5 Questions about Substance Use with Dr. Kirk Mochrie: How to Know When You Have a Problem
We sat down with Kirk Mochrie, PhD, the TAP Clinic’s post-doctoral fellow who has particular expertise in substance use. We asked him 5 basic questions to understand how he thinks about substance use and treatment for substance use concerns.
Q: Dr. Mochrie, what does it mean to have a “problem” with substance use?
A: There are a variety of terms that are currently used to describe the intersection between substance use and mental health, including substance misuse, problematic use, heavy use, abuse, dependence, and even disordered use (SAMHSA, 2019). With so many terms, it is often difficult for an individual to know when their substance use has reached a problematic level. Sometimes pamphlets are offered at doctor’s visits that describe how much and how often you “should” use a substance like alcohol (e.g., 14 standard drinks per week). However, it is our belief here at TAP that most people do not fit neatly into a “should” category and would likely benefit more from a discussion of their substance use and how it affects them on a regular basis.
Q: How do you sort through the stigma around substance use to understand what is right for an individual?
A: Unfortunately, people who engage in substance use are often stigmatized by our society. For example, when picturing what an “addict” might look like, many people give the stereotypical, and often extreme, answer: A homeless man with no job, who looks disheveled, and is drinking out of a brown paper bag at a gas station or liquor store. It is important that we recognize this is not true for most people who struggle with substances. Some people may experience drastic or extreme consequences from their addiction- things like unemployment, involvement with the legal system, or losing custody of their children. However, others may be functioning well in terms of working or going to school and taking care of responsibilities, but still experience other problems related to substance use such as hangovers, emotional difficulties, and relationship issues with others.
In addition, due to stigma, there is a common myth that you can’t possibly have a substance use problem if you are using something that is legal, such as cigarettes, alcohol, and (in some states) marijuana, (NIDA, 2019). Someone might catch themselves saying “If it’s legal, it can’t be too bad for me”. Unfortunately, just as people can become addicted to cocaine or heroin, they can also experience addiction with legal substances. In fact, nicotine has been found to be as addictive as many illegal drugs and often results in a life-long addiction to cigarettes or other forms of tobacco.
Q: For someone reflecting on their own substance use, what factors might you suggest they initially consider?
A: I would recommend that you start by considering the function of your substance use, as this will help you understand why you use and what benefits you are receiving. Ask yourself:
Am I using when I am extremely emotional?
Am I using to help cope with problems in my life?
Do I use to help reduce anxiety or depression symptoms?
Do I use to help me relax and be more comfortable talking to people?
Do I use to enjoy socializing with friends?
How do I feel after using in the short-term versus long-term?
In addition, an important risk factor in determining your likelihood of developing a problem with substance use is genetics. Research suggests that children of two parents with Alcohol Use Disorders are between 4 to 5 times more likely to develop this disorder themselves compared to children without this genetic risk (Endenberg and Foround, 2014). It is important that you consider this as one factor in examining your substance use.
Lastly, it will likely be helpful to determine if your substance use aligns with your personal set of values/beliefs. If you find that your substance use doesn’t necessarily align with these, it will likely be useful to explore this further in individual therapy sessions.
Q: When you work with individuals struggling with substance use, what are some “red flags” that indicate substance use may have become problematic for them?
A: An individual’s red flags can vary and I hesitate to say any one factor is indicative of substance use concerns. However, there are certain red flag questions I do ask, and if the person answers in the affirmative, I like to understand more about the ways substances may be conflicting with the goals and values that individuals may have for themselves. Those questions are:
Would you rather be using than spending time with people you care about?
Have you experienced frequent problems from your use (e.g., relationship issues, work/school difficulties, etc.)?
Have you tried to cut down or stop using without success?
Do you crave your drug of choice on a regular basis?
Do you need to use higher amounts to get the same effect you used to?
Do you feel terrible when not using substances (i.e. symptoms of withdrawal)?
Do you use to help cope with other issues (e.g., depression, anxiety)?
Q: If someone does want help with substances, what should they do?
A: First, I would want anyone who believes they are struggling with addiction that you are not alone. According to the National Institute on Drug Abuse, 22.7 million Americans have an addiction to drugs or alcohol (2018). I would also encourage them to make a first appointment with a therapist specializing in treating substance use difficulties to discuss their concerns- whether it be here with TAP or another provider in the community.
At the TAP Clinic, we take a non-judgmental stance and collaborative approach to understanding your specific relationship with substance use. I’m happy to help my clients explore their substance use in a space where they can find their own values and goals. It is not my job to force a label or an interpretation on their substance use. It is my job to help clients maximize their lives and reach their goals. If substances are a current obstacle to those, I help them address it. To learn more about what addiction treatment is like here at TAP, check out my upcoming blog post on substance use treatment.