Episode 94

We have witnessed the impact of substance use on the loved ones of the person who is using. It can feel like the person who is using substances is either oblivious to the pain they cause or at worst, that they don’t care about hurting their friends and family. Perhaps you’ve experienced this with a friend or a family member. How then do we sit with the person using, knowing they are actively hurting others, and have compassion?

I’ve experienced this many times. My work with teenagers means that I end up with kids who have no stable adults. I am very often the only stable non-teacher adult in their lives.  Even though I do substance work as a specialty, I am not immune from anger and helplessness of seeing a person being harmed by another. I too have wondered “Why can’t the parent choose their kid over their substance?”

The truth is, the person isn’t choosing their substance over their loved one. It’s more complicated than that. There is one thing I’ve repeatedly observed over the 19 years of doing this, if love was enough to get (and keep) someone sober, nearly everyone would do it. 

This week on the All Things Substance podcast, why it’s just not true that people who are using choose their substance over their loved ones. My heart, like yours, has hurt for my clients. I’ve been livid with their family or friends and felt helpless. Listen to this episode to hear how I found compassion.


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use 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 competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 94. Today we’re gonna be continuing our series on myths about addiction. We’re gonna be doing one of these every month for the foreseeable future in an effort to help dispel some of the misconceptions around addiction and addiction treatment. Within that addiction treatment, I’m also including people who are using substances, but may not be at the level of full addiction yet. That can be really difficult to determine and our opinion on the matter isn’t actually all that important. It’s the person who gets to decide whether they are an addict, an alcoholic, or not. 

Sometimes people find those labels unhelpful, and other times people do resonate pretty deeply with them. In the recovery community being an addict or an alcoholic is not a shameful thing. It’s something that people accept and wear as part of who they are and how they became the person they are today. So when I use a word like addict or alcoholic, I want it to come across in a way that I mean it. . It’s not meant to be a polarizing word or descriptor. It is coming from a place of being in recovery. 

I am an addict. I am an addict in recovery, but a lot of the addict thoughts still exist, even though I’ve been sober from drugs since 96 and the last time I took a drink was 2004. When I figured out that even if I only drank six times a year, I didn’t make awesome choices and so I just better not drink. I still know that that addict itself lives in me. I’m not upset with her. I’m not ashamed of her. And so please know that that’s where my heart is when I say those words.

This podcast is gonna talk about some really difficult things. Some potentially triggering things like sexual abuse, sexual assault, domestic violence, death overdose, and probably other things. I wanna give that warning at the outset. We’re therapists and we hear a lot of things. However, I think we all still get to decide what we hear on our off time and what we don’t.

As I thought about today’s topic, I was trying to figure out what story I wanted to tell. What I came up with is that I wanna share the kind of human side that I have just like the rest of you, even though substance use is my specialty. I still struggle with this particular thing.

So today the myth about addiction is that people who are using substances are just selfish, that they choose their substance over their loved ones. I am betting that we all have seen the consequences from substance use on another individual.

When someone is using substances, it affects everyone around them. And even many of you probably have someone who has used substances in your life. It can be really hard to work with people who are using substances when that is your background. When you too have felt abandoned, neglected. Have experienced trauma or violence and have wondered why the loved one has chosen their substance over you or over family members. 

For those of you who have that experience, I am grateful you are here listening because it tells me that you want to understand, even though it has hurt you personally. Thank you for being willing to see another perspective.

I firmly believe that addiction is a disease, not a choice. The reason I even mention that is that knowing it’s a disease, doesn’t stop the human side of me, the mom side of me, the protector side of me from getting angry, furious, livid even with parents who are using and neglecting their children.

I ran a program for mental health and substance use. I also ran a program called parent skills, which worked with child protection. Our area doesn’t have a visitation center and so my staff did all of the supervised visitation for child protective services in our county. In supervising all of those programs. I got to hear stories from all sorts of perspectives. 

