Adding substance use to your scope of practice means that you will want to have a source for good information. How do you know who to trust? Why am I the right person for you to talk with and listen to? Over the last 20 years of my career, I have been working in various settings and honing my skills when it comes to working with substance use. I’ve also developed and grown in my own recovery from drug addiction. I believe that I have the skills and experience to be your go-to person when it comes to this area of our work. Today I wanted to share more of my background with you.. I am honored that there are therapists around the world who trust me enough to spend time listening to the podcast.
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 124. Today’s episode is gonna be a little bit different and I’ll explain why. Recently I was thinking about my EMDR training. There was a long while where I wouldn’t train in EMDR because frankly, I thought it was a crock of shit. I have to admit, I didn’t know a lot about EMDR, but what I had heard sounded like voodoo magic, and it wasn’t something I was interested in.
Every time I saw a flyer for EMDR come through my mailbox, I just would roll my eyes and recycle it like I do with most of those flyers I get. But that started to change about eight years ago.
I had been trained as a trauma therapist using TF-CBT, which is trauma focused cognitive behavioral therapy. Without getting into a lot of detail, it’s a narrative therapy plus cognitive behavioral therapy, as the name would suggest, and it’s primarily normed for under 18.
The majority of my caseload at the time was high school students and had some adults as well. I had learned this modality as part of an agency-wide push to get more trauma trained therapists. I had used TF-CBT successfully with a number of different clients, and I really enjoyed the modality. Before that, I had never really trained in anything specific like that. I found the training to be so incredibly important and so useful that I vowed to not do regular trainings ever again.
Then I wanted something that was specific that dug into something not an hour and a half survey here or there. Yes, we all need CEUs, but having a training that was actually super useful was something that I was hungry for, and so I was really cautious about how I got my continuing ed credits after that.
I attended a conference where Bessel VanDerKolk was speaking and he was talking about EMDR. And I could tell that he respected it and I respected him. I decided maybe I should have another look because I need another trauma modality to use, using all of the tricks that I had, just wasn’t helping with severe trauma.
I had to choose where and how I was gonna do the training. I knew that I was only going to do this training once, and that it was gonna be a significant investment of time and money. I had had a number of colleagues recommend a very specific place to me that was in the Twin Cities, that’s Minneapolis and St. Paul in Minnesota.
I checked into it and decided I would do it, that I was gonna go to the Midwest Trauma Center. It was the best money I have ever spent outside of graduate school. I learned a ton, and it prepared me to do the work, and it was honestly career changing for me.
It wasn’t just the modality of EMDR, though. It was the trainer. The woman who trained me had created a program. That was and is EMDRIA approved . The reason that the training was so good was because of her. Yes, there is the modality itself, there is the literature, there are the resourcing skills, all of it that goes along with EMDR. I am convinced though. The reason that I got as much out of it, as did the others that I knew who went through it, was really because of Susan.
As I was thinking about EMDR this week, I was relating it to what I’m asking you to do. I am asking you mental health therapists who were not trained in substance use work to add it to your scope of practice.
I have spent the last two plus years sharing information about addiction, substance use and recovery. I have worked hard to give you information that is accurate, that is concise and as interesting as I can make it so that it’s easier to listen to and absorb. I have shared a ton of things with you and tried to drive home the message that you don’t need a separate certification to do this work. That your clients really do need you to ask about substance use and provide a space where they can talk about it, that you are qualified to do this work without going back to school.
All of the episodes that I have done so far have been designed to help you get to know me and to be able to trust that I know what I’m talking about. But that’s a lot of hours to listen to if you haven’t been listening very long, I thought about what it was that I would want to know if I was gonna jump into something and had to pick someone to show me how to do it. What is it that I would wanna know about that person?
So this episode is to help answer the question, why should Betsy be the go-to person when I wanna know about substance use?
When I thought about where to start, I decided I would start at the beginning. The beginning for me is in the early to mid nineties. Things were difficult for me, and I was a difficult kid. I didn’t wanna listen to anyone and really thought that I should be able to do whatever I wanted, not unlike a lot of kids. What was different for me was that I was incredibly angry and extremely reckless.
