Substance Use Disorder Therapy

My approach to working with individuals presenting with substance use disorder is non-judgmental, holistic, insight-focused, collaborative, and preventative. Evidence-based interventions are applied from motivational interviewing, cognitive, behavioral, exposure-based, community-based, strength-based, solution-focused, and mindfulness-based approaches, while incorporating a central focus upon realigning values.

Also drawing from psychodynamic approaches, we will take into consideration the origins, developmental contributors, and perpetuating factors of the substance use disorder.

When indicated, I work with clients utilizing a harm-reduction approach, which is rooted in principles of justice and human rights alignment and advocacy. Harm reduction is a non-judgmental and highly collaborative intervention seeking to minimize risk and negative impacts of substance use, thereby reducing harm to health and self.

What is a Substance Use Disorder?

Substance Use Disorder (SUD) is a complex medical and psychological condition characterized by continued use of a substance despite harmful consequences. The function of substance use is typically rooted in distress avoidance, emotion regulation, or dopamine-seeking. Substance Use Disorder is chronic and progressive.

SUD’s perpetuate pervasive and harmful impacts on a person’s brain chemistry and are therefore a brain-based disease. SUD’s are characterized by tolerance, withdrawal, functional impairments, and loss of control. SUD’s often co-occur with mood and anxiety disorders, eating disorders, ADHD, and trauma.

Over enough time, the chronic and progressive nature of a person’s relationship with substances will result in a high level of ambivalence. During this period of time (the stages of change), the brain and body continue to remember and relish in the good and helpful parts of the substance use, while simultaneously suffering from the negative and unintended consequences.

Diagnostic Substance Use Evaluation

If you are interested in participating in a comprehensive diagnostic substance use evaluation, please reach out to me. This is a stand-alone service I provide with no continuing therapeutic commitment expected or required. Continuing care and level of care treatment recommendations are provided upon completion of this evaluation.

Progression of a Substance Use Disorder

A person navigating the disordered substance use journey may experience a range of feelings similar to a person progressing from a new and exciting intimate relationship into an established relationship with someone who is controlling and abusive.

  • Early stages of use might feel similar to a honeymoon period, with all positive feelings and experiences, highly social and exciting, and flowing with oxytocin. Early stages of use are also comparable to the initial love bombing stage of an abusive relationship cycle.

  • Middle stages of use (substance misuse/abuse) can still feel highly enjoyable at times but at other times, much more challenging, time and labor-intensive, confusing, guilt-ridden, negotiable, rationalized, or volatile. This middle stage creates and perpetuates an addictive cycle of use, similar to a person chasing relationship highs to offset relationship lows.

  • Late stages of use (dependency) can feel isolating, lonely, secretive, shameful, and typically involve physical, social, emotional, and mental disturbances and consequences. In this stage, a person is feeling more desperate to get out of the relationship with the substance(s), but doesn’t know how or how to do so safely. This can be likened to finally seeing an abusive intimate partner as unchanging, and feeling trapped and unsure how to leave them.

Substance Use Disorder Thoughts Might Sound Like:

  • “That was so fun or felt so good, I don’t want to be without that feeling again.”

  • “I fit into this group by using substances and I like these people…other people don’t accept me as I am.”

  • “I will never drink/smoke that much again.”

  • “I will never use that substance again.”

  • “I have it under control.”

  • “This substance helps me control my weight/eating.”

  • “I will only use socially or on the weekends.” (attempts to reduce or control use)

  • “I have to use this substance in order to manage my difficult feelings. I can’t handle them otherwise.”

  • “I don’t want to use anymore, but all I think about is when I’ll get to use again.”

  • “I’m not feeling well, but as long as I still make it to work or school, I am ok.”

  • “So and so uses more than I do and no one is telling them that they have a problem.”

  • “This relationship had problems before I was using substances in this way. I just need to get out of this relationship and the problem with substances will get better or go away.”

  • “The problem is my job..my partner..my stress..my circumstance (not my substance use).”

