MMN 027: Addictions Counseling – with Stacy Speedlin

On this episode of the Make a Mental Note podcast, Stacy Speedlin, a licensed professional counselor and licensed drug and alcohol counselor, discusses characteristics of addiction, why people become addicted to substances, and ways in which counselors can help them. Give it a listen and find out why this episode is worthy of a mental note!

Stacy Speedlin interview (Click on Stacy’s name to listen to interview)

Mental Notes:

* It is not unusual for clients have co-occurring disorders (i.e., display mental health problems and addictions).

* People become addicted to substances for various reasons. For example, some people use substances to deal with pain – physical or emotion.

* When people are under the influence of substances any hurt, pain or traumatic experiences become compartmentalized because the addiction does not allow them to feel.

* Some clients with addictions say that they don’t feel connected…that they are on the outside looking in.

* Addiction is a stigmatizing disorder. People who are addicted to substances are blamed for having gotten themselves into their predicaments.

* Addiction is an illness. It is not a disease that is contracted, but a progressive illness with progressive symptoms. In the past, society viewed addiction as a moral weakness or a choice as opposed to an illness over which people are powerless. The obsession of the mind and the compulsion of the mind is so strong that it leads people back to using substances despite the consequences.

* Oftentimes, people with addictions stop using substances for short periods of time, but end up using again. Because they have experienced negative consequences, they believe that is enough to stop them from using substances. However, they usually need to be in treatment to stop the cycle of using.

* When people with addictions make a decision to stop using substances they may experience a similar feelings as people who break up with a boyfriend/girlfriend/partner/spouse. Helping people with addictions is analogous to helping a friend or family member who is going through a break-up.

* Even though people with addictions understand their relationships with substances are no good, they eventually come to realize that the relationship must change in order to break the cycle of addiction. People with addictions grieve the loss of their substances similar to how people grieve the loss of romantic partners, friends and/or family members.

* “What if I let this (substance) go and I can’t find something else? What am I going to replace it with?” Substances are familiar and comfortable, which makes change difficult.

* It’s important not to identify a person according to their illness (i.e., “alcoholic” vs. “person with an addiction”).

* Shame is associated with addiction. In addition, low self-esteem, free-floating anxiety and depression are associated with addition. Using substances helps regulate painful or uncomfortable feelings.

* Confrontational methods of counseling are “old school” while methods such as motivational interviewing and Prochaska’s transtheoretical/stages of change model are “new school.”

* It can frustrating to counsel people with addictions. It is important to be aware of personal values, attitudes and beliefs and how these may impact one’s work with this population.

* Similar to how people with addictions feel as though they don’t have control over the use of substances, family members don’t feel like they have control or can help loved ones who are suffering from addiction. In this way, it is a parallel process. This is why it is important to involve family members in the counseling process.

* When counseling people with addictions, it is important to acknowledge that clients are ambivalent about change. Helping “tease out” the ambivalence/getting clients to talk about the pros and cons of change is part of the counseling process. Using a scaling technique (i.e., “On a scale from 1 – 10, with 1 being not important at all and 10 being the most important, how important is it to you to not go to prison/to stay in your relationship/to keep your job/etc.”) can be helpful.

* Counselors shouldn’t assume it is their responsibility to get their clients to change/to stop using substances. This will result in a great deal of frustration and therapeutic conflict and is a recipe for burnout.

* In terms of helping clients with addiction move from point A (beginning of therapy) to point B (end of therapy), counselors should discuss with clients know what point B is or what it looks like. This varies from client to client. For some clients it may be abstinence while for other clients it may be reducing the amount or frequency of use or switching to less harmful substances (harm reduction approach). Counselors should spend plenty of time discussing point B and clients’ feelings/concerns about what it means to change (e.g., “How will I cope with pain?”) in helping them prepare for change.

* The goal of addictions counseling is not always abstinence.   Counselors need to meet clients where they are at and set goals based on their preferences. Trusting clients is key.

* Helping clients establish small goals on the way to the overarching goal at point B occurs at the beginning and throughout the course of counseling. Planning and education is also part of this process.

* Challenges of working with clients with addictions: 1) this work can be heartbreaking; 2) keeping tabs on personal values and not allowing them to enter the counseling process; 3) being content with small changes and understanding that setbacks can occur.

* Counselors should be cognizant of areas of their lives that are not yet healed as the feelings associated with these areas can be triggered when working with people with addictions and detract from or negatively impact the therapeutic relationship. Counselors need to learn how to manage their own feelings when working with people with addictions. Self-awareness is key.

Mental Notes Takeaway:

* It is common for people with addictions to use substances to deal with physical or emotional pain. In this sense, substances serve a positive function. However, with continued use these substances can lead to harm. The key is for people to replace substances with a palatable alternative or to change the way they use substances in order to reduce the potential for harm.

Check It Out:

* Stacy Speedlin’s e-mail address:

* Stacy’s phone number: 830-377-0713


209 Castlewood Drive Suite D
Murfreesboro, TN. 37129
(615) 403-5227

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