Finding Balance in the Struggle: A Relational Approach to Substance Use

A question I keep turning over: why is this so hard?

Not hard in the sense of "why can't people just stop," which is the wrong question entirely. Hard in the sense of: why does substance use grip people so completely? Why does recovery feel like deep-sea diving with limited oxygen in the tank? Why do people who genuinely want to change find themselves back at the beginning, again and again?

I've sat with this question for years. The clinical work is not tidy. Relapse happens. Relationships fragment. The self gets shattered and rebuilt and shattered again. There's grief in this work, and frustration, and a kind of defeat that can settle into the body. It is not an easy road.

And yet. The people I work with who struggle with substances are some of the people I find most moving to work with. I don't say that lightly. There's something about this population: they are sensitive feelers, often lost in their own feeling. They've been carrying something heavy for a long time, usually without knowing what it is or where it came from.

The Scapegoat and the Shadow

Here's a frame I return to often: the scapegoat.

In family systems, the scapegoat is the one who carries the unmetabolized pain of the whole group. They hold the shadow, the parts the family can't look at, can't integrate, can't acknowledge. The anger no one expressed. The grief no one processed. The dysfunction everyone pretended wasn't there.

The scapegoat acts out. They become the "problem." And in doing so, they serve a function: they give the family somewhere to put its discomfort. As long as one person is the mess, everyone else gets to feel comparatively okay.

Substance use fits this role perfectly. It's visible, it's concrete, and it gives people something to point at.
That's the problem. That's what's wrong.
It draws focus away from the underlying relational fractures, the emotional neglect, the ways the system failed long before the substance entered the picture.

When I sit with someone who has been using, I'm often listening for the shadow material. What feelings were never allowed in your family? What roles did you get assigned? What have you been holding that was never yours to hold? What does this substance help you avoid and/or regulate?

Why It Grips So Hard

Substances work. That's the thing no one wants to say plainly, but it's true. They regulate the nervous system. They soften unbearable feelings. They create a sense of connection, relief, or control in a body that learned early on that those things weren't available from other people (and now unavailable from the self).

For someone who grew up without consistent attunement, without a safe place to bring their emotional experience, substances offer something the relational world never did: reliability. The drink doesn't leave. The high doesn't disappoint. The relief comes when you call for it.

This is not a moral failure. This is an adaptation. A smart, costly, ultimately unsustainable adaptation to a world that didn't meet your needs quite enough.

The grip is so strong because the need underneath is so real.
We're not just treating a behavior; we're treating a grief.

The Ugly Truth

I want to be honest about something: this work can be ugly.

Relapse doesn't feel like a "learning opportunity" when you're in the middle of it. It feels like failure. It feels like evidence that you're broken, that you'll never get it right, that everyone who gave up on you was justified. The shame is enormous. The self-criticism is relentless.

Relationships get damaged. Trust erodes. People who love you get exhausted and sometimes they leave. The person in recovery is left holding the wreckage, wondering if it's even worth trying again.

I don't say this to discourage anyone. I say it because pretending recovery is a linear path of growth and insight does a disservice to the people actually living it. The road is hard. The setbacks are real. Acknowledging that isn't pessimism. It's respect.

A Different Kind of Approach

Harm reduction, in my opinon, isn't about lowering expectations. It's about meeting people in the truth of where they are.

That means not insisting on immediate abstinence as the only marker of success, though I fully support abstinence when it's accessible and desired. It means prioritizing safety, choice, and self-awareness. It means working with someone through relapse rather than treating relapse as the end of the therapeutic relationship.

Most importantly, it means getting curious about the function of the substance. What is it doing for you? What need is it meeting? What would you have to feel if you couldn't use?

From a psychoanalytic and relational lens, we're not just managing a behavior. We're exploring a story. We're looking at early attachment, at family roles, at the parts of yourself you learned to exile. We're asking what it would mean to meet those needs differently, to let relationships do some of the work that substances have been doing, and ask why relationships haven’t been that regulating force until now.

This isn't about willpower. It's about understanding. And it happens slowly, in the context of a relationship that can hold the mess.

You Are Not the Family Shadow

If you've struggled with substances, you've probably internalized a lot of shame. You've been the "problem" for so long that it's hard to imagine yourself any other way.

But here's what I want you to consider: you may have been carrying something that was never yours alone. The pain you've been numbing might have roots that extend far beyond your individual choices. The role you were assigned in your family, the feelings you absorbed, the dysfunction you acted out, these were systemic, not just personal.

You are not broken.

You adapted to an impossible situation with the tools you had. And now, if you want, you can start to put down what was never yours to carry.

If You'd Like Support

I work with adults who want to understand their substance use in the context of emotional and relational patterns, reduce harm, and find new ways to meet the needs that substances have been meeting. This work is not easy, but you don't have to do it alone.

Request an Appointment to start.