What Does CBD Do? A podcast for therapists

Episode 68

What Does CBD Do? Is it good for anxiety and/or PTSD?

Is CBD good for treating substance use disorders?

Is CBD good for chronic pain and arthritis?

With CBD being added to more things all the time (drinks, lotion, vitamins and even water) it can be hard to know what is real and what isn’t. In our work as therapists we really need to know what science is saying about CBD and its benefits. I took on the (somewhat arduous) task of sorting through research to find the truth. The caveat here is that I could only access certain articles and there is FAR more research than I could possibly read for this episode. I took the most commonly cited research to share with you and answer the question “What Does CBD Do?”

Transcript

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 68. Today we’re going to be finishing our conversation about CBD. Cannabidiol is the extract from the hemp plant. In the first episode about CBD, we talked about where it comes from, how it differs from marijuana, even though it’s the same plant, and the legalities of creating CBD.

We covered side effects potential uses and the endocannabinoid system, which plays a large part in a number of different ways in the body. Today, we’re going to talk about specific claims about CBD and the research that’s behind it.

I should note that there is no definitive on CBD in almost any of these categories. Every single thing I read talked about needing more trials, more human trials as much of this comes from animal trials, with the exception of two things. One is the medication Epidiolex, which we’ve talked about before. Epidiolex is a CBD based medication that was approved for two particularly difficult forms of childhood epilepsy. The second is a medication called Sativex. This is a THC and CBD combination medication that’s used to treat the muscle tremors, having to do with MS. This is not available in the U S but is available in other countries.

Much of what we know about CBD comes from all of the trials that went into creating Epidiolex. This is not to say that there’s no research about what CBD does in the body. There is a ton of it.

It’s just that the way research happens is it starts with animal studies which they often call preclinical research, and then into human trials and there’s a number of phases. Up until recently, it has been very difficult to get permission to do human trials with CBD. Some of the difficulty had to do with the legal gray area that CBD was falling into. There’s also still a lot of stigma about doing research on something related to marijuana.

Today, we’re going to be covering CBD and its impact on anxiety, post traumatic stress disorder, opiate addiction and substance abuse disorders in general, arthritis and chronic pain and finally, we’ll end with some comments about how it impacts epilepsy. The question we’re looking to answer here is, does it work? As therapists, we often have people come to us and tell us the things that they’re trying on the outside of therapy to help their conditions. When it comes to CBD, we want to know, does it work? Is it effective? So with each of our topics today, I am going to try to answer that question.

For anxiety, the answer to does it work is, potentially. One of the main things that’s noted about CBD is that there is a calming effect that happens fairly quickly after ingesting. The idea here is that CBD may be able to help anxiety in the moment and the benefit of that being that we don’t have to wait for SSRI or SNRI to kick in; that someone might be able to have some relief from anxiety now. Some of the medications that we prescribe SSRIs and SNRIs can have some side effects that we don’t like.

Now CBD of course has side effects and some of them might be unpleasant. However, they seem more mild compared to some of the others. There are some medications in the psych realm that can actually increase anxiety. One of the things that CBD proponents talk about is that CBD isn’t going to increase anxiety. Some have suggested that perhaps CBD could be used in the interim while someone is waiting for their prescription medication to kick.

There are a couple of main studies that people quote when they’re talking about anxiety. One of the frustrating things I found was that some of these scholarly articles would speak as though this is a given that CBD is effective for anxiety and talk about it as though it is a well known fact. The studies that they’d be referring to, I’m familiar with and in those studies, the authors talk about the limited scope and what can be drawn from their own research. They don’t speak in such unequivocal terms. That was kind of frustrating if you’re reading those articles. It may look as though, “well, here it is, this article says that it’s a well-known fact.”

One of the studies that’s often referred to, has to do with what they are calling SAD. Now, SAD to me is seasonal affective disorder. SAD in this context is social anxiety disorder. There was a group of students, a small number the researchers point out at 24 people and half of the group were given CBD at 600 milligrams and the other half of the group were given a placebo.

The 24 people had some history with social anxiety and they were presented with a situation where there was simulated public speaking. What they found was that the results were promising in lowering anxiety prior to the public speaking event. The authors of that research are very clear that more research is needed and that their sample size is very small.

