I'm not sure if I want to stop using entirely or just control my use: Well, this question can be the starting point of the treatment process. Often, patients aren’t sure what’s happening to them, since addictions alter the brain internally, and the brain is the only organ that doesn’t recognize itself as being sick. For example, consider the phenomenon of a “phantom limb,” where the brain identifies that a limb is missing and sends a pain signal (neurotransmitters) that causes pain in a part of the body that no longer exists. But we know that neurosurgeons operate on brain structures while the patient is awake, often listening to music or going about their normal routines if the surgery allows it.
This is because it lacks pain receptors, and when it becomes ill, it cannot recognize itself as such; in certain mental illnesses, this is known in professional jargon as “insight into the illness,” and it is common for many people who seek advice on whether they are using too much or too little to lack insight into their condition or to have incomplete insight.
From there, we take a motivational approach, guiding the patient to ask themselves questions, reflect, and ultimately reach conclusions about their relationship with substance use. Although this is not what we as a professional team would prefer—and we would like to see a world free of drugs—the reality is that the drugs and the altered states of consciousness They have accompanied humanity since its earliest days (as a spiritual or transcendental pursuit, etc.), but never before—as in modern times—have they become a “market commodity,” and this leads to the constant invention of new toxic substances in order to sell sensations to a world thirsty for them.
So, if a patient—of their own free will and after having reflected on all aspects of the situation with professional help—decides that they do not want to stop using but rather to use in a controlled manner, we will have to evaluate with them the risks associated with that decision and determine whether it is feasible or not (in the case of certain substances and individuals, it is). Ultimately, however, it is always the individual’s own free choice.
In our experience, many patients tell us, “I’m not sure if I want to stop using entirely,” and the patients who come to us with this question are very reluctant to begin the process of drug withdrawal, but they end up being the most grateful and the ones who do the best, since once they have all the information, have been clean for quite some time, are feeling well, and no longer feel cheated by the money they spend on drugs and the problems that come with them, they make a clear decision never to use again—not even a little. After all, who wants to feel bad?
