Episode 70

What keeps therapists from asking about substance use? ​Fear of practicing out of scope? Not enough information about drugs? Not sure what to ask?  There are a lot of reasons why a therapist might be hesitant to assess substance use. Knowing ourselves is one of the most important parts of our work. Our fears, anxieties, feelings of unpreparedness can all impact our sessions. What are your hesitations about assessing a client’s use of substances? 

I often wonder what the reasons are that a therapist doesn’t ask about substance use. I’ve spent more time than I can quantify thinking about this. I don’t have judgment or criticism of therapists who don’t ask about it. I just figured they weren’t trained and it just seems like it’s out of their scope to do so. This week we’ll talk about some of the reasons a therapist might not want to add substance use to their assessment. 

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 70. Last week we covered the main 10 reasons why we as mental health therapists need to add substance use to our assessment questions.

If you haven’t had a chance head over to betsybyler.com/podcast and you can pick up the new episode there. As I thought about what to cover in the next step I thought about barriers to assessing for substance. I think there are three main categories and I’m going to cover them all in their own right. 

The three main categories I thought of were therapist barriers, client barriers and process barriers. In therapist barriers, which we’ll be covering in a bit, this is about things that the therapist feels and other factors around bringing this up with their clients.

 In client barriers these are things that clients struggle with when talking about substance use. We’re going to cover that in more depth, in a different podcast. There’s a lot of in-depth things that we need to talk about. Like, are they worried about us reporting them? What if they have kids? Does that change that? There’s a lot of things we can talk about and we’ll cover all of them. 

The last set of barriers are process barriers. This is more about the process of therapy and the logistics of doing this. I sat down and brainstormed all of the reasons why a therapist might not want to assess for substance use.

I decided to start with therapist barriers, because if we’re not ready, then the rest of it isn’t going to fall in line. These reasons aren’t necessarily in any type of order. As you listen, I would love for you to think about what stops you from assessing substance use in each of your clients.

As therapists, there are so many things we have to consider with our clients and we’re juggling a lot of things all at once. Whatever hesitancy you might have about assessing for substance use, it is valid and needs to be taken care of in order for you to feel like you can move forward.

I would love it if you would share those things with me. If you have a  moment please send me an email to betsy@betsybyler.com with the reasons why you might be hesitant to assess for substance use. Or perhaps you used to feel hesitant and are okay now, I’d love to know what that was. 

I am passionate about this work and I’m assuming that’s pretty evident if 70 episodes or anything to go by.  Even though I have that passion, I recognize that not everybody is going to feel as excited as I do. I want to be able to address each of those concerns in turn. So even if you’ve never emailed a podcaster or a radio station or anything before I encourage you to do it, I would love to hear from you.

One of the main reasons I think that we get hesitant to talk about substance use is the fear of practicing out of scope. When I think about the pitfalls of doing therapy, a few things come to mind. The first one of course is keeping appropriate boundaries with clients. 

I remember talking about inappropriate therapist, client relationships on the very first day of graduate school. Since then, it’s been drilled into my head and our collective minds about keeping appropriate boundaries. We are entering a space of emotional intimacy at times that is above and beyond what that person is experiencing in their life. We have to maintain our professional distance or else. There are a number of things that could get in the way. 

The second big risk. And again, these are going to be in a different order for you is the risk that somebody might have suicidal ideation and indeed might go through with committing suicide. In other healthcare professions, like in the medical profession they are concerned about clients dying from injury, illness, all sorts of things. 

For us it’s their mental health that we’re worried about and we know that suicidal ideation is actually pretty common. Most people at one time or another in their life will have thoughts about maybe they’d be better off dead.

Now, I don’t know the numbers on that and I don’t know how many people have their ideation go from just a passing thought to a planning stage or even to actively wanting to die. But it is really, really common. As humans. Death is the only way we know how to stop something permanently, and completely and it is normal in times of high stress and despair and grief to experience those thoughts.  

Feeling somewhat responsible for someone else’s will to live is an incredible weight. For a lot of us, it is something that is frightening. The longer you do this. The more you’ve been around people who have suicidal ideation that starts to get easier, but it is one of our big fears. 

On the heels of that, is getting sued. We worry about someone reporting us to a board, losing our license and getting sued.  In the discussion about getting sued is practicing out of scope. This is something that I think average people don’t really think about. However, it is something that we talk about. We talked about it in graduate school. We talk about it in supervision. We talk about what we feel competent to address and what we don’t. I recall that when I first got into the field, I would hear other therapists say that’s not in my scope.