I heard stories from therapists about a third grader whose dad was really angry and so he brought him a tray of marijuana and suggested that dad used the weed to help him calm down. I heard the story of a first grader who saw her mom choked out and laying on the floor because of somebody’s rampage on meth.

I heard many stories about kids whose parents didn’t show up for visitation. It led me to create some pretty strict policies about even picking up kids for visitation. I made the rule that parents had to confirm within two hours of their visit or else the visit wouldn’t happen. Because those kids waiting for their parents then the parent doesn’t come is devastating. And I don’t know many people, even if you’re not a kid-person, who can watch that and not feel angry and hurt for that kid. 

As a supervisor, my job was to  help them process. They worked with these kids; they’re the ones who saw it. And my job was to help them hold.  It was easier for me than it was for them, because I wasn’t with the kid when that happened. I didn’t hear the pain. I didn’t see a kid struggling to figure out why their parents chose to drink instead of buy food. It is part of the ugliest side of addiction. 

I think most people know that when someone is using the person’s life as a train wreck. The details of that are probably worse than you imagine. I have been on both sides of the fence. I have known children who were in therapy with staff that worked with me, and I have had those parents in group.

I have heard those parents berate themselves for not being able to get clean. I have heard them deal with their own trauma and struggles and try to uphold the promise that they wouldn’t do the same thing to their kids that happened to them and they were failing. I got to see both sides of the spectrum and have compassion on both.

It’s different though, when it was my client. Even though I am convinced that addiction is a disease and not a choice, I am not immune from anger and helplessness and shock and rage on behalf of one of my clients, I have a number of stories over the years that I have had to manage my own reaction and I was thinking about which one to tell you today. 

Because I want you to know you don’t have to be perfect at this. When you work with people who are using substances and you basically hear with a third ear, what it must be like to love this person. It can be hard because we know what happens to the loved ones around them and that the person who’s using can be kind of oblivious. 

This happened a number of years ago and there was a girl that I had known of for quite a while. I had heard her name from other clients of mine. I had heard her name from another staff person I had heard about her parent who had been involved in treatment programming. I had seen her parent on the jail roster. I didn’t meet this person though until they were in high school and tragedy had struck.

The counselor at the school had contacted me, told me about this thing that happened and told me this story. That a student of hers had found their mom dead from drugs. Apparently the girl and her mom had been in an argument for a couple days and the girl had been staying elsewhere. When her mom wasn’t answering her texts, she came home, went up to her bedroom and found her there. 

Estimates say that she had been dead at least a day. If not two. Imagine a teenager pulling their parent off the bed to try to do CPR. Without going into detail, you can imagine what that was like. So I agree to see this person for a crisis appointment. There’s no way we’re getting paperwork. There’s no way we’re getting a diagnostic assessment. This is just crisis. 

She looks like a teenager, but something about her speaks to a lot of things that she had seen and heard and witnessed. She sits down and she’s a little shell shocked. I ask her to tell me where she’s staying and what the current situation is. She tells me in sort of a detached voice where she’s living at the moment and the complications because her dad is also a drug addict and she has very little contact with him. She tells me about infighting among the relatives and tells me about the drug use rampant in the family. She tells me about the plan to have a celebration of life at a bar.

I ask her if she wants to talk about the day that her mom passed away. If she wants to tell me what happened. So she does. Staring at a spot on my desk. You could hear a pin drop in between words. She’s telling me this horrific story in incredible detail, and then she breaks. And instead of an almost graduated teenager, who’s been parentified for years, I have a small, maybe six year old in my office wondering why her mommy is gone and my heart was filled with pain and rage. 

 I’m sitting there trying to hold back my own tears as a powerful wave of grief hits me. I am filled with rage because this isn’t the only trauma that this girl suffered  because of one or both of her parents.

Remember I had known of this girl for a long time. I had heard stories from friends of hers. Their disgust and their shock at what this girl had been through. I had heard the mother’s story from the other side. She had had sobriety for a while. Things were better until they weren’t. The drugs were powerful, the addiction was powerful and by the time she was found there was nothing more that could be done.

