SHIRA H. DOMBIAK, LPC- THERAPY AND CONSULTATION

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Substance Use Disorder and Other Compulsions as a Form of Regulation

3/1/2026

 
If you grew up in an environment where no one helped you calm down, problem-solve, hold hope, or move through distress, it makes sense that you found other ways to regulate.
Children are not meant to regulate alone.

In healthy development, a caregiver helps a child settle. They soothe. They name feelings. They model perspective. Over time, the child internalizes those skills and develops an inner regulator.

If that process didn’t happen — or happened inconsistently — the nervous system is left without a reliable internal calming system.

But the distress is still there.
So the system adapts.


Compulsive behaviors, fantasizing, overworking, people-pleasing, food, scrolling, alcohol, and substances often serve one primary function: regulation.

For many people, substance use disorder is not about recklessness or pleasure-seeking. It is about relief. It is about managing anxiety, shame, hypervigilance, loneliness, or emotional overwhelm.

In that sense, these behaviors are not stupidity.
They are solutions.
The problem is that they are short-term solutions with long-term costs.

Recovery is not just about stopping a behavior.
Recovery is about building regulation from the inside.
Breathing through discomfort.
Learning to think differently.
Creating safe connection.

Tolerating feelings without immediately escaping them.
Repeating new patterns until they become familiar.

This can feel frightening because you are often building a skill set that was never properly installed in early life.
That fear and doubt in recovery?
It’s often the original wound surfacing.

You are not just giving up a substance.
You are facing the fact that you were left to regulate alone.
That is hard.
But it is also repair.

​If you developed compulsions as a way to survive, that does not make you broken.
It means your nervous system did what it needed to do.
Recovery is not about becoming perfect.
It is about increasing capacity — the capacity to feel, to pause, to choose, and to stay present without anesthesia.
When we understand substance use and other compulsions as regulation strategies, confusion decreases.

And when shame and confusion decreases, change becomes possible.
​-Shira


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