I really believe that they believe that about substance use, that it is not in their scope. Well, the question I have is, is it just not in their scope or is it not in our scope? So I made the case last week that substance use is in our scope and I believe that to be a hundred percent true. 

 

Substance use is a real specialty and there are other things that are real specialties, too. Like trauma, like working with people on the spectrum, like doing work with children and then specifically children from zero to five, sex therapists also are a specialty. 

So we need to think about specialties in a way that makes sense. Specialties are not saying that we can’t do those things. Specialties are those people that have specifically leaned into a specific niche to make that the thing that they know the most about. 

Our scope of practice in the very beginning is pretty general.  We know how to do some cognitive behavioral therapy. We know how to reflectively listen. We know how to validate feelings. We know how to do basic techniques. As we move in our career, we start to learn certain modalities a little better. We end up finding certain techniques we like better than others.

Our scope is what we make it. For our purposes today I want you to remember that we are not talking about treating substance use. Not at this stage. We are only talking about assessing for substance use. You will not get reprimanded by anyone for assessing substance use.

Substance use is a normal part of life and in all of the code of ethics, it talks about  that our assessments should involve all areas of normal human behavior. I looked at the code of ethics for counselors, LMF Ts, MSWs, and each discipline talks about needing to assess all areas of a person’s life.

I want you to think about the fact that we assess medical issues, even though we are not medical at all. We are supposed to know about things like thyroid affecting mood or vitamin D levels having a correlation to depression or head injury having an impact on daily functioning.

We have to know a lot of things that aren’t necessarily our specialty. If fear of practicing out of scope is something you struggle with. I want you to remember that we are only assessing. If you are going to start treating substance use, that is a different discussion. And I do think that there is some specific training that you should get.

I don’t believe that you need to go back to school and get a whole different certification. The only reason you would do that is if for some reason you needed it for billing purposes or your state specifically forbids you to do any substance work without having that license. Again, we are qualified, we just need to have the information. Assessing substance use is in our. This will not get you sued.

I have an experience of a friend who was reported for practicing out of scope by another therapist. I know I was shocked too.  It was the culmination of a long standing disagreement and frankly was done out of revenge.

What happens when that happens is that if the board does anything, then the person who is being accused shows the board what their experience is and what training they’ve had in order to practice in that area. In this case, the person was of course, able to provide proof of training and experience and the board was like, yep, that’s fine.  Drop the complaint.

Assessing is not the thing that’s going to get reported.  You can feel free that assessing for substance use is in our scope.  Not only can we do it, but the implications and our code of ethics is that this is part of normal human behavior so you really are doing the thing you’re supposed to do. 

Another reason that somebody might feel hesitant about assessing it is having a lack of information about substances. Maybe you feel like you don’t know much about drugs or alcohol or what it does, or you don’t feel like you know enough that’s updated or maybe you don’t have experiences with drugs and alcohol yourself.

I have talked with people who definitely feel like they can’t speak intelligently about drugs and alcohol. And specifically drugs in a way that makes it sound like they know what they’re talking about. Most of us have general knowledge. We know that opiates are killing people. We know that meth is bad. We know that marijuana is in this gray questionable area. Maybe you’re not even sure what your opinion is on marijuana. 

You could, of course, go to Google and type in anything you want to learn about.  The problem is when you go to Google, let’s say you type in meth facts. You want facts about methamphetamine. You’re going to come up with Web MD, VeryWell Mind and a bunch of treatment centers at the very top. These are part of the algorithm and each of those websites are putting out page after page after page, with certain words, to get the algorithm, to choose them, to show up on the front page.

Each of those pages may have some decent information and if you read a bunch of them, you’ll probably find where it overlaps. The trouble is who’s got time for that? If you want to know meth facts, you really need to go to a place that has basic stats and information. I find that the government website,  not the DEA, because they’re a little alarmist, but the main government websites or SAMHSA  are the most helpful in this endeavor. 

Additionally, this is why I started the podcast the way I did, I have over 25 episodes covering  different substances in detail.  I gave you the effects, long-term short-term, risks. I talk about controversy around it, the legality of it and for every episode, there are a plethora of links to where the information can be found if you’d like to read more. I do the work for you. Any substance that I could think of is on that list.

