Episode 78

Deliberating setting up for a sensitive conversation will make the whole discussion easier on both you and your client.  People know when they come in to see us that we will be asking them questions. They even know it’s going to be personal. They might have the best of intentions of being as open as possible. In the moment, however, those good intentions can go out the window. Our cultures teach us to put our best food forward, to hide weaknesses and imperfections. For some people it can be instinct that causes them to hold things back from us. I find that doing a good thorough set up is a huge bonus to the conversation. It doesn’t take very long, but it makes a big difference.


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 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 78. Over the last few podcasts we’ve been talking about beginning the assessment about a client’s substance use. We covered some things that might cause a therapist, some pause and we covered some things that a client might respond with. 

The conversation about substance use can be difficult. That is because of shame and fear. We talked about those as well in episode 74 and 77.  If you haven’t had a chance to listen to those and encourage you to go to betsybyler.com and check out those episodes.

Knowing that talking about this is going to bring up some issues can make us a little hesitant. Even for me after all these years, when I have a client that I think might be kind of defensive about it, I can feel myself getting a little nervous.

I think it’s easy when we’re in a group to feel like we can bring up anything. It’s no big deal. But when we’re in the room with one client and trying to win their trust, it can feel a little scary to talk about something like substance use.

I was running some things by my husband and asking him what might make him feel more comfortable or less comfortable with someone asking about his substance use. My husband is a normal drinker. It’s actually probably less than normal. He drinks maybe once every six months, but  there were some questions that if he was asked that by a doctor or a provider that even he might end up feeling defensive, 

So I imagine that if we had a client who did have drinking or substance use, that was even a little problematic they might be hesitant to tell us. I really believe that this step is the first step when we talk to clients and that we really can’t skip it. 

It’s a little bit like asking about suicidal ideation. Certainly those aren’t the same thing, but people do tend to respond in a similar way. Every time we meet with someone new, we ask about suicidal ideation and self harm. This is something that we just have to know because it is part of people’s history to have had these feelings or behaviors.

I’m certain that many of us have found a good way to ask about those things. And we’ve probably experimented with ways that didn’t work out so well. 

So I had this experience the other week that reminded me of this. I was at the doctor establishing with a new primary care provider. So I’m there with the nurse beforehand and she’s asking me a bunch of questions.

I know that the hospital systems and doctor’s offices have been adding questions to their intake to kind of a ridiculous degree. All of the questions sound like a good idea. We want to know if people have food scarcity. We want to know if they have a different learning style. We want to know if they read well, or if they have issues with finances. 

The problem is that these questions are a lot and there are a ton of them and the person who’s asking isn’t even the doctor and that is by design. When they add these things or measures as they call them, they’re usually pretty cognizant about whether or not the physician should be the one asking the questions.

I’ve been in both of those conversations at the admin level and at the provider level. Doctors resent having to ask all sorts of questions, just for someone to have numbers, to give to a payer or the government or whomever. They want to be able to just  talk to their patients and help their patients with the problem they came in with today.

But instead they have all of these questions and the answer usually is, we’ll have the nurse do that. We can have them give questionnaires. We can have them ask these questions and that way it’s all done before the doctor comes in. Great. Well, a lot of the questions aren’t a big deal, but one of them that I’ve been asked probably for the last, I would say five years at doctor’s appointments, I always watch for how they ask me.

And the question is, “Do you feel safe in all of your relationships”? That is a really interesting question. It’s a good question. I think it’s an important question, but nine times out of 10, when the nurse  asks me that question, they don’t look at me. They’re looking at the computer, they’re asking this extremely personal question and they don’t look at me when I say yes. 

We know that when someone is in a situation where they’re not safe in their relationships, most of the time they’re going to be covering that up. I have worked with clients who were in very serious domestic violence situations and it was at their doctor’s office that they finally were able  to say no. Saying no that you’re not safe in your relationships opens a giant door for a lot of questions and for people to have opinions about what you should do about it.

So when the nurses ask me if I feel safe in my relationships and they don’t look at me, I think about how easy it would be for someone to just say yes, they feel safe, even if they absolutely do not feel safe. The doctor’s office is probably one of the only places that they are alone. 

Abusers often will accompany their person everywhere. It’s why we see domestic violence pamphlets in bathrooms so that the person is alone and could potentially see that there is a place to call for help. I think these are good questions. I just think they need to prepare someone for them a little differently to increase the chance that the person can be honest.

