Author Archives: Stacy Overby

Understanding Trauma

Trauma. It’s the latest trend in therapy, right? Yes, yet it’s more than a trend. If we look at how trauma has been perceived historically, it’s easy to see how this focus on trauma could be considered a trend. However, when we look at what recent research has to say about trauma, it changes our understanding of why we need to focus on trauma. When all of this comes together, then we can better understand what we need to do to address the trauma in our lives and in the lives of our loved ones who may be continuing to use substances to cope.

Brief History of Trauma

Historically, people think about trauma as something that happens to veterans in war. Shell shock, battle fatigue, soldier’s heart, and combat stress reaction are all names that have, over the years, been employed in attempts to describe what we now call Post Traumatic Stress Disorder. Experts did recognize trauma as a possibility outside of a wartime scenario but believed these incidents to be limited. Therefore, these instances outside of wartime trauma exposure were not looked at much. So, when you look at trauma from this lens, it’s easy to see how limiting our understanding of trauma can be.

Current Understanding of Trauma


Image by John Hain from Pixabay 

Now days, though, researchers have done quite a bit of work around trauma in other settings. We understand PTSD can stem from things like abusive situations, bad car accidents, witnessing things that can be seen as life threatening, and more. And, thanks to researchers in the last few years, we also know how challenges and difficulties in the home environment that disrupt attachment can affect development. In fact, many researchers, therapists, and specialists are advocating for a new DSM-5 diagnosis of Developmental Trauma Disorder as a result. This is because research has found that symptoms of PTSD and symptoms of trauma stemming from developmental trauma are distinct, even though they do have some overlap.

In sum, this shift to focus on trauma is not just a trend. It’s a broadening of our understanding of what symptoms of trauma look like and what trauma means. In fact, for most clients who struggle to maintain recovery and who struggle with mental health symptoms, underlying trauma is likely part of the problem.

Supporting Someone with Trauma

So, then, what do we do about it? How do we support someone with underlying trauma in their lives? There are a few key things to remember. First, we must keep in mind, people with a history of trauma are living their lives hyperalert to everything around them. They are constantly keyed into anything that could be conceived of as a threat. This hyperarousal is also exhausting. Which means not only is the person scanning for danger all the time, they are exhausted on top of it. Put those two things together and it’s clear they’re not going to be thinking things through as clearly as someone not in this position would be.


Image by John Hain from Pixabay 

Also, keep in mind they cannot control this. Just because the rational brain can understand the threat is not there, doesn’t mean the emotional part of the brain believes it. A classic example is the idea of walking through a parking ramp late at night all alone. Men tend not to be as alert in this scenario when compared to women. Why? Because most women have been taught situations like this are dangerous. In general, men have not had this same lesson. It doesn’t matter if it’s a parking ramp a woman knows like the back of her hand, she’ll still most likely be on high alert for any danger if she’s there late at night and all alone regardless of what ration and reason may tell her.

Once we establish this understanding that the part of the brain controlling the traumatic stress reactions doesn’t respond to ration and logic, it becomes clearer we need to tap into the emotional part of the brain to calm that stress reaction. That’s mainly a role for therapists and specialists. As a support person for someone with trauma challenges, we can remember to honor as many of their requests as possible while still ensuring we are caring for ourselves. For example, if your loved one feels like they need to sit in a specific place and there’s no obvious reason not to honor it, let them. Also remember their anger is not about you despite what it may feel like. Accompany them to therapy appointments when appropriate and when possible. Learn what you can from the experts to help you support your loved one. And keep those healthy boundaries we’ve talked about in the previous articles here and here.

Trauma and Yoga

A final thought for you on how to support a loved one who’s struggling with trauma. Encourage yoga. Research from The Trauma Center, a leading training and research institute on trauma, shows the use of yoga in people with trauma can be a very effective tool in being able to rebuild the mind-body connection that can be broken with trauma. But go slow and be prepared for it to trigger trauma reactions. Make sure if you choose to offer this as a support to your loved one, you’re working with their therapist.


