Substance abuse

By Max Lloyd


In the words of an old joke, you know if you are drinking too much if you drink more than your doctor. While this statement might have had some point to it once, it is less than helpful now. Given the proliferation of substances, legal and illegal, that are available and the tendency for multiple use, it can be difficult to sort out what is a problem and what isn't. It can be hard for parents and others to gain accurate information about the properties and effects of substances young people are using. As well, there have been major changes at the cutting edge of how society views problems with substance use.

For many who work in the substance abuse treatment field, harm reduction is the current new thinking and practice. Based on well- researched and evidential findings, it offers a way of working with individuals and families without stigmatising or judging the substance user. It recognises that people use alcohol and other substances for a variety of reasons and with many different outcomes. Of those who develop problems associated with their use, many recover without input from professionals.

More challengingly, this approach asserts that addiction is not a disease, but instead addictive behaviours are made up of a combination of biopsychosocial ingredients. These include the nature of the substance, the relationship between the user and their drug of choice, the obvious fact of self-medication by many for other disorders or discomforts, biological vulnerability and changes in use over the individual's lifespan.

Clearly, there is not an inexorable progression from so called "soft" to "hard" drug use for the majority who try the first option. Equally, alcohol and other drug use problems can be understood using the same psychological knowledge and tools that apply to other groups in society. Most importantly, from the point of view of help or treatment, change occurs in stages and must include consideration of the individual's ambivalence about giving up the benefits of their use. The focus of such work is on the harm done, rather than on the substance itself. For instance, illicit use is not necessarily abuse from this treatment perspective.

Harm reduction has sometimes been maligned as being pro drug use. This is not the case. The approach recognises that there is a continuum of use, including non-use, moderate use and persistent addiction. For am individual in the latter position, non-use may well be the best harm reduction.

Max Lloyd is a counsellor and psychotherapist practicing in Ponsonby, Auckland. He has a developing interest in schema work and can be contacted on