Inner Dialogue and Thinking Patterns

Inner dialogue and recurring thoughts can shape how substance use, change and recovery feel. Understanding these patterns means distinguishing a thought from a fact, an urge or an intention, while recognising when an experience needs further help.

A person can want to change their substance use and still find their thoughts returning to the relief, pleasure or familiarity it has offered. This tension does not require two separate selves. Different wishes, expectations and concerns can be present at the same time.

Thinking about a substance is not always craving. A thought may be a memory, a worry or a passing association; craving involves wanting or an urge. Ordinary self-talk is also different from a perceived voice. Neither where an experience seems to occur nor how easily it can be stopped is enough to diagnose it.

New or unexplained experiences of hearing voices or seeing things that other people do not hear or see need urgent medical advice. Voices telling someone to harm themselves or others need immediate medical help. If these experiences are quickly worsening, immediate medical help is also needed.

Sudden confusion needs immediate medical help. Urgent help is especially important if someone cannot be woken, is breathing abnormally, has a seizure, becomes severely confused or delirious, or shows other signs of major deterioration. Someone who may be physically dependent on alcohol should seek medical advice before abruptly stopping or sharply reducing drinking.

If you may act on suicidal thoughts, cannot keep yourself safe, or have seriously injured yourself, contact emergency medical help in your area now. Possible self-poisoning needs immediate medical help, even if you feel well. If you are having thoughts of suicide or self-harm without immediate danger, contact a health professional or local mental-health crisis service promptly. You do not have to wait for an injury or a diagnosis to ask for help.

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