Episode #106

Substance use is our problem. By “our” I mean mental health therapists. The subfield of substance use isn’t big enough to be its own thing. It’s just a further specialty. Like other specialties such as eating disorders, sex therapy, OCD treatment, trauma treatment. Generalist mental health therapists will (and should) work with those disorders.. We don’t turn people away lightly.  We have to evaluate if the level of issue they are having is something that is severe enough to warrant a specialist or not. The same is true for substance use. We evaluate and determine if we can work with it or not, we don’t just blindly refer out. 

Today’s episode explains why I think substance use wasn’t included in the psychological conversations that formed our field. I don’t think it was on purpose, I think it was simply a victim of circumstance (with a bit of stigma thrown in). 


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 1 0 6. . Well, it’s Halloween on the day this comes out, and fall has officially shown up in most parts of the Northern Hemisphere. Up where I am. It actually started in early September.  Thankfully, the colors lasted quite a while. I’m hopeful that for many of you in the Northern hemisphere, the colors of fall stay closer to Thanksgiving. 

Today we’re gonna talk about substance use during the holidays. There are a number of challenges when it comes to substance use over a holiday period. For some, it is a period where they end up using more than they intended; for others perhaps it is a challenge to their recovery because they have been just doing normal life. 

I wanna talk about the different things that face people when the holidays come up. In this particular instance, the holidays, plural, we’re talking about the time from mid to late September with Raha Shauna, the Jewish New Year through early January. Certainly there are other holidays at other times of the year, and there are gonna be people who celebrate different things with their families. For our purposes today, that’s the period I’m talking about. 

When the holidays start approaching, people feel a lot of things. For some people, it’s pure excitement. They love this season. They love the decorating, They love the smells of it. They love the food and all the activities. For other folks, they dread the holidays. 

We have an idea that it should be a joyous time, that we should be having all the fun and all of the feel good of our families. The truth is often very different. Each family has its own challenges, as we well know. 

Very rarely do I have someone talk with me about their unbridled joy over the holidays. Instead, I have people talk about difficult family members, certain dates that are hard for them and their like or dislike of certain things in their families. And for those who don’t have a lot of family, the isolation of the holidays.

The word holiday itself means a day of festivity or recreation when no work is done. Well, the truth is, is that holidays are only no work days for a very few number of people. Even if they’re not doing work at their job. There is a lot of work to be done. When we think about a holiday, we think about a special time, something that doesn’t happen all the time.

Supposed to be something unique out of the ordinary, not day to day stuff. That means something extra. When we think about holidays, a lot of times there are a few things that come to mind. Certainly gifts for many holiday. Food for pretty much all of ’em, and drinking and general merriment.

When it comes to the holidays and substance use, there is always an increase in people’s use of substances, statistically speaking, the reasons for this are varied. But what we know is that if someone that we are seeing is struggling with substance use or does struggle with it in the sense that they use too much or they’re trying to moderate their use, we can expect that that’s gonna be an extra challenge for them. 

For those who maybe aren’t trying to moderate but use substances to cope, we can expect that they’re going to want to use more. Certainly this isn’t the hard and fast, and there are going to be people as outliers, but in general as therapists, we see people’s anxiety, frustration, and the aftermath of the holidays.

Every person’s experience around a given holiday is going to be unique to them. I often ask clients what makes up a holiday for you? Taking Thanksgiving, for instance, I asked them to complete this sentence. It wouldn’t feel like Thanksgiving if we didn’t. Fill in the blank and I have gotten any number of answers.

It could be we didn’t watch football. It could be we didn’t go cut down a Christmas tree. It could be we didn’t have turkey and pumpkin pie. It could be we didn’t have our annual bingo game. We have these things, even if we haven’t thought about it, that are the holidays to. In my family, we had some unique traditions because of what was happening during those dates for us.

My older sister has a birthday on Christmas Eve. That meant that growing up Christmas Eve was birthday dinner. Now, I don’t know who has a full Thanksgiving dinner for their birthday, but perhaps there’s some people. But for us, that’s what Christmas dinner was. It was turkey and stuffing and mashed potatoes and cranberry sauce.

We then would open presents and have birthday cake. And in my house we left birthday cake and Diet Coke for Santa. That was just how things. Christmas Day that was Christmas and no more birthday stuff. 

Years later, my little brother would be born. Little being an interesting adjective for a man that’s six four now, but he had a birthday on Christmas Day. Different moms, but same family. And so Christmas became even more complicated. We had Christmas Eve at my mom’s house with my sister, and then in the morning we’d have Christmas with my mom. Then go to my dad’s, have Christmas with them, and then my brother’s birthday.

