Substance Use Disorder 101 - How much is too much?

Transcript

Leah Young: 
What keeps me going is that I know that recovery is possible. You hold out hope and you keep doing the work and I've seen incredible things happen. And so, I feel really passionate about that and that's what gets me out of bed in the morning and gets me to work is I know, I know that these folks can make it.

Ellie Pike: 
Discussions of substance use disorder usually don't start with hope and I understand why they don't. The overuse of drugs and alcohol has negatively impacted millions of people regardless of race, gender, income level, or social class. And when I say millions, I mean millions. The latest national survey by the Substance Abuse and Mental Health Services administration states that 17.3% of people aged 12 years and older qualify as having a substance use disorder. That's almost 50 million people whose lives are negatively impacted by drug, opioid, or alcohol use, not to mention their partners, children, and communities. Yet hope is what makes Leah Young so effective at her job.

Leah Young: 
Hello. I'm Leah Young and I am the Clinical Manager for substance-related and addictive disorders with ERC and Pathlight.

Ellie Pike: 
Leah is a master at discussing this topic without resorting to shame-based language. She's here to help us recognize when our use of substances is becoming problematic as well as options to support better habits. Given the scale of today's topic, I found it helpful to split our conversation into two separate episodes. You can think of today's podcast as Substance Use 101. It answers the question, how do you know if your use of alcohol or drugs is a problem? We will cover topics like early warning signs, how to approach denial, what is sober curiosity, and of course, next steps for getting support.

Our second episode will look closer at the different models for recovery, abstinence, and moderation, and how to know what works for you. You are listening to Mental Note Podcast. I'm Ellie Pike.

Well, thank you so much for bringing your passion on the show and also your expertise. It can be really difficult for us to know when we have a substance use problem and when we don't. So how do you get this conversation started in a way that really encourages self-exploration?

Leah Young: 
Honestly, the way I get it started with the patients or the clients that I work with is I find it goes so far to just be genuine. And so, if I just come as myself and prove to the people I'm working with that I'm not going to judge them no matter what, they move really far. And I think a lot of it comes from developing trust and rapport with them, trying something on and seeing how it fits. We can always go back to the way things were. So I think knowing maybe that this doesn't have to be a forever change can be a really good way for someone themselves to start the process, whether they have access to a Leah or not.

Ellie Pike: 
And what are some of those self-exploratory questions that you might coach someone to ask themselves? If they're coming saying, "Leah, I don't know if I have a problem or not," and the context is so much greater than just, "Well, are you using alcohol or not using alcohol?" Right? There's so much more to it. What are some of those questions you might have someone answer for themselves?

Leah Young: 
I think what people would expect, what's making you ask the question in the first place? Because clearly something there sparked that thought of, maybe my use is problematic. And I always used to playfully tease my patients who would come in and say, "Oh, well, I took this quiz online about whether or not I have a problem with alcohol." And I said, "People who don't have problems with alcohol don't take those quizzes," and that would usually get a chuckle out of them. And anyone who's really struggling to identify, I usually start with exploring what their definition is of a problem with a particular substance or a behavior.

And oftentimes I find it's someone that they know, whether that's within the family or a friend or otherwise. And so we have this image in our head of what a problem looks like and as long as I'm not that, it's not a problem. So once they've explained that to me, we can start to pull that apart and not be so narrow in our focus in terms of defining what a problem is. I might ask because I get a lot of folks who may say, "Well, I'm doing really well at work. I get promotions. I sell this. Or at school I get straight As. I'm functioning really well. I have friends," et cetera.

And I might start with some of the internal stuff and ask some questions about, well, do you find yourself being dishonest about your spending or your drinking and hiding it or minimizing it a little bit? Then how does that make me feel if I am doing that, right? A lot of people feel like frauds or ashamed or guilty. And those feelings alert us to there's something that's not jiving in my world. And then we can address that and then start to move towards something that feels a little bit more in line with our values.

Ellie Pike: 
I really appreciate how you really are exploring from a broader perspective. You're not just saying, "Okay, how many times a week are you using this substance or doing this behavior?" It's so much more about, what are some of those alerts that would indicate that this could be a problem? Are your relationships starting to be affected? Or how do you feel about yourself when you're using this behavior or substance? So that to me is really beneficial and context seems like everything, especially within someone's relationships or family. And it can be often a barometer for ourselves of how we measure if something's a problem or not.

So, thank you for diving into that. I think that that really shows the ability to think more critically rather than to look at just a diagnostic manual regarding what substance use is. So now that I just mentioned a diagnostic manual, are substances only a problem if someone shows signs of addiction? And with that, could you explain what addiction is defined as?