We are in the same situation. When we have someone in our office, typically it’s alone. I have had instances where a partner wanted to come in and I’m always looking at my client to see, are they okay with this? Because I want to be able to get unfiltered information and even if we trust someone implicitly, I find that there is a difference if someone else is present.

When we are going to bring up substance use, we have to do it in a way that is going to give the best chance that we’re going to get the most honest answer. I say it like that because typically when somebody has substance use and they know that it’s causing a few problems, they are going to minimize. Anything that we think is going to be socially unacceptable or make us look bad, we have a tendency to minimize. That I think is human nature, the white lie as it were. 

So when you begin this conversation, there are a few things I want to talk about today. So in the first scenario, we’re going to pretend that this is in the beginning of a relationship with someone. So this is a new client. It is entirely possible that you won’t have time in the first session. There’s a lot of information to get. I just had a third session with one of my new clients yesterday. 

I hadn’t finished the intake or sent through anything yet because I wasn’t totally certain about which diagnosis I wanted to choose. I had a few more questions  because I couldn’t answer whether or not this person had this particular symptom or not and that was going to make all the difference in my diagnosis. So the way I started the conversation yesterday is.

I’m not sure what’s on your mind today and I want to make sure we check so that we can get to it. I have a few questions that I’d like to ask because we didn’t get a chance to get to all of them before. Then I’ll ask the person to tell me if they have something specific and more times than not, they say to me, well, why don’t you ask your questions first so we can get through those.

The person really does want me to have a good view of what’s happening in their life. I am trying to help them make sense out of behavior and feelings that they may have felt confused on for quite a while. It’s a little bit like putting information in and having a program tell you about yourself. When it feels right it can feel really validating. 

So my client said to me, why don’t you ask your questions first? Now we had already gotten to the substance use questions because that was one of the reasons they came to me. But in other intakes, when the primary thing isn’t substance use, which for you, most likely, it’s not going to be substance use. This is an addendum to the things that you normally ask. 

We want to set up the conversation well. How you set this up is going to change how you do the assessment and it’s going to change the answers that you get. To me, this is the most important step in assessing substance use, setting up the conversation well.

So the very first part of that conversation is letting them know that you’re going to be asking them some questions and that some of them will apply and that some of them really won’t. Letting them know that you’re going to be asking them questions and that not everything is going to be about them or fit for them helps them feel really safe about saying no, that’s not true, or yes, that is. 

This is an important step and helps them not feel like you’re pigeonholing them or being judgmental, because you’re already acknowledging in the very beginning that you’re not sure if these questions are going to fit them or not. It already sets someone at ease. 

Something like I have a few questions I’d like to ask about your history and some of them are going to fit and some of them aren’t. But I want to find out which ones fit for you and don’t, you’re asking them for permission to talk about their history. 

This is implied, of course, when they come to therapy, as we are talking with them about present symptoms, but also we’re always asking about where things come from.  Getting their agreement sets them at ease rather than feeling like, whoa, you brought that out of nowhere.

Imagine that you’re in a session you’re going well, nd then you’re like, oh, by the way, do you ever feel suicidal? That is a record scratch. That question puts people on edge because they are concerned about answering it. A lot of times, there’s a lot of shame that they ever thought about suicide, that they ever thought about wanting to be dead or wishing that they didn’t wake up. 

Even though that feeling and those thoughts are really. It’s not necessarily common where it happens all the time. But it is normal in an instance where somebody feels like there are no other options, like they’re overwhelmed and deep in grief and alone  or deeply depressed. Not prefacing that by letting them know that it’s okay to say yes is going to cause them to stammer out some sort of answer, just to get us past that difficult and uncomfortable conversation.

Once I’ve gotten their permission to ask them about their history, then I say, great. So I want to ask you about your history with any alcohol use or use of substances at all. I don’t use the word drugs because the word drugs makes people really uncomfortable. I separated out and say alcohol and any other substances because alcohol is legal and the one that most people have probably used. 

So instead of saying, I want to ask you about substance use. That’s a little clinical and a little distancing. So I say alcohol or any other substances. Once I’ve stated what the topic is. Then I explain why.

Use of substances is really normal. Humans have been finding ways to get drunk or high, whether it be celebration or for coping or whatever since there were humans. Most adults have used alcohol or another substance at some time in their life. Since pretty much all of us have some kind of history. I really want to know what yours is and so  those are the questions I’m going to be asking you.