You want to know about ketamine? Sure. That’s there. You want to know the real truth about marijuana? That’s there too. In fact, there are three episodes about that. You want to know about cocaine and crack and what the differences are. You want to know about kratom or any other substance? The information is there. All of the podcasts are about 30 to 45 minutes. I try to make them around there and they all have works cited  on the episode page. So if you feel like you don’t know enough about certain substances, this is where you can go. 

You don’t necessarily need to know everything about every substance. There are some basics that you need to know and I would focus on listening to some of the episodes on the major drugs. That would be alcohol, marijuana, heroin/opiates and meth. Certainly there are others, but those are the main ones. 

Another potential reason is maybe someone doesn’t feel like they know a lot about addiction. They know that addiction is a thing. They believe that it gets worse. They believe that it’s really hard on people, but maybe they don’t feel like they know enough to explain it. This is actually the first section of the podcast after the intro. 

Episodes 6 through 12 cover addiction in detail. You’ll learn about  addiction in general,  you’ll learn about the science behind what’s happening in the brain and the body with addiction, you’ll hear about progression of use, stages of use, risk factors for becoming addicted, protective factors and the concepts of harm reduction and abstinence.

This is a great place to start. Even for people who feel like they understand addiction, it could be helpful to hear some of the most recent information. Each of those episodes have a page dedicated to them with all sorts of links as well, where you can do further reading or just double-check to make sure I’m not full of shit.

My commitment to you is that I will do my very best to present everything in an unbiased way with scientific evidence behind it. If there is a bias, I do try to tell you so that you know that I’m aware and so that you know that I’m not speaking about something as though it’s fact when it’s not.

In the years that I’ve done supervision, I’ve been asked about a couple of things regarding actually discussing this with a client.  One of the barriers there is therapists often don’t know how to bring this up. There is a fear, I believe, of offending our clients. Of people being defensive and assuming we are thinking badly about them.

It is true that people get defensive about their use of substances, and it could be a drug, it could be alcohol, it could be tobacco, it could be food, whatever it is that we think we might be doing in excess tends to bring defensiveness. What I can tell you here is that it is all about the setup.

Bringing up this topic is a hundred percent about how you preface it. We are going to be covering this detail in a future podcast. In that podcast, I’m going to talk with you about the main points to cover when you’re setting up the conversation and the things to think about when planning to bring this up with a client. It can be scary the first time you do it until you get used to it.

Think about how in the beginning, when you started practicing asking about suicidal ideation  and self harm was scary to. Asking someone flat out, do you ever think about killing yourself is a sure fire way to be jarring and for them to say no, because that’s the answer that they’re supposed to have with that harsh of a question. So we ask it in a different way. 

When I talk about substance use and suicidal ideation, I sat it up in a very similar way. I let them know why I want to talk about this and what I’m going to be asking and what I’m doing with the information. You may not feel like you know how to bring it up yet, but I am going to walk you through that and I hope that it will be helpful. That’s going to be coming up in just a couple of weeks.

For other people. They feel comfortable bringing it up, they know how to bring it up, but they’re not sure what exactly to ask. Is it as simple as just saying, do you use drugs or alcohol? Yes and no. In some ways that is as simple as what we’re looking for. We want to find out if they ever use substances and we want to find out frequency and a number of other factors. This is also going to be its own podcast, where I’m going to tell you exactly what I do when I assess  and what I’m looking for.

Very briefly now, I’ll tell you that when assessing for substance use, we’re looking for presence of any substance use ever, age of first use, frequency of use over time, age of last use, whether any of those substances ever cause issues for them and what the substance that they use the most did for them. Why were they using it? We will go over in detail in another podcast what questions to ask, what order to ask them in and what to do with that information. 

Which brings us to our next potential barrier to assessing substance use. Some people feel like, okay, so I’ll assess for substance use, but what do I do if the answer is yes? What do I do if it sounds concerning? What does that do to therapy? Can I do therapy if they’re still using? How do I address that with them? Do I have to report that? How do I document that? Do I document that? Do I need to give them a diagnosis? All of those things can come up when thinking about doing the assessment, because if the answer’s yes, we kind of need to do something about it.

The exact same way if we find out that someone isn’t sleeping well, we need to help them figure out how to get good quality sleep. If someone says yes to having suicidal ideation  or engaging in self-injurious behaviors, then we need to address that as well.

