If you have a problem with cocaine, you may be stuck in flight mode.

Most of us have heard about fight or flight. There’s a good chance you may be familiar with the term, stuck in fight mode, which describes when someone is constantly angry, and quite possibly in rage.

“Stuck in flight mode” is somewhat similar. The term means that someone is constantly searching for an escape. For an alternative to where they are and how they feel.

When would someone become stuck in flight mode? Most likely, the need to escape started quite young. In my experience, people with substance dependence problems (which means they have an addiction) started using substances when they were around 13-years-old.

They may have used alcohol or marijuana. They may not have been aware of it at the time, but the substance helped them to regulate their emotions. Said another way, they were self-medicating their emotional reactions to situations because they were in pain.

Their early use of alcohol or marijuana likely helped them to survive their childhood so I’m not going to knock it. The problem is that this coping mechanism didn’t solve the original problem. And it’s led to a larger problem today. Because now they still have the original problem they were trying to escape from, plus they have an addiction.

The path was insidious. Their alcohol or marijuana use as a young teen helped them to feel better because they were able to escape the painful emotions they were feeling. This successful escape – or flight – caused them to view their substance use as positive. And it was, because they managed to remain alive through whatever their young selves had to deal with.

Their early use continued through their teens. They may have used openly with their peers during a period when experimentation is normal. The problem is that they continued to use, and to use more heavily, than their peers.

Their use continued to increase as they moved into their 20s, in part because they developed increasing tolerances to alcohol and marijuana. And they likely experimented with more drugs, including MDMA, hallucinogens, and cocaine. They believed they were in control of their use and that they can stop at any time. They socialized with other people that used, and so viewed their behaviour as normal.

People frequently start to use cocaine because it allows them to function, regardless of what they have been doing. Drink too much? Cocaine will make you feel sober so you can drive home. Need to function at work the next day? Cocaine will deal with the hangover so you can perform at your desk.

And then they start to party with cocaine, to even themselves up so there will be no consequences tomorrow of what they have done today. Except that they are playing with cocaine, which they may realize has gotten a strangle hold on them a little too late.

I have worked with a number of clients that fit this bill. Some have started to see me in their 20s or 30s, after their substance use has interfered with a valued relationship. Maybe they’ve tried to quit on their own and have discovered that it going to be hard. Maybe they’ve been stopped by the police for driving while intoxicated and given a DUI, which means they can no longer drive, which has cost them their job. Maybe their ex-wife has threatened to file for full custody of the children because of their cocaine use.

However they arrive, these individuals are looking for help. And they deserve help because no one becomes dependent on substances on purpose. They have gotten to where they are because they were trying to self-medicate their pain. They were in flight mode and needed to escape their reality.

In session, the first thing we talk about is how long their substance dependence has been going. We talk about how their ability to regulate (or self-soothe) their emotions has not developed since the age they started to use. We do this so they can realize this is going to be a project of some duration that they are taking on, as they work to stop using and to develop the ability to self-regulate.

I ask them to track their substance use on a daily basis. I tell them they will most likely lapse and relapse several times, and to not become discouraged when this happens. We discuss the stages of change, and how they are likely simultaneously in the contemplation, planning, and action stages, all at the same time, and that this is to be expected.

We talk about why they were attracted to the idea of escaping from their reality, or flight, when they were young. This is important because this is where it all began. We explore their underlying foundational beliefs about themselves, which may include, “I’m not loveable,” or “I’m not good enough,” or “I have no value.”

Touching on these beliefs is painful. I explain that we need to step lightly during this period because strong emotions can come that will drive them to want to use. It’s during this period that they begin to really understand why they use – when they touch on the pain and then crave the distraction that comes from being high.

When I first ask if they are in flight, and maybe even constant flight, everyone appears to get it. They say they can’t handle being alone. They say they don’t know how to spend time by themselves, even though they know they need to change their circle of friends because most of the people they hang out with use. They say they can only read for so long and then need to get out to do things. To distract themselves.

And so we discuss harm reduction. We talk about how it’s okay to immerse themselves in their work, or in exercise, if it helps them get off cocaine. We talk about how they are going to take one step at a time for a substantial period, and if they have a year or two or heavy bike riding as a way of keeping busy while they learn to live without cocaine, then that’s more than okay.

We discuss their resistance and their grief when they realize, through experience, they will have to give up all substance use and not just cocaine. They say they want to remain social drinkers, and we discuss whether this will be possible.

We discuss how using any substance means they have not gotten clean. We explore how achieving sobriety means giving up all use of alcohol, marijuana, MDMA, hallucinogens, cocaine, as well as opioids, pornography and gambling, and maybe even computer games and over-spending over the longer-term.

As a clinical psychologist, I was trained to work with people only after they had stopped using drugs and alcohol. I was taught not to accept clients with substance dependence issues because they need to be clean and sober before they can do the work in therapy.

But here’s the rub. People need to already have other coping skills in place that they can rely on before they can remove their maladaptive ones. Sure, substance dependence is maladaptive, but it has helped them to cope with their pain by numbing it. If they are going to successfully eliminate their substance use, they’re going to need to have other methods in place that they can use to cope.

So, we proceed slowly. We remain aware of the urge to flee that substances meet. People resist using to the best of their abilities, and when motivated, they work to develop alternate coping skills that will serve them so much better over the longer run.

What kind of alternate coping skills are we talking about? They all lead to the same place. We’re talking about developing the ability to tolerate their physical sensations (think a knot in the stomach or tightness in the chest) and their emotions (think fear or anxiety) without going into flight mode. The ability to remain present and tolerate how they feel, both physically and emotionally, with the knowledge that these feelings will pass through them and they will be fine.

This process can take a long time. To be realistic, it may take years to develop the ability to remain present and tolerate the whole range of human emotions without feeling the need to flee. But there’s an upside. As your ability to remain present grows, with diligence and the help of a good psychologist, you will grow happier. And the desire to flee will fade away.

— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta