Episode #115

People often hide things they are ashamed of. They also hide things that feel like it’s the only thing holding them up. That can make it really hard to find out organically if someone is overusing substances. In today’s episode we’ll hear about five real people who had issues with alcohol, but wouldn’t have presented for alcohol treatment alone. Each had underlying issues that they were managing with alcohol.



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 115. 

In the last several weeks, we’ve been talking about private practice. It may seem like perhaps an odd thing for me to talk about, given that the podcast is called the All Things Substance Podcast and while there is a play on words there, it really is about substance use.  The way private practice relates is that I believe that the future of our field is going to be in private practice. Of course, there are going to be people who work for agencies, and I think there always will be.

However, the changes in the field, the press of budgets and productivity constraints are pushing a lot of folks to be thinking about moving into private practice sooner than they might have. If private practice is where the therapists are going, then private practice also needs to be the place where people who are struggling with substance use can get help.

Since the start of the podcast, my goal has been to share with all of my fellow therapists that substance use is a part of our scope. Just because we weren’t trained in it, doesn’t mean that we don’t work with it. It doesn’t mean that it doesn’t pop up in our offices because it does.

I’ve been telling you that I’m not looking for all of us to be specialists. I don’t believe that everybody should go back to school and get a substance use counselor license. I don’t believe that is necessary for the work that we do. I think that most of us have all of the skills we need to work with substance use and that all we’re lacking is a little information and perhaps a little guidance.

This week I wanna talk with you about clients that benefit from mental health therapy and who also happen to have substance use disorders.  I’m gonna share the stories of five clients with you today.

These weren’t my clients, and I have permission to share their stories, but they are representative of the types of people we see in practice all the time. When we think of substance use and addiction. I think at times we have a certain image in our head that isn’t totally accurate.  And so I wanna share some of those stories today. 

First, we’ll start with the story of Andrea.  Andrea grew up in a family where she says that hard things didn’t really get talked about. She feels like she was born with this need to tell the truth, the need to share that the emperor has no clothes. It wasn’t a popular thing, but she always felt like she wanted to be the one to share what was really going. This led to her feeling anxious and being a bit awkward. 

She enjoyed a close relationship with her dad as a little girl and enjoyed their time together. However, something started to change when she hit puberty. Her dad started pulling away from her and she didn’t really understand what was happening. As therapists, we can guess what was happening. And it happens in a lot of father-daughter relationships. 

When their daughters go through puberty. Sometimes men don’t know how to relate to them anymore. This isn’t their little girl now. It’s a girl that’s becoming an older girl. Someone who dates someone who might even look like their mom. And in Andrea’s case, she feels like that might have contributed to why her dad was pulling away. By the time she was 14 and 15 she had no relationship with her dad to speak of. 

The way this manifested for her is that she sought a replacement for that, and she says that she turned to boys. What came after was a series of relationships and always trying to find the person that would feed her need for acceptance and love. She called herself a chronic cheater who was always needing more in her relationships. Her alcohol use came into play later. 

She was married and at the place where she was talking with her partner trying to have their first child. It was during this time that her husband’s affair came out, and it also came out that the woman he was having an affair with was pregnant. It was their neighbor across the street. Going through a messy divorce was really hard. 

She ended up dating a man who had a terminal illness. He said that he had cancer and had a certain number of months to live. She found out later that really he was an opioid addict and that he needed treatment. It was devastating for her. She also found out then that she was pregnant with his child. 

Still reeling from these events she would end up dating and marrying her now husband. Her drinking during this time was escalating, being used to cope. We’re not talking about daily drinking but we’re talking about middle ground drinking, gray area drinking. She had been a party girl. But those kinds of habits weren’t serving her as a mom. 

To hear her tell it. She came to a point where she realized that if she didn’t stop that this drinking thing was gonna get outta control and that it was gonna go really bad. She calls it getting off the elevator at an earlier floor. The elevator certainly goes all the way to the bottom, but for whatever reason, she was able to take that epiphany and get off several stops early. She has spent that time building herself a recovery from codependency and from alcohol.