I didn’t really think about our family traditions until I got married. One night my husband and I were talking about what we do on Christmas Eve and we both talked about reading the Christmas. Well, the Christmas story in my house is was the night before Christmas and the Christmas story in my husband’s house was reading from one of the gospels in the Bible. That in itself was such an interesting difference in that I had never thought about the story and the Bible being the Christmas story. 

So as I thought about what makes the holidays difficult, here’s what I came up with. The first thing is substance use is intertwined with celebration. Because of the nature of holidays and the fact that there’s an expectation to do something different and extra and to let loose a little bit. This is the time when people say things about, Oh, it’s the holidays. I’m gonna eat what I. Not go on a diet and I’m gonna make sure I just get to enjoy all the holiday foods. Or someone who’s drinking is saying, Oh, it’s the holidays. I’m gonna let loose. The idea is that we can indulge and then after the holidays are over, get back to normal life.

If substance use during the holidays was simply for celebration, It might not be as much of a problem as it can be for some folks, but the holidays are far more than just celebration. Very often, one of the things people talk about when the holidays come up is who isn’t there anymore,  that this is their first holiday without someone in the family or that this is their first holiday after someone passed away, or this is the first holiday where the family won’t be able to get together.

 These anniversary points are a big deal  they talk about stories regarding this person or noting an absence. In some families it’s something people don’t talk about, but everyone’s aware of. There are families who will set an empty place setting at a table for the person who would’ve been there. There’s others who will go out of their way to ignore the fact that that person’s not. 

What we know being therapists is that it’s on people’s minds. They think about the last time they saw the person.  They think about their childhood. They think about the traditions that used to be. Or they remember who used to do the special gifts, who dressed up as Santa, who had the best ideas for presents for the cousins. There are so many things that go along with the holidays and there are almost always bittersweet feelings, at the very least.

We know that there are a lot of feelings going into these holidays for a lot of people. We also know that people in general aren’t prone to excellent communication. It takes a lot of effort and focus to make sure that everybody’s talking about how they’re feeling, respecting each other and making wise choices when they’re feeling kind of emotionally dysregulated.

It’s also not just the people who aren’t. But for a lot of folks, it can be the people who are there. This is the time they have to see the person that they try not to think about. This is the time where they’re expected to play nice with a certain relative or the whole family. This is the time when they’re supposed to forget some major argument and just move along. Get together.  Have a nice holiday at the expense of everyone just shutting down their feelings and pretending with a smile.  

It is stressful. It is all of the family dynamics, secrets, arguments, underlying shit that nobody’s talking about, all coming together in one room.  Pictures are taken and it looks like everybody is having a great time. What we know is that there is a huge undercurrent of shit under it.  It’s not that every family is gonna be at each other’s throats. What we know though, is that every family has its own stuff. 

Another thing that makes the holidays stressful can be the financial strain. For someone who’s struggling with finances heading into the holidays, just adds insult to injury. They’re already struggling making ends meet, and now there’s gift expectations. And with gift expectations, it’s not a matter of just having a gift to give someone. There’s quality of gift, thoughtfulness of gift.

Whether or not you bought for the right people, whether or not you’re paying attention to what that person likes. I have been a part of many conversations where someone will tell me something that someone got them versus what they got the other person and there is discrepancy between cost, thoughtfulness, value, quality size even. 

Because that person is aware of how they feel about gifts, they’re also potentially aware of every gift they give someone else, and whether it’s enough. Financial strain is a huge deal. I was speaking with one of my young adult clients who just found out that her parents routinely went into debt over Christmas.

She thought this was really. And she didn’t understand why her parents would do such a thing. She remembers being a brat she called it and having tantrums about what she wanted. Her opinion at 20 years old is that her parents shouldn’t have given in and gone into debt that they should have just given her what they wanted to give her and not overextended themselves.

When my children were young, I realized that the problem about Christmas was not the kids. It was me. It was me wanting to get my kids everything. It was me wanting to make sure that I had spent or done enough to make Christmas be Christmas. 

There are credit card offers galore, starting to pour into my inbox about all the ways to afford the holidays. The encouragement for us to spend more money. The fact that stores are open on Thanksgiving in America. There are families whose tradition to go shopping on Black Friday has moved to Thanksgiving because that’s the day the sales are happen.

