My Approach to Substance Abuse Treatment

How I work with Substance Abuse

-DBT

-Trauma therapy as needed

-Motivational Interviewing & the Stages of Change

-Recovery counseling incorporating your preferred program, e.g. AA or Smart Recovery  

Motivational Interviewing Defined

MI is a deceptively simple, non-judgmental, conversational strategy proven to help clarify your thoughts and feelings about your relationship to substances (or other behaviors), and help you generate authentic motivation to change.

The spirit of motivational interviewing (MI)

MI informs my general attitude and approach in treating substance use problems. I try to embody 'the spirit of MI' in my work; that entails acceptance, a non-judgmental posture, and genuine curiosity about your life experience. I help you explore your relationship to substances and clarify your goals. Often it can be very helpful to simply verbalize why it's important to you to quit. 

It may be that you have not adequately thought through why you use or what it might take to stop. For instance, if alcohol helps you manage anxiety, or other emotional pain, how do you plan on handling it when you are sober? What will fill the void? Another common scenario: If alcohol is a central part of your social life, do you imagine you have to lose all your friends to get sober?  

I love working with people at various points in the 'stages of change,' defined as precontemplation, contemplation, preparation, action, and maintanance. Perhaps you're just thinking about quitting, are dealing with negative consequences in your life, e.g. family problems, or have tried to quit and failed. A therapist trained in MI can effectively help guide you through the stages of change. 

*See more MI info and examples below

DBT (Dialectical Behavior Therapy) for Self-Confidence, Self-esteem, and Courage 

Core components of DBT:

Mindfulness – Accepting and being present in the moment.

Distress Tolerance – Coping with negative emotions rather than seeking to escape them.

Emotion Regulation – Learning to manage and change intense, problematic emotions.

Interpersonal Effectiveness – Becoming more assertive and prioritizing self-respect.

How I explain addiction & DBT

DBT can help you gain confidence, and get in touch with your best self, or adult self. It includes cognitive and behavioral interventions, education, mindfulness skills. It will take courage to explore and to face difficulties such as overwhelming emotions, avoidance patterns, and the pain of not living up to your goals and values.

    -Addiction (drinking, drugging, food, entertainment, etc etc) represents a behavior to make you feel ok, to cope with stress, or celebrate

    -Often these behaviors developed out of necessity, to help you sooth an overwhelmed nervous system, emotional and developmental trauma 

    -You may have unresolved developmental, childhood issues. Substances are like an old friend that helped you survive, but now they causing more harm good, holding you back.

        ****When you learn to rely on substances and behaviors to handle life you don't develop                 your own internal resources, strengths, and competence. DBT can help build you up.*****

    -DBT is widely adapted by professionals to help people who struggle with overwhelming emotions. It teaches cognitive and behavioral skills that build you up internally. 

Motivational Interviewing Examples, and Trauma

        Tipping my hand

I want to share with you my goal as an MI therapist. I want to 'create discrepancy' and be disruptive. I know you crave this. But actually I don't have to try very hard to do this. I'll leave it to you. When we explore the cost of your substance use versus your core values, the motivation that evades you will grow. You will realize that you feel drawn to change, even start to imagine the benefits of a sober life. 

Remember, there's no pressure to change today. No judgment. I understand very well how hard it is to be stuck with behaviors, emotions, and habits that aren't serving you well. The first step is a courageous one; talk to a compassionate professional and explore these things. While your substance use may continue while you're in the contemplation stage, talking with a therapist you are doing some essential 'heavy lifting', paving the way forward in your imagination until you reach a tipping point.

One MI intervention I like to use involves examining the pros and cons of substance use. It may seem counter-intuitive to discuss candidly what you like about your addiction or substance use, but all human behavior serves some kind of purpose. For instance, maybe your anxiety interfered with your ability to get social needs met, so alcohol helped you out. 

"Before we can understand what's wrong with our addiction we must first understand what's right with it." -Gabor Mate 

Next, we can bring 'the pros' in conversation with 'the cons'. What do you dislike? Why is it important to you to change? At this point we explore your values in general. Often this is where the tears come, because our relationship with the substance has caused us to neglect the things we really care about i.e. care of self and others. 

The real work of recovery is not a subtraction project; it is about adding value and satisfaction to your life, which has been lost. When you truly learn that substances interfere with the good life you will chose sobriety

I usually try to explode a common myth: the central task of true recovery is not about stopping an addictive behavior; it is actually about building a fulfilling life, consistent with one's values. Eventually substances become irrelevant. (Check out Johann Hari's amazing TED Talk on the subject!) You become attracted to living a productive, fulfilling life. Your desires will change. You will finally grow up.