A second study is often quoted as well and this one has a bit of a larger sample size at 72 people. This study was done with people who identified as having anxiety on a regular basis. Within the first month of regular dosing of CBD. 79% of people had reduced anxiety scores and they remained lowered throughout the duration of the research. They were also measuring impact on sleep in the same cohort 66% , noted improved sleep in the first month. But after that, those scores fluctuated over time. It was noted that CBD was well tolerated In 69 of the patients out of 72. The implications of that study are promising.

Lower anxiety by self report or self-perceived anxiety is what we’re looking for. If people feel less anxious and they’re having some relief from anxiety, that’s great. The fact that those scores kept being lower throughout the study is also promising.

The issue of sleep is a little bit different. Some of the research I found about sleep and CBD found that CBD was not necessarily helpful in dealing with insomnia. I’m wondering then in this study, if the reports about better sleep have to do with just general better anxiety levels and so they were able to initiate or stay asleep better, and it wasn’t necessarily due to the CBD impacting the sleep cycle. Because CBD can cause drowsiness there was some thought that perhaps CBD would be good for sleep. The research that’s been done, which isn’t very large at this point, doesn’t really show that CBD is effective for treating insomnia.

The research noted that CBD has a similar effect to a medication called imipramine. Imipramine is an old tricyclic antidepressant in the similar age range as Trazadone that has antidepressant effects. It’s typically not used very often in that realm any longer. It is something that has been used to treat bedwetting in children, six and older.

In another study, that was not a blind study, meaning that the participants knew that they were getting CBD. They found that CBD expectancy was alive and well. Meaning that the placebo effect was active. They stated that CBD expectancy alone impacted several subjective and physiological responses.

Additionally, expectancy related factors were implicated in anxiety reducing effects of CBD for those who believed it was. Meaning that for those who already believed that CBD was going to help their anxiety, they showed a much higher incidence of lowered anxiety reports. The researchers point out that this indicates and reiterates that there is a need to control for CBD related expectancy in future research. That is a very short summary of a bunch of different studies and what they found. Again there is a number of preclinical studies, which typically involve either very small sample sizes or animal studies and moving into clinical trials is something that is needed, but has been hard to get approval for in the past.

So the answer for our clients is potentially. I personally don’t see a problem with someone trying it. The issue that we have to remember of course, is that the majority of CBD being sold on the market is not real CBD. There are reports all over of those substances having no cannabinoid at all or having some, but having THC, which is the psychoactive component in marijuana or others, having completely different compounds like dextromethorphan, which is the cough suppressant medication that in excess can have dissociative hallucinogenic effects.

If our clients are going to be taking it, they need to be taking it from a reputable source that has the third party testing that has a certificate of investigation. And honestly, it’s going to be fairly expensive because getting CBD out of hemp is extremely complex and expensive. Those are the caveats that we want to be aware of when we’re talking to our clients about this intervention.

When it comes to CBD and post-traumatic stress disorder there’s some interesting research about the different parts of the brain and how they’re impacted by CBD and how that affects specific symptoms of PTSD.

We are familiar with PTSD and for many of us, it’s what we primarily end up treating. What we’re talking about in relation to CBD is the impaired memory processing that can develop. PTSD gets complicated by impaired plasticity and medial prefrontal cortex activity, hyperactivity of the amygdala and impaired fear extinction.

The reason that CBD could be a promising candidate for treatment is due to its multimodal action that enhances plasticity and calms hyperexcitability. There’s been some extensive research on CBDs mechanism of action in the prefrontal cortex in PTSD patients. But there needs to be some more research on the mechanism of action in the dorsal raphe nucleus.

There was research done at the Mayo Clinic in Minnesota published in 2020. In a clinical trial, healthy volunteers were administered the FAA H inhibitor and showed improved baseline anxiety levels, reduced negative affect and enhanced extinction memory one day after the stressor. In this study, they were inducing a stressor reminder or a stressor event, and then implementing the CBD intervention and then measuring fear response. Because one of the things in PTSD is that the fear extinction isn’t happening the way it should. The thought here was to see if CBD had an impact on that and it seems as though it might.

It’s proposed that there are two acute effects of CBD, which limit fear network excitability. First CBD, activates neural-transmitter projections to the amygdala, limiting excitation of the amygdala and CBD potentiates endocannabinoid signaling at the synapse between the amygdala input and the five HT neuron the dorsal raphe nucleus. This mechanism ultimately reduces anxiety during re-experiencing and then second begins to restore some of the inhibitory control to the prefrontal cortex by reducing the activity disparity.