In that moment, I struggled with addiction being a disease. In that moment, I was furious and watching this girl crumble in my office and all of the previous trauma that she experienced because of her parents’ drug use melted away. All she was left with were the words in an argument that she shouted at her mom before she left. Those were the last words she would ever say to her mom while she was living.

In that moment, I was face to face with being a daughter, with being a mom, with being a therapist and being one of the only sober adults in this kid’s life. And it was hard. I held the space and I kept myself managed. After she left was a different story. I remember going home that night and all the way home running over this and over this in my head.

And there is no way to fix it and there’s no way to make it better. And there literally is nothing I can do except listen. In that moment, I felt in my bones how selfish her mom was. It wasn’t until later, probably a few days, that I was able to think about her mom and why her mom was using to begin with, because I actually knew.

And so I reminded myself of a woman who had significant trauma as a child. Who had addiction in her family all the way up the ranks; who had domestically violent situations who fought hard to try to put a roof over her children’s heads. And my heart started to soften.

I recalled the pain of the parents that I’ve worked with, when they failed at their attempt to get sober. When they once again let down their children, how ill-equipped they felt to be adults? How in their own soul they felt as though they were teenagers still. That they couldn’t be responsible for others, but knew that they were. That they wanted the love of their children to be enough, to get them sober and keep them sober. At their incredulity at their own actions and the mountain of shame. And my heart softened, 

I came to a place of holding both things true. That this woman loved her children and her use and actions deeply hurt and traumatized them. That she didn’t mean to and that she was a wounded person, just trying to figure out how to climb out of a hole. And her children needed her to do better. 

How does a parent allow their children to be placed in danger? Sometimes mortal danger, sometimes danger from sexual predators, sometimes danger from themselves. How does a parent leave for days at a time letting their eight year old take care of the younger siblings? Cooking for them and making sure they get to school so child protection doesn’t find out. It’s not always the one being traumatized by their parent  or by their loved one or their partner that shows up in our office.

Sometimes it’s the one who’s using. We can’t help but hear the fallout on their loved ones. Their children, even. We are tasked with finding compassion. Of setting aside judgment and seeing the person in all of their woundedness. For some of you, this hits all too close to home and perhaps you can’t work with those folks, perhaps you can’t be objective. And that is perfectly fine. There is no judgment. And in fact, we all are called to know our limits. I think we also have to challenge some of our suppositions, but there are people that each of us aren’t gonna be able to work with. 

Let me paint the picture of the people I have known who had children largely not on purpose and what their addiction life was like for them. I think about the people that were in our chemical dependency program over all the years I was there. I would say that likely two thirds, if not higher than that were parents. 60 to 70% of who we had were men 30 to 40 and 30 to 40 were women. Largely the men had very little to do with their children. There were often a few different mothers of their children. 

Of course there was the occasional man who didn’t care, didn’t wanna be involved and in general did not wanna be a dad. I’ll tell you that was not the majority. The majority of those men felt deep shame because they were bad fathers. They weren’t there. They lied. They didn’t show. They got angry and hit people. They went to prison, they went to jail. 

And in some cases where they were living with their children, there were sketchy people crashing all over the house. Children had been abused, right while they were passed out nearby. They had woken up to bloody faces, stolen electronics, missing piggy banks and babysitting money with no excuses and no ability to explain why. 

For the moms that we had, the shame was greater and indeed, I think the stigma’s even greater. How could a mother do this or that? It’s like a lot of the dads could get a pass, but somehow mother’s instinct, mother’s love should overcome addiction. For the moms the situation was often domestically violent, their children watching them get the shit beat out of them. The children, hearing them selling sex for drugs, children getting abused in the next bedroom with them either not knowing or unable to stop it. 

So we have two choices here, either all of these parents and all of the other people who weren’t parents are truly anti-social. Truly have no care, concern or empathy. Or perhaps they’re not quite that far gone, but they’re still selfish and have to be on the spectrum of antisocial personality disorders to do these kinds of things. To let these kinds of things happen. That’s one choice or there’s something greater going on, something bigger, something stronger, something more powerful. To override, basic instinct to protect self and children, to preserve life at all costs to avoid danger.

