People trust their therapists or counselors with a variety of problems that arise in their lives. Typically, they share freely about these topics after establishing a supportive relationship with their therapist. However, a patient might also be struggling with a problem that they are less willing to talk about, which is their drug or alcohol use.

   It is important for counselors to be able to identify behaviors and symptoms that may point to the existence of a substance use disorder because these issues can be so damaging to a person’s life. Oftentimes, the problems that bring a person into therapy may be caused or worsened by their substance use and these issues cannot be fully resolved until the substance misuse is addressed.

   There are several reasons why a person may not be forthcoming about their drug or alcohol use. A person could simply be in denial or think they don’t have a problem. Sometimes a person will rationalize and compare themselves to others to justify their usage.  One might say, 'well, I have a successful job and a loving family, so, I can't possibly have a drinking problem.” Or another may say, 'I just use pills and I've never had an overdose, so, my usage isn't that bad.” 

   Another primary reason is that they fear the consequences of being honest about their usage. Consequences could include legal repercussions, the dissolution of their marriages or relationships, the removal of children from the home, or damage to their careers. In these cases, it is vital to review confidentiality laws with them to mitigate any fear that might be keeping them from being honest.

   Another reason that a person may conceal their drug and alcohol use is the stigma or “shame” of struggling with drug or alcohol use. Even though the medical community agrees that addiction is a disease and not a choice, a person going through addiction issues may still feel like they will face social judgment for getting help. One way to help a person work through this issue is to educate them about the disease concept of addiction and remind them that rehabs would not exist if people could address addiction problems on their own.

   So, what are some signs that therapists can look for in a person who may be struggling with substance use issues? Gateway Rehab uses a biopsychosocial assessment to identify impairments in functioning and to make substance use diagnoses. However, the most basic explanation is that substance use becomes a problem when it causes other problems in a person’s life. Other, subtler, indicators may include:

  • Changes in mood or persistent mood disturbance despite adherence to medication regimens
  • Loss of interest in activities or reliance on alcohol or drugs to be able to enjoy hobbies
  • Changes in performance at work or school
  • Cycles of illness that frequently include flu-like symptoms
  • Fear or anxiety when faced with the idea of “running out” of their drug of choice
  • Resistance to the suggestion of quitting the drug of choice

   Of course, this list is not all-inclusive and symptoms may be different for each type of substance. The reality is that substance use disorders fall along a spectrum of mild, moderate, and severe.  If a client meets only a few criteria for a substance use diagnosis, their usage is mild; their usage is moderate or severe if they meet additional criteria.  For example, a person who has multiple DUIs may have a mild substance use disorder.  On the other hand, a person who has a physical dependence on a substance, has lost jobs, is estranged from family, and/or has experienced overdoses, likely has a severe substance use disorder.

   Ultimately, what’s important is that counselors and therapists recognize the signs and symptoms of addiction so that they can assist their patients in getting the right type and/or level of treatment. If someone might have a substance use disorder, please encourage them to contact Gateway Rehab to schedule a complete drug and alcohol assessment.