So imagine that I am  saying this to you. I am a virtual stranger. This could be the first, second, third session and you don’t really know what to expect of me, but now I’ve told you, Hey,  we’re going to shift gears and focus on some questions in history. And not only that, I’m going to ask you about alcohol and substance use. And then I’m telling you out of the gate that I think substance use is really normal. That pretty much everybody has done it or does do it. And basically letting you know that it is safe for you to answer these questions.

This is a much better way than saying. So how often do you drink? That kind of question is one of those that people will very commonly visibly sit back or you can see them sort of retreat a bit. Asking a question like how often do you drink with no lead-up is going to cause people  to feel a little bit hesitant. Look at you a little bit side eyed. 

Sometimes if somebody still looks hesitant, I’ll say  I am hoping to get to know all parts of your life so that I can help you better. How are you feeling about me asking you these questions?  I use immediacy a lot in sessions. When I notice that someone has started to check out, that someone is pulling back from me or that someone is perhaps feeling on edge or uncomfortable, I will ask. 

I don’t point it out in a way that is making them feel like they’re on the spot, but I do it in such a way that is like, so I’m getting that you might not love this line of questioning. Can you tell me about that or is it okay that we’re talking about this?. Should we set this aside for a different time? 

I want to continue to have their buy-in and their permission to ask these things. When somebody comes to therapy, we do have sort of implicit permission to ask these questions. What the person is deciding is how much of their internal life we are going to get. They might have decided in the lobby that they’re going to be as honest as they can.  Then when they get into your office and the question starts, they might be like, oh, I don’t know about this. 

There is always this question of, can I trust you? Are you going to judge me? Is this safe? Of course there are exceptions and there are people who come in and will spill every detail. In fact, they probably have almost no boundaries about what they’re willing to share. That in my experience is not the norm. It is the exception. Most people are going to want to present themselves in the best light.

If you notice that there is even the slightest pullback. You’re gonna want to say something about, there is no judgment. I don’t have any opinions about what you’re doing with your drinking. I’m not going to give you any opinions about what you’re using and when. I just want to understand what’s happening so we can talk about if that’s working and if that’s something that you even want to talk about.

So what you’re doing there as you’re giving them this neutral stance of non-judgment putting the control back into their hands about whether or not they’re going to talk about it. And if they are willing to talk about it, that they get to decide if they’re going to want to change anything or not. This helps put someone at ease.

Earlier this month, we heard from Jonny in our recovery story week. He talked about the fact that he could not imagine living without drugs or alcohol. He went to therapy for a year and a half and was never straight up with his therapist about it. He just didn’t think that he was able to stop drinking.

The whole time he was seeing psychiatry. He was taking medication and drinking on top of it. So every time he came in to see his psychiatrist and they would ask him how he was doing, he would be mostly honest that he was still really depressed and they would up his medication. He automatically thought that talking about his drinking would mean that it would get ripped away.

Of course, we know that someone drinking and drinking heavily on those kinds of medications isn’t a great idea.  The stance we’re taking though, is that everyone gets to decide about their own use of substances. We are not trying to convince them to stop. We are not judging them. We are not making our opinions known. No. We are helping them evaluate and if there are problems shining a light at them so we can talk about them and look at them. But ultimately the decision is up to them. 

Sometimes what people are concerned about is what we’re going to do with that information. Sometimes they’re worried because we’re writing things down. Those are things I also address. Someone might ask, why do you need to know? Or is that going to be in the report? The whole time that we’re asking these questions or starting this conversation, we’re listening for their agreement and any kind of reluctance to answer.

Usually. I’ll let them know that all I’m doing is getting information. If they are worried about it getting written down, we can let them know what we’re going to do with those notes.  As therapists we do not have to diagnose substance use disorder. We can put it in our note and say that  we don’t have a diagnosis yet, that we’re still assessing. 

If someone is worried about that, going to their insurance company or being on records, the point here is not to cover your own ass, but to help the client get honest about what’s happening. If they are worried about that, then you can bet that there is some problematic use behind it. Explore that with them, do not move forward until you have agreement. 

Even when you have agreement, you want to pay attention to the signs that they’re giving you and the questions that you’re asking. You should see some relaxation in their stature or in the way that they’re answering you, if you’ve done the setup well enough.  If they’re not doing that,  I wouldn’t ask the full set of questions that you want to. I would ask a few and then move along and just say, well, let’s set that aside and let’s switch gears. 