And yes, if someone is using, there is some further assessment that needs to be done and there may be some action that needs to be taken. What I want to remind you is we’re just talking about assessing at this moment. If you ask, or if you don’t ask, the substance use is still there and it will impact therapy. So you need to know about it for no other reason to account for it when you’re doing therapy.

What to do, if they say yes, is a little more intricate of a topic. it won’t feel super complicated once you know what to do about different stages of use. Just like when we do risk assessment for suicide, there are different levels of response, depending on the answers. It’s the same way with substance use. And yes, I will tell you all about that in a future podcast.

Another comment I’ve heard is that people are worried about screwing someone up, making a mistake and their client ending up dead. This, I think, is at the heart when it comes to fear about our work. Many therapists that I’ve talked to are either afraid of being sued and losing their license or afraid of screwing up and a client ending up dead because of it. 

We are in a field where people do commit suicide as a result of their mental health issues. Sometimes they do that when they haven’t been in therapy. Sometimes they do it even though they’re attending therapy. I’ve shared before that I had a client commit suicide in 2009 and it was hard. It was shocking and scary and sad and a whole bunch of other feelings. And I’m still here doing this work. 

I remember calling my supervisor the night that my client went missing. I knew that my client was at risk because people who had his particular set of mental health issues are at very high risk. My supervisor said to me, Betsy, there are very powerful forces at work inside of people pushing them in a direction and we are but one person. I don’t take that to be fatalistic. Like maybe we shouldn’t do what we do. I take that to remind myself that a person’s issues, all the things happening in their life are moving and changing and progressing all on their own, whether I’m aware of what’s happening with them or not.

If your person is using all of that’s going to be happening, whether you’re aware of it or not. You asking about it is not going to make it worse. It’s not going to increase it. In most cases, you aren’t going to send your client away. What you’re doing is providing them a space to be honest about it. You are not going to screw up and end up with your client dead because you assess for substance use.

In the treatment planning tool that I created, I talk about risk assessment about lethality of different drugs and what requires immediate intervention and what isn’t as urgent because the lethality is quite low. If you haven’t had a chance, the treatment planning tool is completely free.

You just go over to betsybyler.com/treatmenttool or go to the resource page and you can download it. It is something that you can fill out online for one client and save it and use it for another client. It is meant to help you conceptualize somebody’s use. It is there specifically to help address some of the issues that we’re talking about. It is full of questions that I would ask you if you were sitting in my office doing a case consultation. Since that’s not really possible, head on over and take a look at it.

The last two therapists barriers I could think of are general feelings of incompetence around substance use or unpreparedness and personal bias. So I’ll address the issue about competence first.

One of the concepts I like to talk about is this concept of conscious competence. In the beginning of our practice, we go into grad school and a lot of us are in the place of unconscious incompetence. Meaning that most of us who go to be therapists are good listeners. Our friends come to us for advice; we’ve been told by multiple people that we should become a counselor. 

And when we go in, we don’t really know what we don’t know. . We’re in this place of not being competent at it and not even really knowing that. Just knowing that there’s a lot to learn. Shortly thereafter or after your first practice session with a classmate, you get into conscious incompetence.

I have told my story about conscious incompetence in a couple other episodes. If you want to hear about it, I believe it’s in episode three in the beginning. That feeling of conscious incompetence sucks. Of like, oh my God, I totally fucked that up. Oh, Or ruminating on it later because you can’t believe you asked a question or because your client got pissed off or whatever it is you did. But that place of conscious incompetence is hard and it can lead a lot of people to be like, am I supposed to be doing this? Am I cut out for this work? And it is difficult.

If you stuck with it, which if you’re here, you probably did. You get into conscious competence. Conscious competence is a great place to be feeling like, you know what I’m doing this okay. I’m actually not as freaked out. I don’t get nervous every time a client comes in. Might still get nervous when a new client comes in, but seeing your regular clients, well, that’s becoming pretty normal for you. As you go in your career, you get consciously competent about more and more things. 

You even start moving into unconscious competence, where a lot of things that you found difficult or challenging or things that just required a lot of thought, they don’t even really register anymore. You’re just doing it and you know how. Maybe you realize it. Maybe you don’t. For the rest of our careers, we move in and out of stages. Hopefully spending most of our time in the competence areas, but occasionally finding places where we don’t feel competent at all. 

