Substance Use/Addiction/Harm Reduction

Let's be honest. The high pressure, competitive, and fast-paced atmosphere in Silicon Valley can be incredibly stressful. Sometimes you need a little help to unwind. Perhaps a cocktail after work. Maybe a blow-out weekend with friends. Something to help you fall asleep at night. But have you noticed your substance use starting to get out of hand? Is it impacting your work or relationships? Do you find yourself hiding your use from your coworkers and loved ones?  Is it becoming increasingly difficult to keep it hidden? Do you worry that you might be losing control?  

Substance use is not uncommon in Silicon Valley. Stimulants, such as Adderall and cocaine, in order to stay up for days on end and meet important deadlines. Microdosing to help with creativity. Opioids, such as Oxycodone and heroin to help relax. Benzodiazepines, like Xanax and Ativan, to quiet the mind. Alcohol to unwind. Cannabis to promote well-being.   

No longer is substance use reserved for dark characters hanging out in seedy alleys. Today's user is likely to be highly educated, hardworking, and high-achieving. Because of the ability to remain relatively high-functioning, individuals are less likely to seek the support they need.   


  • 1.4 million: Current annual number of prescriptions for hydrocodone, a powerful pain reliever, to Bay Area residents.

  • 159 per 100,000 population: Number of visits to hospital emergency rooms each year in San Francisco, Marin and San Mateo counties for stimulant abuse; the national average is 30 visits per 100,000 people.

  • 5.6: Percent of people age 12 and older in Alameda, Contra Costa, Marin, San Francisco and San Mateo counties who take prescription pain relievers for nonmedical purposes.

How Can Therapy Help with Substance Use Disorders?

Therapy can help individuals figure out triggers for their use and teach alternative coping skills. It is imperative that individuals struggling with substance use disorders have a safe place to talk about their use openly and honestly without fear of judgment. It can be freeing to work through the guilt/shame that can often accompany substance use. It is also important for individuals to set personal goals regarding their use (e.g., harm reduction vs. abstinence) and have someone who can help them achieve these goals.

Substance use does not occur in a vacuum. It not only impacts individuals but also loved ones and communities. If it is a family member that struggles with a substance use disorder, therapy can serve as a source of support, helping you to manage your expectations, be able to set healthy boundaries, and engage in good self-care.

Dr. Pomeranz has over 15 years of experience specializing in the treatment of substance use/addiction through the use of narrative, cognitive behavioral, mindfulness, and ACT-based approaches.