I was also looking for a way to numb out and to stop the feelings that were happening in my body that I didn’t know how to deal with. I didn’t grow up in such a way where we really talked about feelings all that much. It wasn’t that my parents were mean or abusive, it was just not something we did. If I wasn’t bleeding, then I was fine.
So when I started experimenting with substances, like lots of do. Perhaps to someone else, it would’ve looked just like any other kid except for me from the very start, it wasn’t just a little bit. Every time I would try something, it had to be all or nothing.
If I was gonna drink, I was gonna get hammered drunk. If I was gonna smoke, I was gonna smoke until I could barely stand. If I was gonna trip, I was gonna do it for days on end. Whatever it was, I was gonna go all in. That is how I lived at that time in my life.
I’d always been a bit like that. Addict behavior was present for me, I think from the beginning.I can look back at some of the ways that I was acting and the things that I did and see addict behavior. I was really good at manipulation, at finding loopholes, at figuring out a way to get what I wanted without those around me really being aware of it.
I would take chances that others wouldn’t. I had a way of quieting my conscience so that I could do things and not feel guilty about them. All of those traits meant that when I started using drugs and alcohol, there wasn’t a lot in my way. I didn’t feel guilty. I had figured out how to lie. I had figured out how to hide things. I had figured out how to get my needs met. I was willing to do whatever it took to make myself numb out.
At the time, I didn’t know that I really thought that it was about numbing out. Certainly there were times when I was well aware that that’s why I was using, but in the beginning, it was simply because I wanted to. I wanted to, so therefore, I did. There wasn’t anything that was closed to me. My life was such that if I wanted it, I did it.
If I wanted something, I’d take it. If I needed to go somewhere, I got someone to do it. It didn’t matter whether I had a driver’s license or had my own money or my own connections. I figured out how to make all of those things work.
To be really frank, drugs were the answer for me. I didn’t know the question I was asking, but drugs answered them for me. I am a downer kind of girl, meaning that I don’t like stimulants and uppers. I don’t want things to make me more amped up. I was very much into being as calm as possible.
I think it helped quiet the rage that I was feeling inside. And when I was using, I didn’t have to feel anything and I didn’t have to worry about anything either. It became such that I wanted to be high all the time, every day from when I woke up until I went to sleep. I had the patience to push tobacco out of a cigarette so that I could pack it with weed just so I could smoke it on the way to school.
Do you know how long it takes to take a pack of cigarettes, empty the tobacco out and mix it with weed and pack them all back in. A fuck ton of time, and I would do that routinely.
I understand addict behavior and addict thinking. I know what it is to care only about getting high. I know what it is to sacrifice relationships, integrity, personal morals, to sacrifice everything that meant anything to me in order to get that need met.
know why someone would steal from those that they love. I know why they would lie. I know why they would plan ahead so that nothing got in the way of their use. I understand how things get cutthroat and how you get involved in things that you never meant to be involved in. And how you witness things that in the beginning might have been shocking, but later don’t even register.
I didn’t get as far into using as some folks do, and that is only because I got sober really early. And I’ve talked about this in a number of different episodes. I didn’t get sober early because I’m smarter than anyone cuz I’m not. I didn’t get sober early because I’m special somehow. I don’t actually know why I got to get sober early.
It happened randomly in a non-spectacular. There were certainly moments where there were more spectacular things happening, like getting arrested. I could have decided that that was enough for me, but those weren’t enough for me.
Instead, it was a quiet night all by myself where I finally realized that I couldn’t keep going this way. If I hadn’t gotten sober when I did, which by the way, wasn’t a one and done. Getting sober was a process for me that took a bit of time where I was using and not using and using and not using, which is pretty common for most of us.
I do know though, that I didn’t have control over it. I do know that as a downer kind of girl, I would’ve absolutely wound up using heroin because that’s where it would’ve ended up. And I didn’t have self-preservation at the time. I didn’t understand that my choices were gonna impact everything in the future. At the age I was, it’s not something that I could see, and frankly, with as fucked up as my brain was at the time, I didn’t care.