If substance use is one of those areas, I want to remind you that at one time, all of therapy was in the non-competent area and you don’t feel that way any more.  If you do, it’s probably because you’re either new in the field or because something really shocking just happened and you’re kind of reeling from it.  You will get to the place of conscious competence and it is true for substance use.

It can feel scary in the beginning and the more you do it, the better you get at it and the more competent you’re going to feel. Part of that is experience and just doing it. Part of that is information. Conscious competence about assessing substance use is going to come. It will happen for you and you will feel really good that you are doing a thorough and comprehensive assessment.

So the last part, what about personal bias? We all have personal biases. We have personal biases about pretty much everything and every situation that we could think of. It comes from our history, our experiences and family, our experiences in life in general, our current stage in life, socioeconomic status, et cetera. We have opinions and biases that we are sometimes aware of and sometimes not.

I was in a conversation with a client last night about spoken and unspoken family rules. Typically people are able to name a few rules, but until we ask them they aren’t aware of the magnitude of family rules that exist. When you start pressing into different things in someone’s family history, you find a lot of rules about what could be and what couldn’t be.

One of the particular ones was who has to clean up after a family dinner. How old are they? What gender are they and who gets to be exempt?  In your family, after a big dinner, where it’s more than just the immediate family who cleans up, who’s allowed to sit and just stay in conversation, who is allowed to not be there at all? Who goes into the living room to sit and watch TV? Who is immediately getting up to get dishes. There are rules about that. Sometimes they’re spoken, but a lot of times it’s just known. 

These unwritten rules turn into bias. Who should be getting up to go do the cleaning, we have an opinion about that.  Sometimes our opinion doesn’t fit with the family opinion.  That can cause some conflict. When it comes to addiction, you have experiences. Whether it’s distant. Whether it’s something you’ve read, something you watched in a movie, something that you heard about from someone else.

Some of you have experiences that are more personal, a family member, a friend, a co-worker a classmate, and some of you have experiences even closer. Maybe it’s you, maybe it’s your partner. Maybe it was a parent. All of us have experiences with addiction. 

I can remember the first time I really was aware of addiction. It was that my grandmother drank a lot of wine and gin apparently, but I didn’t really know much about liquor because my parents didn’t drink. Like kind of at all. I think I’d seen them maybe having a glass of wine at a new year’s party but the kind of party where all the kids are there too. So it wasn’t really a thing. 

However, when we would go into my grandmother’s house, there was always a wine glass and  these beautiful crystal decanters of hard liquor with an engraved silver label on. I didn’t think much of it. They were just there. I knew that people had cocktails sometimes, but it seems like an occasional thing.

I remember becoming aware of my grandmother’s drinking somewhere around age eight or nine. It wasn’t something that we really discussed and she never got drunk that I saw. There was disapproval when I heard about it, that the level of drinking she was doing was apparently too much. No one talked about it, really around me as a kid. I know more about it now, but at the time I wasn’t aware of it.  The message was don’t drink too much. 

I grew up with my dad sailing, doing races. I remember him doing a race from Bermuda to Newport. We met up with the other families there to wait for the guys to come in. Whenever they got back from a race, that is a time when people would be drinking. For my parents, maybe it was a rum and diet. But I remember super rowdy guys on boats. They’ve been on a boat for however long. If it’s a short race, like in one of the Great Lakes, it’s three to four days, but on a Bermuda to Newport, that’s a long race, and completely depends on the wind. 

A lot of people will drink while they’re racing, but it’s kind of frowned upon because you sort of have to be aware and you’re out in the middle of the ocean or a Great Lake. That is no joke. And so they get in and they’re tired and they’re happy to be done and they’re celebrating and they get hammered. I remember the attitude there being, this is an okay time to let go, but some of these people are a little out of hand and that was the attitude. Those were the first times I remember being aware of substance use and what was normal in my family system and what wasn’t. 

I remember the first time I became aware of drug use. I’d been aware of alcohol use in the context I explained, I had been aware of some classmates of my sisters who, when I was a freshman in high school, had gotten into an accident because the driver was drinking. And I realized that drunk driving was a thing. 

The first time I became aware of drugs was when a classmate again of my sisters died from huffing Scotchgard. I didn’t even know that that was a thing. I knew people smoked marijuana. I knew that the attitude about that was that it wasn’t really great and that the attitude was that responsible adult people don’t smoke weed, although no one ever said that to me. But I didn’t really know that huffing was a thing. I knew that  heroin and crack and cocaine were things. Meth didn’t exist in any form that I was aware of. I’m certain it existed somewhere, but in the early nineties, this wasn’t something that I was aware of.

