Dominic O’Ryan – Substance Use

Hello, my name is Dominic O’Ryan and I am the Lead Psychologist for Substance Misuse Services in Camden and Islington NHS Foundation Trust.

I am going to talk about something that many of us might be facing.

During these strange times it is very common to find we have increased our use of substances.

By substances, I mean different types of stimulants, depressants, cannabinoids, psychedelics and opioids; substances like nicotine, caffeine, alcohol, sleeping tablets and strong pain killers.

And we do these things often because substances help us make the best at the good times – they help us to celebrate, they help us to mark occasions, whether that is a large event or simply making it through the week or the day.

We use substances to make something better of the difficult times as well – we use them to commiserate – we use them to switch off and unwind and sleep – to get rid of difficult thoughts, feelings and body sensations.

And we can use substances because they are a way of connecting with people, they become integral to our social network, we drink when a friend is drinking; we have our next cigarette often because our smoking buddy is smoking.

And there isn’t anything necessarily problematic about this. It may be fine.

Substance use becomes more problematic when it feels like we don’t have any other way of doing those things – we lose sight of other ways of celebrating or switching off or connecting with people.

And when we disregard the risks associated with the substance use it can transform itself into substance misuse.

This is something that can happen slowly over years but at confusing and stressful times, it can very quickly sneak up on us, catching us unaware.

And so it is important to realise that often these using behaviours are happening in autopilot.

And then to spend some time reflecting on why we are using substances and what thoughts and feelings, and body sensations are present as part of our urge to pick up a drink or to have a smoke or sniff.

Stepping out of autopilot is a very particular and also learnable skill of gentle, curious and compassionate self-observation.

We need to reflect on what the function might be of our use the substances – what might we be avoiding or trying to achieve.

What is it that is so tricky about these tricky thoughts, feelings and body sensations that we would rather do something potentially harmful in the long term than experience them in the here and now?

Having noticed and become aware of these things, are we ready to be open to these tricky experiences, to unhook from stories that maybe we have fused with, stories that tell us the experience is unbearable, or that we are not able to manage?

We can unstick and de-fuse from these stories sometimes just by naming them – “there’s that old story about failing playing again”, “I’ve tuned in to Radio Idiot again.”

Maybe we can sometimes be truly courageous and thank our minds for nudging us. “Thank you mind for reminding me that I need to unwind tonight.”

And then, at the choice point, when we have given ourselves space to decide rather than to act on autopilot, have we identified alternative workable actions that can help us with our short-term goals and connected them to longer term important personal goals and values?

So when next you need to celebrate, switch off or connect, give yourself permission to pause, step out of autopilot, become aware of your internal and external experience, be open to tricky thoughts, feeling and body sensations and make a more active, sustainable choice in the direction of your long term wellbeing.