I am Lisa Curtis, a licensed clinical social worker and credentialed alcohol and substance abuse counselor.

Adult child of [abusive] alcoholic here, checking in to say thank you for what you do.

What is your favorite success story? I can imagine your job sees some tough shit, but do you have a "that's why I still do this" moment?

First off, congratulations on surviving and getting to be an adult! Well done! Under battlefield conditions I'm guessing.

This is a tough question because yes, there are tough days and there are good days but I'd have to say the real "this is what keeps me going" moments come years (and now decades!) after folks leave my office. It's when I hear from them that they are sober and now have 3 kids or when a new client tells me they ran into someone with tons of sobriety and gee, they think I'm the counselor that helped them.

It's also when I hear, "I relapsed but knew I could come back and we'd figure it out..."

Growing up in a family where alcohol controls the scene or being the one living with the problem is not easy so again, I really hope you're giving yourself a high-five for getting to the other side of your childhood.

And thank you for the question ~ it made me smile to remember some of the amazing humans who have crossed my path.

Well thanks! Definitely had some wounds but I'm on the other side and a lot better than I really knew I needed to be--I'm sure you know what I mean by that!

There are probably a large number of kids whose parents you've helped counsel that appreciate your efforts or may not know to/who you are. I can't imagine (I mean, I kinda can, but not really) what a really tough day looks like for you. Thank you for doing your thing - you rock!

Thanks! You rock too! Keep up the forward motion!

With the holidays coming up I know there is a lot of tension in some families and with individuals who want this year to be "different" but aren't entirely sure they can make that happen ~ years of past experience has shown them that the using sometimes takes a bigger stage than they want it to ~ so, ask me anything about how do this year differently or what it means to be in recovery...or how to get the help you might want.

Hi Lisa,

How can you intervene with a close family member who cannot stop consuming alcohol? They are in complete denial it’s even a problem; they get black out drunk and drive and when I talk to them they deflect. It’s to the point they are going to get themselves killed or someone else. They see a psychologist; but the moment that person denies them meds (Xanax etc) they drop them and say they’re worthless. I’m glad every psych they have seen can tell they are drug seeking; but hasn’t been able to see they are also an alcohol abuser. I’ve tried telling this person I’m worried for their life, but they always find a way to downplay it. Short of calling the police, I don’t know what else to do.

Thank you for your time.

Edit * I should add we’ve lost three immediate family members to alcohol abuse, and this doesn’t seem to impact them at all. Our family has a history of depression/anxiety.

First off let me start by saying that I'm sorry you've lost so many to alcohol abuse; that makes it especially hard to see it in yet another family member.

But, to answer your question ~ there is no one size fits all way to help someone get through the denial and see what you're seeing. A few suggestions to get you started however:
~ You can let them know, when they are sober, that you'll not be interacting with them when you suspect they are drunk or intoxicated. That's a hard boundary to hold but I am sure you can do it. An example of what to say might be, "I realize you don't believe your drinking is an issue but it is really hard to know when or if you're in a blackout. Actually, it's impossible to know. So, if I suspect you're using please know I'll be stopping our conversation until you're sober."

~ The driving is harder. And, as much as this might sound awful when you're outside of the situation, calling the police is the best thing you can do for them if they insist on driving. Be sure to have the make, model and plate number of their car if you go that route and know that it is NOT something some families can easily live with. So....

~ Another option is to let them know you'll drive them home or call them an Uber or cab.

~ My final suggestion for you is to seek out your own therapist or Al-Anon meeting for support. There are also lots of support groups online now that will be able to give you more suggestions.

I wish you the best for this situation and am impressed that you're seeking some support.

10 out of 10 a DWI is the best thing that ever happened to me. Definitely call the police if they're getting blackout drunk and driving.

Thanks for your response!

A number of clients I've worked with feel the same way you do ~ wishing you the best!

I hadn’t even thought of an AA support group! Thank you for taking the time to write all this out. I know there’s no easy answer, but much appreciated. Thank you for all that you do!

It's my pleasure! Al-Anon was started by one of the wives of the founders of AA so it's a good fit. Good luck!