Leah Young: 
Yeah. No, you don't have to have crossed the line into addiction. I tell people that all the time. You can. You can wait until if and when that day comes before we do something about it, certainly, and we don't have to. And so a lot of what I try to get folks to explore is sometimes it's completely preventative. Sometimes it's like steering ourselves down a different path than the one that we were heading down, which can change everything. But I think we could sit here, there are 11 criteria that you tick off or whatever particular substance use disorder in the Diagnostic and Statistical Manual, DSM, and that's lovely to tick off those criteria because it can help in terms of getting treatment paid for by insurance. So that's a good thing.

It can help in terms of identifying a treatment modality that's been researched and is appropriate for that particular disorder. But I always tell people, I don't quite care. I kind of don't care about the diagnosis. If something is creating a problem, it's a problem and we can parse it out and figure out how big of a problem it is, or we can just address the problem. I'm a very big fan of, let's look at the solution. I don't need to label it. I don't need to decide if it's really bad or it's just kind of bad. Let's just do something about it instead of worrying about where on the scale it falls. Our solution to how we address it might match how severe or mild or moderate is, but it's not necessary.

I've had some people who, if I sat down with the DSM, I'd tick off maybe one criteria and they don't appear to have let's say an alcohol use disorder, but they decide that whatever it was that brought them to question this was enough that they decided they no longer want to drink. I'm not going to argue that. I'm not going to say, :But you don't tick off enough criteria to decide." Why would I? So if someone decides that they want to stop doing something or they want to change how much or how frequently or why they're engaging in something, I'm not going to argue that and try to get particular about whether or not a diagnosis matches. But I think for me, it's a bit more important to just really focus on, is it causing me some sort of distress? Is it creating a problem? Let's go from there.

Ellie Pike: 
As oversimplified as that can feel, and I know a lot of people are like, "No, let's dig into the criteria," I really like the simplified version. And I think that that is so beneficial for us just to call it what it is. If someone's experience is that it's problematic or if someone's life could be enhanced with a different solution, then why not explore that? So I really appreciate how simple you just made that for all of us. Thank you.

It's easy to think about problematic behavior relating to substances, or at least for me it is, this is not my specialty, but is that all that different from problematic behaviors like risky sex or "addictive behaviors" like using video games, gambling, et cetera?

Leah Young: 
So, a substance is certainly going to introduce changes to the neurochemistry that a behavior is not and different substances can interact with different neurochemicals in very different ways. And with the behavior we're not necessarily going to see that, right? Blocking receptors, cocaine, for example, blocks the reuptake receptor for dopamine. And so that creates the issue in our brain there, and then we get this depletion of dopamine afterwards. It's one example. We're not going to see that with behaviors.

However, many of the same mechanisms are occurring in the brain, the same areas of the brain are getting stimulated because one of the things that I drive home with my patients, whether they're working directly with me or I'm presenting to the entire milieu of even folks who don't have any substance or behavioral issues, is really understanding that the brain seeks out dopamine because all things that are good for survival release dopamine. And the problem is that there are a lot of things that are not good for survival that release dopamine oftentimes in egregious amounts.

And so, it can trick our limbic system into thinking over the long term that we now need this behavior or this substance for survival. So, what I often tell people is, while some of us may have a preferred drug of choice or a preferred behavior of choice, for many of us in a pinch, we'll rely on something else. If I can't have access to my drug or behavior of choice, I'll use anything because the brain kind of doesn't care at that point. So, it sort of doesn't differentiate when it comes to the whole process around it.

And then we see a lot of the same thinking, some of the magical thinking, this time will be different. We find ourselves having to be dishonest with people that we care about and respect in order to engage in our substance or our behavior. And that can feel real bad. So it doesn't really matter what the behavior or the substance, you can almost kind of just fill in blank and the thinking is just very much the same.

So what would definitely be different is oftentimes how we would treat it. So there are some addictive behaviors that we can't not engage in. So it's about finding balance with those which can be extraordinarily challenging for folks. Whereas I can, if I want to, make a decision to never drink again because we don't need alcohol for survival for any reason. And we could make that decision around gambling, but we can't necessarily with spending, right? Unless we're wealthy and we have somebody who does our shopping for us, and then we never have to be involved in that aspect of it, therefore not activating that addictive process. But the fact is most of us want to figure out how to have sex or be intimate. We want to figure out how to be able to spend. We want to figure out how to engage in exercise in a way that's more balanced and not detrimental to us. So that's where I think it gets a little bit trickier.

Ellie Pike: 
So the moderation piece, or engaging in a behavior that's still important for us to sustain life, but to do it in a moderate way where it doesn't become addictive or that we're not engaging in addictive patterns. That's a key one that we hear about food a lot too, where if someone is binging on food and really feeling like that behavior is problematic, you can't just take away food the way you can take away alcohol from someone because food is life-giving and we have to learn to live with this substance and to use it within moderation.

