Written by Oprah Dean, CSW-I
Most people who use substances heavily are not doing it for pleasure by the time it becomes a problem. They are doing it because it works — on pain, on sleep, on fear, on memories that will not stay put. Treating substance use as a failure of willpower misses what is actually happening, and it makes the problem harder to solve. Understanding what the substance is doing for someone is the starting point for anything that helps.
None of that is a reason to keep using. It is a reason to stop expecting shame to accomplish something it has never accomplished.
Ask what it does before asking what it costs
Everyone around a person who drinks or uses heavily is focused on consequences: the job, the money, the driving, the missed events. Those are real and they are also the least useful conversational opening, because the person already knows.
A more productive question is what the substance is for. Not rhetorically — literally. Asked plainly, most people can answer it immediately, and the answer is usually specific.
It gets me to sleep. It stops me thinking about it. It makes me able to be around people. It turns the volume down. It is the only hour of the day that does not hurt.
Every one of those is a description of a problem being solved. Badly, at growing expense, but solved in the moment — which is why the behavior persists in the face of consequences that would deter anyone with a better option available.
The jobs substances get hired to do
In this work the same handful of functions come up again and again.
Sleep, above all. For someone who has lived in a house where nights were dangerous, sleep is not restful — it is undefended. Alcohol produces unconsciousness where rest is not available.
Numbing intrusive memories, which arrive uninvited and do not respond to reasoning. Something that dulls them is immediately effective in a way that almost nothing else is.
Managing a body stuck at high alert — muscles that will not unclench, a heart that races at nothing.
Getting through social situations after years of isolation. And for some, physical pain from injuries that were never properly treated because being seen at a hospital was not possible at the time.
Seen this way, the use is coherent. That does not make it safe, and tolerance means the dose needed to do the job keeps climbing.
Why willpower framing goes nowhere
If someone is using a substance to hold down three genuine problems, then removing the substance without touching the problems means asking them to face all three at once with less capacity than they had before.
That is why the lecture never works, and why shame makes things worse instead of better. Shame is an unpleasant internal state, and unpleasant internal states are exactly what the substance has been reliably fixing.
It is also why people can stop for a stretch and then return. What usually breaks a period of sobriety is not weakness but the reappearance of the original job — a spell of bad sleep, an anniversary, contact with the person it all started with — arriving before anything else was in place to handle it.
The point where it turns
The uncomfortable part is that the thing that was helping becomes one of the main sources of harm, usually without an announcement.
Sleep gets worse rather than better once alcohol is involved every night. Anxiety rises in the hours between doses, so the next one is needed sooner. The isolation it once relieved deepens. And the memories being numbed do not process — they wait, which is why people often find that the material is exactly where they left it when they stop.
Noticing that shift honestly is more useful than any external argument about it, and people generally know. They are just not often asked in a way that makes it possible to say.
Stopping is a medical question, not only a moral one
This part matters and is frequently left out.
If you have been drinking heavily every day, or using benzodiazepines regularly, stopping abruptly on your own can be dangerous. Withdrawal from these is a medical situation and should be managed with a doctor, who can make it both safer and considerably more comfortable. That is not a reason to keep drinking; it is a reason to make the plan with a professional rather than at midnight on a resolution.
For other substances, abrupt stopping is generally less medically risky and still much easier with support than alone.
If you reach a point where you are thinking about not being here, 988 is available by call or text at any hour. Substance use and despair frequently travel together, and that is worth saying out loud to someone rather than riding out.
What has to be in place instead
The gap left behind is the real work, and it is why treating trauma and substance use together tends to go better than treating either alone.
Sleep, addressed directly — with a doctor, with a routine, with whatever is needed to make nights survivable without alcohol.
Something for the intrusive material, since it does not simply stop once the numbing does. Trauma-focused therapy exists precisely for this and works at a pace you set.
Regulation skills for the body, practiced when calm so that they are available when not.
People, which is usually the hardest and the most decisive. Groups do something particular here: they replace the social function the substance was covering, and the explaining is already done before you arrive. Group therapy is one route, and free peer-led meetings around the valley are another.
And a plan for the specific moments — the hours, days, and dates that reliably bring it back — decided in advance and written down, because those hours are not when good planning happens anyway.
Common questions
Does calling it survival mean it is not a problem?
No. It explains the behavior without excusing the harm. Something can be entirely understandable in its origin and still be doing serious damage now, and both of those things need to be true in the conversation for it to go anywhere useful.
Should trauma be dealt with before or after getting sober?
Usually alongside, with stabilization first. Waiting for complete sobriety before touching the trauma leaves the reason for using untreated; diving into the worst memories with no stability in place tends to increase use. Good practice sequences it — steadiness, skills, then the deeper work.
Is moderation possible, or does it have to be abstinence?
That depends on the person, the substance, the history, and any medical factors, and it is a question for a clinician who knows the details rather than for a general rule. What is fair to say is that if moderation has been attempted repeatedly and has not held, that is information worth taking seriously rather than repeating.
What if I am the family member watching this?
You cannot supply willpower to another adult, and pressure rarely produces change. What helps is staying connected, being honest once about what you see, declining to cover the consequences, and getting support for yourself — this is exhausting to watch, and people who last have somewhere of their own to talk.
Drinking or using that has quietly become the thing holding a difficult life together deserves a conversation with someone who will not lead with judgment. Book a time, or read a little about how I work first.