Episode 1

What do addiction and therapy have to do with each other?

What role should we play in treating addiction?

Part one of a five-part discussion why addiction is absolutely the business of mental health therapists and why we all need to know how to assess and treat addiction in our mental health clients. Addiction and therapy need to coexist. 

In this Podcast

  • Each of us have a different story about how we became a therapist, here’s mine.
  • When we start work as a therapist we find out what skills we have and we also find out what we are missing.
  • Many programs had no addiction raining or else it was optional. 
  • Addiction touches all of our clients lives and we need to know how to address it

Helpful Links:

Free Treatment Planning Tool  https://betsybyler.com/treatment-tool/

My Counseling Practice


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler, and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and confidence needed to add substance use to their scope of practice.

I take topics that are typically aimed at substance abuse counselors and share them with mental health therapists in a way that is relevant and tailored to meet our needs. By adding substance abuse to your scope, you can expand your ability to treat the whole person and better meet your client’s needs.  Bringing more hope, healing and freedom to the people you serve.

Doing therapy is hard work. Made harder when addiction is thrown into the mix. Many of us didn’t get the training we needed to deal with substance use and finding the knowledge that you need to fill that gap can be difficult. Each episode, I’ll bring you information on substance abuse, topics that impact our work, helping you gain knowledge and confidence. In a relatable and practical way. So join me each week as we talk about All Things Substance.

Welcome to the All Things Substance podcast. I’m your host, Betsy Byler. I’m a licensed counselor with a substance abuse specialty, seeing teenagers and adults with trauma and substance use. I became a therapist in 2003, and since then I’ve had the opportunity to have a number of different types of jobs both in addiction and therapy.

I’ve worked in residential treatment, long-term and short term. I’ve done in-home therapy, outpatient therapy, substance abuse counseling, school-based services, and became a clinical supervisor and a director. Most recently I added private practice to my resume.

I live in the woods of Northwest Wisconsin. We’re on the border of Minnesota and Wisconsin, about two and a half hours from the Canadian border. It is gorgeous up here. Lake Superior is about 30 miles from my house. And I see it every time we have to go into town to get groceries. We looked for two and a half years for the right place, probably saw 50 different houses. And when we drove up the driveway to this one, we both just knew. There are many days I still can’t believe that it’s ours. We share our home with our two cats who we love and spoil. I have two grown daughters who live about 30 to 45 minutes from us. We don’t get to see them nearly as much as we’d like, especially with all of the virus stuff going on this year. But I am grateful that they are close enough. I moved up here to this area in 2008 with my family and was working in an outpatient clinic and became the supervisor and the director. Moving into private practice was a great move for me, but I miss my team. I had some of the best therapists, substance abuse counselors and definitely the best clinic manager in the whole area.

During my time, I ended up interviewing, hiring tons of different people, interns, therapists, counselors, and I would always ask them what made you want to be a therapist? And the stories were always super interesting to me because everyone has the story. Once in a blue moon, I’d get somebody who was like, I don’t know, seemed like the thing to do. And usually that was kind of the end of the interview right there. And it wasn’t that I didn’t think that people could just fall into this field, but I was looking for passion. I was looking for commitment and I was looking for some kind of spark that they were going to fit in with our team. So I figured that’s where we’ll start today. I’ll tell you how I decided to become a therapist.

There are a lot of words that people have used to describe me over the years. My mom used to tell me that I was so busy all the time, moving, moving, moving. She was telling me that I moved through life like a Mack truck. Other people in my life have told me that I’m like a force of nature. All these things were said in a positive way. Well, I might’ve had the same type of personality, but there were definitely years where I did not use that in a good way. In high school was one of those times.

My sister was the good daughter. She was older, far more obedient, not getting into trouble. That was not my way. I decided I wanted to do whatever I felt like doing. And so by the time I was 16, I was really out of hand. My mom tried lots of things to try to get me under control and it just wasn’t happening. So then she landed on a way that was going to work. Blackmail.