All of this to say there’s a bunch of really technical descriptions of how this works on the different transmitters and the different parts of the brain. What they’re hoping for is to uncouple the experience from the fear response. So removing the link between certain triggers and the trauma memory. So something like an emergency siren being unlinked to the traumatic memory. The idea is that CBD could help in this process. That I think is an exciting and interesting potential application.

Another study had participants taking CBD at bed time. This study did have people reporting better sleep and reduced nightmares. It’s the reduced nightmares that they’re targeting here with the reduced fear response. The study done in 2019 was fairly small at 11 people total. In a third study, healthy volunteers inhaled 32 milligrams of CBD following fear conditioning and showed enhanced extinction memory consolidation during fear extinction tasks.

The idea here in terms of PTSD is that CBD may improve functional deficits of the amygdala hippocampus and the prefrontal cortex. Improving these functional deficits is the point of therapies like EMDR, which helps with fear extinction. The idea here in this particular study was that CBD may imitate a small part of what EMDR is supposed to do. And they’re suggesting that the two might be used in conjunction.

From what I gather the focus of using CBD with PTSD is specifically about fear extinction triggers and helping the body respond in a better way to those triggers. For instance, the way that I described this to my clients is that it’s like having a motion sensor light. Amotion sensor light that is too sensitive isn’t quite as helpful. So imagine a motion sensor light that is supposed to go off when a person sized object moves through the area, but instead that motion sensor light is going off as soon as a leaf willows. Anytime a leaf or something of a small size like that goes through the field of view, the motion sensor light turns on. This is related to our fight flight or freeze getting triggered each time something small goes through the field of view.

We call that hypervigilance which is very difficult for people who have PTSD and normally one of the very first things that we need to address. If the person is getting triggered and their body’s alarm system is going off at the smallest thing, it is very difficult for them to feel like they can relax and therefore they’re always on edge.

The suggestion here is that some of how CBD acts in these different parts of the brain may help reduce the reactivity. For us, I would think that if one of our clients had PTSD, wanting to start taking CBD, I would be tracking their nightmares, and their reactivity to different stimuli. The research did comment that it was not effective on intrusive thoughts so much as the response to outside stimuli.

Specifically, there were some notations in a couple of different places that the type species, strain and the way that it’s consumed, the way that the CBD is consumed will have great impact on its efficacy in the body. The research is really clear that the way that the CBD is synthesized, the purity of it, the strength of it totally changes the effect in the body. Additionally, they’re doing some research about whether it’s oral or whether it’s inhaled and these studies have shown that the route of administration does impact the outcome. Going on to say that only unadulterated CBD oil had strong and statistically significant suppressive effects.

So does CBD work for PTSD? Potentially for specific symptoms like the hypervigilance and response to triggers.

Moving on to talk about substance abuse. There has been a lot of talk about using CBD to treat opiate use disorder and alcohol use disorder. Specifically, these conversations are around opiates and alcohol versus other drugs because of the way opiates and alcohol act in the system and that they act similarly.

The initial study of using cannabinoids to alleviate morphine withdrawal started happening 40 years ago. The main thing that we’re looking at when it comes to addiction is the dopaminergic activity in the reward system. If you want to know more about how addiction functions in the brain there is an episode about the brain science of addiction that you can find on the website. Just go over to Betsy beyeler.com/podcast and I believe it’s episode seven. In order to talk about the reward system, we need to talk about the fact that reward from using a drug is different from reinforcement. Reward is what causes initial substance use. This is the immediate effect that somebody gets from using a substance, the initial reward. It makes them feel good. It increases dopaminergic activity, which is related to increased dopamine levels in the striatal and limbic regions.

Reinforcement instead of reward refers to the compulsive substance intake, loss of control and persistent intake, despite the substance’s adverse effects. This is what keeps people using, even though they have built up a tolerance and so the reward isn’t as strong as it was in the beginning. In this realm, we’re talking about CBD being used to treat the addiction once it’s in place, this isn’t about modulating the reward effect that happens when somebody uses. This is about dealing with withdrawal and relapse.

The idea here is that the CBD would bind to the CB one receptors in the brain. The CB one receptors we talked about when we discussed the endocannabinoid system and that they’re the most prevalent type of receptor in the brain. The idea was that by stimulating that particular receptor that they could reduce craving and therefore relapse.