Is it ever possible for an alcoholic to successfully drink "normally" after nearly 3 months in rehab? My husband drinks daily still, but says rehab (2 years ago) taught him how to be more aware of when it will be a problem. He refuses to quit completely. He has not been "too drunk" since then.

I've been holding my ground that I'm not okay with it, but I honestly can't tell if I'm being paranoid because of the past and I should loosen up.

I know everyone is different (we are in therapy together), but knowing if it's "possible" may help... I just feel really hurt and confused, honestly. Everything support groups say tells me it's most likely a ticking time bomb, but I also feel like a bad partner for not being supportive.

Great question. Tough question.

To answer your question quickly here's the short answer ~ no. Once someone has crossed a line between, 'not a problem' and 'problem' there is no going back.

Longer answer:

There is no way to map out what course someone needs to take to get to a place where they are ready to stop and stay stopped. The natural progression of change is that we try to make the change, figure out what works for us (we think), we try the change and that lasts for some period of time. We "relapse", try again, hopefully learning from our previous attempts.

Dieting is an excellent example of this. We try to not eat sweets but then realize that's not really working so we switch to a low carb diet and, over time, we figure out what works best for us.

What I hear when someone says, "I refuse to totally stop" is that they don't have the evidence they need yet to make that leap to, "nope, that's not working for me anymore!" Even when they get that evidence they may still continue to try to do it differently this time. That's normal too.

There is something called the natural history of an addiction: it follows a pretty predictable path. And, to add to the stress, drinking problems have a way of fading into the background due to life circumstances, and then come roaring back to the front, when the circumstances allow for that.

Please don't be too harsh on yourself. What you need in a partner might not be something he can live with. And he may have some great qualities but the drinking is clearly occupying a lot of space in your relationship, and that's really too bad.

I would really encourage you to stick with the couple's counseling so you can decide, together, what the best course to take will be. Good luck!

Thank you so much for that. I honestly feel fortified now. I will continue therapy with him, and I will be easier on myself if I end up concluding that the relationship will no longer work for me.

You are more than welcome ~ I wish you the best ~

Thanks for doing what you do, Lisa. I very often see how valuable the work in your field is, and how much more is needed. For context, I'm a public defender and I've seen many people ordered to participate in substance abuse counseling as part of their sentence.

What's your opinion of court ordered counseling? Do you see a difference in outcome whether a person volunteers for treatment or is court ordered?

Wow! Do I love this question!

Thanks for your work as a PD! That's tough stuff!

But, to answer your question of me ~ regardless of how someone is first introduced to the consequences of their behaviors, if they want to make changes they will and if they don't, they won't. Or at least that's been my experience.

The other thing that often surprises me is what it takes to get someone's attention. For some folks a single legal encounter for something like a public intoxication is enough to get them to seriously reconsider their relationship with alcohol while others, with 7,8,9 Driving While Intoxicated arrests and jail time, go back out and do it again.

I wish I could say that there was a single, easy, path to getting people the support they need to make such big changes. I will also tell you that in my practice I tell court ordered clients that if they aren't willing to make a real and sincere effort to change, they might as well return to court and get the jail time because in the long run "faking it" doesn't work.

Thanks again for the work you do!

Thank you for the thoughtful response!

You're welcome! Thanks for the question!

I’m looking at applying to grad school. How did you decide on addictions as a specialty? There are so many options for licensing and specialty, it’s haaaaard!

Well....that's a funny question because I didn't "decide" on addictions as an area ~ I sort of fell into it and it turns out it's a good fit for me.

There are indeed a lot of options about what to do for a career and my best suggestion for you is to make sure, whatever you pick, that it matches both your skills as well as those qualities that really light you up, otherwise known as aptitudes.

Good luck and have fun in grad school!

I will continue therapy with him, and I will be easier on myself if I end up concluding that the relationship will no longer work for me.

I wish you the best ~ you both deserve to live a life that brings you joy and happiness.

How do you feel about the misconception that marijuana is only "mentally addictive" referring to the false assertion that you can't become physically dependent on it?

I've got to say, it bugs me.

Bugs me too!

Well, as you may have already guessed I don't believe it's "only" mentally addictive. The same can be said of gambling or any other addictive behaviors we engage in.

The process of addiction is such that our brain chemistry is changed by the behaviors we engage in ~ not just the substance or behavior which is chosen.