These are basic instincts that we have. The drive to live. We know that it’s not possible that all those people are antisocial. Statistically speaking, it’s not possible. In my career., I have met maybe five who were truly antisocial and of the kind where there’s no one home behind their eyes and it’s scary. And I’ve heard of maybe a handful to maybe 10 total from other staff. The majority of all of the people that I was in contact with were just broken.

Not broken in the sense of being damaged goods, but inside traumatized, fragmented, running from their own demons and the ones they inherited. The adults were largely kids themselves. Teenagers when they stopped being able to emotionally progress. I heard about being trafficked by their parent. I heard about finding their parent dead. About watching a parent kill the other one. I heard about scrounging for food and eating food that had been eaten by mice. I heard about being alone for weeks at a time. I heard about deliberately being burned because they had dropped something that broke. 

Those are just a handful of the things and not even the worst things. That is what was in those parents. That is what they were facing. Using drugs and alcohol when you have trauma is understandable and common. When you’re a kid and you have trauma and you can’t stop it and you can’t leave because you’d be called in as a runaway and the cops would just bring you home. You have to escape. 

They didn’t choose addiction. They chose to use. Nobody believes they’re gonna get addicted. Nobody. Everybody believes that they’re smarter than that. And that they will pull the plug before that happens. In this case, we’re talking about teenagers who are making these choices.

We’re talking about teenagers who are now involved with older people, because that’s what happens in that world? Kids who are teenagers and using, they have older friends and sometimes much older friends. Some of the teenagers I’ve worked with have 35 year old friends who buy them alcohol who have parties at their house for teenagers.

Those teenagers have pregnancies, those teenagers end up being dads and moms certainly before they’re ready, but definitely before they’re even remotely able to take care of themselves. And so here we have young adults who are parents of children and infants who need care, who need a mirror to reflect to them that they are wonderful and precious and loved.

And yet that trauma is still there and the support that they need, those people are still using and they’re low income in a lot of cases. And they’re trying to scrape by and they don’t know why their baby won’t stop crying and they’re exhausted and need a break. Lots of kids physical needs are met, but emotionally their parents just don’t have it. 

We get attachment issues. We get learning disabilities. We get a number of other challenges before the kid even hits kindergarten. The parent needs to do better. The parent needs to step up and be a parent. And that parent is likely still a kid inside.

I have seen so many parents try to get sober for their children. They wanna be a better parent. They wanna fix the stuff that happened when they were kids. They don’t wanna recreate the same situations and they are desperate, but addiction is a disease. Yes, they chose to use. And likely that choice was a hell of a long time ago. 

And here they are deep in the disease of addiction. And their brains are now permanently changed from the disease of addiction permanently. It’s visible on brain scans. It makes them more susceptible to relapse. These people have PTSD, depression, anxiety, and almost no distress tolerance skills and no emotional regulation skills. And they suck at relationships and holding a job. Oh my goodness. . 

It’s this cycle. And then someone gets pregnant again, even if they’re on birth control. And then we’ve got two kids or three kids, then child protection is involved and the children get taken. And now the world knows what a horse shit parent they are. That’s how they feel. And so they shy away from contacting the social worker and they don’t wanna tell people how bad things were because of how terrible it was and how they have recreated what their parent did to them. 

So as I sat with my teenage girl and she had found her mom, I had to have compassion on her mom. And understand that while she was a mom, she was still her with all that that entailed. And I know that her mom tried and she succeeded sometimes and she kept trying. And addiction unless it’s arrested, unless it is stopped in its tracks is deadly. 

We have to hold both things true. The choices of people who are using can seem extremely antisocial and selfish and yeah, they are self-serving for sure. It does hurt other people tremendously. The impact is far and wide. And nobody would choose that life. Nobody’s choosing the life of addiction over their family. They want to climb out. They want to get on solid ground and there are so many challenges to it. 