A medication that had been created was tried. And we talked about this last episode about the medication called Rimonabant. This was created as a weight loss medication and it had good effects. And in this instance with substance use and relapse it showed to be promising. However, it also affected people’s mood and increased suicidal ideation. While that was being used for the weight loss purpose. It had to be recalled immediately due to the level of suicidal ideation. So back to the drawing board of trying to figure out what it is about the mechanism of that medication and that substance and how to get the effects without the suicidal ideation.

Remember that we’re talking about the fact that CBD and how it’s synthesized as well as how it’s ingested impacts greatly, how it affects the system. The endocannabinoid system is responsible for so many parts of our functioning that when we add it to something like a medication in terms of how it’s synthesized it can have great effect. Like Epidiolex, which helps with seizures, but isn’t just straight CBD. It’s a CBD based medication with other ingredients that are active.

Some preliminary findings regarding CBD and opiate addiction was that it did not alter self-administration or aid in the extinction of self-administration, but it did change cue induced self-administration following 14 days of abstinence. And the CBDs effects lasting up to two weeks post administration.

So what that means is that following 14 days of abstinence, the impact that it had was that the triggers for using such as people, places, things that reminded them of using were lessened and that seemed to continue for up to two weeks with continued dosing of CBD. This would need to be replicated of course, but it is similar and promising to what we talked about with PTSD. In PTSD, we were talking about triggers being related to a traumatic event. In this case, we’re not talking about fear, but we are talking about the relation between the cueto use, whether it be being around certain people, hearing certain music, being in a certain place, seeing paraphernalia that those cues and how strongly they cue the person to act might be decreased. that would be a great help.

Triggers are a huge deal in dealing with addiction. And in this case, we’re talking about triggers being, not the substance itself, but things surrounding it. So we’re not talking about being able to look at morphine or heroin or opiates and have less of a response. We’re talking about looking at the paraphernalia or other triggers around it and that being able to be potentially reduced.

In the research about opiate addiction is reference to the impact on reducing anxiety and stress. Because CBD influences the serotonergic system. In addition to contributing to the reduction of stress and anxiety might be responsible for blunting the reward facilitating effect of the substance use. May be able to help in modulating the formation of emotional memory related to the substance of abuse. This was in an animal study so preclinical research rather than clinical trial. It is promising though.

When treating opiate addiction, what we have is something to block the opiate receptor, totally that’s naltrexone or something to plug the receptor, which would be Suboxone and methadone. We don’t have anything that will necessarily help with the other parts of addiction that people struggle with the memories that they have and how strong those cues are, or with the different triggers that are associated with it. Now, having the opiate receptor blocked is an important part and probably the most important part because the craving is coming from that receptor being angry that it’s empty.

There are studies that involve alcohol, cocaine, and other psychostimulants like meth to see how CBD interacts with recovery from those substances as well. So similar things are being found that it may help with some of the cues and triggers. CBD’s impact on the body acts differently when we’re talking about stimulants, as we would expect, because those have different impacts on the body as well.

Basically, will it help an addiction? We don’t know. The potential here would be for reduced anxiety, which would help reduce stress that might push someone to use. That if it can help with the calming effect, that it may help blunt some of that desperation that people feel when they’re using. If there is an effect that was available to reduce the impact of triggers, that would also be hugely helpful. ‘Because at this point, we have nothing to help with that. And so I guess in my opinion, anything to help with that would be beneficial.

Remember that we’re also needing to control for the purity of the CBD that someone has taken. We definitely don’t need to be adding other unintended chemicals to someone who is trying to work on recovery.

There is some research looking at the use of THC, the psychoactive component in marijuana to treat opiate addiction. We don’t necessarily mean removing their opiate addiction, but mainly it’s sort of like distracting them. That to me is a bit of a slippery slope because we’re still talking about a mood altering substance and marijuana isn’t the thing that’s probably going to kill them and the heroin and opiates definitely will kill them. That research is continuing and I think it’s important to find out what they mean when they talk about using THC. Are we talking about just smoking weed?

Are we talking about using some sort of liquid- like the medication Marinol or what is it and what effect are we looking for?

Moving on to talking about arthritis and chronic pain. This is one of the things that CBD is most known for and I think was primarily known for. Chronic pain sufferers and people with arthritis are stuck in a catch 22. They need to treat their pain because there is a level of pain at which the person can no longer function on an average basis.

