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Substance Use

Substance Use: When It’s Recreational and When It’s a Problem

Here in NYC, it may seem like drinking and use of other drugs, legal or not, it sort of part of the NYC lifestyle. In some age groups, subpopulations and professions, it may seem like everyone is partaking. So it can be hard to gauge whether your own use is excessive or normal.

Talking to a non-judgemental Psychiatrist about Substance use is a good place to start. Because in truth, to use alcohol as an example, some people may be fine drinking a relative large number of drinks while someone who drinks quite a bit less has a problem.

How Do I Know if I Have an Addiction?

When a client comes to me wondering if they have an addiction or substance abuse problem, I don’t use an arbitrary cutoff. We will begin by talking about what substance(s) you use, in what settings and for what purpose. I will want to hear why you enjoy that substance, what it “does for you”. We will also talk about any downsides that you see related to alcohol, marijuana, cocaine or other substances you use. I’ll be curious to know if you feel your substance use affects your job, your relationship, your sleep, your health, your weight. And we will also talk about anything you may have already tried to reduce your use of alcohol, marijuana or other drugs.

What If I Know I Have a Problem with Substance Abuse or Addiction?

Please know that no one “starts to stop” their substance of choice on day #1 of psychotherapy. First we have a lot to discuss and we need to agree on a plan. Do you want to reduce your substance use or be completely sober or abstinent? Are you ready to start now or do you want to wait until other pressures die down? Do you have other people to involve and support you in cutting back or getting sober? And most important of all, do you have the proper coping skills and mechanisms in place to set you up for this challenge? Cutting back or getting sober is HARD. If it weren’t, you wouldn’t be considering seeing me about it! So before we begin we need to make a plan. If you know you will have insomnia or anxiety without your substance, let’s work out some solutions before we begin. If all your friends drink or use drugs and you are going to be lonely or isolated when you try to stop, then let’s put some plans in place to help support you once you do start.

Substance Abuse Treatment Geared Towards Cutting Down vs. Getting Sober

Not all people want to pursue abstinence from their drug of choice. Some of my clients want help feeling more intentional and conscientious about cutting back and feel that it will be helpful to collaborate with a Psychiatrist on a plan of how to do so. Sometimes just having someone to be accountable to can really help you stay on track. Other people know they need to get completely sober, but don’t know where to begin. Whether you are looking to reduce your substance use or eliminate it altogether, talking with a Psychiatrist will help you decide what is safe, what’s realistic, and what approach will set you up for success.

Medication Assisted Treatment for Substance Use

Fortunately there are many medications available to help reduce cravings and help you refrain from alcohol and drug use. Medications can also be helpful if your substance of choice played a role in treating anxiety, depression, social anxiety etc. Treating the underlying condition first can set you up for greater success once you try to reduce or get sober.

Therapy for Excessive or Problematic Alcohol or Drug Use

While medications may play a role, therapy is an essential tool in trying to reduce or get sober. By the time you walk into my office you have likely already developed a long term relationship with alcohol, marijuana, cocaine, club drugs or pills. And before you can successfully end that relationship it helps us to understand what I call the “love affair” with the substance.

Why? There are 2 reasons. First of all, it’s important for you to know that I’m not here to scold or shame you about your substance use. If you don’t have an issue with it, I doubt I can convince you there is one. Second, I understand that people drink or use drugs excessively because they feel that substance is doing something for them, they enjoy it, it helps them cope, it helps them relax, it helps them feel social, it helps them feel less sad, it helps them bond with the team at work, it helps them work long hours, it helps them stay slim…the list goes on and on. If we don’t try to find alternatives to address these needs, it’s likely that your substance abuse treatment will fail. In treatment, we will attempt to explore and out into place all the supports and bolsters you need to optimize success.

What If I Need an Inpatient Detox Program?

Some substances cannot be safely stopped or decreased at home because the risk of withdrawal is potentially life threatening. In these instances we will make a plan to discuss when you can take the time to focus on obtaining safe, medically supervised, inpatient detox treatment and I can help you with referrals to places which provide these services. It may be comforting to know that when you are done with that stage, I will be here to support you as an outpatient in your next steps.

I’m Motivated, but Can I Stay Motivated to Cut Back or Stop Drinking or Using Drugs?

In treatment, you are much more than your addiction. It’s important to have a treatment provider who knows about your life, your goals, your familial history with addiction. I strive to know my clients as a whole person because it’s here that we can identify the motivations and the stumbling blocks. We will work to identify the things that motivate you most whether that is fears about your health, the desire to save your relationship, the desire to not disappoint your kids etc. Most of my patients attempt to reduce way too fast or all at once and are very harsh with themselves when they fail or can’t sustain those changes. I believe in small steps, in not biting off more than you can chew, in small sustainable changes, accompanied by ample encouragement and admiration for every little step. Getting sober or reducing your substance use is an enormous life accomplishment, you deserve all the support, self care and kindness to yourself as you embark on this step.

Are you ready to schedule an appointment to explore reducing your use of alcohol, marijuana, cocaine, pills, club drugs or other addictions?

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