Thanks for your question!

What is your experience with endocrinology as a tool for recovery? I'm 44m and since testosterone replacement therapy I feel like this might have been addressed sooner instead of psych meds. Are hormonal therapies on the radar for addiction specialists?

Good question and interesting observation for yourself.

Hormonal therapies haven't been on my radar nor do I know of any of my peers who talking about it.

Thanks for your comment ~ appreciate it!

Does AA help a lot of people? It felt more like a cult to me

Interesting question ~

Like any other group, there are those that find their place and feel it works well for them and others who don't find it to be the best fit possible.

Think about it the way you'd think about a gym to work out in ~ you could go to a CrossFit 'box' which has its own language and culture, you could go to someplace like a basic Planet Fitness or perhaps pay a whole lot of money and go to a very posh place like LifeTime Fitness or just walk around your neighborhood and do some push-ups on the front lawn/porch/living room floor. Whatever works for you is just perfect.

Ultimately one the most helpful parts about AA specifically are the other people. Since addiction is, by its nature, isolating as you move through it, getting out and socializing is a good way to start healing.

Whatever you opt to do I hope you find it helpful for you and that you get the support you deserve.

When did you realise that this is what you wanted to study?

Great question but honestly, I have no idea! I have always enjoyed volunteering my time and helping people, so it's a good fit!

Are people who abuse adderall more likely to act on their own desires that they didn’t know they had/amplify them or does it really make them just act out of character?

I found out things about my ex that he says are not his “real feeling”. He states he’s a different person, but I don’t even understand adderall .

The response you got from Angelusz is spot on! Thanks to you Angelusz!

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People use their relationship to anything ~ drugs, alcohol, gambling, etc ~ as a cover.

Substances in particular lower one's natural and healthy filters about what we say to others. When we opt to lower those filters to be cruel or when under the influence, things are said for any number of reasons but very rarely are those helpful things to both say or hear.

I'm glad to hear your ex is an ex ~ you deserve to be in a loving and supportive relationship. Good luck!

Thank you so much for doing this AMA!!!

I work in academia. My boss is an unadmitted alcoholic. He has shown up drunk to work functions (when in-person events were a thing pre-pandemic), at conferences, to phone calls, and on video calls. Others have noticed too, so I am not the only one noticing.

He is in denial though. He likes to make excuses (I had a lot of stress; this is how I let my hair down, etc.) and I'm pretty sure he's had a drunk driving conviction.

Whenever I mention it, he gets defensive and pulls the "you don't understand" card. Others outside of our group have submitted reports about him but I don't think the university has acted.

What can be done? How should I approach bringing this up with him? He had one year when he abstained from alcohol and he was so incredibly sharp (it might have been part of a plea deal for his DUI). I miss that person. He's become increasingly unstable and hostile.

I would greatly appreciate any advice!

This one is tricky because he's your boss, you clearly work at a university with its own unique ecosystem.

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My first suggestion is to stop saying anything to him ~ that only makes him more defensive and dug in about his position that his drinking isn't an issue.

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The university hasn't done anything because they don't 'see' a problem ~ the more frequently his behaviors are reported to those further up in administration the better.

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You can also start putting up and keeping up boundaries, "I smell alcohol right now and it would be best for me not to interact with you when you're under the influence. I'll get back to you tomorrow about this..." This is a rather direct approach but it keeps the focus on you, not him. YOU don't want to be around alcohol, YOU aren't clear what's being asked of you under these conditions. This is a very difficult route if you opt to go this way.

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And finally, I would suggest that if you DO say anything to him you keep it rather light, "Gee, I really liked that version of you we saw a long time ago...the one that was nice and oh so very sharp. This version of you? Not the same....It would be nice if that 2015 version returned and stayed."

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I wish you well with this one ~ it's extremely tough. Working for and with someone who is actively in middle of their using is unpleasant at best and brutally hard most days.

Why shouldn't I smoke weed one the daily? I have no ADHD, or mental disorder, nor do I have very high anxiety, at least I don't think. So is there a reason I shouldn't?

It turns you gay

If that's what you choose to do, that's totally your choice.

