Episode 103

One of the things that gets in the way of a therapist deciding to step into substance use work is this belief that if they aren’t in recovery, then they aren’t going to be able to work with this population. As therapists, the imposter syndrome can be all too real. We can feel like we don’t belong in any number of situations. We are very sensitive to things like this as it’s something we pay attention to constantly on behalf of others. The message about needing to be in recovery is pervasive, but that doesn’t make it true. The truth is that you are enough, as you are. You do not need to have the exact personal experiences as your clients to do good work. This includes substance use work. 


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 103.  Last week, we talked about the fact that I believe that substance use is our problem. And by our problem, I mean, the problem of the mental health field. I believe that substance use is just the same as any other subfield, like eating disorders or trauma or sex therapy that it is under the purview of mental health.  My mission has been to lay out for you the reasons why adding substance use to your scope of practice is not only ethical, but something that your clients need.

The thing I wanna address today is this idea that if you don’t have personal experience being in recovery or with problematic using that you can’t effectively do this work. In other words, if you aren’t an addict or an alcoholic, then some people believe you don’t have a right to be in the substance use space.

I have heard therapists over the years, come to a place where they’re ready to jump in,  but that imposter feeling springs up. They would say things to me. Like I’ve never been truly addicted. I don’t know what that’s like. Or the only person I know who’s been addicted was a relative of mine. Do I know enough? Is my experience enough? So I wanna address that.

The substance use subfield started in a different way than a lot of psychology. People have been studying psychology for a long, long time, and it started being formalized well over a hundred years ago. The substance use subfield  is still kind of in its early stages.

Certainly substance use issues have been around a really long time. However, first, it was treated as a medical problem so they needed medical detox because generally when people were talking about substances, they were really talking about alcohol. And then as a criminal problem. One of the things that research is bearing out is that we cannot arrest our way out of the problem.

I had the privilege here in my small community to work with the chief of police, to create a diversion program where low level drug offenders could choose treatment over jail. If they complete treatment successfully, then the charges wouldn’t be filed. Because the chief always says that we cannot arrest our way out of our substance use problem.

I think in general, people are starting to grasp that. We’re not totally sure what to do with the drug dealers yet, but generally I think people know that addicts and alcoholics need help, not criminal charges. This is not to say that consequences aren’t important because of course they are, but that’s not gonna be the answer to addiction.

The reason all of that matters is that how substance use as a subfield came to be is important because it tells us how  mainly people in recovery doing the work. Before AA. So this is pre 1935. There were societies called mutual aid or temperance societies where members would get together and try to help each other cut back or quit drinking. 

People who’ve struggled with substances and have been trying to get sober, have gathered together for years. The idea of a support group is not new. In the last episode, I talked about how these groups were meeting and AA was being founded all during the same time that the psychological field was expanding exponentially. Social workers, counselors, marriage, and family therapists, and psychologists were all forming their own societies and trying to deal with licensure issues.

All the while the substance use subfield had peer run groups. There wasn’t a lot of research. There was focus, especially whenever there was a drug that was mainstream for causing problems. And when political campaigns were revving up. But there wasn’t a lot of treatment focus. This meant that not a lot of professionals were in the field.

For many years people doing substance use work, meaning work with people who were using problematically didn’t have advanced degrees, didn’t have specialized degrees. And in some cases, no education about the subject at all, only personal experience.

It became natural for people who’ve been in recovery longer to turn around and to teach those behind them. It’s actually a tenant of the 12 steps and 12 traditions of AA that we keep what we have by giving it away. The call to service specifically is the one that people who’ve been in recovery longer start turning towards. This is when they do things like chair meetings or become sponsors for people.

There haven’t been a lot of treatment options over time. In the last 20 years or so, there has been a huge move to try to find something as an alternative to AA. This is not to say that the 12 steps are bad in any way, only that people wanna have different choices. There are some things about the 12 steps that not everybody is a huge fan of. And one of those tends to be a focus on a spiritual awakening or revelation based on a higher power.