I know the desperation that they feel when they’re stuck in a cycle of substance use or addiction. I know what it is to feel like you will never be able to crawl out of that hole that you created. I understand what it is to be afraid that you would never be happy again if you gave it up. I know the fear of looking into the future and having to face it without substances.
When I got sober, I didn’t go through treatment. That’s not a bragging right. It’s just the circumstance of what I was going through. I didn’t recognize that I was an addict. I knew I had a problem, but I didn’t really have the language for that.
I just knew that I was using drugs and I needed to stop, and so I had to figure out how to make that happen. And I had to figure that out for myself because since I didn’t have the language, I didn’t know who to ask for help, and so I just made it up.
I figured out that I couldn’t hang out with people who were using, because it was too tempting and too easy for me to use also. I figured out that I had triggers around certain times of the year when there were anniversaries that I couldn’t handle. I began to recognize certain feelings that would make me want to go use. And I had to figure out how to get myself busy, so I didn’t do it.
When I ended up moving to a new city with my sister. She worked nights and I worked days, and I realized I was bored outta my fucking mind and that that probably wasn’t a great idea. And so I got a second job. Not necessarily because I needed the money at the time, but I needed to do something. And so working was what I did.
Because I’d been using all through high school my grades were absolute shit. And in order to get to the college I wanted to go to, which was Michigan State, I needed better grades. And so I had to work my way up to that. And I went to three different schools before I went to Michigan State.
Once I got to MSU, I ended up getting into doing mentoring work through a program called Young Life, and I spent a ton of time doing that. It was probably 20 to 25 hours a week of volunteer time on top of full-time school. On top of having a job, on top of having a social life that didn’t involve drinking and getting hammered.
It was busy, and that is how I built my recovery from the ground up. I got to the place where I remember one of my roommates saying to me that she couldn’t imagine what I used to be like. That she didn’t understand the stories about the person that I was.
And I realized then that I had done it, that I really had moved away from that life and that I didn’t really have a lot in common with it anymore. That was something that I hoped would happen, but not something that I knew. Because again, I didn’t have anybody walking with me on a path to recovery. I didn’t even have the word recovery.
I just knew that I couldn’t go back to that place because I did stupid things and made bad choices when I was using, and that it was too easy for me to fall into a hole.
All of those experiences make it possible for me to understand where clients are coming from, when they are struggling with substance use, when they have to face a life where they may not be able to use again . when they have to go to see a new provider, when they have to be honest about certain things. I know what that’s like.
I may not know everything about the lifestyle that they have led. I may not have gotten into the place of using heroin, and I don’t need to. I get it enough. I know the fear that you will always want it. And that you’ll just have to fight against it for your whole life. Spoiler alert, that doesn’t work that way. Thank God it does go away. The longer you’re in recovery, the less the lifestyle pulls you, and that is a miracle in and of itself.
During that time in my life when I was at Michigan State, I was working with teenagers, specifically teenage girls, and I had a tendency to attract girls who got into similar trouble. Not all of the kids I worked with, but a number of them.
One of the reasons I wanted to go to grad school is that I realized when I was working with those girls that they needed more than I could do for them. That simply being a mentor and a friend wasn’t going to be enough. That for a few of them, the lure of drugs and that lifestyle were just too heavy. I didn’t know what to do.
When I went to graduate school. I didn’t know much about the whole LPC, LMFT, MSW thing. I found out about it and learned about all of the complications of licensure and all the different ways to get trained as a therapist. I have a lot of respect for the training that I had. I had in-depth training on a ton of different things. I even had training on doing assessment testing the way a psychologist would. I ended up actually doing a job as a psychometrist where I would be the one administering the tests for the neuropsych doctors, and it was all because of the training I got in grad school.
The one thing that was lacking was in substance use. I had classes in undergrad, and I took the optional class that we had in grad school. All of that helped prepare me when I got into the field, but it was what happened next that really prepared me for the work that I got to do.