What I would ask you however is what quality of life do you want later on? How well do you want your body to work ~ your lungs, your heart, your brain to mention a few organs ~ and how important is it to you to be physically healthy. Those are the longer term questions to ask when it comes to using any substance.

How do you ensure a loved ones experience with detox, rehab and treatment is most effective? Is there anything a family member can do to help create a best case scenario when some one is going in for treatment for the first time? (He’s agreed to go after being drunk for 20 years. All of his adult life.)

Thanks for your time! Hopeful my brother will find healing.

Oh, I'm so glad to hear that your brother is seeking some support and healing! Yippee!

I would remind you that this is just a start ~ or I should say more of a continuation of his drinking. Any recovery center has its positives and its negatives ~ its totally up to the person to take the pieces that work for them and leave the parts that don't.

My suggestion to you is to get yourself support as well ~ this is going to be an up and down experience.

Addictions are family issues and the more family members know about and participate in their own recovery, the better for your brother. Good luck to you all!

In your experience how often can someone stay sober or clean long term, say 5+ years?

I guess I'm trying to ask how successful is the treatment of alcoholics and drug abusers without someone giving me the boiler plate "there are many metrics to measure success" answer. I feel that's a gas lighting cop out.

LOL ~ I promise, I won't give you the boiler plate answer or try to gaslight you!

To be fair there are, indeed, lots of ways to measure "success" but to answer your question more directly ~ yes, staying sober 5 years, 15 years, 30 or 40 years is more than possible. People are doing it every day.

BUT and this is a big BUT ~ getting and staying sober ~ as in not using the substance of choice and indeed, not using any mood or mind altering chemicals that aren't Rx'd by a doc who knows about one's addiction history, is only PART of the equation.

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The real 'measure' is whether or not someone's attitudes and behaviors change. There's a term for it ~ 'a dry drunk' ~ someone who stops drinking but continues to behave poorly. This is not the goal of recovery....recovery is about healing for everyone impacted by someone's using behavior.

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I hope that answers your question without the fluff ~

I have been an alcoholic for the past 20 years. It's the only thing that gives me some kind of relief from PTSD. Last Thursday I quit. The depression and insomnia is killing me. Do you have any advice?

Well, first off, congratulations on making an effort to move away from the alcohol ~ it sounds like you've tried before and it's not gone so well.

I would urge you to seek out an MD and talk to them about some medication options for the depression. The insomnia is both a side effect of the PTSD as well as detoxing...which seems rather cruel to me to have it as a result of both of those things!

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So some suggestions for you: seek out support from an MD or a therapist in your area who specializes in PTSD as well as substance abuse, get to a 12 step meeting (or several to find one that fits you...they are NOT all the same!) or, if that's been helpful in the past, start puzzling out what has been helpful in the past.

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Remember, if you've tried before to move away from drinking you have already gotten some valuable clues as to what works for you and what isn't as helpful. If you can start to piece together the helpful parts you'll put together more and more time with each attempt.

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Sleep hygiene (horrible title for it but hey, it is what it is...) would be helpful here too ~ I've written about it, lots of folks write about it. Google it and see if anything pops up for you ~ I found this and you might find it helpful ~ https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173

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Good luck ~ this is hard but you're doing it!

Thank you very much for you're response. I have tried talking with a doctor in the past. Told them about why I use alcohol as a tool to cope. The doctor made me feel like a junkie and flat out told me that he isn't going to prescribe me any drugs because that's what he thought I was seeking. Made me embarrassed and ashamed to bring it up again.

Oh dang ~ I'm so sorry that happened to you! ~ but it's not unusual.

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I have 2 suggestions ~ get yourself a therapist so the next time you go to a doctor (psychiatrist who specializes in addiction medicine) you've got the 'backing' of that therapist. It gives your request and efforts more creditibility.

Suggestion #2 would be to ask peers in a 12 step group who they are using for medication support.

I'm not saying that medication is the be all end all ~ it's helpful however.

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You can also help the depression and anxiety issues with a good solid diet of whole foods, salmon and sunflower seeds (all the pieces your brain needs to rebuild...)

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Wishing you the best for your efforts! You are worth the effort to get where you want to go!

how would one go about quitting vaping after quitting smoking ?

