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SUBSTANCE USE BEYOND STIGMA

Understanding the Real Story Behind Addiction

What We Get Wrong About Substance Use

When someone struggles with substance use, our first instinct is often to ask "Why don't they just stop?" But this question misses the deeper truth: substance use is rarely about the substance itself—it's about what that person is trying to cope with.

Substance use disorder. All Heart Initiative

Most people who develop substance use disorders aren't seeking to get high. They're seeking relief from:

  • Untreated depression or anxiety

  • Trauma from childhood or recent experiences

  • Chronic physical or emotional pain

  • Overwhelming stress or major life changes

  • Other mental health conditions


The Reality: Substance use often starts as self-medication—a way to manage feelings or situations that feel impossible to handle otherwise.


The Science: Why It's Not About Willpower


Research shows us that substance use changes the brain, but not in the way most people think. Here's what actually happens:


Step 1: The Need to Cope When someone experiences trauma, chronic stress, or mental health symptoms, their brain's stress response system becomes overactive. They're living in a constant state of emotional pain or hypervigilance.


Step 2: Temporary Relief Substances provide immediate (though temporary) relief from these overwhelming feelings. The brain remembers this and begins to crave that relief.


Step 3: The Cycle Deepens Over time, the brain adapts to expect the substance. Without it, the original symptoms return even stronger, plus withdrawal symptoms. This isn't weakness—it's biology.


The Bottom Line: By the time someone has a substance use disorder, stopping isn't just about willpower. Their brain has been rewired by both their underlying mental health needs and their attempts to cope with them.


Take a deeper look. Substance use disorder. All Heart Initiative

Recognizing the Signs: Look Deeper Than the Surface

Instead of just watching for substance use, look for signs someone might be struggling with underlying issues:


Emotional Changes:

  • Persistent sadness, anxiety, or irritability

  • Sudden mood swings or emotional numbness

  • Expressions of hopelessness or feeling overwhelmed

Behavioral Changes:

  • Withdrawing from family, friends, or activities they used to enjoy

  • Changes in sleep patterns or appetite

  • Declining performance at work or school

  • Using substances in response to specific triggers (stress, social situations, bedtime)

Life Circumstances:

  • Recent trauma or loss

  • Major life transitions (divorce, job loss, empty nest)

  • Chronic health problems

  • History of untreated mental health conditions


How to Help: Move Beyond "Just Say No"


Instead of: "Why can't you just stop?"

Try: "I've noticed you seem to be going through a tough time. How can I support you?"


Instead of: "You're destroying your life."

Try: "I care about you and I'm worried. What's been going on that's making things so hard?"


Instead of: Giving advice or ultimatums

Try: Listening and asking, "What kind of help would feel most supportive right now?"


Key Principles:

  • Address the "why," not just the "what" - Help them access mental health support

  • Be patient - Healing takes time, especially when trauma or mental health issues are involved

  • Focus on connection, not control - Shame and isolation make everything worse

  • Get support for yourself too - Supporting someone through this is emotionally demanding


Real Stories: The Human Side


"I started drinking in college to calm my social anxiety. Nobody saw a problem because I was a good student. But inside, I was using alcohol like medication for panic attacks. By the time people noticed, I couldn't function in social situations without drinking. It took years to realize I needed anxiety treatment, not just addiction treatment." - Sarah, 29


"After my military deployment, I couldn't sleep. Couldn't turn my brain off. Pain pills didn't just help my back injury—they helped quiet the nightmares. I wasn't trying to get high. I was trying to get some peace." - Marcus, 34


"My teenage daughter's 'drug problem' turned out to be untreated ADHD and depression. Once we got her proper mental health care, the substance use stopped being her primary coping mechanism." - Linda, mother


Resources for Getting Help

For Mental Health Support:

  • National Suicide Prevention Lifeline: 988

  • Crisis Text Line: Text HOME to 741741

  • SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)

For Substance Use Support:

For Families and Friends:

Upcoming Events


The Bottom Line

Substance use disorders are not moral failings or character flaws. They're complex conditions that often develop as coping mechanisms for underlying mental health challenges, trauma, or life circumstances.

When we understand this, everything changes. Instead of judgment, we can offer compassion. Instead of "Why don't you just stop?" we can ask "What do you need to heal?"

Recovery isn't just about stopping substance use—it's about addressing the reasons someone started using in the first place. And that journey is much more hopeful when it's supported by understanding rather than stigma.


If this newsletter helped change your perspective, please share it with others. Breaking stigma starts with each of us.

All Heart Initiative

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