When it comes to problematic substance use, most people sit in my office and say some version of, “I know I should just stop.” If only it were that simple. Substance use isn’t a moral failure or a motivation problem—it’s a coping strategy that’s become unhealthy. For a time it was doing a job, often quite efficiently, until it wasn’t. Talk therapy helps you identify that job, meet the need more safely, and rebuild real choice—whether your goal is cutting back or pursuing abstinence.
Substances Have a Job. Find It Before You Fire It.
Alcohol, weed, pills, cocaine—each tends to “work” for something: numbing grief, quieting anxiety, easing social pressure, turning down intrusive thoughts, or interrupting loneliness. When we treat use like pure bad behavior, we miss the function. In therapy, we map patterns: What’s happening right before the urge? What relief does the substance deliver? What’s the cost—now and later? Naming the job gives us leverage to meet the same need with fewer consequences.
Don’t start with “stop.” Start with “what is this doing for me?”
Harm Reduction Isn’t Giving Up—It’s Getting Safe Enough to Change
Harm reduction is a compassionate and practical approach to managing substance use or risky behaviors. Instead of insisting on complete abstinence, harm reduction focuses on making these behaviors safer and reducing potential harm, supporting you in progressing at your own pace. It recognizes that for many people, an all-or-nothing mindset can feel overwhelming or unattainable, so it provides a middle ground where safety takes precedence.
This approach includes strategies such as planning for safer use by choosing cleaner substances or using measuring tools, reducing dosing by spacing out consumption or lowering amounts, and changing the environment to safer settings or using with trusted people. Adding food and water helps your body process substances better and can lessen negative effects. Tracking triggers and patterns can help you identify situations or feelings that lead to risky behaviors, so you can develop ways to manage or avoid those triggers. Preparing exit strategies, such as having a safe place to go or someone to contact during cravings or emergencies, adds another layer of safety. Engaging support from medical professionals, counselors, or support groups is also essential, especially when managing withdrawal symptoms or overdose risks.
Harm reduction is rooted in the belief that safety is non-negotiable, but recovery is a gradual process built on compassionate care and trust. It provides a stable foundation, allowing you to make responsible, incremental changes when you're ready, rather than cycling through an all-or-nothing mindset.
Many people find themselves trapped in this pattern of “nothing-then-all,” but harm reduction offers a middle path. This includes planning for safer use, delaying or lowering doses, changing environments, staying hydrated and nourished, tracking triggers, and preparing exit strategies for when cravings hit. It also involves coordinating with medical providers to manage withdrawal risks and ensure safety.
My background in addiction work is firmly rooted in harm reduction principles, and I bring this perspective into my work as a therapist. I am experienced in supporting individuals at all stages of their recovery, emphasizing steady progress at your own pace while always prioritizing your safety, well-being, and personal growth.
For Loved Ones: Boundaries Are a Form of Care
Partners and family often carry frustration, fear, grief, and guilt. Supporting someone doesn’t mean shrinking your life or doing the work for them. In therapy, we clarify boundaries (“I’m willing to drive you to appointments; I’m not willing to fund your use”), replace lectures with requests, and learn how to step out of power struggles with the substance. You can protect your well-being while staying connected; those aren’t opposites.
Try This Week (Small, Doable Experiments)
The 10-Minute Delay: When an urge hits, set a timer for 10 minutes and do one neutral action (shower, short walk, text a friend). Re-evaluate after.
Trigger Map: Write down the top three “when/where/with whom” patterns. Pick one to tweak this week (change time, place, or people).
If-Then Plan: “If I feel the 4–7 pm slump, then I’ll eat, drink water, and text __ before deciding.”
Use Log (No Judgment): Track what, when, how much, and how you felt before/after for seven days. Patterns beat hunches.
Boundary Script (for loved ones): “I care about you. I’m willing to __. I’m not willing to __. If __ happens, I’ll __. I’m here when you want support.”
Substance use thrives in secrecy and shame. Therapy offers a steady, non-judgmental place to tell the truth, reduce harm, and build the skills and structures that make change durable—whether that means drinking/using less, stopping altogether, or learning new ways to cope with pain, stress, or mental health challenges. If this perspective resonates, I work with individuals and with partners/families navigating a loved one’s use.
This article is for general information and isn’t a substitute for medical or mental-health care. Alcohol, benzodiazepine, and opioid withdrawal can be dangerous—consult a clinician. If you’re in crisis, call 988 in the U.S. or your local emergency number