She had experiences in therapy, but her drinking wasn’t something that got addressed. She doesn’t remember whether or not she got asked about it really, even though there were periods of time where it was really a problem. Today, Andrea Owen is an author, a global keynote speaker, and a professional certified life coach who helps high achieving women, maximize unshakeable confidence and master resilience through her books coaching and her popular podcast that has over 4 million downloads. If you wanna hear Andrea’s story in its entirety, you can check it out here on the podcast at episode 113.

Andrea’s story, if she came to us, wouldn’t seem like someone who was having a substance use problem. She was someone who grew up in a family where her primary attachment to her father got broken at a really difficult time. She went through puberty and all of a sudden lost her relationship with her father. 

She ended up having relationship after relationship and sabotaging herself in those relationships, as well as dating people who weren’t great choices for. She got hurt and wounded in these relationships and kept seeking more.

How often do we find that? I see that a lot with the people  I work with, where they seem to keep finding the same person to date over and over again. Her drinking was definitely a part of all of that and contributed to some of the poor decisions that she made. But that’s not what she would’ve called the office for. She would’ve called the office for anxiety, for relationship problems, not for alcohol use. 

The next story is of a woman named Jill. Jill grew up in a home where she experienced childhood trauma as many of our clients do. She worked really hard to get out of it and to make something out of herself. She went to nursing school and realized her dream of becoming a nurse. As she began her nursing career, she started in pediatric oncology.

Her drinking was normal, social and wasn’t a problem. She met her husband, fell in love, and the two of them embarked on business adventures together, they created a consulting company.  They started and ran a pharmaceutical company and they traveled to different practices to share information about different medications.

This was not part of the pharmaceutical rep industry where other pretty people went around and talked about things they didn’t know about. They were professionals. She had a medical background and she was passionate about the medications that they were talking about. Their business was super successful. They were all over the place moving at high speed and creating a ton of success.

In her thirties, she had three children. Each pregnancy and following C-section was more difficult and more complicated than the one before. She was advised after her third child that she really couldn’t be having more children or else it would put her own health at risk. This was really sad for her and difficult.

During this same time period, she was about to turn 40 and her husband and her were selling their company. It was a two year process that did not go as planned, and it was full of stress and her drinking escalated.

 She knew that she was drinking more than normal and figured that once the business sale was over, that her drinking would go back to what it was before, only it didn’t.

Her drinking became its own thing and was impacting her life, her relationship with her children and her husband.  After the sale of the company, they moved to a new town and she got heavily involved. They had a retail store that was highly successful. She was a yoga instructor and a spin instructor. She was a triathlete and wrote a cookbook. 

As she tells her story. What changed was that when menopause hit, it changed how alcohol was metabolized in her body and she ended up getting intoxicated very easily. She had been drinking daily up to that point, and it got to the point where her husband gave her an ultimatum about getting sober. 

She took him at the tough love she says that it was and about six months into her recovery, she was sitting in a meeting and realized that someone was telling a story about their trauma and that she had the same experiences.

She thought that things weren’t right growing up and that things were hard, but she didn’t realize that it was trauma with a big T. The more she learned, the more she realized how much she discounted her childhood. She has a five out of 10 as an ACE score. That’s Adverse Childhood Experiences.

As she came to grips with her past and how it set her up for the things in her life, she began a path of healing. Today, Jill is a holistic health nurse and a recovery coach. She still retains her nursing license and is active in the community bringing awareness to nurses that struggle with alcohol use disorder and other substance use disorders. 

If Jill had come to our offices, she probably would’ve called about stress, anxiety, phase of life problems like children growing up and menopause. She had a life that seemed like it was pretty great. They had money. They lived in an excellent area with a lot of really forward-thinking people. She was a yoga instructor, a triathlete, wrote a cookbook, and was busy with all sorts of things. 

I don’t know that we would have known to ask about her drinking. Yet she was drinking daily and she was drinking to the point that her husband, who had been her husband for many, many years, gave her an ultimatum about getting clean. The next story, if you wanna hear more about Jill’s story and Path to Recovery, you can check it out here on the podcast at episode 59. 

The next story is about a man named Sean.  Sean grew up in southern Wisconsin. He describes his childhood as fairly normal. His father was the local police officer  in their town, and was well respected. Sean grew up playing sports and his dad was right there all the time. He describes his father as his hero.

When he went away to college, he met his wife, fell in love, and the two were married. The couple settled down near his dad, and he was an active grandpa and part of their life.