Consent is important. People’s innermost thoughts and feelings are the most sensitive thing about them. Consent is important all along the way. I asked for consent, even if we’ve covered a topic before, and it’s kind of a sensitive topic, I’ll say, are you okay if we talk about this today, or even if they’re here for trauma therapy and we’ve talked about trauma, I will ask them so are you up for this today or do you feel like you want to switch to something else? 

I never assume that when they get to therapy that they’re ready to go. Because whatever’s happening in their day, even whatever happened up until the moment I picked them up from the lobby, or we got on a call is going to impact their ability to be present for therapy and to talk about historical or even current events.

A lot of times when people show up for therapy, they are overwhelmed and they do not have an extra ounce of emotional energy to spare. Part of our work is getting them emotional space. One of the things I talk about with trauma therapy is  that I will never drop them into the deep end of the pool and that they will always know when we’re going to talk about their trauma. This sets people at ease. 

The way I explain it is that dropping into the deep end of the pool is just starting a trauma conversation with all the details right away. I let them know that instead, what I want is to think of it like the one of those pools that doesn’t have stairs, but has a slow gradual slope where you just walk in and it’s really slow and progressive evenly.

I let them know that I’m going to be side-by-side with them and never push them farther than they’re ready to go. That we’re going to respect their brain and their body’s response to trauma and make sure that they are feeling ready. I let people know that we will not address their trauma until they tell me, I think I’m ready.

I am also checking inside myself to make sure I feel like their mood and life is decently stable and then I feel like they have the bandwidth to bring this up. I don’t like going into trauma therapy and then having to back up because I misjudged where we were at. Certainly that’s still going to happen once in a while, but I do a lot of the prep work so that I don’t wind up in a situation where they are stressed out, backing up, being reluctant, and I’m like, oh fuck. I didn’t realize we were here. Let’s back up about five steps.

One tack I take when I’m sensing reluctance is to ask them what kind of conversations they’ve had before about their substance use. I’ll say what do you typically use if you’re going to use, is it alcohol? Is it weed? Is it another thing? And there’ll be like, oh, it’s this. 

So let’s say it’s alcohol, for instance, because weed is a different issue and we’ll get to that. And I’ll say, okay.  Who has talked to you about your alcohol use? What’s your experience with that? Maybe they’ve had a doctor talk to them. Maybe they’ve had a partner say something. Maybe they have opinions because there’s someone in their family that is a raging alcoholic, and they don’t want to be even in the same universe in terms of being categorized with that person. 

There’s usually something behind it and once I can figure out what that is, I find that there is a lot more flexibility in talking with someone about it. Sometimes I will flat out ask them what they’re concerned about when it comes to talking about this. Their answers are kind of interesting and  their answers are going to be telling. Let’s say it’s an answer: because it’s not a problem and I don’t want someone telling me that I can’t drink.

Okay. So I want to ask, has someone told you that you should quit drinking? Who has an opinion like that? I want to separate myself from that right away. I want to say something like, well, I don’t have an opinion about your drinking and even if I did you get to choose. You’re the one who’s in control of whether or not you drink or how much you drink or any of it. 

I just want to know, because I want to know all the factors and I want to let you know that we’re going to move in a direction that you are totally okay with and we’re going to move at a pace that you are totally okay with. You are a hundred percent in charge of where things move. Now I might challenge you a little bit if I feel like you’re not wanting to talk about something, but I’m going to respect that. I am not here to try to make you do something according to what I want. 

Of course, you’re going to have a way to say that in a different way than me and in your own words, I have a really blunt and laid back style and so when people come to see me, they kind of know that.  In all of this questioning, you are getting a sense of the dynamics between them and the other people in their life and this is incredibly useful. It also is giving them an experience of talking about something sensitive with you in a way that feels good to them. 

So let’s talk about if marijuana is the substance that they’re using.  What word you use for marijuana is completely up to you. I will go between marijuana and weed, but if someone is using marijuana regularly, I will usually switch to weed. That is typically the more used phrase and marijuana is a little clinical. It just kind of depends. 

So this is where you have to know whether weed is recreationally legal in your state or not. Where I live, it’s not legal.  It’s not even legal for what’s termed medical marijuana. If someone’s using marijuana and they have it for a medical use then that’s likely going to be in a state where that’s been approved and they have a card. 

