Amber Hollingsworth (a counselor with ~15+ years' experience) argues that regular outpatient counseling is insufficient for many people with substance use disorders because clients may withhold or be unable to report the full truth, families often send clients with conflicting goals, and there is typically no accountability. She recommends clearer goal-setting, use of motivational interviewing by specialists, structured family involvement (separate advocates for family and client), and concrete accountability measures (monitoring and reporting), and points viewers toward a playlist on treatment options.
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In this video, I'm going to tell you all about why counseling does not work for people with substance use disorders. Now, I know what you're thinking, Amber. Aren't you a counselor for people with drug and alcohol problems? You are correct. I am a counselor for people with drug and alcohol problems. So why would I be telling you that counseling doesn't work for addicts and alcoholics? Because I've tried it tons and tons, hundreds and hundreds and hundreds of times. In fact, I've been counseling people with drug and alcohol problems for, I don't know, more than 15 years. Regular counseling will not work for someone with a drug or alcohol problem. And I'm gonna give you three reasons why. And then I'm going to tell you three things that would be more effective. Okay? Maybe most importantly, number one, people with substance use disorders either can't or won't tell the whole full story. Let's start with won't. Most of the time, when people come to counseling, you know, it's like you want to get your counselor to say the answer that you want them to say. So what you do, you tell part of the story so that you get the response from your counselor that you wanted to get. Maybe you do this subconsciously, maybe consciously, maybe a mix of both. Let me give you an example. Sometimes a teenager will come in and say something to me. Like, my mom, she called me like a lazy, no good loser. She said I was not gonna make anything out of my life. And a whole bunch of mean stuff. And I'll say, well, what happened? And they'll say, well, I just. I made a bad grade on one test. I don't know where the problem is. And then if I didn't go much further than that, I'd be like, wow, here's what I'd be thinking. I'd be like, wow, your mom's kind of a B. That's what I'd be thinking. My head. Why not say that? But here's the real truth in that. The person probably neglected to tell me that they haven't been turning in assignments. They haven't been going to class. They were really, really nasty to their mother before that conversation. I mean, do you get what I mean? Like, there's a whole bunch of other details. So it may be that they're telling me the truth, but they're just not telling me all the facts so that I can give productive, helpful, effective advice. If I don't know the whole story, how am I supposed to advise you? I can't. Now, that's A won't tell the whole story. Sometimes they want to tell the whole story, but they can't tell the whole story. I know what you're thinking. Like, how does somebody can't tell the whole story? Well, the nature of addiction, especially in the later stages, is, like, delusional thinking. Addicts and alcoholics do not see life the way everyone around them sees for lots of reasons. And I have some videos on that. You should totally check them out. But to put it simply, they're either intoxicated when they're experiencing life or in withdrawal when they're experiencing life, which totally messes with their filter. So when you're talking with an addict or an alcoholic and you're like, what are you thinking? Like, are you on this planet? The answer is not really, because their subjective point of view, the lens is way off. So even when you're trying to tell your counselor the whole story, you might not have the whole story. Okay, number two is a biggie. So let's move on to it. It's usually the family that sends the addict or alcoholic to see the counselor. The family wants them to go talk to someone. And I'm a fan of that. You guys know I have tons of videos on how to get someone to go to treatment, how to talk them into seeing a counsel. Fine. I'm good for that. But the problem is, if the family just sends a person with substance use disorder in to talk to a counselor, the family is sending that person because the family wants certain things to happen, certain behavioral changes to occur. Well, it's every counselor's job to help their client meet the client's goals. And usually in situations like this, the client has one set of goals, which is usually, get my family member to shut the heck up. Stay out my business. And the family has a goal, which is usually get this person to tell the truth, quit using drugs and alcohol, and get their light on track. You can see that there's, like, a conflict of interest here. And so the family sending this person to counseling, the family's like, I'm not seeing any changes. Nothing's happening. And that's because the person, they may feel like they love counseling. They may feel better every time they leave because maybe it's meeting their goal, but it's not meeting the family's goals. And then the family gets frustrated. You've got to understand, a counselor's job is to help her client meet their goals. And so if you're sending someone else to