For those outside the United States, for us Thanksgiving is an annual national holiday. With a traditional meal, including Turkey. It’s supposed to commemorate a harvest festival celebrated by the pilgrims in 1621, held on the fourth Thursday in November. There is a similar holiday in Canada, usually the second Monday in October. 

The real origins of Thanksgiving have a bit of a darker story regarding the pilgrims that came over to the US and their, frankly decimation of the native tribes that existed in this land long before Europeans found out it exist.

The next day, Black Friday, which is supposed to be the day that all the sales start, and we start shopping for Christmas. However, if you’re in a store anytime recently, you’re gonna find that Christmas stuff is on its way. 

At the end of the holidays is the new year. The new year for some can be looming, where they realize that another year has passed and this thing didn’t get done. This goal didn’t get reach. And they start feeling regret about lost time. 

There are folks who love a new year. Who love the idea of starting fresh. However, the majority of folks that I have worked with when we talk about the new year, have some regrets. In some ways, it can seem like what better thing to do with regret than forget about? And frankly, alcohol and substances help you do that. They don’t help you do it forever, of course, And it’s short lived. But if we’re talking about relief, it works. 

So what does this have to do with how we work with people? Well, first I wanna talk about the category of folks who are not trying to moderate their use.

For people who are  not at a place of moderating use or changing their relationship to the substance in question, they are likely going to be using more over the holidays. Whether they realize it or not. The response to the increased stress of family relationships of having to deal with things that normally aren’t in their day to day.

Of dealing with financial pressures of regret and approaching of a new year that is going to amp their emotions and the need to numb them out. When we’re working with people who routinely use a substance to cope, I think it is absolutely essential that we talk with them about what they want the holiday to look.

Here are the things I would be talking about with these people. I would talk with them about what’s happened in years past in regards to their substance use in the holidays. I’m listening for any kind of talk about something they wish they hadn’t done or wish was different, or they should have done this.

I am not passing any moral judgment on someone’s substance use. This is more about future them. That when they come see me after the new year, I wanna be able to talk with them about how things went and what successes they had. There are so many things that we cannot change about the holidays because we simply cannot change our families.

We are only responsible for and can only change our own behavior. This leaves so many other things up to others. When I’m talking about substance use during the holidays, I wanna be really frank and really honest about what that looks like. I have had people who outright told me that the only way they get through a holiday is by using. 

I talk to them about what that means, what kind of quantity we’re talking about, and what kind of things might be potential downfalls. And we talk about how to plan around that, how to plan for it, and how to minimize any repercussions that might happen because of the substance use.

In no way am I suggesting that these folks are going to abstain from these substances during this time, I am more thinking about harm reduction. I think that being intentional about how we do a holiday is really important. I think that it makes it so that we can truly get more out of any event if we’re aware of what we’re looking for, what the goal is and what we want the outcome to be.

I spend a decent amount of time with my clients  when it comes to this time of the year, talking about their expectations. People will often tell me they don’t have any, but I don’t think that’s true for most of. I think that we have them we just haven’t really voiced them out loud.

For instance, we expect people to show up for this particular event. We expect there to be certain things to eat. We expect there to be certain things to drink. We expect certain people to behave a certain way. We expect certain conversations to show.

I recall going to my aunt and uncle’s house on Thanksgiving, and knowing that there would be three TVs set up in my Uncle Bill’s den. Now we’re talking about the eighties and early nineties here, and so we’re not talking where there’s internet and you can flip back and forth and picture and picture. We’re talking about the main TV in the den and some small 13 inches or whatever brought in and chords everywhere so that my Uncle Bill could watch multiple games at a time. If you wanted to go watch football with Uncle Bill, you could. But the expectation was that you were not talking. If you wanted to talk, you could go out where my Aunt Diane was. But for Uncle Bill, he was gonna watch the games. That was an expectation that I had when we would go to their house. It wasn’t something I actively thought about, but it was a scene that I saw numerous times in my life and was super normal. 

So for folks  who are not trying to moderate, and for people who are trying to moderate or consider themselves to be in recovery, I like to use a future template for this. I want them to think about when the holidays are over, what do they want to be true?  So as we’re sitting in mid-January, do they want to feel like they ate everything that they wanted to and they feel great about that choice, regardless of if they end up gaining weight?

I don’t have an opinion about whether they gain weight, but a lot of people have an opinion about whether or not they should gain weight over the holidays. I want them to think about the after of a particular event with a side of a family. I want them to think about how they interacted with the people that are around them. What do they want to be true? 

What do they want their financial situation to be like? What do they want the pictures to look like? What do they want the memories to be? My client is an individual person, just like your client is an individual person. They can’t be responsible for how the holiday goes, but some planning ahead of time means that they can think about how to make something different.