I came home one morning after having been out with friends and she was like, well, you’re going to go to therapy next week. And I was like, uh, what? And she’s like, yeah, you’re going to go to therapy next week. And I said, uh, no, I’m not. And she said, I’m pretty sure you are. And she proceeded to pull out pieces of paper folded really intricately. Now I’m dating myself here, but there are those of you listening who remember what it was like to have to pass notes rather than sending texts. And we used to fold our notes in like these really intricate ways. So I had these and I had tucked him in something that she had found while I was out. She read these notes and. I have to say we were sort of dumb. Not really sure what convinced us that we should write about doing drugs, getting them and drinking, partying. And we should write about all that in these notes that we pass while at school, was really pretty stupid. Oh, and our names were on them every single one. So she pulls these out and says to me, oh, you’re going to therapy. Cause if you don’t, I’m going to call these girls’ parents and tell them that they’re using with you.  Speechless.

I’m pretty sure I found my voice and started yelling, but there was literally nothing I could do. She had me dead to rights. And this wasn’t the kind of situation where she couldn’t find these parents or didn’t know them. Like the town I grew up in was 55,000 people, which compared to Chicagoland, not very big, but small enough that she could find these people’s parents. And I super, wasn’t going to be a snitch. So there was literally nothing else I could do. Guess I’m going to therapy. What followed was her taking me to a number of different therapists, nine to be exact. And I hated every single one of them until the ninth. Why it wasn’t eight was because the eighth one, I said some choice words to him and walked out. Why it wasn’t 10 is because the ninth one was the perfect fit.

I remember meeting her. I knew she had seen two of my sister’s friends and that they liked going to see her, but I didn’t have a chance to check with them before I went. So I think I was slightly less defensive, but definitely wasn’t expecting anything good. So we go in there and I meet the woman and her name’s Betsy.

Now, I don’t know if you have a common name or an unusual name, but there aren’t that many Betsy’s running around in the world. And so this was kind of unusual. I remember sitting in her office and I don’t remember what she said to me that day, but I remember having this thought of like, huh, maybe this’ll work. She was able to work in addiction and therapy.

She had a way of talking to me that made me feel like she actually heard me. It made me feel like she was listening to me. It made me feel like she understood what I was talking about. She had a way of calling me on things that I didn’t feel like I needed to get defensive. I didn’t feel like she was being judgmental and she wasn’t trying to be my friend either.

She had this amazing mix and it just worked for me. That time in my life between 16 and 17 was a really bad year. I remember during one of our sessions, sitting on her couch, and I don’t remember what we were talking about, but I do remember what I was thinking, all of a sudden I had this thought, you know, someday I’m going to get sober and I could do this. And what I meant was I could become a therapist and I could work with kids like me. The feeling of being truly understood was amazing. It’s not that I wasn’t loved. It’s not that I didn’t have friends. It’s not that people didn’t try, but I was so deep in my head and I was so deep in my own pain that I just didn’t know how to get out. And Betsy was a lifeline to me and it was that moment forward that I knew what I was going to do with my life. And I knew that that day would come. And the day finally did come.

I was in college, up North of Chicago, and I finally got to the place where I knew I had to quit and I had to get my shit together and I had to do something. And so I did, I changed my friends. I changed all sorts of things and I transferred schools. I spent a year doing community college and establishing residency in Grand Rapids, Michigan. And then I went to Michigan State. I had decided I was going to study psychology because at the time it didn’t really know about the whole psychology/social work thing yet. And so psychology was what I wanted to do.

While I was in school. I got the chance to be a part of an organization that worked with kids; high school kids to be exact. And I got to work with teenagers in a mentoring role. I did that all through college and in the year following. And something that was interesting is the kind of kids that I would attract were kids who were just like  I was. Girls who were sassy, smart, funny, in pain and using drugs.