Substance Use Disorder Behaviors Might Look Like:

  • Increased use in order to achieve the same effect (tolerance)

  • Shifts from social to solo use

  • Seeking out people, places, and activities that normalize your use

  • Drug-seeking via multiple prescribing providers, peers’ or family members’ prescribed medication access, or attaining new diagnoses to gain more access to certain drugs or medications

  • Hiding frequency of use or need to use

  • Diminished enjoyment of social experiences if not using, and diminished enjoyment of use in general

  • Misusing substances in order to manage anxiety or depressive disorders

  • Physical side effects of use/withdrawal, such as hangovers, sleep disturbance, fatigue, appetite disturbance, libido change, stomach issues, migraines, sweating, trembling

  • Failed or ongoing attempts to reduce or control use (“substance use rules”)

Consequences of Substance Use Disorder

What began as life-enhancing will most often shift to life-compromising as the substance use takes precedence over previously highly held priorities such as health, relationships, passions, productivity, or other values alignments.

Substance Use Disordered responses to distorted thoughts and dysregulated emotions result in more frequent use, increasingly problematic or risky use, social or familial change/withdrawal, or the development of patterns or rituals for use.

Mental and overt behaviors are enacted to protect the substance use disorder, such as lying, rationalization, normalization, minimization, and continued use in spite of negative consequences.

Other consequences of continued maladaptive substance use include health and medical compromises, relationship loss or social deterioration, financial loss or instability, or failure to meet responsibilities at work, school, or home.

What is the Difference Between a Craving and an Urge?

Cravings are experienced as highly compelling thoughts or feelings of desire to use a behavior that elicits relief.

Cravings can occur for drugs, food, sex, gambling, shopping, or anything else supplying immediate or efficient dopamine supply. Cravings are harder to combat as compared to urges because they are mental and can be triggered almost any time, and on the encouraging side, only last 15-20 minutes on average. Cravings are the wanting.

Urges are the impulse to act on the thought or the feeling of a craving.

Urges create a feeling of “urgency” / call to action, and are therefore more behavioral compared to the psychological nature of the craving. Urges are notably fleeting, and can be over-ridden with intention and practice somewhat more easily than a craving that is longer-lasting.

Myths & Misconceptions About Substance Use Disorders

  • Substance Use Disorders are a matter of choice, willpower, or morality

  • Substance Use Disorders are someone’s fault

  • Substance Use Disorders primarily impact individuals with food, housing, or financial insecurity

  • Substance Use Disorders are rooted in rebellion or weakness

  • A substance user has to want to stop using in order to get help or treatment

  • Substance Use Disorders only affects “hard drug” users

  • Relapse means treatment failure

  • Individuals with Substance Use Disorders can easily be identified by their appearance

  • Cannabis is not addictive

  • If a person is meeting all of their role obligations, they cannot have a substance use disorder

To learn more about the truths of Substance Use Disorder and to take the first step toward freedom from this disorder, please reach out to begin your recovery journey with me.

Please feel free to reach out today.

Substance Use Disorder: Vulnerable Populations

  • Adolescents and young adults due to developing brain and higher social pressure

  • Individuals with co-occurring mental health conditions, such as anxiety, depression, eating disorders, and trauma

  • Individuals with ADHD or other neurodivergent diagnoses

  • Individuals working in high stress professions, such as healthcare providers, first responders, lawyers, judges, and educators

  • Adolescents living in high pressure and highly controlled environments

  • Individuals living within conditions of chronic stress, illness, or social isolation

  • Elderly individuals

  • History of Traumatic Brain Injury (TBI)

  • Adolescents experiencing a lack of family involvement

  • LGBTQIA+ population

  • American Indian and Alaskan Native populations, due to complex social and historical factors

  • Housing displaced individuals - unhoused, migrant, immigrant, and refugee individuals

  • Individuals with high Adverse Childhood Experiences - The following link is an assessment tool to evaluate your ACE score

SUD: Stages of Change

Mapping Out Readiness To Change Your Relationship With Substances

  • In the pre-contemplative stage of change you are not considering making change or seeking treatment. You are experiencing limited negative impacts, and the ones that you do experience, are "worth it” to you (i.e. a hangover).

    In this stage of change, psychoeducation and discussing the correlative impacts of substance use with other mental health concerns you might have is the most indicated intervention.

    This stage of change is comparable to the denial stage of grief.

  • In the contemplative stage of change, ambivalence shows up for the first time revealing more overt pros and cons of your substance use. This stage of change is distinctively “meta”: thinking about..thinking about changing.

    In this stage, you might experience decreased work productivity or timeliness, a DUI, or increased arguments with an intimate partner about your use. You will also commonly find yourself starting to create rules around your substance use in order to better “control” your relationship with it.

    A values assessment to help highlight both internal and external conflicts can be helpful interventions, as well as completing a decisional analysis evaluating reasons to stay the same and reasons to change.

