Start where you are

Many people searching for how to stop an addiction have already stopped once. For a week, or for two years. And they went back. Others are still using and don't know whether they want to quit completely, or where to begin.

Both can start here. You don't have to arrive sober, or with your mind made up, or with a plan.

This page explains how I work with addiction, what happens in the body when you stop something, and when the first step is a doctor or an emergency room.

Do I have to stop using before I start?

No. I work from harm reduction, the approach Andrew Tatarsky brought into psychotherapy. Its starting point is that people who use substances "are engaged where they are, not where the provider thinks they should be" (Tatarsky, 2002, p. 21).

Abstinence can be the goal, and for many people it's the best one. Harm reduction "accepts that abstinence may be the best outcome for many" (Tatarsky, 2002, p. 10). What changes is that it stops being the condition for getting help.

Between using the way you do today and never using again there are many points in between: smaller amounts, fewer days, less risk. The approach "accepts small, incremental steps in the direction of reduced harm" (Tatarsky, 2002, p. 2). We agree on the goals together, and they can change along the way.

What you use also does something for you

Almost always, what is a problem today started out working. Tatarsky says it plainly: "People use substances because they work, at least initially, in addressing some psychologically, socially, or biologically based needs" (Tatarsky, 2002, p. 24).

Something similar happens with gambling, screens or work without a break: something calmed you down, lit you up, or made a moment bearable when there was no other way. Understanding what it does in each life is part of the work. It usually helps more than fighting it.

From the body, it often looks like this: a nervous system that learned to regulate itself through a single route. When that route closes and no other one opens, it goes looking for the old one. You don't need a flaw of character to explain it.

What happens in the body when you stop

When you cut down or stop something the body was already expecting, physical withdrawal appears, which depends on the substance and in some cases needs medical supervision.

Once the physical part passes, many people notice something else: poor sleep, irritability, anxiety with no clear reason, a restlessness that won't let you sit still; that's a nervous system still looking for other ways to calm down. Sometimes relapse arrives right there, when it feels like everything should already be fine.

Quitting all at once can be dangerous

If you drink alcohol or take tranquilizers or opioids every day, don't stop all at once. That doesn't mean carrying on as before: it means stopping with help. Stopping some substances abruptly can cause seizures and put your life at risk. With a doctor, you can come down safely.

After a stretch without using, the body's tolerance drops. Going back to your old amount can cause an overdose, especially with opioids.

If you take a prescribed medication and think it has become a problem, talk to whoever prescribed it. Don't stop it on your own.

How I look at a relapse

In harm reduction, relapse is treated as a common part of change. Summing up Marlatt and Gordon, Tatarsky writes that "relapse should be seen as a common, natural part of the process of changing behavior, which can be an opportunity for learning that might decrease the possibility of future relapses" (Tatarsky, 2002, p. 2).

In my practice that turns into two concrete questions, the same ones in the book: "What didn't work? What led to the relapse?" (Tatarsky, 2002, p. 113). The answers belong to the person who relapsed. My part is to help look at them calmly and without judgment.

Relapse prevention also talks about emotional relapse. Before any use, the state changes: sleep gets worse, you stop calling people, anger piles up, meals get skipped. That's why it helps to learn to notice those changes in the body before they reach your head.

What working with the nervous system adds

It doesn't replace a treatment program, a support group or psychiatric treatment. It can go alongside them. Groups, in fact, do something this work recognizes very well: they regulate people in company.

It adds something concrete: working directly with what the substance or the behavior was doing. With somatic therapy, the body learns little by little to stay with an uncomfortable sensation without having to escape it, and to find the brake through other routes; with Gestalt we look at what gets avoided and what repeats.

If there's a difficult history behind it, the page on trauma explains how I think about it. That isn't true for everyone. And you don't need to know it to start.

How we begin

I see people who are still using, people who stopped and went back, and family members; I work with any addiction, to substances or to behaviors.

I'm a doctor, so the first session includes the medical side: what you use or do, how much, since when, what medications you take and what the risks are. With that we agree on where to begin: reducing harm, using less, or stopping, depending on what you want and what is safe.

If what you need is a different level of care, such as supervised detox, residential treatment or a psychiatrist, I'll tell you and help you think about where to go. Tatarsky proposes looking for the "right fit" for each person (Tatarsky, 2002, p. 109). Sometimes that fit is somewhere else, and finding it is part of the work too.

Sessions last 60 minutes, in person in Tepoztlán or online by video call, in English or Spanish. I don't work with a fixed number of sessions or promise results within a timeframe. Changing your relationship with something is almost never a straight line, and it takes its own time.

When something else comes first

If you're in danger today, or intoxicated, the first step is an emergency room, not an appointment.

If there is physical dependence and you want to cut down or stop, that happens under medical supervision. If you need detox in a hospital or a specialized center, that comes first. This work can come afterwards, or alongside.

If you want to bring a family member who doesn't want to come, this work doesn't happen by force. What I can do is work with you.

If you're looking for a substance or a treatment that takes the addiction away in one go, I don't offer that.

Not the moment? That's fine. This page will still be here.

Frequently asked questions

Do I have to stop using before I start?

No. You can start while still using. Abstinence is a possible goal, and for many people the best one, but it isn't a requirement for starting. We agree on the goals together, and they can change along the way. If you drink alcohol or take tranquilizers or opioids every day, any change happens with medical support.

What should I do after a relapse?

First, look after yourself. If you used after a while without using, your tolerance is lower and there's a risk of overdose, especially with opioids: try not to be alone, and if there's danger, go to an emergency room. Then talk it over with someone you trust or with whoever is supporting you. A relapse doesn't erase what you achieved before. Calmly, you can look at what didn't work and what led you there.

Do you work with substance addictions or behavioral ones too?

Both. Alcohol, tobacco or other substances, and also behaviors like gambling, shopping, screens or work without a break. If in the first session I see that a different level of care is needed, I'll tell you and help you find it.

Do you see family members of someone who doesn't want to come?

Yes. You can come on your own, even if the other person doesn't want to or isn't ready. We work with what is happening to you: how it affects you, what is in your hands and what isn't, and how to look after yourself in the meantime.

Does this replace a rehab center or a support group?

No. It can go alongside them. If you need supervised detox or residential treatment, that comes first, and I'll tell you in the first session.

Who leads the sessions?

I do, Juan Moller: a physician trained in homeopathy at the Universidad del Valle de Atemajac, with a three-year training in somatic trauma therapy, and a Gestalt psychotherapist trained at the Escuela de Gestalt Viva Claudio Naranjo. More about me.

From here

If you want, we start with a conversation. In the first session we look together at what is happening and what makes sense to do first, without rushing.

Book a first session or message me on WhatsApp.

You may also want to read: anxiety you feel in your body.

Source

Tatarsky, A. (Ed.). (2002). Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. Foreword by G. Alan Marlatt. Jason Aronson.