Author Archives: Stacy Overby

The Doorway Into Treatment

Treatment centers regularly get phone calls. Someone is calling looking for some help. Sometimes it’s for themselves. Other times, in fact most often with adolescents, it’s someone else looking for help for a loved one. But the caller is lost. He or she may not understand where to get help, regardless of who it is for. Or they think because they’re looking for help, they can check themselves in to a program as the first step. However, there is a critical first step to finding help for a substance use concern. It’s the comprehensive assessment.

What Is the Comprehensive Assessment?

While they can go by other names, such as a Rule 25 assessment here in Minnesota, the comprehensive assessment is about getting a global view of the client’s life. Therefore, any decision to seek treatment for a substance use disorder for someone of any age should start here. See, the comprehensive assessment will review substance use patterns and the consequences of using for a person. It will also evaluate other factors in the client’s life—things like jobs, transportation, community supports, and more. It’s these factors that have just as much influence on the level of treatment recommended as the use itself does.

Understanding Substance Use Patterns

First, and foremost, the assessment will examine what substances the client uses and how the client uses those substances. This is about how much they use of a substance, how they use it, and how often they are using overall. Understanding this pattern of use helps LADCs assess the risk in the way a client is using. For example, adolescents have a riskier pattern of use than adults in general. This is because adolescents tend to experiment with more substances, mix substances, and use in binge patterns. Adolescents use like this because often they are uncertain when they will get to use again so they’re “going to make it count”. They also don’t always understand why they’re not feeling the effects of a substance right away, so they use more thinking it will help. Then, by the time the substance takes effect, the adolescent has pushed it to where they’re risking an overdose.

The route, or way, someone is using also influences the level of care recommendation. People who are using intravenously run significantly higher risks of overdosing and of having serious secondary health problems. The intravenous use can be more difficult to reduce and eliminate due to how fast the substance takes effect in the brain. Oral only use, while still perilous, does not carry quite as much weight. Substances ingested orally take 30 minutes or more to affect brain function. This means there’s a greater window to address an overdose. It should be noted, though, that this effect is also what contributes to adolescent binge use patterns and can place adolescents in particular at a higher risk of overdose. Now, these are just a couple examples of how counselors consider a person’s patterns of substance use. Each person’s situation is unique and cannot be fully explored here. Questions regarding a specific person’s situation should be directed to a treatment provider for more information.

Reasons for Substance Use

Once the counselor assessing a person understands the patterns of use and potential risk factors associated with this aspect of the assessment, the counselor will explore other areas of the client’s life. Physical health issues can contribute to a person’s substance use. This is one significant factor that can lead to opioid addictions. Mental health is another area in which there are several risk factors that contribute to substance use. For example, those who have experienced traumatic events have a much higher rate of substance use disorders than the general population. This is because of how the trauma influences and distorts the relationship between one’s mind and body. As you can see, the goal here is for the counselor to find and understand potential areas that are feeding into the ongoing substance use. It’s these areas that treatment must address so a person can decrease and stop using substances in harmful ways.

Barriers to Treatment

After exploring potential underlying reasons for substance use, the counselor will look at potential barriers to treatment. For adults, these barriers could be job concerns, child care issues, housing issues, other relationship issues, and more. For adolescents, these barriers include school, jobs, sports, and trying to explain to parents what is happening. The recommendations will not be helpful to a client if a counselor does not consider these factors. After all, why would a client be expected to follow recommendations for treatment if the cost they pay includes things like a place to live, no way of taking care of children, or not being able to graduate from school? The counselor involved can help address these barriers when they come to light. Therefore, the counselor will ask questions about these seemingly unrelated areas.

Assessing Strengths

Finally, throughout the assessment, the counselor will look for strengths in the client. This is a critical piece of an assessment. After all, no person is without some strengths. Those strengths become the foundation on which everything that happens in treatment is built. A person’s strengths are what counselors use to see people through treatment and to help people develop ways to build up limitations and overcome barriers. For example, someone using in part as a response to trauma has the strength of being a survivor. That simple fact—a person survived a traumatic event—becomes the start of a new chapter in their narrative where they survive the aftermath of that trauma and the subsequent substance use. e 4 Accent

Finally, the Recommendations

Once the assessment is done, the counselor will weigh out all the strengths, barriers, and risks a client presents with to the assessment. And, the ones discussed here aren’t even everything a counselor will explore during the assessment. They are just a sampling of the things under consideration. They weigh each recommendation in the context of each person’s life. Because there are so many unique combinations of things going on for people, this assessment becomes a critical tool in determining what the recommendations for helping a client should be.