Some home groups tend to be more religious than others and that can turn some people off. I have talked about a number of different recovery organizations here on the show, like Recovery, 2.0 Life Ring Women in Recovery. She Recovers. These are all groups that are not religiously based where people can go for recovery support.

 I think another reason why the peer recovery model worked so well is that those of us who are in recovery, as I am, want to give that to other people. We see people struggling with their using, and we want them to get free from it because we know how good that can feel. We know the darkness of using and what happens when you’re alone and all the downsides. And we know how hard it is to quit. And we’ve come to the other side and we want people to know that there is hope.

This isn’t much different than how people become a therapist. Certainly not all of us, but a good number of us became therapists because of an experience we had with the mental health system, good or bad, or an experience that a family member had with the mental health system. Certainly there’s the underpinning that we wanna help people, but there’s lots of helping fields. Why this one? 

Perhaps it’s that you’re a good listener or your friends always came to you for advice, whatever the case. You are a therapist who believes that people can get better. That people can recover. That people can live full and happy and healthy lives, even when they’ve had mental health issues. The difference here is that in the mental health world, we typically don’t share a lot about ourselves.

We are taught in school to be a blank slate.  The degree to which we’re supposed to be a blank slate sort of depends on the discipline you’re in, but in general, self-disclosure is frowned upon. In the recovery world it’s not that way. In fact, at the beginning of the month of September, I shared my recovery story on the podcast, knowing full well that there are clients of mine who listen to my podcast. 

The fact that I’m a therapist does inform how much of my story I tell, but I certainly have told more of my story because I’m in recovery than I would’ve if I wasn’t. So there are differences. When it comes to who’s doing substance use work, though I think that the idea that you have to be in recovery is far overstated. 

Just because a lot of us are in recovery that’s not a precursor to getting into this work. It’s just happenstance. It was how the field developed and it’s something that we personally know and feel like we might be able to offer some insight to folks. And so we get into the field. It’s not unusual for a person in early recovery to start thinking about going back to school, to become a substance use counselor themselves.

I am here to tell you that you do not need to be in recovery. You do not need to have experienced problematic use in order to do solid substance use work. I would say that in general, you probably shouldn’t be using problematically, but there’s other reasons why you shouldn’t be using problematically and being a therapist, but specifically you don’t have to have personal experience.

If you do, you need to do the same work you would as a therapist in understanding your own bias, your opinions, what you believe recovery looks like, what you believe healing looks like and making sure that if it was a family member or a loved one who was struggling with addiction, that you’ve managed your own feelings around their behavior. Because the chance that you are gonna run into somebody who has done the same, probably terrible things that someone in your life did is really high.

Substance use shows up the same, no matter what the drug or where you are in the world. Some of the details might be different and some of the timeframe might be different, but people who are using problematically, their experiences are very similar. So if you have those experiences in your world, you will need to do the work yourself to make sure that you don’t get a lot of countertransference when you have people with the same thing.

For instance, if you had a parent who was using substances and it feels like your parent chose substances over you, that is something that you will need to solve and come to peace with before you’re working with parents who are doing what seems like the same thing. That particularly is a very difficult point for people. I did do an episode on this, that I’ll link in the show notes so that you can take a look at it.

So let’s think about therapists that we have seen. My hope is that every single therapist listening has been to their own therapy. If you haven’t, I would recommend getting one. I truly believe that in order to do our best work, we need to understand what the client is experiencing. For a lot of us, it was a requirement of our program. And for others, perhaps it became a requirement of our own because grad school was a lot. Being surrounded by 30 or so therapists every day you say something and there’s a chorus of Hmm around the room and can’t help but be faced with your own issues.

