Helping Someone with a Substance Use Disorder—When They Don’t Think They Have One

← Return to our blog

By Dr. Scott Schinaman, Psy.D., MBA, CEDS-C

Working in the mental health field, we often encounter one of the most challenging clinical situations: supporting someone with a substance-use disorder (SUD) who doesn’t believe they have a problem. It’s a delicate balance—offering compassion without enabling, addressing concerns without pushing someone away. As mental health providers, it’s crucial that we navigate this space with empathy, patience, and evidence-based strategies.

Understanding Denial: It’s Not Just Stubbornness

Denial in substance use isn't always a conscious choice. Often, it's a psychological defense mechanism—protecting someone from the shame, guilt, or fear that might come with acknowledging a substance problem. The brain’s reward system also plays a crucial role. Substances hijack the dopamine system, leading individuals to prioritize the use of drugs or/and alcohol over negative consequences, relationships, or health.

Recognizing this helps shift our approach from confrontation to curiosity and compassion.

Lead with Empathy, Not Ultimatums

One of the most effective tools we have in the talk therapy world is the therapeutic alliance. When a client doesn't see their substance use as problematic, our first job isn’t to convince them otherwise—it’s to build trust.

• Use motivational interviewing (MI) techniques to explore ambivalence. Ask open-ended questions like, “What do you like about using [substance]?” followed by, “Are there things you don’t like?”

• Reflect back on their own words, helping them identify discrepancies between their values and their using behaviors.

• Avoid labeling. Terms like “addict” or even “substance-use disorder” can trigger defensiveness, shame, and/or guilt, especially early in the process.

Focus on Function, Not Diagnosis

Sometimes it helps to shift the conversation from “Do you have a problem?” to “Is this working for you?” Frame substance use in terms of its impact on the person’s goals, relationships, and health. For example:

• “How is your alcohol use affecting your energy or motivation lately?”

• “Have you noticed any changes in your mood or anxiety since you started using “X” more frequently?”

This client-centered focus promotes self-reflection and increases the chances of genuine engagement and connection.

Involve Natural Support Systems—Carefully

Families and friends often notice the problem before the individual does. If they’re involved, we as clinicians can guide them in setting boundaries while maintaining a supportive stance. Community-based approaches like CRAFT (Community Reinforcement and Family Training) help loved ones learn how to reinforce sober behavior and avoid enabling, as does other community-based group support like Alanon.

It’s important to coach support systems to resist the urge to “fix” or force insight. Instead, encourage them to highlight natural consequences in a non-judgmental way…which is difficult.

Offer Harm Reduction and Entry Points

While abstinence may be the long-term goal, meeting someone where they are is often more effective. Harm reduction strategies—like discussing safer use practices or helping the person consider cutting back—can open the door to deeper change later.

Even if someone isn’t ready to engage in treatment for their SUD, they may be willing to work on related issues like anxiety, depression, or relationship conflicts. These entry points allow us to plant seeds and slowly build insight.

Know When to Wait—and When to Act

We must accept that some people won’t be ready to change right away. That’s not failure—it’s part of the process. Our role is to hold space, offer tools, and stay consistent. But if an individual is in immediate danger—such as experiencing suicidal thoughts, repeated overdoses, or severe withdrawal—we must act swiftly, involving crisis intervention, medical treatment or a higher level of care.

Final Thoughts

Helping someone who doesn’t see their substance use as a problem requires patience, clinical skill, and a deep well of compassion. It’s not about forcing change—it’s about planting the seeds, cultivating readiness, and being there when the soil is ready for growth…growing roots if you will.

The journey from denial to awareness to recovery is rarely linear. But with the right approach, we can walk alongside our clients, patients, and loved ones—without judgment—and help them take the first step toward healing and recovery.

References:

1. Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.

2. Meyers, R. J., & Wolfe, B. L. (2004). Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. Hazelden.

3. SAMHSA (Substance Abuse and Mental Health Services Administration). (2023). TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment.

4. Prochaska, J. O., & DiClemente, C. C. (1983). Stages and Processes of Self-Change of Smoking: Toward an Integrative Model of Change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.