Perhaps there is another sibling or a cousin who would be willing to work with them to make sure that they don’t end up getting in a political argument, maybe they talk to each other about how they’re gonna pull each other out of a conversation. If they sense it going down a bad way. 

Perhaps they wanna make sure that they don’t end up getting in an argument with a specific sibling. And so we talk about how to avoid those, what the triggers are, and keeping their future template in mind. What is the future gonna look like? Because there’s a January self. What does their January self want from their December, November, and October self? What do they want to be true? 

I like them to fill in the blank with blank happens every year and I hate it, or I wish blank didn’t happen every year, or I always end up regretting. Those are things that I want them to think about and answer because most of us have them. 

Perhaps it’s, I always end up with a huge hangover on Thanksgiving because I went out the night before and then I feel terrible and I can’t enjoy any of the.

Okay. I don’t know if a lot of folks know, but at least in the United States the night before Thanksgiving is the biggest bar night of the year, Not New Year’s Eve. It’s the night before Thanksgiving. Think about it. Most people don’t work the next morning. Most of our businesses are closed. Thanksgiving dinner usually isn’t a morning affair. It’s at least at noon, if not later.

And they’re seeing people that they haven’t seen in a while, whether it’s people who’ve come home from college or people who have come home, and it’s been years since they’ve been seen,  with relatives or friends or whomever. It is a huge night. People are thinking that they can manage the hangover. Well some folks manage a hangover better than. And if the goal is that they want to be able to enjoy the food and not have a massive hangover, then we need to talk about what happens the night before and the boundaries around that that they wanna put down. 

I think it’s really important that when we have folks who are struggling with substance use, that during the holidays we are talking with them, not just about what they want the future to be, but potential things that come up and how they wanna cope with.

This is the time when very specific skills are necessary. That waiting until they are in some giant argument over whatever the hot topic is for that family, that’s not a time to decide what coping skill they’re gonna use. Tempers are hot. People’s emotions are all over. People are getting triggered all over, old shit’s coming up, and they need to have a plan to extricate themselves from that or to manage it with some damage control in mind. This is especially true for people using substances. 

Substances are the kind of thing that more typically will solve the emotional problem. At least for the moment. The issue there is that on the other end there are some consequences to more substances. 

Different family members or friends or whomever they’re celebrating with are gonna have different opinions about substance use. In some people, it may be that it is a no holds barred situation where they can use as much as they want because it’s the holidays. For others, perhaps their opinion is that it’s not acceptable to drink that much on this day or that day, and I think it’s important for our clients to have thought that through, to decide for themselves what they want to do.

Just because everyone’s getting hammered doesn’t mean they wanna get hammer. Or just because the family tradition is a specific thing, doesn’t mean they have to do it too. We are always trying to work with our clients to pay attention to themselves, to their emotions, to their goals and desires, and to set appropriate boundaries.

Boundaries around the holidays aren’t super popular. it is a time that we’re supposed to just let things roll, brush over them, and then we deal with the aftermath in January.

For us, I think it would be nicer to be able to celebrate with them the successes they had, where they were able to shift behavior, even if a small. And being able to build on that rather than starting from a place of deep regret. Working on these things with them gives them more presence during the holidays, helps them feel more supported, gives them a plan, and we have a way to check in with them after the holidays are over on these goals.

For folks who are in recovery, the holidays present an extra challenging. Early recovery, and by that I mean probably the beginning of recovery to maybe six months, but it can be as much as up to a year as challenging in its own way. Day to day it’s about survival really. And I don’t mean to mean dramatic, just that they’re trying to do something really different, that they’re existing without the substance that they’re used to having.

And so a lot of times, the days feel long and boring. One of the hard parts about quitting a substance is that most of the people I’ve ever met in recovery  have memories of feeling like they would never have fun again if they had to give up their substance totally.

If alcohol disappeared from the world, how do we celebrate? If they never had substances again, then what differentiates normal life from  excess or celebration or holiday life. It sounds like a small thing, but when they are faced with the reality of not being able to do the thing that others are doing, it can feel really hard.

It can feel like they have to avoid all sorts of temptation and it can feel gray and like nothing’s fun. Doing your first holiday, your first birthday, whatever the celebration is while you are sober, is hard.  Just like having the first loss you have to experience when you’re sober.

There are a whole bunch of new experiences that each time it comes up in recovery, you have to learn how to navigate. The holidays are stress anyway, that’s what we’ve been talking about. Now in recovery, the person has an experience that they used to use substances to manage this stuff, and now not only are they not using substances, they have to endure or manage or navigate all of these areas without that coping skill.

