When Pain Hides Behind the Bottle: Understanding Substance Use as a Symptom, Not the Root

Substance use is often seen as the problem itself—something to fix, stop, or eliminate. But for many people, substance use is not the beginning of their story; it’s what comes after. It’s the bandage they reach for when the pain becomes unbearable. It’s an attempt to quiet the noise of trauma, loneliness, rejection, or despair. To truly address substance use, we must look beneath it—to the unhealed wounds it tries to numb.

The Need to Numb

When someone turns to alcohol, drugs, or other substances, the question is rarely “Why the substance?” but rather “Why the pain?” Many individuals begin using as a way to escape from overwhelming emotions—grief, shame, fear, or sadness. The temporary relief provided by substances can feel like the only form of control in an uncontrollable world.

The cycle often begins innocently: one drink to relax, one pill to sleep, one hit to quiet intrusive thoughts. But over time, the brain learns to associate relief with use. What was once a choice becomes a compulsion. This progression is not a sign of moral weakness or lack of willpower; it is the brain’s learned response to emotional suffering.

Research in neuroscience and psychology has consistently shown that addiction is deeply linked to trauma. According to Dr. Gabor Maté (2010), a leading voice in addiction medicine, “the question is not why the addiction, but why the pain?” Substance use, in this view, is a form of self-medication—an attempt to soothe the unbearable rather than to seek pleasure.

The Cycle of Avoidance

Substances provide temporary comfort but come with a cruel paradox: the more they are used to avoid pain, the more pain they create. Feelings that are suppressed do not disappear—they accumulate. When the effects of a substance wear off, the emotions return even more intense, creating a feedback loop of avoidance and distress.

The person then faces two sources of suffering: the original emotional wound and the consequences of use—guilt, withdrawal, damaged relationships, and declining health. Yet, because substance use once provided relief, the mind still perceives it as a solution. Breaking this loop requires more than detoxification; it requires compassion and understanding for the pain that fueled it.

Substance Use as a Mirror of Unmet Needs

Behind every use, there is often an unmet need. Some people use substances to fill the void of connection—seeking in a substance what they longed for in another human being: comfort, love, or security. Others use to silence self-criticism or memories of trauma.

In therapy, it becomes clear that substance use can serve psychological functions:

• Soothing emotional pain (e.g., childhood neglect, loss, abuse)

• Escaping from inner conflict (e.g., guilt, self-hatred, shame)

• Coping with social disconnection or alienation

• Regaining control when life feels unpredictable or unsafe

Once these functions are understood, treatment shifts from judgment to curiosity. Instead of asking, “How can I stop using?” we begin to ask, “What pain am I avoiding?” and “What healthier ways can I meet my needs?”

Healing Through Connection

Addiction thrives in isolation and begins to heal in connection. Many people struggling with substance use feel trapped in cycles of shame—believing that their behavior makes them unworthy of love or understanding. Yet, shame is the very emotion that fuels continued use.

Empathetic relationships—whether through therapy, peer support, or community—offer an antidote to this shame. When individuals feel seen and accepted, they no longer need to numb as much. Healing begins when people feel safe enough to share their stories without fear of rejection.

Therapeutic approaches like trauma-informed care emphasize safety, empowerment, and collaboration. The focus is not only on stopping the behavior but on rebuilding trust in oneself and others. Recovery becomes a process of learning to tolerate emotions that were once unbearable and discovering that pain can be faced, not feared.

From Numbing to Feeling

Recovery is not about becoming perfect or erasing the past—it’s about reclaiming the capacity to feel. For someone who has spent years suppressing emotions, feeling sadness, anger, or fear can initially feel like failure. Yet, these emotions are signs of reconnection with life.

The goal is not to remove pain but to create space for it—to understand that it is part of being human. Through mindfulness, therapy, creative expression, and supportive relationships, individuals can learn to process rather than suppress their pain.

Every moment of craving can become a message rather than a threat—a reminder of an unmet need asking for attention. As people learn new ways to respond—with self-compassion rather than self-punishment—they begin to heal from within.

A Compassionate Lens

Viewing substance use as a secondary problem allows us to see individuals not as addicts but as people in pain. It shifts the narrative from “What’s wrong with you?” to “What happened to you?” This simple change in perspective fosters empathy and opens the door to genuine healing.

When we meet people with compassion rather than condemnation, we help them rediscover the strength they’ve always had. Because beneath every substance-use story lies a story of survival—a person who has been trying to cope the only way they knew how.

True recovery begins when that person finally feels safe enough to lay down the weight they’ve carried and learn new ways to heal.

References

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550