5. National Institute on Drug Abuse (NIDA). (2022). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).

Stress: Its Effects on the Body and Brain

← Return to our blog

Written by Halsey Redman

Stress is something everyone experiences, but few fully understand its impact on both the body and the mind. Whether it's the pressure of work deadlines, family responsibilities, or unexpected challenges, stress affects nearly every aspect of our daily lives. While some stress can be motivating and help us stay on track, chronic or overwhelming stress can have serious consequences. In this blog post, we’ll explore how stress affects the body and brain, and then take a look at some unconventional ways to destress that might surprise you.

The Science of Stress: How It Affects the Body and Brain

Stress is a natural response to a perceived threat or challenge. It triggers a complex reaction in the brain and body, known as the "fight or flight" response. When we encounter something stressful, our brain signals the release of hormones such as cortisol and adrenaline. These hormones prepare the body to deal with the perceived threat, increasing heart rate, blood pressure, and muscle tension.

While this response is vital for survival in short bursts, chronic stress can cause a range of problems:

1. Impact on the Brain

The brain is deeply affected by stress, especially in the long term. High levels of stress can alter brain function and structure in a few key ways:

• Impaired memory and learning: Prolonged stress can reduce the size of the hippocampus, the region of the brain responsible for memory and learning. This can make it harder to concentrate and recall information.

• Mood disorders: Chronic stress is linked to mental health conditions like anxiety and depression. Stress hormones like cortisol can affect neurotransmitters such as serotonin and dopamine, which regulate mood.

• Impaired decision-making: Stress can impact the prefrontal cortex, the part of the brain that helps with planning, decision-making, and impulse control. As a result, stress can lead to impulsive behavior and poor decision-making.
  

2. Impact on the Body

The body reacts to stress in various ways, many of which, when sustained over time, can contribute to serious health issues:

• Cardiovascular problems: Long-term stress can lead to high blood pressure, heart disease, and even an increased risk of stroke. When stress causes the heart to beat faster and harder, it puts additional strain on the cardiovascular system.

• Weakened immune system: Chronic stress suppresses immune function, making the body more susceptible to illnesses. This is why people often get sick during or after stressful periods.

• Muscle tension and pain: Stress can cause muscles to tense up, leading to headaches, back pain, and other muscle-related problems. If left unaddressed, these tensions can develop into chronic pain conditions.

• Digestive issues: Stress can disrupt the digestive system, leading to issues like irritable bowel syndrome (IBS), acid reflux, and stomach ulcers. The gut-brain connection is powerful, and stress can have a significant impact on gut health.
  

Unconventional Ways to Destress: Breaking Free from the Norm

While meditation, yoga, and deep breathing are widely known for their stress-relieving benefits, sometimes these traditional methods don’t seem to cut it. For those looking for something more dynamic or outside-the-box, unconventional stress relief can be just what the doctor ordered. Here are a few surprising and effective ways to destress:

1. Rage Rooms

A rage room, also known as a "smash room," is a place where you can destroy objects like old electronics, glassware, and furniture. The concept is simple: pay a fee, suit up in protective gear, and break things in a safe, controlled environment. The cathartic act of smashing items can provide a massive release of pent-up frustration, helping to reduce stress and clear the mind. It's a hands-on, physical way to process emotions and take control of stress. *We don’t condone aggression as a way to let out your anger or frustrations in most cases. Don't utilize a rage room if it doesn’t feel right for you- it’s merely an interesting concept!

2. Boxing

Boxing, whether practiced as a sport or fitness activity, is an excellent way to release tension and stress. The combination of physical exertion, coordination, and mental focus provides a full-body workout while also helping to clear the mind. Throwing punches at a heavy bag or sparring with a partner releases endorphins and adrenaline, which not only boosts mood but also strengthens the mind-body connection. Boxing also helps in building self-confidence and discipline, two important factors in managing long-term stress.