My internship was in Montana at a Boys and Girls Ranch, it was called, where the majority of the girls I was working with had severe trauma and substance use issues. I got to work alongside therapists in this environment as part of my internship. Because I was living on campus and spending months there, I got a chance to really be a part of the team. It showed me a lot about what residential treatment can be like.
The first major job that I had was at a residential treatment center. It wasn’t the same as the one I had been at. This one only kept for 30 to 45 days. Again, working with teenage girls and specifically they were there for substance use treatment.
I was working among substance use counselors as one of the only master’s level therapists there. I was able to work on my hours, which was a huge deal. But the majority of my work was in substance use treatment. It was incredibly eye-opening. I was able to learn so much.
In past episodes I’ve talked about the shock that I had going into the field because I truly believed that I had the training I needed, but when it came to substance use, it just wasn’t enough. I thought that I was the only one that other therapists must know these things as I would find out later they didn’t.
During the years I was working for the treatment center, I got to see teenage girls coming in in all stages of their use history. Some in deep withdrawal because they were using really heavy drugs. Some who were more in the middle of their drug use and weren’t all the way down at the end yet.
I got to see them get sober. I got to see them change and grow and send them back into their lives. It was an incredible experience. I got to see treatment that I saw would work as well as things that didn’t work so well.
I also got to work with who had been in recovery for decades who were my colleagues, and taught me a tremendous amount about what it meant to live in recovery. That is when I got those words for myself.
After that, I ended up doing in-home therapy, which man, I feel like all of us should spend some time doing in-home therapy at some point. It is an enlightening, difficult, humbling experience in a lot of ways. It helped me understand my clients in a way that I just don’t know that I would’ve.
It also helped my city girl mentality start to wane as I understood what it was like for different types of families in a way that I just don’t know that in an office I would’ve achieved that.
Learning to work in an outpatient setting was all about productivity. I remember at one time having 104 open clients. I was seeing mostly teenagers and kids at that time, although I had some adult clients as well and I was running groups. Running groups was something I was super familiar with from the treatment center, and it was nice to be able to feel like I at least knew how to keep up with that.
Getting used to the documentation of an outpatient therapist was challenging at first. Doing solid assessments full of differential diagnosis and the backup for it, as well as solid case history. I got decent at it and was able to keep up on things. It was busy though.
That was helpful for me when I became the supervisor. I wasn’t planning on being a supervisor, although I had planned on eventually doing some kind of management type gig. This is mainly because I tend to wind up in supervisory type roles. It’s part of a personality trait.
I ended up taking this job, even though I absolutely felt like I was in over my head a bit. I was the youngest person on the team of therapists, and I was keenly aware of that. When I took over my supervisor job, it was for outpatient mental health, but also outpatient chemical dependency treatment.
I learned all about how to do outpatient substance use work, how to work with going to a residential treatment center and coming out of one. I learned all about drug tests and use patterns and how to manage crises when it came to substance use.
I learned about the relapse cycle and how it worked in ‘s lives. I learned a ton about working with the Department of Corrections, probation, and parole. . I had to figure out how to balance the goals of the Department of Corrections folks and our clients, because that was our main referral source.
I learned how to manage the bureaucracy of funding coming from the state or the county, and coming from insurance. I had to work with limited resources in a way that I didn’t really understand existed. There would be a thing that I knew someone could benefit from and doesn’t exist. They live in a different state, sure. They have commercial insurance. Yep. They can have that. But for the majority of folks we worked with, that just wasn’t possible. I learned a ton about working with child protection and parents who were using drugs and alcohol.
I began that job in 2009 and ended it in 2019, and by that time had become the director. I had tried out different programs that were evidence-based. I had applied for different types of funding, found new ways of treatment to implement, navigated through the opiate crisis and the crackdown on prescription pills, which gave rise to heroin use in an area that pretty much never saw that before. And navigated through the crisis we had here with synthetic drugs and the fight to make those illegal. Then came, of course, the rampant meth use.
All of that meant having to go through ways to manage that with our clients, with staff, and how to run treatment that started at 8:00 AM and ended at 9:00 PM It was a challenge. It also meant that we had to have a lot of staff. That I had to train front desk staff to manage this difficult population, that I had to train our mental health staff to understand substance use to help them be able to work well with this population.