Vaping is highly addictive in its own right ~ I'd suggest talking to your primary care doctor about some medication to help with cravings such as Wellbutrin (which is now marketed under another name for smoking)....good luck! The sooner you get off vaping the sooner your body will thank you!

Is cannabis becoming more of a problematic addiction in light of legalisation? Certainly more available and accepted.

It's always been a problematic issue. Some of us believe the situation will only get worse as more states legalize it.

At what point is someone considered an alcoholic? Also, how long does it take the brain to recover from the effects of drinking?

OK ~ this is both an easier and harder question to answer than you may like ~

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There is 'point' at which one is considered an alcoholic ~ there are diagnostic criteria, sure, but at the end of the day it really only matters if it means something to the person doing the drinking.

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The very simple way to decide if alcohol is a problem is if you continue to use it despite negative consequences ~ think of it a bit like ice cream. If you're allergic to ice cream and 50% of the time you eat it, you end up getting super sick to your stomach but yet you keep eating it...that's a problem. If someone continues to drink even after they recognize that it's causing problems in their lives and the lives of those they love, there's a problem.

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Healing the brain depends on how much damage is done. Not to mention that there is both physical damage as well as emotional damage. Generally speaking people start to get a little bit better after about 6 months and feel remarkably better after about a year.

Hope that answers your questions!

Thanks for this! What are your thoughts on online therapy for substance use disorders?

Great question and thank for asking!

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Online therapy is highly effective, and in some cases, more effective than in person therapy. For those who have childcare or family care needs, or who live in rural places with limited access to service, online work allows them to gain access to providers who might otherwise be out of reach for them.

Specifically for substance use disorders online therapy is a very real option, especially in the middle of a pandemic. If the clinician is set up with a lab to order urine screens for substances and familiar with other tools to monitor progress, it's an excellent route.

In my experience, if someone wants to address their using they will do so and if they don't, they won't. So the argument that someone could use right after they shut down their video on a call with their therapist makes me laugh ~ I've had people drink on a bathroom break while we were in person or pop a pill in front of me ~ the pull of an addiction is strong and if the individual wants the help, they would benefit greatly from wherever they are ready to start from, including online work.

I hope that answers your question and thanks for asking it since so many people are now seeking out online work.

Hi Lisa, LCSW is something I've considered as a career path for myself after working in the court system and having a lot of face to face interaction with people in the throes of addiction and at their lowest points, but I have a few hang ups holding me back. 1. I've never been an addict myself nor had a close relationship affected by addiction. Do you think a lack of first-hand experience would limit my ability to connect with patients or have them feel like I can understand their experiences? 2. Addicts are tough to deal with sometimes. They're not always the nicest people, and as you mentioned in an earlier response, if they don't want to change, they're not going to. Does it start to weigh on you if patients aren't successful, don't really want to change, or have a terrible relapse or overdose? Thank you!

Wow! A lot of really excellent pieces here so let's see what I can answer as thoughtfully as you asked them!

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First off, if you're seeking a social work degree please know there are lots of options out there to be helpful to people.

Working in the addiction field is a bit of a cross between working as a detective, a counselor, an educator, a grief counselor and, sometimes, a cop; all that to say, first hand knowledge isn't a requirement. And if anyone tells you it is I'm here to say very clearly, that's their own bias.

Yes, addicts are tough to deal with and depending on the situation you're working in, the conditions can be tough too. This is part of the reason why you can't, as someone in the helping professions, tie your self esteem or day to day life satisfaction to the outcomes of your clients. Doctors have a saying about how, "the surgery was a success but the patient died" ~ they did a good job technically but ultimately they aren't always able to make the impossible, possible.

Making sure you're on good, stable footing yourself, taking care of yourself and having a life outside of your professional one is critical. I wish you well if you choose to keep on this path!

Wow, that's super helpful in answering my questions! Thank you!!

You're welcome!

Lisa,

I don’t know if you will see this, but I was wondering if you had suggestions for staying clean? I have been clean from heroin for 4 years after a 10 year battle against it and I feel like I’m doing worse than I was when I was freshly sober. I am just depressed and feel like sober life is boring and was just wondering if you had any words from the wise or suggestions for people like myself.