Sean  was happy and in love. His drinking had been social, probably a little more as he got older, as tends to happen in Wisconsin, as I’ve talked about before, we have quite the drinking culture here, but it wasn’t anything out of hand. He wasn’t drinking any more than the people around him.  He had run a successful business and had a good relationship. Was being a good dad. It wasn’t until August of 2015 when his father received the diagnosis of ALS.

I’m not sure if you know much about ALS, but as Sean tells it, nobody wins against al s. There isn’t a cure, there isn’t a way to stop it, and in the end you’re basically stuck in your own body, unable to move or speak. Watching this happen was devastating for Sean.

It took five years for ALS to take his father, and during that time, Sean tried everything he could to spend as much time with his dad as possible. He did what he could to raise money for Al s research training for the Boston Marathon, and put together a team of donors. He was able to work with  a research team doing actual research on a l s. He was in the best shape of his life.

After the race, however, he feels like that’s when things started going down. His father’s condition continued to deteriorate. He remembers his dad having a text to speech voice. He liked to use a John Wayne voice, he said about his dad, even though they all hated it. But his dad had an incredible sense of. 

It was difficult for Sean to watch all of this happening and continue to be the strong stay-at-home dad of his now four girls. His youngest had been born in the last year of his father’s life. When his father passed away, Sean fell into a very deep state of grief and depression.

His hero was gone. His dad, who had been his anchor, who had been his right hand, who had shown him how to be a dad and how to live life was gone and he didn’t know how to grieve. He didn’t know how to do this for himself. And so he drank. He still managed to keep up with his duties as a stay-at-home dad  and drank when he was able to be off duty, so to speak. 

He was drinking every day and he was able to hide it. Even now, he’s not sure how he hid it so well, but he was drinking to the point of having withdrawal. He talks about how he had tried to build up courage to tell his wife and he had written an email  and was planning on sending it and kept thinking, tonight, I’ll send it tonight, I’ll send it. And it wasn’t until his wife caught him in a small lie. 

She had asked him to make a chiropractor appointment and he said that he did, but he hadn’t. And somehow she saw something that indicated that he hadn’t done that.  And she asked him why he lied to her, and the truth came tumbling out as they sat in bed, all of their girls asleep. His wife’s response was, okay, then we need to get you help. And she took him to detox. 

This was during the pandemic, and so he needed to do things at home once he was out of detox. And so he did therapy from home and the basement computer and spent the rest of the time parenting his kids,  and rebuilding his life.  Meetings were not something that really were Sean’s thing. He tried them, and knows lots of people who love meetings like aa, but for him, that wasn’t the thing that was gonna keep him sober. 

I’m not sure if you know what Peloton is. Peloton though started as a bike and it became a movement, sort of like CrossFit, except bikes and now treadmills and other classes. Peloton folks are intense about their Pelotons and there is a sober squad community and that is where he met other people like him who were trying to live their lives in a sober way. 

Very recently, Sean came out on Facebook to everyone as being sober. It took him a while to get to that place because it was a hard thing for him to talk about. But now he is loud and proud about his recovery. And still he’s taking care of his girls coaching basketball, running a business, and feels like the luckiest man on the planet. If you wanna hear Sean’s story in its entirety, you can do that here on the podcast at episode 71.

Imagine that we had Sean come into our office either before his dad passed away or after. He would’ve called because he would’ve had trouble with motivation and grief. I don’t know that we would’ve sensed that his drinking was out of control.  He was taking care of his girls, feeding his family, helping with homework, getting up and doing it every day. Yet he was drinking daily and hiding it fairly well. 

It’s true that Sean needed detox. It was the right call. Alcohol withdrawal is no joke. I’ve said it numerous times and I’m sure I will say a ton more. Alcohol withdrawal is one of the withdrawals that can kill you outright. Alcohol is also one of the things that people seem to think they can quit cold turkey. I am grateful that his wife knew that he needed help and he needed medical help. 

Just because someone in our care is drinking daily doesn’t mean we can’t work with them. It just means that if they’re gonna stop, that they need some assistance. They don’t necessarily have to go inpatient into detox. There are doctors who are willing to help people by giving them medications to take while they’re at home to help them down to reduce the risk of seizures. I wonder how many folks come to us with grief or anxiety, or work stress or phase of life, and what about their drinking?

