Substance Use and Addictions Counseling
Addictions counseling involves identifying problematic substance use and helping the person to develop the motivation and skills to manage urges. A practical definition for problematic substance use is when obtaining the substance (or accessing other addictive behaviors such as gambling) becomes the person’s primary objective.
When the disease of addiction reaches the point of dependence, where the person can scarcely function without the substance, all other considerations become secondary--family, friends, health, work, hobbies, household management. At this point, seeking treatment can literally be a life-saving step.
At less troubling levels of use, characterized by substance abuse rather than addiction, therapy can improve relationships, work performance, energy, focus, and quality of life. I’ve repeatedly seen my clients’ lives change for the better by making the important decision to begin therapy.
Is substance use addiction an illness?
Substance use addiction is now widely considered an illness or a disease by the medical community. Three characteristics are typically present to categorize a condition as a disease:
a body organ is affected;
a deficiency is present in the organ; and
symptoms are identifiable
(McCauley, 2012, Pleasure Unwoven (1).
For example, in diabetes the organ is the pancreas; the deficiency is that it cannot produce insulin; and symptoms include thirst, hunger, frequent urination, fatigue, and blurred vision.
With substance addiction, the organ is the brain; the hypothesized deficiency is that it cannot produce enough dopamine; and some symptoms include:
craving
failed efforts to quit
damaged relationships
taking increasingly larger amounts of a substance
and spending significant time acquiring and recovering from the substance(s).
Substance use is also characterized as a disease by another common definition: the presence of symptoms; a predictable progression of illness; and treatability. I have repeatedly seen this progression in clients, whether their addiction is to alcohol, cannabis, stimulants, opioids, or benzodiazepines.
How does substance use or addictions therapy help the person to recover?
Addictions therapy, particularly Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI), help the client to overcome impulse urges by applying consequential thinking skills. These treatments subscribe to the belief that the decision to use typically occurs long before the substance is taken (Gorski, 2006, Relapse Prevention Counseling Workbook). This means that certain environmental triggers and physiological cues, or warning signs of use, are present and predictable.
I work collaboratively with my clients to identify and review these warning signs, allowing them to catch unhelpful thinking and behavioral patterns early in the process and prevent the painful consequences of substance use or misuse.
Education is another key component of my approach to substance use therapy. Many times people would not engage in behaviors--or would reduce the frequency, quantity, and duration of those behaviors--if they were more aware of the consequences prior to use.
For example, alcohol is a central nervous system depressant, meaning it slows brain activity. When alcohol is used, the brain releases an abnormally large amount of reward neurotransmitter chemicals in the brain, creating a temporary “feel good” sensation. However, the brain recognizes that too much of those chemicals were released, causing it to stop producing them for a period of time. This is an explanation for why many report sadness, guilt, regret, and self-blame the morning after heavy drinking episodes and why a high comorbidity exists between depression and alcohol use disorders.
I also educate my clients on the effects of substances on critical self-care practices such as sleep hygiene. For example, it takes the liver an exceptionally long time to metabolize, or break down, alcohol (approximately one hour per drink). So if alcohol was consumed near bedtime, particularly in large quantities, the body is working hard to break down that alcohol during sleep. So while the individual may have slept, they typically awake fatigued and experience reduced energy and concentration the next day.
Many of my clients are relieved to learn that they can take simple, specific actions to improve their lives and reduce the harmful impact of substance misuse.
“Addictive thinking is based upon the belief that addictive use is a real solution to managing pain and solving problems. In reality, addiction makes things worse and never better. Accepting this truth is part of taking the first step to recovery.”
What are some of the types of treatments for addiction?
Treatments for addiction or substance use disorders include outpatient therapy (which I provide), Intensive Outpatient Therapy (IOP), residential therapy, and medication management.
In addition, supplemental social programming, such as support groups, can be highly beneficial in the recovery process. The severity of the condition dictates the appropriate treatment type for an individual at a given time. I provide continual assessment and work collaboratively with the client and other professional and social supports (as indicated and consented to by the client) to identify the appropriate level of care. This process affords the client the best possible likelihood of successful outcomes.
Most of all, therapy with me involves hope. Hope rooted not simply in blind faith or pollyannaish optimism, but in tried-and-true, evidence-based practices that have helped hundreds of my clients rediscover their passion for life and enjoy the freedom of recovery.
I welcome your commitment to therapy if this is something you desire for yourself.