And the medications we use to treat that pain are addictive and can cause hyperalgesia meaning an extra sensitivity to pain. So the medication itself might relieve pain, but also might make them more sensitive to.it as they move forward, causing them to need more medication. It is a very difficult thing to know what to do.

Something else that might help with inflammation would be a really big deal. What we know is that the endocannabinoid system plays an important role in the regulation of tissue inflammation, and also of pain. In the majority of animal studies CBD was found to have analgesic effects, reduced hyperalgesia that extra sensitivity and did so through various routes of administration.

Since the early two thousands clinical trials involving CBD for the treatment of chronic pain have shown ranging effects from placebo equivalent to highly effective. Many of these studies were well-designed and randomized double-blinded and placebo controlled with a mixed cohort of patients suffering from intractable pain due to multiple sclerosis, spinal cord injury, brachial plexus injury, and limb amputation. CBD treatment seems to significantly reduce pain on a visual analog scale.

The studies were limited though by small cohorts and the various disease states indicated that the effects of CBD are context dependent. One study found that locally administered CBD, meaning injected to a specific spot, seemed to help with the late stage osteoarthritis. CBD treatment before later stage pain and nerve damage seem to be a preventative.

The findings seem to indicate that CBD would be a safe and useful therapeutic tool for treating osteoarthritis joint neuropathic pain. The preventative piece seems to be related to a potential blocking of acute inflammatory flare ups which drive the disease progression and joint neuropathy.

As someone who had osteoarthritis in my left hip before they replaced it, it was excruciating. The pain was ever present and would flare up for seemingly no reason and was so intense. As a person in recovery, taking opiates is not an option. That is not a thing that I was able to do knowing that opiates and opiate like medication we’re sorta my jam. And so managing the pain in different ways became really needed.

CBD seems to have good reports for dealing with inflammation. These inflammation flare-ups sparking the progression of these diseases like arthritis. So when the question of, does it seem to work? I’d have to say yes for some. It does depend on the type of CBD and in some diseases with some different conditions, the route of administration is something that changes the effect. Clearly people at home are not going to be self-injecting CBD into the joint area. And so I’m not really sure what the oral way of taking CBD is going to do versus the injectable, but it does seem like there is some decent research on chronic pain.

Again, the quality of the CBD is key here. this isn’t like taking name brand medication versus generic medication. This particular point makes all the difference.

The last thing we’ll talk about today is epilepsy. Epilepsy is a pathological condition that affects about 65 million people worldwide. Its principal characteristics are recurrent seizures and the cause ranging from genetic syndromes to brain damage. It is a condition that often doesn’t respond to the pharmacotherapy that’s used. And so in this sense, cannabinoids appear to be a promising alternative.

The two phytocannabinoids, most researched for the treatment of epilepsy are Delta-9, now that’s THC, which is the psychoactive component of marijuana and contaminant dial CBD. We’re not necessarily talking over the counter CBD here, but CBD has been found to prevent seizures and reduce mortality with low toxicity and high tolerability.

They do talk about the entourage effect, which is really interesting. The entourage effect is a term referring to a situation where a group of endogenous compounds, similar to endocannabinoids when acting together potentiate the effects mediated by the cannabinoid receptors, basically that when the cannabinoid is introduced into the system, that the way that it acts with the other endocannabinoids around seems to mediate its effect., it’s something that they’re watching because I’m assuming it was unexpected.

In the marijuana using community. I have often heard people talk about THC being good for epilepsy, and this is not the case. THC has been researched quite a bit in relation to epilepsy, but it’s CBD that has come out on top. There’s no research stating that THC reduces seizure activity and they’re concerned about seizure aggravation. Particularly in withdrawal from THC. So the potential here is that seizure activity could be increased if someone is using THC and then coming off of it, that the withdrawal from it may aggravate their seizures.

The big deal here about CBD and epilepsy is that it seems to be good for epilepsy with far less side effects than other anti-epileptic drugs. One of the things they commented on though, is that we don’t know about rebound seizures. If CBD treatment is abruptly stopped, that is always a concern when someone goes off an anti-epileptic medication,

Research about CBD is difficult and it’s difficult for a couple of reasons. One of them is about the legality of it. That has been under scrutiny and has been difficult for researchers to get approval to do the research they need to do. It seems as though that is easing somewhat.