I don’t know if any of the therapists that I have worked with have struggled with depression, anxiety, or trauma. At this point I can look back and think probably because most people have struggled with it at one time or another, but whether they’ve had significant trouble with it, I don’t know. The point there is, it never occurred to me to ask. I don’t need to know their resume of personal experiences in order to see them as a competent therapist, I need to see that they know what they’re talking about and that I can build a good relationship with them. 

Think about the therapists you have seen. Do you know if they struggled with things and if you did know, are you comfortable with that information? In some cases, it makes people feel more understood that the person that they’re speaking with truly does understand what they’re saying. And in other cases, it can make them feel like, well, if you can’t be healthy, then what choice do I have?

It is definitely a double edged sword to share that kind of information. In our fields we are told that we shouldn’t, unless there is benefit to the client that we’re sharing it. We can’t know if it’s benefiting the client, unless we are really, really aware of how they’re gonna take that information.

 I’m not gonna say that there is nobody who would look at your non-experience and be like, Ugh, they don’t know what they’re talking about. Because there are every treatment group I’ve ever had. There have been a couple folks who wanted to check my cred, so to speak. Do I know what I’m talking about? Have I been where they’ve been.

Over the years, I’ve had staff of both kinds, some that were in recovery and some that didn’t need to be in recovery. This is typically how a conversation in a group setting goes. I’m usually filling in when it comes to groups. As the supervisor. When there were times when someone was gonna be on vacation or groups were conflicting, it was my job to step in.

And so I’m filling in and I’m new. And of course, it’s kind of like a substitute teacher and they wanna check where you’re at. Well, I happen to be in recovery and I don’t get into how far into my addiction I got, but. I say enough to quiet the conversation. Inevitably, somebody else says, see, I think you should have to have these experiences to be a counselor. I’m in so, and so’s group and they don’t know where I’ve been. They’re not in recovery. 

And someone else pipes up. And in fact, more than someone’s typically pipe up and say I had so and so too. And it doesn’t matter that she hasn’t been there. She is good. I learned a lot from her, or it doesn’t matter that he doesn’t know that stuff, or he hasn’t been there himself he knows what he is talking about. This tends to be how it goes. The people who want to quote require that their counselors have lived the life they’ve lived are in the minority , and frankly, that kind of rhetoric is pretty much a cop out. It sounds rude, but it’s the truth.

We see a lot of that in early recovery and in early treatment. Remember too, that when we’re talking about the level where there’s treatment groups, we’re talking about people who are much further down the line than a lot of our folks. We’re talking about people who are mandated to be there because they’ve gotten in legal trouble. Those people are already defensive and they want any reason to discount what you’re saying.

Yet they never ask what their mental health therapist’s world is like. They never ask if their mental health therapist lived the life they lived. They accept that that person probably doesn’t know what they’ve been through.

 What I believe is that the experience that we have is a shorthand when somebody wants to know, can they trust me. Telling them that I’m in recovery from drugs, tells them a little bit of what they need to know. However, I can still get there, even if I never tell them. It’s the same way with therapy clients, we eventually get there. We eventually get to the place where they trust us and know that we know what we’re talking about. It just takes time.

There are differences I believe in what the experience of the therapist has been and how that impacts the client. And in that sense, I would say, culturally speaking that is different and important.  It’s not necessary that every person have someone from their cultural background as a therapist, that is a personal preference thing and I do believe it can make a great difference. 

Where I live. There is not a single therapist of color in the area, not one, and this is small, but it’s not that small.  There are hundreds of therapists in this area and not one therapist of color. Somebody wants a white female for a therapist and you got tons of ’em. So in that sense, I do think it can matter who the person is seeing. 

When it comes to substance use, though. That is not a culture in the same sense of a big C. That is culture little C. Certainly there is a drug subculture or a subculture for alcoholism, or even for problematic using. It is a social norm basically, I’ve talked about this before being in Wisconsin. And for those of you who don’t know about Wisconsin, it is a state that’s known for beer and cheese. Mainly because we make both here. Lots of it. 