Image by Mary Pahlke from Pixabay 

Trauma is not just a trend in the therapy world. It’s a very real part of what clients in substance abuse treatment programs, mental health programs, jails, prisons, and more deal with. It can be an underlying reason why they struggle to remain stable in the community for long. Caring for a loved one requires lots of understanding, patience, and insight. And healthy boundaries.

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.

Support System Roles in Recovery

Over the last couple months, we’ve talked about what relapse means in recovery and how to set healthy boundaries with loved ones to support their ongoing recovery. The next piece of this puzzle of supporting loved ones in recovery is to understand how their behaviors and substance use has affected the people around them.

The Pond

Imagine for a moment a clear, still pond. The surface is just like a mirror it is so smooth and still. Now imagine someone comes along and throws a rock into that pond. What happens? That’s right. Ripples and waves spread out across that pond. When they get to the edges of the pond, those ripples affect the grass, the mud, and more at the edges. Then they bounce back across the pond in another direction. Those ripples continue until enough time has passed to return that pond to its still state. But that pond has been changed by those ripples. It can’t go back to what it was before the rock was thrown.

This image is what happens in a support system when a loved one uses. The rock is the loved one’s behaviors around their substance use. The pond is the support system. Those behaviors create disturbances in how people in the support system behave. The good news is that those ripples will subside, and things can find a new normal with time and support.

The Enabling Role

In order to find that new normal, though, it is important to understand what those ripples are and how they are working in your life. One of the more common ways a loved one is affected by substance use behaviors is to become enabling. It doesn’t happen overnight, but it can happen. Most often people we’ve worked with who have ended up enabling their loved one’s using talk about doing it because they’re scared of what could happen if they don’t. For example, with teens, parents and family have said they have allowed substance use in the home because that way they know their teen is safe while they’re using. They’re afraid if they set a limit preventing use in the home, the teen will leave and find somewhere else to use and potentially engage in even more dangerous behavior. That’s why someone who is enabling can be referred to as a caretaker—they see their role as taking care of the person using rather than enabling the use.

The Family Hero Role

Another common way these ripples affect loved ones is to become the family hero. Shame, fear, and guilt over the loved one’s using behaviors drive this person to become overly positive. They work to make everything look good and give the support system the illusion that everything is fine. Perfectionism is a common trait seen with people reacting to substance use behaviors in this way.

The Mascot Role

A third way these ripples can affect a support system is to create the role of a mascot for the support system. This role holds someone from the support system up as a clown and joker. The person uses humor to deflect and divert attention away from the person using and the dysfunction developing in the support system.

The Lost Child Role

Another role that can develop in a support system affected by substance use behaviors is where people in the support system disappear. They may still physically be present in the support system, but they are quiet and careful not to make problems. This means people in this role can be easily overlooked in the activity being generated elsewhere in the support system. It also means people in this role end up sacrificing their needs to the perceived need to keep a low profile with everything else going on in the support system.

The Scapegoat Role

The last role to be discussed here is a critical one to understand when it comes to understanding adolescents in a support system affected by substance use behaviors, as teenagers are often cast in this role. The role is called the scapegoat. The person or people in this role will often act out, rebel, use substances themselves, engage in illegal behavior, and more to divert attention away from the secrets the support system is holding. In essence, they take the blame and consequences for what the loved one using is doing.

Teens in Treatment

This last role is vital to understand when discussing teenagers in treatment programs, because often there are much bigger issues in their support systems than their own use and behaviors. And it is for this reason that substance use treatment should always include interventions and supports for the loved one’s support system. These interventions often include family groups and individual family therapy. But it doesn’t have to be limited to that. Sometimes it may be getting someone else in the support system their own substance use treatment or mental health therapy. It could be addressing legal, educational, and/or economic disparity issues.

The Connections

Now, to bring these roles back to the original discussion on boundaries and supporting loved ones in recovery. In order to best support and help a loved one in recovery, people in that loved one’s support system need to understand how the behaviors have affected how the rest of the support system thinks and behaves. Only when we understand how we have been affected by that rock thrown in our pond can we make the changes needed to set healthy boundaries and truly support a loved one in recovery.

