Top 10 Substance Abuse Client Remarks

No matter if you are an international athlete, a high school student, a single parent of 3, or any other demographic, substance abuse will be detrimental to many domains of life. 

Substance abuse has left families crippled, individuals homeless, and the teen population at high risk of overdose and potential death. Sometimes it is not immediate, each story is different. Sometimes the substance is laced with another substance, leading to a reaction. Other times it is a slow process, stripping the individual away of all dignity and control leading way to increased depressive symptoms and high risk of suicide.

Regardless of the story, here are 10 of the most common phrases I hear from clients struggling with substance use.

1) "I have no idea how my Urine Sample is showing positive!"

   Shocking right?! Absolutely no clue how THC, Cocaine, Opiates, Amphetamines, Benzodiazepines, Phenocyclidine, Barbiturates, Methamphetamines, Methadone, Tricyclic Anti-Depressants, Propoxyphene, Buprenorphine, Alcohol, or Oxycodone happen to show up positive in your body?

Either A) That is a complete lie or B) That is completely true and completely frightening. 

It is an odd mix of denial and disbelief. Denial of the existence of substances in the body "I thought it would be out of my body by now" and the denial of ones own identity "I'm not an addict/ substance abuser/ criminal". 

It can be hard to swallow what ones own reality has defined them to be. For some they identify as a survivalist. "I have to survive in this world, and this is the only means that makes the most sense to me."

It can be hard to face the facts of the matter; Regardless if it is a therapist sharing this information, a dipstick drug test, or even a laboratory full of scientists that send back the Drug Test results. 

For others they may be idealists and philosophers "Substances ought not be illegal." to which the therapist may respond "What a wonderful yet tragic opinion, unfortunately that reality may only exist in the future (or another state). A reality in which we do not live in. Let's review our present reality and how it bodes with this philosophy of THC (or other drugs) you hold dear to your heart."

2) "Do I absolutely have to include family sessions in my recovery?"

   - So much of recovery is mixed with fear and anxiety. A little bit of pride, and an ounce of pseudo confidence. There exists the impact the client has had on those closest to them, but the desire to not bridge them closer to the recovery story. The honest to goodness truth is that the client has answered their own question. "Do I have to include family?". You already have! Now lets see how we can continue their involvement, but now in a positive way.

3) "This time my recovery will be different!"

   - This statement can carry so many hidden meanings ( I can trust myself more now and don't need accountability! I feel that I'm past the point of possible relapse! I'm disregarding the past data of pattern of behavior, I can handle myself in risky situations.)

Or the hope is that this statement will mean (I trust my DESIRE to remain sober! I have a solid plan of accountability! I have a strong support system! I realize mental health and substance recovery is a life long journey and understand the probabilities of possible relapse. I realize my past patterns and am constantly pulling data to learn from those patterns. I'm implementing new responses triggers to cope with stress and managing my maladaptive behaviors.)

4) "I'm not like the others here."

 - "I'm not "As bad" as those around me struggling with substances" This is a very dark statement to make. It suggests a higher perspective of ones self through a sense of superiority, or perhaps even carrying a misinformed narrative of empathy. It is a clamor for escape. A desire to run from ownership and responsibility. It is not necessarily maladaptive, just very primitive and, again, survivalist in nature.

It is true though, to an extent. They are not like the others there. Their story is unique to them, perhaps carries certain elements of generality and pattern, but not a clone of everyone else there. To discredit this notion completely would be to strip the client of their person-hood and identity. So then lets unpack the ways in which your story is different.

5) "I can work on recovery by myself."

     - Many clients feel that they got themselves in this mess, so they must get themselves out. This belief is reinforced by parents or family who repeat this remark to the client. The truth is that your thoughts and efforts will fail. While your intention is passionate, your accountability and support system will be stronger. Yes take ownership of your use and recovery, but realize isolation only escalates the patterns of behavior you wish to terminate. 

6) "I choose to use, I'm in control of my use."

   - How much control do you have each morning when you "choose" which side you start brushing your teeth? You may have control over being intentional of which side, but being intentional and stopping habituated neurological pathways from firing are two totally different things.

Choosing is a very allusive concept. So much of "choice" is impacted by so many elements. Yes we have items to pick from in life, thus we have the option of choosing between paths, items, people, places. The concept of choice is much different than the option of choice. 

Marketing firms pay millions of dollars to their Research and Development departments. Millions to scientific observes who survey people, run studies, and conduct probability testing on the masses. The psychology of choice is deeper than a mere picking between A or B. 

True choice is a reflection of ones identity. Where do you source your identity? Who do you source your identity from?

7) "How will I stop using, you ask? I will just tell myself to stop!"

   - Lets be real. How many time have we told ourselves we will lose 10 lbs, save more money, etc etc. If you tell yourself something enough times, sure you might begin to believe it, but you need more than believing, you need action. You need a safety plan, coping skills, accountability, and a lot of one on one practice. This a one of the basic premises of the stages of change model! Moving through the stages, from contemplation to preparation to ACTION!

8) "I've lost the trust of those closest to me."

   - No one believes what you say now because you've lied to them so many times. That is awful, it truly is. But rather than work yourself up about how awful it is, lets develop some paths to regain trust and build a stronger relational dynamic. Trust is something very fragile, it takes time to build, and seconds to break.

It is not impossible to regain trust, but it takes a great deal of desire, determination, and evidence. We are beings that require evidence for relationship. We cant expect trust, or start from a place of trust. It must be worked on and formed. "Those closest to you" cant trust the "you" you have been, so you will require some external effort to bridge them closer to "you". Perhaps negative Drug Tests, increased family time, decreased conflict, accomplishing life goals could be those external efforts/ evidences.

9)" I can handle myself around my peers who use substances."

 - No,,, no you can't. And if you can,, just stop. True friends do not use around friends who are actively in recovery or in a treatment program. I'm not saying ditch your friends and never talk to them again. Peers come in seasons, and seasoned friendships understand that sometimes space is healthy.

This isn't a quest for you to "handle" yourself or your impulses. Its a path of recovery in which identity is structured and restructured time and time again. Placing yourself in high risk environments will only lead to high risk decisions. 

10) "I've already messed up, so I kept using, and am going to continue to use."

     - Living a life of concrete statements will end up making you rigid and static. Your mind will become inflexible overtime, and that is not even due to substance use per say. That is just you being resistant to your own potential and ability. Giving up on ones own sense of hope is devastating. Apathy is a silent killer.

The above statement ought to prompt therapist to begin venturing into symptoms of depression, meaning, value. A great tool is to play through approximately 10 or so different future realities that could play out based on client life decisions. Detailed realities that the client can define and construct. The mind is a very powerful thing. By simply envisioning these realities, the mind becomes more susceptible to change.

Individuals who struggle with substances often get judged and treated poorly. This can be very demotivating considering these individuals are already hurting themselves in one way, thus it doesn't makes much sense to then also be hurt by external parties.

Regardless what sort of hurt an individual is experiencing, or what sort of maladaptive behavior they are exhibiting, grace is always the first perspective to take in this industry. Grace is the force in which both the therapist and the client will benefit from most.

Geries Shaheen is a Provisionally Licensed Professional Counselor operating in and around St. Louis Missouri. Geries teaches psych classes as an Adjunct at Saint Louis Christian College and offers Adolescent/ Family Therapy through Preferred Family Healthcare . Geries holds his BA in Intercultural Studies from Lincoln Christian University, and his MA in Professional Counseling from Lindenwood University. Holding a certificate in Life Coaching, Geries provides life coaching services to clients online throughout the nation.