There’s this new ad campaign going on, and it’s drink Wisconsinbly. And I think they’re trying to make Wisconsin be drinking responsibly, but that is a fucking uphill battle that I don’t know that they are going to win. Because drinking Wisconsinibly to me is the fact that every time there’s like major party school lists in like Newsweek, Wisconsin’s got numerous schools on the map.

This state has a lot of alcoholism and people who would never consider themselves alcoholic, but their drinking is absolutely not in the normal range at all. The fact that you can take your teenage kid to a bar crawl and they can drink as long as the bartender wants to serve them. Um, that’s not normal. However, it is Wisconsinbly.

Culture, little C is a different thing. And I believe that’s what substance use is. There are varying degrees of this. So for instance, I have never lived in a trap house. A trap house for those who don’t know what that is, is like a crack house, a flop house. Basically it’s either an abandoned house or a house that somebody is owning or renting and people are crashing. And they’re strangers to each other and they’re only commonality is that they’re using the same or similar drugs.

There is oftentimes no power or furniture to speak of and it’s about as gross as you can think. however, when you’re needing a place to stay, sometimes that is it. I have never been in one. So in treatment groups,  most of the people who are there for IV drug use, such as meth or heroin, those kinds of things have been in a trap house even if they haven’t lived in one. It is part of the culture, little C and there’s an understanding about what that’s like.

When I see people get asked about their recovery status, it has typically not been in an individual appointment. And they don’t ask if they’ve known the person for a while. It is a defense mechanism, it is a test and the recovery community is guilty of sort of playing into that sometimes. And there are people who feel like maybe their stories aren’t “bad enough” to warrant being at AA or NA, but that’s just people being people. That’s people needing to have something that their past life stood for that makes them stand out or maybe makes it not be a total waste of a life.

I do not think you are going to get that question from your people. If you do, I would encourage you not to respond with what makes you wanna know that you can say something like, thankfully I have not had an issue with drinking.. I know lots of people who have, but I haven’t had that experience. That’s enough to solve it. And if they wanna push that, you can say to them. So tell me  what about this is important to you? What would be different if I had? What would you feel like I would better understand?

I think that the majority of folks you’re gonna have in outpatient mental health though, I don’t think they’re gonna question you on that. And I can tell you as a person in recovery, and I can tell you from others in recovery, we don’t need you to have that. We need you to know what you’re doing in terms of helping us make better choices and learn better ways to cope.

The only thing you may not be aware of is how deceitful addiction can be. For those of us who were, or are in a full blown addiction, people who are actively using lie a lot. They tell the truth in a way that they could say it’s the truth, but only if you’re looking at a very specific angle.

And so you might find that you didn’t ask the right question. And if you had, then the answer would be different. That might be the only difference I can think of. Because once you have had that experience with a couple people, you get really quick to it and you’ll learn to ask the question differently.

You are not an imposter here. If you don’t have an issue with drugs or alcohol and you can use in a normal moderated way, that is a good thing. That’s great. You don’t need to feel sorry about that. You don’t need to apologize for that. You belong in this space. I am inviting you into this space and I’m able to speak on behalf of a number of people in the recovery community. 

Last month, we did an event and a friend of mine, Jean McCarthy, who also has a podcast, came to the event to share her view as a client so to speak. That if she had shown up in our offices back when she was drinking daily, we wouldn’t have been able to tell.

And she shared what things were like for her and the people who got to hear her were fairly moved at least from the feedback we got.  She also told the audience that mental health therapists are needed in this space. Here’s one of the reasons why. There are a lot of recovery coaches out right now.

And I know that when I say the word coach, there are mixed feelings about that. I think the majority of the field doesn’t have an issue with the idea of coaching. We have an issue with the idea that people are practicing therapy without license or without training. We’re concerned that people are stepping into territory, that they shouldn’t be not necessarily because of legality, but because you can do some real damage to people. 