You may not have people that are this far into addiction in your practice. It can head that way because at one time, these people who are now deep in alcoholism were social drinkers. They could moderate. They might have been able to hold a job. They might have been good parents. And now they’re where they are. So you might be getting ’em before all that happens. 

Reminding yourself that we can hold both things true is what I think is needed. In most cases, people are doing the best they can and they need to do better. All of this can be so incredibly heavy and hard because what the fuck. Terrible things happen to people and we, therapists, signed up for this shit. We signed up to hear this stuff. Even if you are not specifically a trauma therapist, trauma shows up anyway, just like if you are not a substance use therapist, substance use shows up anyway, there’s a spectrum on both of those substance use and trauma.

There is a point at which you need to refer out, whether it’s to a specific trauma therapist with a specific treatment modality, or a substance use specialist. But that line is kind of further out than we tend to think. Doing this work is hard. 

My colleague, Jenny Hughes, and I have been working on a thing together. She runs a group called brave providers. It’s a group for therapists to provide support around vicarious trauma, burnout, and compassion fatigue. I recognize that what I’m asking people to do is to add a bit more to their scope, to address substance use. And the stuff we talked about today was fucking heavy.

Jenny and I are passionate that people need support. That therapists need more support. More and more we’re finding that agencies are cutting supervision, cutting support, increasing productivity, running our new therapists into the ground. There are people all the time in the Facebook groups I see questioning whether they can stay in the field or not. In my heart I want people to stay. We need them. And I get it. 

Jenny is passionate about helping therapists develop sustainable ways. To deal with vicarious trauma and burnout. She and I are putting on an event in two weeks. On Tuesday, August 16th, there will be a free event online at 7:00 PM Eastern 4:00 PM. Pacific called Braving the Course.

We are very lucky to have two guest speakers. One is Guy MacPherson of the Trauma Therapist Project, and the other Jean McCarthy, who you got a chance to hear last week. She’ll be talking from a non therapist perspective about what people want from their therapists after she’s interviewed hundreds of people in recovery.

We will be talking about how to work with substance use and trauma without the burnout. It is so important to us and we are so very excited to do this event. You can find the information on my website betsybyler.com/braving-the-course. And that’s braving-the-course.

For those of you who are subscribed to email updates, it’ll also be on the bottom of your email that came out the same day as this podcast release. If you aren’t signed up for updates, there are two ways you can do that. One is by downloading the free Substance Use Decision Tree, and that is at Betsy byler.com/tree.

Or you can go to the contact page on my website and towards the bottom, there is a specific form that says, sign up for updates. If you have questions about this event, the website answers I think most of them. If you need more information, please feel free to email me at betsy@betsybyler.com. There will be a replay if you’re unable to attend, that will be up for several days after the event.

Jenny and I are very excited about this. We’re talking about it all over the internet. I did two podcast interviews this week alone. So check out betsybyler.com/braving-the-course for more information and to register. 

Thank you for listening today. It has been a heavy kind of topic, and I wanted to share with you the realness that I struggle with as well when I see my clients hurting because of someone else. People come in and they’re using substances and you know it’s hurting other people. We can get curious about what makes this person tick? Why did they start using, what is it they’re running from? What is in the way of them getting a handle on the use so that it’s less damaging or so that they get sober.

As for next week. I have a couple ideas yet. I’m waiting on a couple callbacks before I can tell you for sure what we’re gonna talk about. There will be a podcast next week, of course, but I just don’t have the topic picked out yet and so it’ll have to be a surprise. I hope you’ll join me for that podcast and I hope you’ll join us for the event 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.

Helpful Links 



Chapter 2 The Neurobiology of Substance Use, Misuse, and Addiction, The Surgeon General’s Report on Alcohol, Drugs, and Health – chapter-2-neurobiology.pdf

https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112 https://www.asam.org/docs/default-document-library/nccbh-infographic.pdf?sfvrsn=dfe787ab_0