Addiction, Regulation, and a Somatic Path to Harm Reduction

Oct 10

A dominant narrative regarding addiction and recovery often centers on willpower, morality, and the singular goal of abstinence. This framework can inadvertently create shame, alienate individuals, and ignore the fundamental wisdom of the human body. As we shift our perspective, we can begin to understand addictive behaviors not as a rebellion or a character flaw, but as the body's best attempt at self regulation and survival. This is a core principle of meeting the body where it is, not where we, or society, think it should be. When we view recovery through the lens of survival rather than morality, we open the door to compassionate, realistic, and effective approaches like harm reduction, supported by the profound insights of Polyvagal Theory.

Polyvagal Theory gives us a biological map of the nervous system. It describes a hierarchy of states that dictate how we feel and behave. Our ventral vagal state is one of social engagement, safety, and connection. When that feels unavailable, we may shift into a sympathetic state of fight or flight, a high energy defensive mode. If these strategies fail or are too dangerous, we can collapse into a dorsal vagal shutdown state, marked by numbness, dissociation, and collapse.

Addiction, from this perspective, is a powerful tool the nervous system uses to manage being stuck in a chronic state of threat, whether that threat is internal, like trauma and anxiety, or external, like systemic oppression. A substance or behavior might be used to jolt a person out of dorsal vagal shutdown and numbness into a semblance of feeling, or to calm the frantic energy of a sympathetic fight or flight response. It is a form of self medication, a desperate and intelligent effort to regulate a system that does not feel safe.

Harm reduction aligns perfectly with this understanding. It asks, "What does your nervous system need to feel a little safer, a little more regulated, right now?" instead of demanding immediate abstinence, which can itself be a profound trigger and shock to the system. This approach honors the survival function of the addictive behavior while collaboratively working to reduce its negative consequences. Somatic strategies are essential companions to this work, as they offer the body new, less harmful pathways to find that needed regulation. Simple breathwork, particularly extended exhalations, can directly stimulate the ventral vagal nerve, signaling to the body that it is safe to begin to calm down. Somatic tracking is another powerful practice, inviting a person to notice bodily sensations, like tension or warmth, without judgment or the need to change them. This cultivates a capacity to be with discomfort, a vital skill when the urge to use arises, and builds the foundational neural pathways for interoceptive awareness, which is often compromised in addiction.

Ultimately, harm reduction is a form of embodied advocacy. It is an act of resisting the moralism and medical gatekeeping that have long defined addiction treatment. This advocacy requires us to name the systemic traumas that create and exacerbate unsafe states in the nervous system. We cannot talk about the body's need for regulation without acknowledging the constant dysregulating impact of poverty, racism, homophobia, and carceral systems. These forces actively destroy safety and connection, making addictive coping mechanisms not just understandable, but in many cases, a logical response to an unbearable environment.

True advocacy, therefore, extends beyond the individual therapist's office. It demands we work to create policies, design spaces, and foster relationships that cue safety for all nervous systems. This means championing access to safe consumption supplies, supporting housing first initiatives, and training peer support specialists in Polyvagal informed principles. It is about creating a world where the body does not have to resort to harmful substances to find a moment of peace, because it is met with a world that offers genuine safety, dignity, and connection.