You still want to know though. Because the thing about medical marijuana is that there isn’t dosing from the doctor. They just get a card and then the person is handling how much and how often they’re using. Which is not how we do medicine. We typically do medications with the doctor telling us how much, how often. Once in a while you’ll get medication that is as needed or up to three times a day. But there’s a limit on the milligrams on that. With marijuana that’s not so. It’s sort of a blanket “do what you want” and that changes what they’re using and how much. 

The research on marijuana, for a lot of the things that it gets approved for, is not solid.  In the marijuana episodes that I’ve done, we talk about what the research says. The research is not solid for depression or anxiety or PTSD. Some might question whether or not that’s because the research just hasn’t been done. I suppose that’s possible. My bias is no,  that’s not the reason. 

Marijuana is partially a psychedelic and it distances people from their current emotions and alters their view of time and space. . It’s not correcting something. It’s only for the time that they are actively high or actively using. Once it’s gone out of their system, then they have to do it again. When we’re talking about psychotropic medications, they build up a blood level where, yeah, you keep taking them, but there isn’t that distance from time and space and there isn’t a difference in perception.

I don’t think weed is the worst thing on the planet. I don’t think it’s probably going to kill em and it’s not something that I’m urgently going to address. So I just want to say that here in case you haven’t had a chance to hear the marijuana episodes and you’re just wondering where I’m at. I also don’t think it’s neutral and has no negative effects.

If someone is using weed and it’s illegal, you’re going to want to address that. Because we don’t want them thinking that they have to lie just because they’re using some weed. We cannot report them. We would not report them even if we could. Weed is not the kind of thing that you’re going to blow our relationship over. But beyond that they could be smoking meth and we can’t do anything about that. They could be dealing meth and we can’t do anything about that.  

It is easy for us to just say, okay, so if you’re using weed, I want you to know you’re not going to get in trouble. No one gets to know I don’t report it. I can’t report it, even if I wanted to, which I don’t, I can’t, because it’s illegal for me to report that. That usually sets them at ease. Because if a person smokes weed all the time, they probably don’t think that it’s that bad. They probably believe that it’s better than alcohol and better than other drugs they could use. And in a way they’re right.

So we’re just letting them know that legality wise they are okay and they don’t need to worry about us contacting the police. If you want to hear more about the legality of reporting substance use, we talked about that in the episode about client’s responses to the substance use questions.

So we’ve been talking about all of this as though you were with a new client. If you are with a client that you’ve seen for awhile And you don’t know if they’re using it all. This is something that you should probably find out. I have found that people at that point are pretty willing to tell me whatever I want to know.

I do, however, want to set up the conversation. I’ll usually say something like,  I was thinking about you the other day and realized that when we first met, there’s a couple of things I didn’t ask you about and I don’t know that they’re an issue, but I just wanted to know. And they’ll be like, oh, okay. What’s that? And I’ll say, so I wanted to ask about your history with alcohol or any other substances, because substance use is really normal and I just want to know what your history is like with it.

And I’m pretty nonchalant about it and then get their consent and ask them my questions. You will likely find that there are some people that you figured if they were using. I would know. And the truth is that is not true. People who are really functional and still using, hide it extremely well.

Sometimes it’s because there’s no way they feel like they could let it go. Sometimes they feel like it’s totally separate and not impacting them. And we know that it is. Any kind of substance use on a regular basis is going to have an impact on someone’s mental health, because it does impact their brain. When we’re talking about normal drinking or even occasional smoking weed, well, it’s not going to be daily. It’s not going to be even multiple times a week. It’s going to be on a more casual basis. I’m not worried about things on a casual basis.

Someone using weed on a casual basis it’s not going to have a super high tolerance. They’re going to have one, of course, if they’ve done it, say every weekend for the last few years, but it’s going to be much slower than someone who’s using every day. So I just want to know where they’re at.

I remember a time when I didn’t ask someone about substance use and I think I just assumed that  I would know if there was a problem. Even though I knew better. But I just didn’t ask. This person was a really functional parent of adult children, married, steady job, steady relationship, just really high anxiety. Which I believed was some chronic PTSD from growing up with a really angry alcoholic parent.