I didn’t seek them out. They just sort of gravitated towards me. As I got to know each girl, it became really clear that they had some stuff that they needed to deal with. Because when you’re in the drug world, trauma happens. And these girls needed someone to help them through their trauma. And I didn’t have those skills.  It’s not like Michigan State is in some sort of tiny area where we couldn’t find therapists. There were therapists there. And I tried sending them to those therapists, but it didn’t work. They were like, no, they’re not you. She’s this. I felt judged, et cetera. And I just couldn’t seem to find the right person for these kids. I did what I could do; built relationships with these girls, was there for them, loved them, did my best, but I knew they needed more.

After college, I got the typical, well, now what?  I knew that I couldn’t be a therapist unless I went to grad school. At the time I had done five and a half years of college and I wasn’t super sure I was ready to go back to school. So I spent the next year working. That pull to work with these girls and to help them through their pain, never went away.

And so in the spring of 2001, I found myself applying to grad school. I was applying sorta late. I just decided one day, I think I’m going to do this. And the deadline had passed for the school I was applying to. I called down and the admissions counselor, whose name was Jose and I adore him wherever he is now, helped me get an interview. And within 48 hours, I had managed to pull together all my references, right. A couple of essays, transcripts, all of it. And there, I was heading back to my hometown. That fall, I started grad school and it would turn out to be one of the best experiences of my life. I remember sitting in class and lots of my classmates didn’t really know what they wanted to do as therapists just that they wanted to help people.

My experience was sort of rare to know exactly the kind of population I wanted to work with. My first semester, I was there. A guy came to talk to our class. He was the director of a residential facility in Montana, and I listened to him. And as he’s talking, I have this thought I could work for him. Because I listened to him talk about his passion for kids. And he talked about kids the way I talk about kids. So I applied to do my internship in Montana. Now I might not have grown up in the city of Chicago, but I am a city girl. So going to Montana was sort of a stretch, but I knew that this is what I wanted to do. So I did. I got to do addiction and therapy. I did my internship over a summer in Montana, and I’ve got to tell you it was culture shock for me.

I remember that there was a Pizza Hut and I had been there with some coworkers. And I was walking out to my car and there was a middle aged guy fixing sprinklers. And he starts talking to me and I’m a little surprised and weirded out. And I’m thinking, is he hitting on me? And then I realized later, uh, no, he was being friendly. It was just the weirdest thing for me to be there.

I had an amazing time when I was in Montana. It was super hard work. These kids were in way rougher shape than the kids I had dealt with. These kids had been through some of the most severe trauma I have ever heard in my entire career. And it wasn’t just one kid out of the hundred that were there. It was every single one of them.

And it was like every single story was worse and worse. I remember laying on the couch in the intern house I was living in and The Bachelor was on and I didn’t really get into the whole Bachelor thing, but I was so drained by the time I came home at night that I would just lay there and watch it. But I do remember walking across campus to get to my building and thinking, this is where I’m supposed to be. This work. This is my purpose. This is why I’m here. And it was the sense of rightness that I was right where I was supposed to be doing exactly the kind of work I was built to do, addiction and therapy.

Now just take a little sidestep and let you know that I met my husband on the way to my internship. Had no plans on meeting my husband. I didn’t know when I met him, he was my husband, but I ended up marrying him two years later. Best decision I ever made. So I ended up moving to South Dakota. I had no idea. I’d wind up in South Dakota. There was a time when I thought South Dakota was in the middle of the woods. I mean, like. Twin Peaks, Alaska sort of woods.

And if you’ve ever been to the Dakotas, it is nothing like that. It is Prairie. I just had zero idea what existed past the Mississippi. So living in South Dakota, I interviewed at a couple places, but the one job that I wanted so much was at this treatment center. It was a residential treatment center, short term, about 30 to 45 days.

And they were going to start an adolescent girls unit. And I couldn’t believe my luck. This was exactly what I wanted. Teenage girls who are using drugs and have mental health issues. Oh, hell yeah. That’s exactly what I wanted to do. And I felt so lucky and so excited. I remember doing the interview. And feeling really confident, feeling super confident in my skills that I had great training that I knew what I was doing, and I was going to kick this jobs ass.