Healthy Boundaries and Relapses

A couple weeks ago we talked about what to do if a loved one relapses. Part of what we talked about was maintaining healthy boundaries. Yet, this is something society does not talk much about. In fact, society often pressures us into letting go of healthy boundaries in favor of other, less beneficial gains. So, let’s take a little time today to talk about how we maintain healthy boundaries, so we are prepared when a loved one relapses.

What are Boundaries?

Image by Gerd Altmann from Pixabay.com

First, let’s talk about what boundaries are. In the broadest sense, boundaries are limits. Concrete examples include state and federal borders. They’re not as clear when we talk about boundaries with people, but the concept is the same. It’s the limits we place on what we deem acceptable and not acceptable. Examples include your physical space, the energy you spend in a relationship, and how much money are you willing to spend on a relationship. While these are not the only boundaries we have, they should help you understand what we mean when we talk about boundaries.

Healthy Boundaries

Now that we’re clear on what we mean by boundaries, we can address what healthy boundaries are. This gets a little trickier to define. Each person has their own definition of healthy boundaries, so it’s not as easy to give a universal definition. The simplest way to think about if a boundary you’ve set is healthy or not is to answer a set of questions.

The Why Part

The first question is why are you setting the boundary where you are? What is it doing for you? Is it to help provide safety and wellbeing? Is it to ensure you have enough resources left to take care of yourself? Or is it because you can’t bear to let go of someone and/or their issues? Or someone has hurt you several times and are working to keep yourself from getting hurt again? How you answer these questions still won’t give you a clear-cut answer on if a boundary is healthy or not, but it will give you some clues. If you are setting boundaries to make sure you can take care of yourself at the end of the day, it’s probably a healthy boundary. If your answer is more like the scenarios in those last two questions, you may want to consider that boundary further. These last two questions don’t mean the boundary is unhealthy but can indicate a problem at times.

The Energy Part

Image by Okan Caliskan from Pixaby.com

The next question is how much energy are you willing to invest in enforcing this boundary? While this may seem like an odd question, consider this. If you set a boundary but are not willing to enforce it, you’re in effect teaching people not to take your boundaries seriously. So, it is critically important to enforce those limits where you’ve set them or make a conscious choice to adjust those boundaries to where you will enforce them.

The Goal Part

Finally, is the boundary you’ve set achieving the purpose you have for setting it? This circles back the first question about why you’re setting a boundary. It’s about testing to see if the boundary is working the way you want it to work or not. Even when we have good intentions and good reasons for certain boundaries, if they’re not working the way we want them to we may need to change them.

Changing Our Boundaries

That’s perhaps the best part of all this is that we can change our boundaries to work when we want or need. We need to keep these questions in mind when we make those changes. As long as we are satisfied with the answers we discover when evaluating our own boundaries, then it’s most likely a healthy boundary.

The toughest part with setting boundaries is everyone will have different boundaries. What one person considers a healthy boundary, others may not. It doesn’t mean we have to change a boundary when others disagree with that boundary, but we should consider why they’re concerned. It can get easy to think we are doing something good for ourselves and not see how it may harm us.

How Boundaries Apply to Relapse

Image by
Лечение Наркомании from Pixabay.com

Now, how does this connect back to what happens when a loved one relapses? The nature of addictive and using behaviors is to push limits, manipulate, and deceive. It’s not that our loved one is intentionally being cruel to us, it’s the disease driving those behaviors. That means we must be careful when considering why we are doing the things we are with that loved one. Is the decision to bail them out of a tough situation going to help them? Or will it enable them to continue the negative behaviors?

Perhaps the most important boundary to hold when a loved one relapses is that line between your loved one and the disease. Because we see the behaviors, we can slip into blaming the person for the choices they are making. Choice doesn’t play that kind of role though. Remember, the behaviors are about doing what they can to minimize the pain, shame, anxiety, and all the other uncomfortable feelings that come with addictions. This limits what choices the loved one has despite what it may look like on the outside.