However, I got a call from this person’s partner. I didn’t talk to them, but I heard the message and the message was that this person had a drinking problem and that they had  been injured multiple times while drinking.  I have talked about before that where I live drinking is very common and that what people consider normal drinking up here, isn’t normal, in my opinion. And in other places I’ve lived, wouldn’t be considered normal. 

So one of the  hobbies up here is four-wheeling. So for those who don’t know what that is, it’s an all terrain vehicle or a four Wheeler that somebody drives off-road in the woods through fields, et cetera. A lot of people don’t think this is drinking and driving. They will ride four wheelers or what’s called a side-by-side or snowmobiles and be drinking and not think much of it because it’s not the same as being behind the wheel of a car.

Well, a lot of people get injured because, well, of course they do. It’s still driving and you’re moving at speeds that are faster than walking.  Some of the four-wheelers can go pretty fast and when I’ve been on a four Wheeler, the faster we go, the more unsteady things feel. 

When I heard this message, I had no idea and it just floored me. I had to realize that I had made an assumption that was entirely incorrect. So in this situation I had to let my client know that their spouse had called me and left me a message. That was not a secret that I could hold. That was rough. It also was rough trying to get my client to talk to me about their drinking, because they were already on edge and angry. That took a little coaxing, but eventually we got, I think probably 75% of the truth and there was a significant drinking problem. 

It just didn’t affect their job.  They didn’t call into work because they were sick. They hadn’t gotten into any kind of legal trouble. They did have some injuries, but that wasn’t something that they saw as being a big deal.

My encouragement  is that every one of the clients that you see,  that in your mind, as you think about them, that you know what their use is like. If it is in a normal range, if it’s always been normal or if it’s elevated or if it’s problematic. That if you don’t know, that’s just an opportunity for you to go find out.

Your client will be grateful for being able to get it out in the open if they have some problematic use. It will seem a little out of the blue. And you can just acknowledge that. You can say, you know what, I’ve been  listening to this podcast  about alcohol and use of substances. And I realized that we never talked about that. And since it’s really normal that people have some history with it, even if it’s a long time ago, I realized that I don’t know that about you.  Is it okay if we talk about this? 

Just acknowledging that this is something that is on your mind is fine. I find that clients are actually grateful that I was thinking about them outside of the hour that I see them because we do. When I stop seeing somebody at the end of an hour, that isn’t the only time I ever think about them. I don’t spend a ton of time planning for sessions, but I do think of them as things pop up. They still exist outside of session for me and I find that they like knowing that. We all want to be memorable.

This step setting up the conversation to me should not be skipped. This is something that is so important, and that will literally set the stage for the kind of information that you’re going to get. You will either find out that the person doesn’t have any issues with substance use, or you will find out that there has been some here and there, and not necessarily that they were getting drunk all the time or whatever, but people have experiences.

There are lots of people  who have been experimenting with alcohol or other substances and had bad experiences. They’ve watched someone do something dangerous. They’ve experienced some kind of trauma because of it and that is going to affect their relationship with that substance. It is important for us to know. 

I have found that when I ask questions, like when the agency started screening for trauma in the beginning for every patient, we found that there was more trauma than we knew of. When we started focusing on making sure we were asking more about medical history, we found a lot of unmet medical needs. The same is going to be true about substance use. 

If you haven’t been asking, it is always okay for you to backtrack and to ask. You just have to set up the conversation. You explain that you’re going to back up or that you’re going to ask questions about history. You get their agreements. You tell them what it’s going to be about the topic and you get their agreement. And then you start out gently about alcohol and then about marijuana. As you’re moving into these topics, you’re going to get the sense of, are there more questions to ask or is this pretty much about it?

When we get into the next episodes, we’re going to be talking about doing a substance use history. And technically that’s what I’m helping you do. This is how you assess substance use. We’re going to talk about questions to ask, and we’re going to talk about red flags that pop up. That’s going to be coming in the future episodes.

Next week, however, is recovery week and we have another story of a man named Gabe. Gabe and I had a great conversation. Our use histories are similar. We both started using and basically fell in love from the moment we started. I’m excited to bring you his story and I hope you’ll join me for that podcast. And until then have a great week. 

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.

Helpful Links

Assessing Addiction: Concepts and Instruments

Clinical assessment of substance use disorders – UpToDate

The Clinical Assessment of Substance Use Disorders

Resources for Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA

NCDAS: Substance Abuse and Addiction Statistics [2022]

Free Treatment Planning Tool https://betsybyler.com/treatmenttool/