I got the job and started work. And I was going to get to do my hours and get my license. Perfect. I don’t know if you guys remember, but the idea of looking for a job and trying to get supervision and making sure you had the right kind of supervision and that your master’s level work was going to count in that state. It was super stressful. And so finding a place that I could do my hours and that I could get the kind of experience I was gonna get and work with my population, man was super awesome. And I am so grateful for that job.

As I began working there, I noticed something, I didn’t know, as much as the other people there. I’m going to talk about that more in the next podcast, but what was dawning on me is something that would change the future of my career. I didn’t know how to treat the addiction. I truly thought I did. I would have sworn on a stack of Bibles that I knew what I was doing, and I really, really didn’t. I spent the next two years, learning that over and over.

And I thought about it and I was like, why didn’t I learn this stuff? How did my program not tell me this? I took the optional class for substance abuse, had my own history. I really thought I was prepared, but I’m telling you addiction work is really, really different. And when I moved into outpatient jobs and doing in-home therapy, it was the same thing.

People were using drugs, either my clients were using or their parents were using or people they lived with, or you name it. But alcohol and drug use was everywhere. They needed addiction and therapy. And I started thinking about like, what is this? Is this just my program? I felt like I was ready to do the job. And then I got this wake up call that I was missing the skills I needed to do this work.

This is exactly what happened before I went to grad school. When I had that realization of, Oh my God, I don’t know what I’m doing. I need to get some help. I need to get skills in order to work with these kinds of kids. And be effective. So here I was done, gone to grad school, 60 grand later, and I’m at the same point now. Granted, it wasn’t all of the skills it was substance use, but I had no idea that was coming.

And I’m wondering how many of you had the same experience? When you started doing work and you started hearing about people using, maybe they’re smoking weed, maybe they’re drinking alcohol, maybe they’re using meth, maybe it’s opiates, whatever. Right. Where you started realizing like, Oh, I’m not sure I do substance use. I’m not really sure what to do here.

So this is where I’m at now. And this is why I’m starting this podcast. I’ve been a therapist since 2003. I have had numerous roles, whether it’s inpatient, outpatient, residential supervisor, director, and I have had the opportunity to work with tons of therapists and interns over the years. And I spent those years training anyone who would hear me and anyone who crossed my path about substance use. It’s my belief that substance abuse and addiction touches the lives of nearly all of our clients. It’s also my belief that most of us were not adequately trained to deal with that. We got some tools, but we didn’t get every tool we needed.

And the tools that we missed could have lethal consequences. Addiction is a deadly disease. The NA  basic text says that there are three ways that you get out of addiction, jails, institutions, or death. And I would shorten that even to say that you either quit or you die. I don’t know why our programs didn’t have addiction stuff. Didn’t have addiction and substance use built into them, but they really didn’t. I believe that in order to bring more freedom and hope to more people that we need to know substance use. And that we can evolve and include that as part of our skillset.

Which leads us to the question of Okay, but how? I know the idea of getting more training can feel overwhelming. I remember after grad school that I didn’t want to read anything of literary value because I was so burned out on it. It took me a while before I really had a desire to learn again. Chances are, you’re seeing clients all day every day, and it can feel daunting to try to learn something new when you’re already feeling stretched. And the amount of information out there about substance use is staggering. It’s hard to know where to start, which information you need and even which information is accurate. Addiction and therapy training can be hard to find. This is why I started this podcast. I’ve spent the last 17 years of my career learning how to integrate substance abuse and mental health.

And I want to share that information with you in a way that honors your time and gives you truly useful information. In the next few podcasts I’m going to be talking about integrating mental health and substance use in more depth, making the case for why all of us should know about substance use and feel competent in addressing it.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist, friends, and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast and until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal clinical or any other professional information. If you want a professional, you should find one.