Substance Use and Abuse

Most people are familiar with AA, and what professionals in the field call 12 Step Programs. Folks closer to substance abuse issues know words like “program” or “recovery” to mean a particular kind of peer support and self-growth work. There are other programs, too, like Rational Recovery and SMART. Still others choose hospitals, sober living, or other environments to support work toward healthier behaviors.

There are also people who want to address this issue, who know the havoc substance use is wreaking in their lives, but it is just too damn scary to quit.

Substance abuse encompasses a kaleidoscope of issues, including any or all of the following:

  • physiological dependence
  • psychological dependence
  • financial distress
  • feeling trapped and helpless
  • work or school problems
  • legal struggles
  • relationship difficulties
  • sleep and appetite problems
  • and often, medicating of emotional issues nothing else has helped manage

Seeking treatment for substance abuse can be terrifying. Clients fear being judged, having to drop out of treatment if they relapse, or saying out loud what they already fear is true about their lives. Often by the time they seek a therapist, they have already tried to quit and have not been able to do so. Coming to therapy to face it is a big deal.


So let’s make it less scary: My approach to substance abuse is to work with a client exactly where they are. We can talk abstinence and we can talk harm reduction. We can talk about the friends, family and partners who are impacted by your use, or the fact that they use with you. We can talk about what you are afraid will happen if you stop using, and what you are afraid will happen if you don’t. Your job becomes being as honest with yourself as possible, and bringing that truth to therapy. We’ll figure out the rest of it together.