In the recovery coaching space there are no regulations on coaching. You can call yourself a coach. There are schools you can go to, but whether they’re certified or anybody takes a look at anything they’re teaching is up for grabs. A lot of folks are looking for someone to help them with their use. And these people are not using in a way that they need treatment. They’re often subclinical when it comes to that. And yet they’re reaching out for support all over the place.

That tells me that there is an unmet need. That there are people that are aware of their mental health issues and so seek out therapy. When they’re not able to address substance use with their therapists they are looking outside for that as well. Our field is protective over the things that are under mental health. I believe we need to be protective about substance use as well.

Most people who are using problematically have underlying mental health struggles, the substance is just the coping skill. Just like cutting, just like overeating, just like doing any other things that could potentially be damaging.  Our expertise is needed in this area.

 I want to leave you with this. When we have gone to see a therapist, we don’t ask the therapist to tell us their mental health issues. When we go to our doctor and they’re treating us for some particular thing, we don’t ask them if they’ve had it too. Many of us treat significant trauma and yet have never had that trauma ourselves. 

The only reason that the substance use field has been peer run is because that’s who was available. The professional community hadn’t stepped in yet. When we started to step in, it took a while to kind of make standards and not invalidate all the work that the peer recovery people were doing. But in any relationship where there’s a power, differential damage can be done and so the clients need to be protected.  All over the country now in the United States, we have standards for what constitutes someone getting into substance use counsel. That is on a bachelor’s or a technical college level, not at a master’s degree level.

 I’m not totally sure why substance use is seen as something less complicated than mental health, and therefore can be done with less education, but we are where we are. The message is just, like I said, last week, and just like I say, all the time, it’s you, that they need. You are enough. Your life, your experiences, your way of doing things. You do not need to be in the recovery world in order to be effective and to be able to confidently do this work. 

You’re adding it to your scope of practice just like anything else you work with. Just like maybe you’ve never had generalized anxiety yet you work with that. Or you’ve never had depressive episodes or manic episodes or any of those kinds of things. And yet you’ll work with that. It’s the exact same thing. 

If you ever get questioned on it, you can be very honest about it. And just say, I haven’t had that experience. I’ve worked with a lot of people that have had that experience, but I personally haven’t. If the person feels like it’s important, I would explore that. I would explore why it matters to them that you had substance use history and that they didn’t ask about your mental health history. That usually stops people because they’re like, oh yeah, hadn’t thought about that. I suppose it doesn’t matter. Okay.

My mission is twofold. One to convince therapists around the world that substance use needs our help and that we have a place working with people who are struggling with substances. And the second. Encouraging you to try it, to just dip your toe in and start getting there and start the work. That’s why I’m putting on a free webinar to help you stop avoiding the substance use talk: the five steps to confidently ask about drugs and alcohol.

It’s on October 18th, which is a Tuesday at 8:00 PM. Eastern time, 5:00 PM Pacific. For all of my international folks, I will send the replay out the next morning. As I can’t imagine that you would be attending, then my Australian folks might be able to attend, although it would be first thing in the morning for them. But I wanted to be able to present to you a very clear five step way to start the substance use conversation that will feel good to both you and your client.

They will not feel alienated. It doesn’t have to be awkward. And it is giving you the in to start asking the questions so that you can get the background. You can’t do much until you know what’s there. I hope that you will come join me on October 18th. And believe it or not, that is next Tuesday. 

The next two weeks, the podcast is going to be pretty short. There are some really specific things that I wanna highlight coming up this month. And I’m gonna talk specifically about those things in the next couple episodes. You can register for the webinar at betsybyler.com slash steps. That’s S T E P S.

You are needed and wanted in this space. There are not enough people to work with substance use and mental health. If you are in private practice and short on referrals, I can tell you right now, if you were to add substance use to what you’re willing to work with, it would be raining referrals. Because truly there are not enough people willing to do this work. I think it’s really great work to do and I find it really rewarding and I believe you will too.

Don’t forget about the webinar next Tuesday, and until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

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