Those of us working with substance use with our clients, we will be working with them on a holiday plan of how are they gonna handle different things?  What events are the most challenging? Why are they the most challenging? Where do they think the pitfalls are for them in their recovery?

In later years after they have had a few holiday seasons under their belt it’s less challenging. The first time they quote go home and aren’t drinking with everyone, they’re gonna get a lot of questions. Why people feel like it’s acceptable for them to harass someone about not drinking I don’t know, but it happens a lot. 

And there are probably numerous reasons for that, but we are helping them figure out how to manage. How to field questions. For a lot of women,  somebody will ask them if they’re pregnant and that could lead to a discussion about why they’re not partnered or why they aren’t pregnant yet, or any number of pretty invasive questions get started because of things like abstaining from a substance. Planning ahead for that is really helpful. 

Is there someone in their family that they could talk to about, Hey, I am sober. I’m not drinking, or I’m not smoking weed, or whatever, and I know people are gonna gimme shit about it. Can you back me up? Can you pull me out of the conversation? Or any other number of coping skills with another person’s help. Or if there’s no one in the family that’s able to do that, that they have a friend or someone else who’s able to help them in that moment.

We have a lot of ability to help people plan how to handle future events. We do this all the time. This is a skill that we use. What we do now is we just transfer it to think about substance use.  I’m certain that almost all of us have helped people deal with the holiday season. All I’m suggesting now is that substance use become part of the conversation. 

If we don’t know about their substance use history or how they use substances now, that’s a moment where it’s really easy to bring it up. You can say during the holidays, a lot of times there’s  a ton of drinking that happens when people are celebrating. What’s it like in your family? Is that something that comes up? It is an easy segue to be able to talk about that. 

If it is a topic you already know about. You can tell them that you’ve been thinking about the holidays and you know that they’ve been trying not to drink, or you know that when they’re really stressed out that they drink more and you wanted to talk with them about what their plans are for getting through the holiday. 

This is in no way suggesting that people have to be sober; that people should never use substances. We are simply checking their values and seeing what they want to do to keep their behavior and their actions in line with their personal desires and goals.

One of the things I find that is most helpful for a person in recovery is to think about traditions that have involved substances and to find a way to do it differently. To find a way to build a new tradition, to find a way to be involved and participate having to completely give up on their own goals for their recovery. 

What new traditions could they start? How can they decide to be involved in something? Maybe they only show up for a specific time period and then they leave, and since they know they’re gonna be driving maybe that’s their excuse for not drinking.

I am always encouraging my clients to make whatever boundary they need in order to achieve the purpose. I find that there’s a lot of people who feel like they can’t do something different because of a holiday expectation. We challenge those beliefs all the time and what I am encouraging is that our January conversations With our clients can be about successes even if the person saw it as a failure.

We talk about the ways that they went into this and  they were thinking ahead and that they really tried to use their coping skills and that we found out some of them work and some of them don’t. And that, that gives us a great place to start in the new year. 

As we start November tomorrow, I encourage you to be talking with your clients about their use of substances over the holidays. About their goals, about regrets, about what they want January to look like.

It doesn’t matter  what area of their life it’s in people have a January self and we wanna help them envision that January self to be the best version of themselves that we can.

I hope the discussion the holidays has been helpful. I would love to hear how you are addressing this with your clients. You can always reach me at betsy@betsybyler.com. 

If you haven’t had a chance to download the Substance Use Decision Tree yet, I encourage you to do so. You can head over to betsy byler.com/tree and download it for free. The Substance Use Decision Tree is built to help you quickly determine whether a client’s substance use is appropriate for outpatient mental health or not. It will also help you determine whether or not it’ll also help you determine how open your client is to talking about substance use. Again, that’s at betsy byler.com/tree/. 

Thank you so much for listening to the All Things Substance Podcast. If you wanna support the podcast, you can do so in one of the three following ways. You can sign up to receive the email updates on the contactPage@betsybyler.com slash contact. I send out about one email a week and do my very best not to spam you. Signing up will give you all of the updates to the podcast and any upcoming events. 

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I am always grateful for the support from listeners. I love hearing from you and I love being able to hear your thoughts, ideas, and clinical questions that come up.

Next week on the podcast, it is Recovery Story Week. I will be bringing you the story of a woman named Amy from Toronto. She is a recovery coach and She is gonna be sharing her story of finding recovery with us. 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.

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