But when this classmate died from huffing, it opened a different world. Now my own moving into substance use was extremely quick. I tried it and that was it for me. I didn’t stop using again for another few years. The further I got into the world of using the more I knew about other drugs and other people that did them.

As you hear me talk about this, what is your experience learning about drugs and alcohol? What is your experience with people who were using. Maybe you had someone closer to you. Was it just alcohol you knew about? When did you find out about drugs? What did you know about them? What was the attitude about them in your family, with your friend group in your community and your neighborhood? What were the messages? Because those messages are still with you. Just like family rules, those early experiences and early attitudes are still there. Add to that any other experiences you have with addicts and alcoholics?

There are times that I have been so frustrated with clients, parents of clients, friends, family, because of what their use, what that person’s used is doing to my client. Tons of that when I was working with kids and with younger kids, and I was so frustrated, I remember working with a couple of girls when I lived in South Dakota and having an eight year old talk with me about cooking dinner and cleaning up where their parent had thrown up.  

I was so frustrated and angry. I’ve seen incredibly neglectful, abusive behavior related to substance use. I’ve heard heartbreaking stories and seen deep pain and grief because of an addict or an alcoholic in someone’s life. I’ve seen families go bankrupt. I’ve seen people in despair. I’ve seen people have family members die. All the while the family is trying to save them.

I’ve also worked with addicts and alcoholics themselves. I’ve seen what the substance does to them. I’ve seen them from the beginning as it progressed. Part of the work I do with teenagers means that I get them when they’re smoking weed and try to convince them that there’s risk here; that they could end up getting addicted and moving on to other drugs. And they all swear to me that that’s not going to happen. And yet I also work with people who are young adults and older adults and their stories are eerily similar.

If you have negative experiences with substances or people using them, it’s going to inform your work with your clients.  For some therapists, they can’t touch substance use. It’s too hot. It’s too painful and they can’t be objective. I’m going to guess that those people aren’t here, they’re not here listening to me because that’s not where they’re at.

I’ve known a number of therapists who’ve gotten into working with substance use because they’ve wanted to help and they felt like their loved one didn’t get help. We all have personal biases. What is yours? What is it that you think about addicts and alcoholics? What could get in the way of your working with people?

I always want to encourage every therapist to know their limits. There are certain things I can’t work with. For the most part, I’m pretty good at working with most things. But when I have a situation where everything in me is like, fuck everything about that. I know I can’t be neutral. I do have to refer out and I want to encourage people to do that.

Again if that was you, I don’t know that you’d be here listening to this. I’m going to assume that if you’re hearing my voice, that you at least feel like you need to know more. You feel like you’re missing some information or you want to hone some skills and a lot of you maybe want to work with people who are having issues with substance use.

I think our personal biases and our personal opinions are always important to know.  In this topic, what a barrier might be to assessing for substance use? Our personal bias may get in there. We may even have an opinion that we would know if someone was using. Or we would be able to tell, and frankly, we can’t. 

There are lots of people who are using and they hide it really, really well. Certainly later in addiction, they’re not going to hide it as well, but for a lot of people they use for a long time and they’re functional. It may seem like they wouldn’t be using, but I’ve had people using from all walks of life, physicians, teachers, religious people, non-religious people, parents, even people who swear they’re anti-drug. Knowing our bias is helpful. 

The main thing I want you to get out of today’s discussion is that these potential barriers are normal. It’s normal for you to have hesitancy about doing this. It’s normal to not know certain things. It’s normal to not know what to ask or to not have all the information. You don’t have to have all of it to do the assessment.

You know how to assess. You do it all the time. What I want you to be aware of is what you resonate with that we talked about today. What are some concerns you have? What are some areas of growth that might be there? As we move forward in the weeks ahead, we’re going to talk about all the things around assessing, and I’m hopeful that you’ll stick with me in this series.

I think it is important to have a foundation of why we’re doing it and how to do it. I encourage you again, to reach out to me with questions, comments, thoughts, anything. I love hearing from listeners, and I would love to answer you and have a discussion about whatever it is you’re bringing up. Perhaps what you want to say other people would like to hear about. So remember my email address is betsy@betsybyler.com. I hope you’ll join me for 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.

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/

Link related to the episode image

https://www.facebook.com/karenpuzzles/photos/447654239020911