by Andrew McNaughton, LCSW, CADC
There are about a dozen criteria in the DSM-5 for diagnosing Substance Use Disorders, but I look for four “red flags” when assessing a patient: Does substance use negatively impact the patient’s money? Relationships? Mental or physical health? Freedom?
If the patient answers “yes” to at least one of those questions, substance use is likely creating or contributing to trouble at work, school, home, with personal finances, family, friends, mind and body, or even the law. If the answers are all “no” but the patient is still concerned, it’s time to explore the role alcohol or drugs play in daily life. If a patient thinks there might be a problem, maybe there is.
So what to do? While some addiction professionals believe that 12-step based abstinence programs are the only approach, I respectfully disagree. Now I want to be crystal clear: I fully recognize and appreciate that AA, NA, and other 12-step groups are highly effective for many people. When I encounter a patient who is working a program, they have my full support and encouragement. For new patients, 12-step is often the first resource I recommend. But I also hear a lot of complaints from patients about their 12-step experiences. It is not my intention to argue for or against the merits of 12-step, but to acknowledge that it does not work for everyone.
That’s why I also suggest alternatives such as SMART Recovery, which draws from evidenced based practices to emphasize empowerment and behavior change; Refuge Recovery, which incorporates Buddhist practices to recovery; or other behavioral support groups that teach coping and mindfulness skills that can aid recovery. Abstinence can still be the goal, but it can be incrementally achieved through harm reduction. Or, if using/drinking less is the goal, we can work towards that. Moderation is possible, though its inherent ambiguity increases risk of regression and can be extremely difficult to achieve without a prior period of abstinence. I have also encountered people who have quit on their own. While not impossible, I don’t recommend it, since the chances for achieving a sustained recovery improve substantially with professional and peer support.
Ultimately, only the patient can determine if alcohol or drugs have become a problem, regardless of how many therapists, counselors, family, friends, employers, co-workers, doctors, paramedics, police officers, lawyers, probation officers or judges have affirmed this. That said, one does not have to hit “rock bottom” to reach this conclusion. Instead, give sobriety a test run. Quit for a month, or take a week, or even a few days off from drinking or drugging*. See how it feels. It might not be so bad. Meanwhile, go to a 12-step, SMART or Refuge Recovery meeting. Go with a friend. It will feel less intimidating and enhance motivation. Also, plan to eat healthier, exercise, and engage social activities not tied to substance use (yes, they do in fact exist!). If the result is even a few sober weeks, that’s fantastic! Aim for at least twice as long next time. It can’t hurt, it could help, and you have nothing more to lose. Don’t delay: “now will never come again.”
Symmetry Counseling has several therapists on staff with expertise in treating addictions. We utilize non-judgemental, supportive and empowering approaches to assess and address substance use disorders, including making referrals to inpatient or intensive outpatient programs if necessary. Please contact Symmetry Counseling to set up an appointment.
*Note: physical withdrawal from prolonged and excessive use of alcohol, opioids or benzodiazepines such as Xanax can potentially be deadly without medical assistance. Consult with a physician or go to an ER if attempting to quit.