping, and instead we learn to deny, dismiss or disregard our emotions.
Psychological
Mental health issues like depression, anxiety, and trauma can all exacerbate substance abuse. Oftentimes, this is what we refer to when we describe the use of alcohol or other drugs as a means of “self-medicating”. In this we learn to “drown our sorrows” or find the “liquid courage” to face our fears, or otherwise numb ourselves to the pain of our past experiences.
Those with severe mental health concerns who have developed a psychological and physical dependence on substances have what is called “dual diagnosis” or “co-occurring disorders”, and may require specialized treatment.
Social
Throughout the course of life, many social factors like family, friends, work, and societal norms can influence one’s decision to partake in drinking or drug culture.
In adolescence this can look like peer pressure or for LGBTQ+ individuals, the desire to find ways to just “fit in” and be “normal” like everybody else. In college, binge drinking and recreational drugs may seem acceptable because they are the norm. At the dance club, ecstasy and cocaine keeps the party alive. For singles, going out may feel like the only way they’re able to meet potential partners.
While these factors are important, often they miss out on an important connecting piece.
For this, we need to understand the larger story to truly tease out what is going on underneath the behavior.
What is the Larger Story?
When we talk about alcohol and drug addiction, I believe that we don’t necessarily need to look at it in the same black-and-white manner as others may try to convince us.
We do, however, need to ask ourselves some important questions about the function of alcohol or other drugs in our life.
Why do I drink?
Why do I use?
Is it to regulate my emotions?
To feel? To stop feeling?
To participate socially?
To relax?
To have a good time?
The Larger Story
Getting to the root of these questions requires having an honest and vulnerable conversation with ourselves.
Shame
One of the most dangerous and destructive things in the world is shame. For those in the LGBTQ+ community, often it develops right alongside our growing consciousness that there is something “different” or “wrong” with us because of who we are or who we love. This is not so different from the shame that stems from engaging in addictive behavior, and the painful shift in priorities that so often affects others in our lives.
We feel shame when we recognize desires within ourselves that go against the social and cultural norms we were meant to abide by. We hear its voice on a loop in our brain. Eventually, we take on its narrative as our own, believing the lies that we are broken or “not good enough”, and if others knew the real us, they would reject us.
Avoidance
Understandably so, our experience of shame is incredibly uncomfortable and painful. To deal with our discomfort, we turn to substances to deny, dismiss, and disregard our emotions. In this, we learn to regulate our internal selves through an external means.
This avoidance technique ultimately solves the wrong problem. Rather than speaking truth to the hurting parts of us, we silence and distance ourselves from them. We operate out of a desire to avoid the discomfort rather than find a solution for the pain.
Often we find that while this may work for a while, the initial hurt and pain we experience has not lessened, and likely has only grown and, not to be ignored, has found other means of unintentional expression in our lives.
Honesty
Moving from a cycle of shame and avoidance requires honest reflection.
Again, ask yourself: Why do I drink? Why do I use? Is it to regulate my emotions? To feel? To stop feeling? To participate socially? To relax? To have a good time?
More than that, you may also want to consider: How are your behaviors affecting others? How are they affecting you? What are the long-term patterns that you are establishing, and is that paving the way towards the type of life you want for yourself?
Vulnerability
The opposite of shame is vulnerability—it cannot survive when exposed to the light of our truth.
Vulnerability, however, is by definition a courageous and uncomfortable process. It requires us to do the opposite of the avoidance that comes so naturally to us, and instead asks us to sit with the fear and hurt and pain, to feel it rather than rush through it.
Vulnerability means giving a voice to the silenced and lost parts of us, nurturing them and reminding them of their value.
For LGBTQ+ folks who struggle with addiction, substance abuse is often a way to cope with internalized shame, which can feel like a cage. When we learn to accept ourselves and know that we are unique, special, and worthy of love and belonging, we can begin to find freedom from addiction and recover.
Acceptance of Ourselves & Our Emotions
Often, overcoming addictive patterns is about learning how to sit through discomfort and regulate emotions when alcohol and drugs are taken out of the picture. For this reason, discovering healthier ways to engage in self-care and process through difficult emotions is key.
Is My Drinking a Problem?
After considering the options, you may still find yourself asking the question, “Is my drinking a problem?” or “Is using ecstasy/ GHB/ cocaine really a problem for me?” You may take comfort in the fact that you are able to separate your substance use from the rest of your life, and keep it relegated to the part of you that goes out and has a good time.
However, there is some insight to be gained from the fact that you have found yourself on a therapist’s website asking the question, “Is my drinking a problem?” While I believe in less of a black-and-white approach to treating addiction, and believe that problematic substance use exists on a spectrum, it is important to pay attention to that voice inside that may be carrying an all-important message, that may already be trying to tell you that there is a problem.
What is Harm Reduction?
Harm reduction is a treatment ideology that moves away from the idea that people need to hit “rock bottom” before they are able to find the motivation to recover. Instead of holding on to our old ideas about what treatment for addiction looks like, harm reduction strategies aim to reduce the negative consequences that people often suffer alongside their addiction.
Most well-known is the use of needle exchanges that offer clean and sterile syringes to help prevent the spread of Hepatitis C, HIV, and other infectious diseases to high risk communities. The movement has expanded to include medication-assisted treatment (Suboxone tapers, Vivitrol shots) as well as other methods of reminding those who use drugs that they too deserve dignity, health, love and respect.
The principles that inform harm reduction strategies acknowledge that complete abstinence from drugs may not be realistic, and that “healthy” use spans from moderation to abstinence. For these reasons, it’s important to discover how addiction may be causing problems in your life, and work to create a relationship with drugs or alcohol that is less problematic.
After determining what function alcohol and other drugs play in your life, it is important to examine the impact substances have on your whole person- body, mind, and soul.
The current criteria that mental health professionals use to determine the presence and severity of a substance use problem are as follows:
Using larger amounts or for a longer period of time than you meant to.
Wanting to cut down or stop but having difficulty doing so.
Spending a great deal of time getting, using, or recovering from the effects of the substance.
Physical or psychological cravings and urges.
Not following through with responsibilities at work, home, or school.
Facing relationship difficulties and yet continuing to use.
Missing out on important social, occupational, or recreational activities.
Continued use despite exposure to dangerous situations.
Co-occurring physical or psychological problem that could have been caused or made worse by the substance.
Developing a tolerance and need to increase the dose to achieve the same effect.
The arrival of withdrawal symptoms, which can be relieved by taking more of the substance.
The Opposite of Addiction is Connection.
While addiction is certainly all of these things listed above, we cannot forget the deeper truth that runs through the narrative, that at its core, substance use is about the inability to connect in healthy ways with other human beings.
As those who identify as LGBTQ+ often face social stigma, discrimination, and other challenges not encountered by people who identify as heterosexual or cisgender, they often learn to downplay or hide this part of them. They struggle to find their own identity against a heteronormative culture, and it is often not until they find connection within a larger community that they also find the ability to share a more true expression of themselves with the world.
Of course, challenges can arise when norms for the community you’re desperate to be a part of are —or appear to be— dismissive of the risks of long-term or even binge substance use. When you’ve spent years feeling like the outsider in social groups, you may feel tempted to change key aspects of yourself in order to fit in.
Overall, It’s important for you to figure out what works for you and determine your own outcome. I work from a harm-reduction framework, which means that my goal is to reduce the harm that substances are causing you. Whatever that looks like is up to you.