    This stage is comparable to the negotiation stage of grief.

  • In the preparation stage of change, you have decided to pursue change in your relationship with substances. This is an active planning stage.

    You might initiate a substance use evaluation with a specialized outpatient therapist, begin substance use-focused therapy, inquire about medication interventions with a specialized psychiatrist or your primary care provider, consider the options for attending recovery-based meetings, or possibly an admission into a therapeutic treatment program (a higher level of care).

    This stage is comparable to the anger or depression stage of grief. Sometimes this stage occurs due to a person hitting “rock bottom” but it is important to remember that you do not have to hit a rock bottom in order to get to this stage of change.

  • In the action stage of change, you are actively participating in various interventions to support your sobriety, such as regularly attending therapy, meetings, or seeking out sober community and activities. This is a “doing” stage.

    Early into this stage, you might experience a period of time sometimes referred to as “the pink cloud” in which sober life seems a little too good or easy. This is similar to a relational “honeymoon period.” Eventually, you will return to a more realistic baseline and thoughts of use or urges to use will reappear. This is normal, natural, and expected.

    Relapse is common. Therefore, in this stage, a relapse prevention plan and practicing flexible structuring of time is essential. Therapeutic skill-building and addressing cognitive dissonance are helpful interventions to support progression through this stage of change.

    This stage can be comparable to ANY of the stages of grief. It is a stable and also somewhat unpredictable stage of change: emotions can drastically fluctuate while recovery-based behaviors are being consistently executed.

  • In the maintenance stage of change, behavior change is sustained and cognitive dissonance is notably diminished or absent.

    Due to the more stable nature of this stage of change, therapeutic interventions supporting reflection upon your using journey, relational and soul repair, and processing underlying issues are more accessible. Relapse prevention remains an active component.

    This stage of change is comparable to the acceptance stage of grief. Loss, change, the former self in a former context, and a new reality are each acknowledged and accepted.

How Do I Recover From a Substance Use Disorder?

Recovery from substance use disorders is best supported when treated using a multidisciplinary approach, including psychotherapy, support or therapy groups, medical monitoring, and medication.

Recovery is not a straight line. Expecting bumps, waves, and imperfection is a realistic and protective mentality we will foster throughout your treatment. Developing a balance between routine/structure while also practicing self-compassionate flexibility gradually rewires the brain to be able to thrive in recovery.

Part of this rewiring is also achieved through intentional and committed re-engagement with enjoyable activities and identifying sober activity and community options. Dopamine becomes more organically accessible over sustained time in recovery and with continuing and consistent exposure to organic sources of dopamine.

What are the Differences Between Recovery-Based Support Programs?

In addition to identifying sober values-based activities that feel approachable, recovery-based programs are another valuable resource to supplement medication and therapeutic support. Recovery programs offer support around increased structure, accountability, encouragement, spiritual well-being, and are a great opportunity to connect with other individuals in recovery.

  • 12 Step meetings (AA, NA) are the most accessible and populated recovery program. Meetings are peer-led and emphasize abstinence and personal accountability.

  • SMART Recovery meetings are CBT-based (evidence-based) and emphasize self-empowerment, skills integration, and accommodate both abstinence and harm reduction recovery journeys. SMART stands for Self-Management and Recovery Training, and was the first secular alternative to 12-step meetings.

  • Recovery Dharma meetings are ACT-aligned, Buddhist-inspired (“but not required”), trauma-informed, and peer-led meetings. These meetings emphasize meditation, mindfulness, empowerment, and introspection. Primary values of this recovery program are diversity, equity, and accessibility.

  • Women For Sobriety (WFS) New Life Program is a recovery program “of women for women”. Meetings are peer-led and will support individuals on working through 6 levels of recovery. WFS emphasizes changing thinking, self-discovery, and a daily commitment to engaging with its 13 Acceptance Statements.

  • Celebrate Recovery is a global, Christ-centered recovery program. Meetings are biblically-based, “grace-filled”, and emphasize introspection and holistic healing both within self but also within relationships harmed by the substance use

Learn More About Substance Use Disorder Therapy with Sara Watts

If it would help, I would be pleased to offer a 15 minute complimentary call to introduce myself and my approach to substance use disorder therapy.

Please feel free to contact me today.

Contact Sara

Resources for Substance Use Disorders

Support Meetings

Recommended Reading