Getting someone who’s dedicated to do the CBD research that’s going to be difficult because we need a lot of clinical trials with humans. I am hopeful that there’s enough money in CBD, that there are some companies that may be willing to fund that.

The second reason that it’s difficult is that CBD can act through 65 discrete specific molecular targets, including 10 receptors, 12 enzymes, 10 ion channels, and 13 transporters. That is a lot of different ways that it acts. It can be hard to know which is active, that’s causing a good effect or a bad effect.

And lastly, the research is complicated because obtaining sufficient quantities of pharmaceutical grade CBD to conduct a well powered clinical trial is already difficult and extremely expensive. You need about one gram a day, and the list price is about $67 per gram. Again, this is because the process of extracting CBD from the cannabis plant is complex and arduous. For the goal of using CBD in people. It has to meet an extremely high bar set for clinical grade preparation. That bar means that only minimal quantities of THC or other contaminants are allowable.

Scientists have been able to create a purely synthetic CBD, which eliminates those other issues. However, that synthetic grade CBD is still a schedule one substance in the United States, which limits its use for research. Even in Canada, where recreational cannabis use has been legalized. It can take six months while an application is approved for research and that’s for people or animals.

So as we’ve talked about CBD, it is complicated. And the majority of people who are using CBD or just average citizens don’t know the things about CBD that we’ve talked about. Finding solid research is hard. I spent hours researching different things and cross-checking studies. I’d have one article that sounded super scholarly, quoting other studies that weren’t the right studies really.

I mean, they were kind of related, but it didn’t say what they were saying it said. And so what are average people supposed to do? I guess for us, it comes down to, if we have a client who’s going to use CBD it’s about the purity in terms of where they’re getting it and if that has been certified by an outside party lab and watching to see what the effects are, when you see them. Checking in with them about certain things that they’re targeting to see if it’s helpful.

I think CBD has some promising applications. The problem is that you can buy CBD at a gas station, Amazon, or pretty much anywhere, and they’re putting it in everything. And so it seems like no big deal. When CBD does have some side effects. They’re not terrible and it’s not going to kill you, but there are side effects. It’s not neutral and it’s not necessarily going to do what people think it is.

And they could be putting other things into their system that cause adverse effects like dextromethorphan or synthetic marijuana, which has shown up often. And, or actually THC itself. Maybe someone doesn’t mind that it’s in their system, but it could definitely fail a drug test or cause psychoactive impacts in someone’s driving around or doing things with heavy machinery while high and not realizing they’re high. There are some major complications here.

I’m not anti CBD. I don’t eye- roll when I see references to it. I am frustrated by the level of kind of runaway capitalism that we tend to exhibit here in the United States, where CBD goes into everything to the point that it almost becomes useless because it’s everywhere and it starts to lose its meaning.

I am all about things that could lower our client’s anxiety. I am all about not having to wait for a psychiatry appointment if it was effective for anxiety or PTSD. I am always on board with trying to relieve people’s pain, emotional or otherwise. And I think that if CBD has some ability to help these things, then let’s do it.

In our work as therapists, I wanted to try to give us good information so that you have an idea of where things are and what we can say is accurate and what we can say we don’t know yet. There are certainly other applications for CBD that I did not cover. One of them has to do with blood sugar levels. The research there isn’t super strong, but there is some being done and there are others. I’m sure that I didn’t even see, I had to narrow down the most common applications so that we could talk about it. I really hope that this information has been helpful for you.

As we move into the new year, we’re moving into a new section in the podcast. We’ve covered substances of interest and substances of abuse. We’ve covered the process of addiction and the brain science of addiction. We’ve even talked about things that are suggested to be included as an addiction or things that are compulsive behaviors.

Next we’re going to be starting our talk about assessment. We’re going to be talking about the purpose of assessing for substance use and why it is definitely in our wheelhouse. We’re going to be talking about the different parts of the assessment, how to conduct those parts of the assessment, what you’re looking for in those sections and what to do about it.

I’m excited about the new year and all of the things coming up. I hope that you’ll continue to join me on the podcast. I am so grateful for the support from the listeners and I always welcome feedback and questions. Please feel free to reach out to me whenever you have an idea, you can reach me@betsyatbetsybeyeler.com.

Thank you so much and happy new year. I hope to see you on the next 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.

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