Our next story is about a woman named Jean. Jean grew up on a rural farm  near Toronto, Canada. Her father described himself as an alcoholic and got sober very early. By the time he was about 23. Jean grew up with stories about that and her father talking about how, because he’s an alcoholic, he can’t drink at all.

So she knew this and it was just sort of something in the background. It would be helpful later in her own journey. Jean was a pretty average kid partying here and there with her sisters experimenting with alcohol , like the other kids around her. In a rural community drinking’s pretty common and so it wasn’t abnormal. 

She got married and became a young mom. She found herself working in the house building industry. She and her husband had a business and were extremely successful. You could see Jean’s name pop up on a number of who’s who type lists around the area.  Her face graced the cover of magazines and publications in the industry. 

She had three children running a successful business. She was a good mom and devoted to her family. Her drinking was something that she was using to manage her anxiety. As you hear her describe it, she talks about how when she would get home from picking up the boys at their sports or a meeting or some kind of work function, she would have to time her drinking. 

She knew exactly how much she had to drink  in order to make it so the moment she laid down in bed, she would pass out. Because if she didn’t time it, Then she wouldn’t be able to get to bed by herself, and if she didn’t time it correctly and ended up laying in bed, then she would be awake and the thoughts would come. The anxious, spinning thoughts that would not leave her alone.

She talks about how she tried to quit every day for years. She’d say every morning. She woke up with hope that today was gonna be the day. She and I have talked about what it would’ve been like if she’d been a client. She said that she would’ve called in the morning when she woke up to get an appointment to come see a therapist.

She would’ve had to make the appointment for the morning as well, because what she knew is that as the day went on and as the withdrawal started setting in, and as the anxiety started coming, she would’ve canceled the appointment and if she had gone, alcohol would not have been on the table as something to talk about. Even though she desperately wanted to stop. 

She stopped buying bottles of wine and started buying boxes so that she didn’t have to count how many bottles she was drinking. I think we have an idea that people get sober by going to treatment, and truthfully, lots of people don’t go to treatment. For Jean it was an epiphany. It was just a moment where all of a sudden she realized that if she didn’t stop, she could see where this was gonna go and that this was gonna get really, really bad. And so she did something. That she didn’t even know if it was gonna work, but she decided to stop and she decided to stop on her own and in private today. 

She’ll tell you that that was unwise and that she found out what withdrawal was like. She makes it part of her story to make sure she tells people about the risks of withdrawal because she didn’t know. She just knew that she was really sick. What she did to help herself though was to start writing. And she started writing a blog from day one. 

She started sharing her story of that day and what it was like to not drink that day. And the next day and the next day. Somehow people started finding her blog. What kept her sober initially was that these other people  were reading her and finding inspiration there, and she didn’t wanna let them down. She shared it with her husband, but kept the secret from the majority of people in her life. She didn’t wanna have to explain if she failed.

What ended up happening is that she became sober about 12 years ago, and she wrote that blog every day. Initially it started  as self-preservation, and then it became about helping others and then it morphed into more. She went on to host the podcast, the Bubble Hour. And just finished its 10th season. 

She’s written a number of books about becoming sober, being sober curious and the relationship with alcohol. Her podcast is full of recovery stories and well over 10 million downloads. She is a voice for recovery and an inspiration. 

Think about what we would have seen when we met her for an intake. She would’ve called because of work stress, anxiety, trouble sleeping. Even if she had told us that she used some wine to help her get to sleep, would we have known that she was drinking bottles, would we have questioned her? 

She was incredibly successful. High achieving kids, high achieving husband, seemingly having it all. Just struggling to cope with the stress of it, yet very much in deep with alcohol. You can hear Jean’s story in its entirety here on the podcast episode 93

Our last story for today’s episode is about a woman named Amy. Amy, also a Canadian from the Toronto area. Grew up in a family where her father was an alcoholic. Her parents split up and it was a pretty messy divorce. During the time they split up, some family secrets came out that nobody was really prepared to talk about and or deal with. By the time Amy was 16, she was drinking alone in her bedroom and having blackouts.

This wasn’t something that was public knowledge to those around her as her drinking seemed normal in light of everyone partying around her. However, it was anything but normal. What exacerbated this for Amy is that when she was 18, she came out as gay. During that time period, there weren’t a lot of spaces where people felt safe being out as they might now. I’m not saying that there are safe spaces everywhere, but there are a lot more of ’em than there were when Amy was coming.