3. Laughter

Laughter is one of the most powerful natural stress relievers. Laughing triggers the release of endorphins, the brain's "feel-good" chemicals, and reduces levels of stress hormones. In fact, there are entire therapy sessions dedicated to laughter, where participants engage in exercises designed to get them to laugh, even if they don't feel like it. The idea is that fake laughter can quickly turn into real laughter, helping to improve mood and reduce tension. You might feel silly, but isn’t that the whole point? 

4. Forest Bathing/Spending Time in Nature

Getting in touch with nature is an excellent way to de-stress that can be done in a number of ways. Whether you’re going for a hike in the woods, just standing with your feet in the grass or sitting by an open window in your apartment building- you can lower your stress level with minimal planning or effort! Shinrin-yoku, or "forest bathing," is a Japanese practice that involves spending time in the woods and absorbing the sights, sounds, and smells of the forest. This mindfulness practice has been shown to reduce stress and lower cortisol levels. By simply being in nature, away from screens and the hustle of daily life, the body enters a state of relaxation, which helps reduce mental fatigue and anxiety.

5. Pet Therapy

Spending time with animals has long been known to lower stress levels. Petting a dog or cat can increase levels of oxytocin, a hormone that promotes bonding and reduces anxiety. Even the act of simply being around animals can lower heart rate and blood pressure. Animal therapy programs are often used in hospitals and mental health facilities to help patients relax and reduce stress. So get some quality time with your pets or just hang out at the animal shelter for a while! Give some love to our furry friends!

6. Art Therapy

Engaging in creative activities like painting, drawing, or even adult coloring can be a great way to release stress. Art allows individuals to express emotions that may be hard to put into words, offering a form of emotional release and introspection. The focus required to create something also acts as a form of mindfulness, helping to pull attention away from stressors and into the present moment

Conclusion

While stress is a natural and often unavoidable part of life, learning how to manage it effectively is crucial for maintaining both physical and mental health. Understanding the ways in which stress affects the body and brain can help you recognize the signs of chronic stress early. Additionally, incorporating unconventional stress-relief activities like rage rooms, boxing, or forest bathing into your routine can offer a refreshing alternative to traditional methods. Ultimately, it’s about finding what works best for you and making time for self-care in an increasingly busy world.

Remember, it's okay to take a break, and sometimes the most effective way to destress is to try something new and fun!

How Mental Health Can Change During the Spring

← Return to our blog

Written by Halsey Redman

As the days grow longer and the weather warms up, there’s something in the air that seems to shift. For many, the arrival of spring is a time of renewal, a season that encourages new beginnings and brings a sense of hope. But for others, the change in seasons can also bring about shifts in mental health. Mental health can change during the spring months is essential to managing our well-being and making the most of the season.

The Impact of Spring on Mental Health

Spring is often considered a time of growth and optimism. However, this shift in season can affect people in different ways, depending on their individual experiences, circumstances, and mental health history. Let’s explore some of the ways spring can influence our mental health.

1. Increased Energy and Optimism

For many people, spring brings a significant boost in mood. As the sun shines more brightly, and temperatures rise, there is often a noticeable increase in energy levels. The longer days and warmer weather promote outdoor activities, social interactions, and a sense of freedom that many associate with the season.

• Sunlight and Serotonin: Exposure to natural sunlight triggers the production of serotonin in the brain, a neurotransmitter that plays a key role in regulating mood. This can lead to an improvement in overall well-being and a reduction in feelings of sadness or depression.

• Vitamin D: Spring means more time outside, and with it, an increased ability to absorb Vitamin D from the sun. Vitamin D has been shown to have a positive impact on mood and can help mitigate feelings of depression or anxiety.

• Motivation for New Goals: The spring season is often linked to personal growth and fresh starts. Whether it’s starting a new project, exercising more, or connecting with others, the change in season can inspire people to set new intentions and embrace a more positive outlook.

2. Springtime and Seasonal Affective Disorder (SAD)

While many people thrive in spring, there is a group of individuals who may actually experience a dip in mental health during this time. For those who suffer from Seasonal Affective Disorder (SAD), the shift from winter to spring can bring on symptoms that disrupt emotional well-being.