counseling because you want certain things to happen, guess who needs to be in counseling you. That's right. If you want certain things to happen, you can come see me and I'll tell you how to make those things happen with your addicted loved ones. Yeah, there's actually lots of tips and tricks to that, but it's you that has to come to make those things happen. Because you're the one that can control the environment. You're the one that can actually create those changes. And so if you want someone else to change a behavior, you come to counseling. And that sort of ties in to number three, which is in regular old counseling, there's no accountability. So even when someone really, really, really wants to get their drug or alcohol problem under control, if they really have an addiction, they have limited ability to manage that themselves. So without accountability. So even if they came because they wanted a counseling, they're not gonna have enough consistent long term willpower by themselves to pull it off. But you need accountability in addition to just the talk therapy. And when I refer to counseling, what I mean is like regular outpatient counseling consists of seeing your counselor about once a week for somewhere between 50 minutes and an hour. It's just not enough to take someone from active addiction to sobriety. You need a little bit more than that. So I guess I'm not really saying, like, don't see a counselor. What I am saying is you need something a little bit more comprehensive than just regular counseling. Usually to take someone from active addiction to sobriety. The lowest level of care that's going to be effective is usually in intensive outpatient counseling. Now that can definitely be effective, especially if you have family involvement, accountability, and some level of desire on the person's part to make things better, maybe they don't want to stop altogether to actually work with. If you're watching this video and you know what I'm talking about, give me the like button. I know you've tried it before. I bet you've tried some things that have worked. I bet you've tried some things that haven't worked. Tell us in the comments below if you've got some experience about something that really, really didn't work, let us know about it. Tell us what it was and why it didn't work. And while you write that in the comments, let's talk about the three things that you can tie in that will make it more effective. We've already hinted at them, so if you're paying attention, you might be ahead of the game. First and foremost, let's get clarity on what the goal of going to the counselor is. Okay, here's one thing that you can do with regular outpatient counseling. If you have. If you're a loved one and you're sending your family member to a counselor or because you want them to stop using drugs and alcohol, then you need to at least send them to a specialist, someone that actually knows how to do a technique called motivational interviewing or motivational enhancement, because this person is trained to find the motivation inside that person and, like, pull it out with tweezers. It is a tedious little process, and it takes some special training to do it. Actually, the technique is pretty simple, but it's actually, like, really emotionally hard to do. Number two, whatever program you pick should include family. But be very careful here, because even though it needs to include family, including family is a big old mess, and it's complicated and it's difficult. So when most people think about family counseling, they think about putting everybody in the same room with one counselor. Man, I feel sorry for that dang counselor, because that's like refereeing is what that is. That doesn't even feel like counseling. That feels like refereeing. When I do it, I feel like I should have some, like, Jerry Springer bouncers, like guys in black shirts that say staff standing on standby, because it's always a mess. At Hope4Families, we do that a little different. We definitely believe in family counseling, but we like to separate you. So we give the family a counselor. We call it lawyering sometimes, and we give the person a counselor so that they have an advocate. That way, everybody has an advocate. And if you're trekking right along, you probably have already guessed what number three is, and that's accountability. You need some level of accountability. If you're trying to go from active use to not using, or even active use to reducing your using, you're going to have to have some kind of drug or alcohol monitoring, some kind of reporting system, because just relying on an addict or an alcoholic to be completely 100% accurate and self reporting, not very likely. Although I will say I've had a few that were actually pretty accurate at doing so. But it's like a unicorn. It, like, hardly ever happens, so I wouldn't quite count on that. So the big three things are accountability, family involvement, and get clarity on what your goal is. And if you're thinking, okay, Amber, I got it. That doesn't work, but what the heck do I need? You're in luck. I have an entire playlist on treatment options. It will help you understand every option out there, whether entry pays or doesn't how much it costs, where to find it. All those questions you'll find in the Understanding Treatment Options playlist. I'm going to put it right here in the corner, so make sure you check it out.