It meant interns from associates degree level, interns, all the way through PhD level interns. Hiring new therapists and training them and supervising them all while maintaining my own caseload. It was a really busy decade for me.
During that time, I became known as I became the go-to person in the area when it came to mental health and substance use. Whether it was speaking with Washington DC Senators, chairing a coalition for the community on substance use prevention lobbying in the capitol of my state, talking to Congress about our needs.
The only piece that I haven’t done in the substance use realm is work in a detox center. I did have experience working with people while they were detoxing, but in a specific center where people are just there to detox that I haven’t.
Otherwise I have been in every position that could be, starting out as a tech on a unit all the way to being the director. I got certifications for a substance abuse specialty and a clinical supervisor specialty. I had a lot of fun being asked to speak at different conferences and colleges on various topics related to substance use and mental health.
I know the difference between the level of use that somebody has, where they need treatment, like in an outpatient treatment program or in an inpatient treatment program, and when they are okay to have individual treatment. Or individual work with a mental health therapist.
I know how to advise therapists on screening and assessment and treatment planning and how to navigate whether substance use needs to be worked on first or whether mental health stuff can take precedence.
I don’t know how many therapists I’ve supervised over my career. I just know that it was quite a number between the interns and the staff that I’ve had. I got a chance to be a supervisor for a lot of folks. It was an honor and a privilege to do, and it’s something I miss. I love helping therapists feel more confident in what they do.
I love hearing stories of success from their client work, and helping therapists as they go through difficult times when things happen with clients that we wish we could take away.
I feel very blessed that this addict in recovery had a chance to work with people who were struggling with substance use, to help others find meaningful recovery. To share information and knowledge with other mental health therapists, helping them feel more confident and competent to work with substance use.
So who is this woman, Betsy Byler, that’s asking you to spend your time with her? That’s what I wanted to share with you today. Just like when I was picking my EMDR trainer, I want you to pick whoever it is that you feel like is gonna give you the information that you need in order to better help your clients.
For the last two years I’ve been trying to show instead of tell why I am capable of helping you in this area. I just thought today I might spell it out a little more.
I am passionate about the work that we do. I am passionate about people finding freedom. Getting stuck in a cycle of substance use addiction, gambling is devastating. Isolating, terrible. It’s terrible for the addict and the alcoholic and the gambler, and it’s terrible for those that love them.
The beauty in recovery cannot be overstated. I love sharing recovery stories because I think most of us love a redemption story. I think we love the idea of making something beautiful out of something that wasn’t. I love the ability to assist people, get rid of their shame and move on from the guilt.
When I thought about what I wanted to do other than therapy, I realized what I missed most about agency work was working with other therapists. I realized that I had a passion to share this information and to see other therapists be able to share it with their clients and better help their clients.
That’s why I started the podcast. That’s why I’ve done workshops and why I have the bigger training program of Charting the Course. I really believe that we have a unique opportunity to help people find freedom in their lives.
I wanna take the mystery out of substance use so that you feel equipped to handle it. I encourage you to go over to betsy byler.com. There you will find the podcast page that has 123 episodes on it where you can find a number of different things to listen to. You will find access to my Substance Use Decision Tree that is totally free and it’s there for you to download to help you decide whether somebody’s use is appropriate for outpatient therapy or not.
And I encourage you to check out betsy byler.com/course. I have taken my 20 years of experience in the field, and 10 years as a supervisor and my years as an addict in recovery, to put together a six week live taught program with continuing ed credits that will tell you the things you need to know about substance use in order to feel competent and confident adding it to your scope of practice.
The doors for Charting the Course registration will open later this spring, and signing up for the wait list means you’ll be one of the first to know. Thank you so much for spending your time with me today. I hope that this has given you an insight into me and what I’m like, and whether I’m the person that you’re gonna choose to help bring this information to you.
If you have questions, comments, or thoughts, please feel free to reach out. I always answer my emails. It’s email@example.com. Thank you so much again for joining me. I hope to see you on the next podcast. And until then, have a great week.
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