In the end, none of this is an exact science. There are no easy answers. Supporting a loved one through a relapse can be painful, intimidating, and frustrating. They’re often feeling the same way, even if they won’t admit it. Next week, we will talk about how trauma plays a role in relapses and one way of working on that trauma while the loved one is in treatment.

Life with the Wright Family

This is a great activity for working on active listening skills with teenagers. It was originally found on the CDC’s website.

Materials:

  • The Wright Family Story found here.
  • One playing card, paper clip, pen, or other small item for each person in the group.

Activity Instructions:

  1. Have the entire group stand in a circle, shoulder to shoulder.
  2. Give each person in the circle the small item that can easily be passed from hand to hand.
  3. Explain you will read them a story. Every time they hear any word that sounds like right, they are to pass their object to the person on their right. And, every time they hear the word left, they are to pass the object to the person on their left.
  4. Start reading the story slowly to give clients a chance to follow what you want them to do. After a few passes of the objects, stop and check in with the clients. Make sure they all have an item in their hands as it is normal for some clients to have several items and others to have none.
  5. Redistribute the items as needed and continue with the story. Speed up your reading a little as you go. Pay attention to how the clients are doing. Stop, check in, and redistribute items as needed throughout the rest of the story.
  6. After the story is done, collect the items and process the experience with the clients. Follow up questions can include:
    1. What does this activity tell us about communication?
    2. What does this activity tell us about teamwork?
    3. What does this activity tell us about listening skills in particular?
    4. What was your experience participating in this activity?
    5. How much of the story can you remember?

When A Loved One Relapses

This is part one of a series on how to support loved ones through the ups and downs of recovery.

Relapse. It’s a scary word. Scary for people using, but just as bad for family and friends. So, as a parent, what do you do if it’s your child? After all, parents are supposed to help and protect their kids. But what do you do when you have to protect your child from him or herself? 

No Easy Answer

 Let me start by saying there’s no easy answer. Sure, there’s the canned answers of “tough love” and “they made a bad choice, so they have to live with it”. These answers aren’t helpful though. Remember, the definition of an addiction is a compulsive behavior you cannot stop. Yes, choice plays a small role in that a person makes a choice to use that first time, but even that isn’t as clear cut as it seems. Way back when someone first used, choice existed. Once the person learned to cope by using, the role of choice becomes minimized. The person cannot unlearn that getting high takes away the problems they have. At least for a while. It’s guaranteed to make you feel better quickly. So, when things get rough, the compulsion to use overrides the good sense of choice. 

They Do Care

Another thing to remember is that “users don’t care about anything or anyone but using” is not true. They care. And they care quite a bit. In reality, that is a big part of the problem. See, the loved one using knows just how much they’re hurting everyone around them by their actions. So, on top of the struggles with depression, anxiety, anger, self-hatred, and more, they’re adding large amounts of shame. It becomes more of an issue of the person using feeling too much, caring too much, not being apathetic despite what they may say. 

Another Way to Look at Addiction

But what should a parent or other caregiver do? Remember first, another way of looking at addiction. Addiction is isolating. People leave. Addiction ruins relationships, loses jobs, until no one is left but the person using. Not an ideal situation for someone battling depression, anxiety, anger, shame, self-hatred, and more. 

So, if the opposite of addiction is recovery, then recovery means connections. As hard as it is, finding a balance between setting boundaries while also not abandoning the person using is important. Encourage the person to take their medications as prescribed if they have them, to see a therapist or counselor, to attend community sober support meetings. Anything you can think of to help connect the using person to positive sober supports. 

Now, I know setting boundaries with a loved one, particularly your child, can be challenging. When minors are involved, there’s a whole different set of legal obligations to think about on top of healthy limits within the family. We will discuss setting healthy boundaries next week, so please stop back. In the meantime, please call or email us with questions or concerns. We are happy to help.


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.  

Islands of Personality Activity

Purpose:

To explore how the ways in which we define ourselves influence our choices and behaviors.

