Struggling with substance use doesn’t mean you’re broken. It means you’re human. In my NYC therapy practice, I use harm reduction to treat substance use as part of your full story, not a defining label. Forget the “clean” vs. “failed” mindset; we’ll start with curiosity, honesty, and real conversations about what works for you.
Why the Old Model Didn’t Work
For close to 20 years I worked in programs where the rule was abstinence or nothing. If you showed up struggling with substance issues, you were told to leave and “come back clean.” Seriously?! In what other situation would you seek help for a problem only to be sent away because you have the problem? Imagine going to the doctor with a broken leg and being told to come back once you could walk?!
On top of that, mental health and substance use treatment ran in separate and parallel silos. Depression, anxiety, trauma? Send to mental health. Substance use? Send away until “sober.” People ended up bouncing between systems without getting real help.
Treating the Whole Person
Most people who use substances are also managing anxiety, depression, bipolar, ADHD, trauma — or all of the above. In fact, many with mental health issues use something (weed, alcohol, nicotine, even social media) to cope. (If you like numbers: SAMHSA’s 2023 National Survey on Drug Use and Health reported that over a third of U.S. adults with a mental health disorder also had a substance use disorder.) So why pretend these struggles exist separately? Therapy works best when we treat the whole person, not just one symptom.
Curiosity Works Better Than Shame
In my practice, I don’t lecture or shame. We talk openly about what you’re doing, why, and what — if anything — you’d like to change. Over time, I’ve seen clients reduce or stop substance use on their own terms — not because I pressured them, but because they were ready. My role is to stay curious, nonjudgmental, and walk alongside you when that shift happens.
Sometimes, yes, substance use gets to a level where safety becomes a concern, and more intensive support may be needed. But that’s very different from the old “all-or-nothing” approach that left people out in the cold.
A Real-Life Example
A young client once told me: “I wish I didn’t like weed so much.” Instead of lecturing him, I asked why. Together, we made a four-part pros and cons list:
- Pros of keeping use the same
- Cons of keeping use the same
- Pros of cutting back or stopping
- Cons of cutting back or stopping
He left more curious about himself. That curiosity opened the door to decreased shame, and thus room to think about what he actually does and doesn’t want. Eventually, for him, that led to a decision to change, and we took steps to help him decrease his use. He maintains decreased use today and feels positive about that choice.
Your choices, your pace
Therapy with me isn’t about following someone else’s script. It’s about exploring your relationship with substances honestly and figuring out what feels right for you. Sometimes abstinence is the goal. Sometimes it’s reducing use. Sometimes it’s simply understanding your patterns. All are valid.
Ready to get curious?
If you’re wondering about your use of substances and want a space free of judgment and shame, I’d be glad to talk. Reach out today and let’s start where you are.
This information is not a substitute for therapy. If you are experiencing a clinical emergency, go to your nearest emergency room or call 988. I am available for online psychotherapy for New York State residents. If you are interested in scheduling a free consultation, you can contact me through my page.