• SAD in Spring: While SAD is more commonly associated with the fall and winter months, some individuals experience a form of the disorder during the spring or summer. This is often due to the change in environmental factors such as increased sunlight or heat, which can disrupt sleep patterns or increase irritability.

• Symptoms: For those affected by springtime SAD, symptoms may include anxiety, irritability, fatigue, sleep disturbances, or a sense of being overwhelmed by the changes. It's important to recognize these shifts and reach out for support, whether through therapy, support groups, or medical advice.

3. Allergy Season and Mental Health

Another factor that can impact mental health during the spring is the arrival of allergy season. For individuals who suffer from seasonal allergies, the onset of spring can trigger symptoms such as headaches, fatigue, congestion, and difficulty sleeping. The physical discomfort caused by allergies can, in turn, exacerbate feelings of irritability, stress, and anxiety.

• Physical Discomfort: When allergies make us feel unwell, it can be harder to stay active or engage in social activities. This can lead to isolation and lower mood, contributing to feelings of frustration or sadness.

• Sleep Disruptions: Allergies can cause sleep problems, leading to a cycle of poor rest and increased stress. Lack of sleep is closely linked to mood disorders, including anxiety and depression, making it important to manage both allergy symptoms and sleep hygiene.

4. Spring Cleaning and Mental Health

Spring is often associated with the tradition of “spring cleaning,” where people tidy up their homes and declutter their spaces. While this can be a physically demanding task, it can also have a positive impact on mental health.

• Decluttering for Mental Clarity: Studies have shown that a clean, organized environment can help reduce feelings of stress and anxiety. Clutter can contribute to a sense of being overwhelmed, so clearing out unnecessary items can lead to a sense of calm and control.

• Accomplishment and Satisfaction: Completing tasks like spring cleaning can provide a sense of accomplishment and boost self-esteem. For people struggling with low motivation or a sense of being stuck, engaging in these types of activities can be a helpful way to regain a sense of purpose and direction.

5. Socializing and Community Engagement

The warmer weather in spring encourages outdoor activities, which often leads to more socializing and community engagement. For some, this increase in social interaction can be a positive force for mental health.

• Increased Connection: Spring brings people outside, making it easier to reconnect with friends, family, and neighbors. Social connection is a vital part of mental well-being, and spending time with others can help combat feelings of isolation or loneliness.

Outdoor Activities: Whether it’s going for a walk in the park, attending a festival, or simply enjoying a picnic, outdoor activities can improve mood and provide a sense of relaxation and joy. Being active outdoors has been linked to reduced symptoms of depression and anxiety.

How to Take Care of Your Mental Health During Spring

Whether you feel energized by the season or struggle with its effects, there are ways to prioritize mental health during the spring months. Here are some strategies to help you stay balanced and well:

• Get Outside: Even if you have seasonal allergies or struggle with SAD, try to spend time outdoors. Fresh air and sunlight can improve mood and energy. If allergies are an issue, try to manage them with medications or natural remedies to reduce discomfort.

• Maintain a Routine: The change in seasons can disrupt routines. To keep mental health steady, try to stick to a regular schedule for eating, sleeping, and exercising. This stability can help maintain emotional well-being.

• Practice Mindfulness: Spring is a perfect time to slow down and be present. Practice mindfulness techniques like meditation or deep breathing to help manage stress and improve mental clarity.

• Reach Out for Support: If you notice a shift in your mood, whether positive or negative, don’t hesitate to reach out for support. Talking to a therapist or counselor can help you understand and process these changes in your mental health.

• Spring Clean Your Mind: Just as you declutter your home, consider decluttering your thoughts. Journaling, talking with a friend, or reflecting on personal goals can help clear mental space and encourage a fresh start.

Conclusion

Spring is a season of change, growth, and renewal.  It’s important to recognize that this transition can have a significant impact on our mental health. Whether the arrival of spring brings a sense of hope or presents challenges, being aware of how the season affects us can help us navigate the changes with greater resilience. By prioritizing self-care, staying connected with others, and seeking support when needed, we can make the most of this season.