Materials:

The Disney film Inside Out (or follow the link below for a clip of the relevant segment of the movie), large sheets of blank paper, markers, paints, pencils, and other art supplies

Directions:

  1. Watch the movie Inside Out, directing clients to pay attention to Riley’s Islands of Personality. If you don’t have access to the full movie, follow this link for a clip of the relevant segment of the movie. I recommend watching the whole movie as there are many great treatment tie-ins throughout the movie.
  2. After the movie is over, hand out the large sheets of paper and art supplies.
  3. Instruct clients to illustrate their own islands of personality. Remind clients that the drawings must stay appropriate. If clients so choose to include substance use and/or mental health issues in their drawings, ask them to consider how they should include it as these are not part of our core personalities.
  4. After everyone is done, discuss the drawings. Discussion questions could include the following:
    1. Why did you choose the things you did for your islands?
    1. How has substance use affected your islands?
    1. What did you learn about the islands of personality from the movie?
    1. What would you want to change about your islands of personality?
    1. What would you hope never changes about your islands of personality?

What’s Most Important

Purpose: To become aware of values and priorities.

Materials: One copy for each participant of the handout, “What’s Most Important” handout; scissors; tape or glue; one piece of blank paper for each participant; one business envelope for each participant; whiteboard and markers or chalkboard and chalk

Time: 40-50 minutes

Planning Notes:

  • Read the handout and add values statements of your own, if you wish, before duplicating the handout.
  • Cut the individual handouts into strips. Place each set of strips in an envelope, creating a packet for each participant.
  • Create a poster of prioritized values for Step 3, one for each value statement. The priorities should read from MOST IMPORTANT to SECOND MOST IMPORTANT and so on, down to LEAST IMPORTANT.

Procedure:

  1. Review the concept of values. Talk about choosing from a series of coins/bills and how the largest value is the one we pick first and so on.
  2. Explain that for, this activity, the participants will choose among several intangible items, rating which they value most, second most, all the way to which they value least.
  3. Go over instructions for the activity
    1. I will give each of you an envelope containing 20 strips of paper. Each strip has the name of something intangible written on it. Arrange these strips so that what is of most value to you is on top and what is of least value is on the bottom. (Display the illustration you have drawn.)
    1. Move the strips around until the ranking matches how you really value them. Then tape or glue your strips in the correct order to the piece of blank paper I will also give you.
    1. This may be somewhat frustrating because you can have only one top priority. Sometimes, we have conflicting priorities. You must just do the best you can.
  4. Distribute one envelope and one piece of blank paper to each participant. Ask participants to begin. Circulate, offering help if anyone who is having trouble understanding what it is you asked. Caution the adolescents to work slowly and think carefully about each item.
  5. When all or most of the participants are finished, call time. Conclude the activity using the discussion points below.

Discussion Points:

  1. What were your top three or four values?
  2. Was it easier to choose the things you value the most or the least? Why?
  3. Were there items on the list that that you had never really thought about before? Which ones?
  4. Were you surprised by your completed list of values? Why or why not?
  5. How do you think your ranking of values would compare to your parents’ ranking?
  6. How might you stand up for your top three values?

What Is Treatment?

Treatment. It’s a loaded word when talking about substance abuse and recovery services. There are many misconceptions about substance use disorder treatment around. This leads to misunderstandings from potential clients about what happens, which can be significant barriers to seeking needed help. With this confusion, what is treatment about?

Treatment is Not Shaming

First, let’s talk about what treatment is not about. First, treatment is not about shaming people. I know, there’s an old school treatment concept that still exists which includes shaming tactics under the guise of helping the client. Treatment programs built this method around the concept that addiction is a moral failing and people continue using despite negative consequences they’ve experienced. This is not true.

Let me say it again—addiction is not a moral failing. Research has proven this in a variety of ways under many circumstances. Addiction is a brain disease. This means the concept of choice plays an insignificant role in substance use disorders. Yes, technically people have a choice to use. However, there are multiple things influencing that choice which are beyond a person’s control. And, the bigger part of the equation to use is that once the person picks up, any subsequent use is beyond their control. Period. No ifs, ands, or buts about it. Therefore, shaming tactics are ineffective and, most times, much more harmful than helpful. Treatment should never be about shaming. Any treatment tactic that includes a shaming component will inherently be problematic.