First off ~ Nice work!!!! 4 years is impressive!!!!

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But yes, it is likely getting harder to stay clean because the first couple of years are all about cleaning up the mess from your time using...and now that the clean up is, well, cleaned up....now what?

This is where building a life comes in. It won't be the same, nor can it be, as the days when you were using. You may need to adjust what is important to you and what your priorities are. So, I don't know if I'm all that wise but my experience (practice) at life tells me the more you can figure out a purpose or focus for you life, the more meaning you can get from your day to day interactions, the more content you'll be....the less depressed, less anxious and hopefully, filled with a bit more joy and life satisfaction.

Again, keep going ~ 4 years is great so now let's shoot for another day of staying sober. I know you're doing a great job of it...

What is the statistics on treatment success rate and relapse rate?

I couldn't tell you!

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I mean, I could look them up but those numbers aren't really helpful. Addiction is, by it's nature, a chronic relapsing, remitting disease ~ so in plain speak that means that people will stop using for no particular reason and start using again for no particular reason...

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Add to that is the tricky feature of 'success' ~ if someone dies sober after decades of using, that's success. If someone who has been drinking daily for months gets to their child's graduation sober, that's success.

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So, short answer ~ its not so easy to measure but thanks for the great question!

Hi Lisa! I'm a beginning therapist (LPCC, just graduated grad school last year) and I'm starting at a long-term substance use rehab tomorrow, levels 3.5 and 3.7. Do you have any tips for a beginning substance use therapist?

Welcome to the profession!

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My best and biggest tip is to make sure you've got a life outside of work! Keeping your sense of perspective is going to be critical.

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Good luck!

I'm currently studying a bachelor of psychology in the Netherlands. What would be the smoothest way to transition into addiction/substance abuse counselor? TIA.

Well, good question!

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I'm not sure how you do it in the Netherlands but my first suggestion would be to complete your BA in psychology and then go on for an advanced degree in something. Really, anything. Law, business, psychology, medical school ~ yes, really, I said and mean that law and business are also great places to start from!....and from there you can get into any number of roles and learn on the job, starting as an intern.

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Good luck!

Hello and thank you for your time and all that you do. Is it possible in your opinion for somebody to stop problematic drinking without some sort of therapeutic support?

Thanks for your question!

Yes! I don't believe there is "one" way to get yourself the support you need to change the behaviors that are causing a problem in your life.

There are lots of options such as 12 step supports, other peer supports that you can find both online and in person. Some people move away from addictive behaviors by taking up a sport or hobby, or getting involved in a community volunteer effort.

There's more than one way to achieve the goal, if that's something that's important to someone.

How do you know you're smoking too much medical marijuana? If you need it for nausea and anxiety? but it's decreasing production?

You're smoking too much if you're using it under conditions and circumstances that you should not be or if it's not helping with the nausea and anxiety.

BTW, pot is a drug that, in the long run, will make one's anxiety worse, not better.

Hope that's helpful for you to know!

Thanks for your question!

Please explain

I'm not sure what you'd like me to explain ~

Pot is a drug that is classified as both a depressant and a hallucinogenic meaning that it's messing with your brain chemistry a great deal.

Anxiety is, basically, your brain being hypervigilant and protective of you....but it has gotten a little too carried away with itself. So, while pot initially chills out the anxiety, and does so for a long period of time due to the fact that it is fat soluble and sticks around, literally, for weeks after the last use, when it finally pulls out your brain is still all anxious and you haven't really learned skills to manage the anxiety.

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CBT is an excellent skills based method for managing anxiety as is exercise, meditation and mindfulness.

Does that help answer it a further?

Thank you so much for doing what you do! Are eating disorders (like compulsive overeating) typically included under the substance abuse umbrella for LCSW specialties, please?

Seriously good question!

Eating issues are very, very effectively treated by social workers and other professionals but, although they have a similar brain chemistry issue, they are not treated as substance use disorders. Very generally speaking disordered eating is best treated by someone with a fair amount of training in that area specifically.

Thanks for the question!

What’s the strangest situation you’ve encountered as a social worker, and if your able to disclose, did it have a happy ending?

I really don't know!

I'll have to think about that but generally speaking not too much strikes me as strange these days...