The bar scene ended up being the first place that she felt safe to be herself. And so when she moved to the big city, queer bars were the place that she felt like she could be herself. Drinking was hand in hand with that. She was able to maintain her life. She went to school, had a good job and was doing important research on world health. It didn’t look  like she was struggling with alcohol use. 

In 2014, her father passed away and their relationship was, had been strained to say the. She ended up serving as the executor for his estate, which was incredibly stressful. This was what seemed to push her drinking beyond what it had been. Her grief was swallowing her and the way she figured out how to cope was to drink more. 

The end came for her from simply being sick and tired of being sick and tired. She woke up and realized, I can’t do this anymore. I don’t want to do this anymore. I can’t go on this way.  She said that she couldn’t stomach the idea of never drinking again, and so she just decided to stop drinking for a while to just take a break. She decided in six months that she wasn’t gonna drink anything for six months, and that after that she could reevaluate.

What happened was that Amy found recovery and she found healing from her grief and purpose as she moved into the future. Today, Amy is a mindset and sobriety coach living in Toronto. Her struggle with alcohol would take over 15 years for her to come to a place where she left it behind.

She dedicates her career to helping others overcome their problematic relationship with substances. She created her own business and has been working with people ever since.

If Amy had come to our office, perhaps it would’ve been for grief when her father passed away, or perhaps before that it was from the struggle of coming out in a society where that wasn’t necessarily acceptable and dealing with the aftermath of her parents’ tumultuous divorce. She was successful, went to school, and did important world health research. I don’t know that it would’ve occurred to most of us that she had a problem with alcohol. You can hear Amy’s story in its entirety. Hear on the podcast at episode 107.

So why am I telling you all of this? What is the point?  I wanted to share with you that alcohol or other substances are in the lives of people we would least expect. They’re using it to cope. They’re using it to numb out. They’re finding ways to manage because life doesn’t stop. 

They show up in our offices because they’re depressed or anxious or have grief. Because they can’t sleep or because their blood pressure is too high and their doctor thinks they need to go see somebody to talk about. They don’t come in telling us they have problems with alcohol or other substances.

When I talk about wanting you to expand your scope to include substance use, this is what I mean. These are the people I want us to be able to see. There are plenty of folks who need specialists who are using heroin or meth who aren’t gonna be able to find recovery, who can’t cut back, who can’t moderate.

Definitely we need to make referrals. In my experience, that is not the majority of people. The majority of people are overusing substances to cope, and what they need to do is learn how to cope without them. I wanted to give you real life examples of people who might show up in our office.

Of people who, in some cases got sober because they had an epiphany and they just had to tough it out and try to figure out how to stop. Because they weren’t at the point of needing treatment. They were able to build recovery plans that didn’t involve going to aa. They found a unique and individual way to build themselves a life worth living without substances. 

This is January, and as you have seen online, Dry January has become a thing. There is a sober curious movement where people are questioning their relationship with alcohol. The statistics are in: drinking days per month have gone up 14% since the pandemic started, and those rates have not come back to baseline. Women are now drinking as much as men, and the research says that they’re drinking to cope. 

I want to invite you to the webinar that I’m hosting in one week. So a week from tomorrow, I am hosting a webinar called Analyzing Alcohol. We’re gonna talk about the sober curious movement, gray area drinking, and how much is too much when it comes to alcohol. It’s a two hour event online. It’ll be on Tuesday, January 24th at 7:00 PM Eastern, and there will be a replay after the event if you can’t make it live.

In addition to the replay video there will also be the slides from the presentation. You can register at betsybyler.com/alcohol. Be sure to use the code NEWYEAR23 to get 25% off your ticket. I really hope you come join me. I want to be able to give you good and practical information about alcohol so that you can support the sober curious people around you, and those who perhaps aren’t at that place yet. Head over to betsybyler.com/alcohol to check it out.

Next week on the podcast, we’re gonna be talking about how to tell if someone is appropriate for outpatient therapy or if their substance use needs a specialist. I hope you’ll join me for that 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.

Helpful Links 


Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults – PMC

Newsweek: Alcohol Abuse Increased During COVID Pandemic, Study Shows