Treatment is Not About a Cure

Treatment is also not about “curing” people. Think about it a minute. Can you forget, truly forget, how to ride a bicycle? Outside of other influences that affect memory and the brain, it isn’t possible, is it? This principle also applies to substance use. A person who has turned to substances as a coping skill has learned, for a short time, substances provide relief from their distress. That’s impossible to forget. And, the problem is, these underlying pieces are generally not “curable” pieces. For example, we cannot yet “cure” the discriminatory behaviors ingrained in our society. Thus, the distressing and traumatic personal experiences with this discrimination are still incurable for an individual. Which means the temptation to return to substance use as a way to cope will never completely go away either.

Treatment is Not About Not Using

Finally, treatment is not about not using. You read that right. Treatment is not about not using. Yes, there is that piece in there. However, the bulk of treatment is about other issues. The not using part is only a small piece of a much larger puzzle. The larger puzzle is more what treatment focuses on instead. Why is the person using? What barriers exist to sobriety for the person? What can treatment staff do to address the reasons for use and the barriers to recovery? What supports does the person need to continue in recovery? These are some examples of what treatment is about.

Treatment is About Resources

Treatment is about finding resources for people. It is about rebuilding connections people have to their families, friends, jobs, and communities. It is about helping them address underlying trauma issues, underlying mental health concerns, financial problems, social problems, and more. Because we live in a society that criminalizes addiction, it is about helping people navigate and address legal involvement. For adolescents, it’s about addressing school needs and parental conflict.

Treatment Is about Respect and Dignity

Most importantly, treatment is about helping people find dignity and respect for themselves again. See, part of what addiction and substance use problems do is rob people of their own sense of self-worth, compassion for themselves, and their sense of well-being. People who struggle with use and the negative behaviors associated with it are acutely aware of how these behaviors have affected loved ones in their lives. The shame and self-loathing they experience is as bad, if not worse, than anything anyone else can evoke in them. Therefore, treatment is about building people back up again. About helping people through these dark periods in their lives when they can’t find the light for themselves. Treatment becomes that light.

Yes, treatment is a loaded word when we look at substance abuse treatment. But it doesn’t have to be scary. Understanding what treatment is, and what treatment is not, is a key piece of removing the stigma and fear around seeking help. Treatment is about humanizing people. It’s about understanding.

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.

Recovery Dice Group Activity

Goals: 

  • Teach the participants the importance of Coping Skills and Sober Resources, by utilizing their creativity.   
  • Assist participants in identifying various coping skills and community resources they have available to them to assist them in improving their relapse prevention skills and knowledge.  
  • Encourage creativity in this hands on recovery activity.  

Materials:  

  • 12 Sided Dice Template (2 for each client) linked below
  • Scissors 
  • Markers/Writing Utensils
  • Clear Tape 

Introduction: Start at discussion with participants regarding what they should do when experiencing cravings or triggers.  Encourage them to brainstorm various options including different coping skills and community resources.  Assist and provide additional examples if needed. 

Procedure:

Explain to participants that they will be creating their own Recovery Dice.  The idea for the dice is to have as a resource when struggling with finding the right coping skill or resource to use in a particular situation.  They will each create one Coping Skill Dice, and one Resource Dice. They may not repeat any resources or coping skills on their recovery dice.   

Discussion: 

  • Have participants share their finished projects, explaining which coping skills and resources they put on their Recovery Dice.  
  • Have the participants come up with various situations or triggers in which a coping skill or resource would be necessary.   
  • Each individual will take turns using their recovery dice for the scenarios discussed as a group.  
  • Closing: Discuss/reiterate the importance of effective coping skills and knowledge of community resources in and effective relapse prevention plan.  Assist clients in identifying additional resources they may not have come up with on their own.  

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.

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.