And it’s not a case of substance use treatment or not. Often there can be recommendations such as mental health therapy, a medication management evaluation, family or relationship therapy, connecting with sober support groups, a physical health evaluation, referrals to state or county resources, and more. Many people make the mistake of thinking the assessment is about using and if someone goes to treatment or not. The assessment, and treatment itself, is so much more than that. It’s about how to help support a whole person in every aspect of their lives so they can get to a place of health and happiness.

Parenting Teenagers 101

I’ve worked as a substance abuse counselor for over eight years now. Most all of that time has been with adolescents, and one of the things I hear frequently from parents and guardians of teenagers is they struggle to engage their teen in meaningful conversation. How do you parent when they won’t talk to you?

Parenting Means Listening

I talk and talk and talk to them but they just won’t listen. While the words vary, I’ve heard many parents and guardians say things like this. The problem with this style of parenting is it relies on the spirit of “do as I say and not as I do” mentality. Teenagers are good at spotting those seemingly hypocritical behaviors and using them as a reason not to “do as I say”. While it can be so difficult to do, turning that pattern around tends to improve the relationships and overall parenting process. Let the teen do more of the talking and listen. Listen not just to what they say, but what they don’t say. Look at what their body language and facial expressions are saying. Teens often struggle to put their thoughts and feelings into words, so these non-verbal cues are a good tool to help them learn how to do that.

Parenting Means Admitting When You’re Wrong

Admitting you’re wrong. That is something so many people struggle to do. We’ve come to equate this admission to somehow being less than or not as good as others. Yet every single person on this planet has been wrong. And more than once. Yes, sometimes teenagers try to hold it against adults when adults are wrong. However, rather than letting the focus turn to who’s wrong and who’s right, deflate their argument by admitting it. Two things will start to happen when we admit we are wrong to teenagers. First, it will boost our teenagers’ self-esteem by hearing they are right at times. Second, it is an excellent way to work on building mutual respect. By acknowledging we are wrong, it tells teenagers we are listening to what they have to say.

Parenting Means Admitting We Don’t Have All the Answers

Another thing I’ve seen is when parents and guardians struggle to admit they don’t know something. It gets easy to pretend you have an answer to try to get them to do what we want them to do. However, when we pretend we have all of the answers, we also teach teenagers to pretend the same thing. This, in turn, sets up situations where teenagers get in over their heads pretty quickly. Instead, learn to admit when you don’t have the answer. Then work with your teenager to learn the answer together. It teaches your teenager the skills to find answers to things they don’t know and it helps them learn to admit they don’t know everything.

More Parenting Resources

Eowyn Gatlin-Nygaard, a therapist from Headway Emotional Health, wrote a great article with additional insight into decoding teens for Minnesota Parent. You can find it here.

Mayo Clinic also has some good insight here.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

A Centering Exercise

Often clients come into sessions agitated and unable to focus. Sometimes it’s walking into a group setting that can trigger this. Centering exercises are designed to calm the mind of racing thoughts and relax the body. While there are many options out there, here’s an easy one to try.

Have the clients sit comfortably in a chair, with their feet on the floor. Instruct them to close their eyes and breathe slowly in through the nose, hold the breath for a moment, then breathe out through the mouth until their lungs are empty. Ask them to notice any thoughts that come into their mind. Remind them, all they need to do is acknowledge and then let go of the thoughts that come to mind. Have them continue breathing in the same pattern for several minutes, just observing the thoughts coming and going. Then, when they are ready, have the clients open their eyes. Ask the clients if anyone wants to volunteer their observations on the thoughts they noticed, but don’t require it of clients when completing a centering exercise. Allow time to discuss any thoughts or observations should clients choose to do so.

And there you have it. A quick and easy centering exercise. Remember the main goal of this exercise–peace and calm. Dealing with those thoughts and feelings are for another time.