So I see exactly what you're saying where there's some instances where we could just choose this abstinence model, but not necessarily always. And I'm sure we'll talk about this, where there's also harm reduction models and ways that we can moderate based on someone's own solution of what's best for them. So, if someone is curious about their substance use or behavioral patterns, it's a good idea to question how those behaviors are impacting them. What are some good questions to ask oneself here?

Leah Young: 
So, some of the internal questions might be, am I finding myself having to be dishonest with people that I love, care about, respect? Do I feel like a fraud? Am I hiding things from others so that they don't find out, either because I'm ashamed or embarrassed or because I'm afraid of getting caught and then I'd have to change the way I operate because as soon as someone knows, then I have to stop? In other words, a lot of these kind of internal things are all protecting the substance or the behavior from being found out by others.

Then, if we kind of look at some of the more external things, certainly, is my health being impacted? Is it possible that my medications are not working as well or not properly because of my use? Does it impact my mental health diagnoses, making them worse or setting them off? I know that sometimes certain substances can, for some people, result in a manic episode occurring, where if they weren't using that substance, they could manage it better through therapy and with their medications, et cetera.

So we'll take a look at if I'm being impacted legally. That varies from place to place, what's legal and what isn't. I would also take a look at whether or not my job or my school is being impacted. Am I losing interest in some of my hobbies? Would I rather be getting stoned than going to play volleyball with my friends? And a lot of these fall under the 11 criteria in the DSM as well. And so we can tick off all of these boxes, which can help. That's data collection. And so this can somewhat be subjective for some people because what's important to one person may not be important to another person.

So also, we would want to explore whether or not friends or family have ever complained or annoyed us by saying something. Sometimes it can be very subtle. You're sitting on the couch and you go in the kitchen and grab a beer and your kid says, "Oh, another beer?" So it can be subtle and not real obvious, but I had a patient once who didn't realize until he got sober that his dog was being impacted because he'd come home and his dog wouldn't greet him at the door. And then when he started coming home sober, his dog was always at the door and he said, "I didn't know that that's what was happening." And so this is where it gets tricky because sometimes we don't realize how a substance or a behavior is impacting us until we stop engaging in it. And so getting someone to try that out can be a little bit tricky.

Ellie Pike: 
I really appreciate that you said that because there's this piece of clarity of mind that I bring in where I'm thinking like, "Oh, you really have to be in a place where you can be insightful and ask these questions," which can be impacted by behaviors or substance use. But the other question I have is, what role does denial play in this whole process? Not everyone is ready to see the problem. And so how often do you see that playing a role? And I'll just let you speak to that in a very open-ended way.

Leah Young: 
I am a firm believer that denial is on a spectrum. And at one end of our spectrum, we have absolute denial. And that's that kind of denial where somebody says, "Leah, you're always late," and I look over my shoulder and I say, "What? What Leah? Who? Not me. I'm never late." That's a version of absolute denial where it's just like the who? Me? Nah, I don't have a problem. And oftentimes other people see it well before we do. And then what I believe is at the other end of the denial spectrum is acceptance and that's the point where we say, "Oh, crap, I think I have to do something about this."

And in between, in no particular order, are what are referred to as the cognitive distortions. This is what I believe. So minimization might say, "Oh, well, you know what? You think this is bad, but remember how bad it used to be? It was so much worse." And here's the tricky part about that. There's some validity to that in some situations. Sometimes we do improve our use, but that doesn't mean that using less is working well for us.

So, that minimization piece would keep us in that state of, "But I have made improvements, therefore this is better than that, and that means I don't have to make any more changes. So on the one hand, there's truth to it in some cases, and on the other hand, it's still problematic. So that can be tricky to navigate. Something like justification. "You know what? I work really hard, so I should be able to spend my money however I want." Or we do comparisons. Oh, comparisons are the killer, right? "Oh, well, if you think I'm bad, you should see my buddy Joe."

And the reason I like it on a spectrum is because I have yet to meet somebody who lands in acceptance and firmly stays planted there. There's a lot of, we get there like, "Okay, you know what? I have to do something about this." And then a few days, a few weeks later, we kind of slide back over and say, "Well, maybe I overreacted just a little bit and it's not as bad as I thought it was going to be." And then we go back to acceptance because we have a night out and we're like, "Okay, okay. No, no, this is definitely bad." And then we go back, "Well, but my friend is worse." So it allows us some movement to be human, to figure this out. Some of us need a lot of freaking convincing that something is a problem. Others of us don't need a whole lot of convincing that something's a problem.

So that's kind of my stance on denial, and absolutely we can work with that. When I'm approaching somebody who's in absolute denial, it can be very, very challenging, but this is about kind of asking them, "Well, what are your goals? What are your values?" If a kid's sitting in front of me and he's like, "Well, the only reason I have to stop is because my parents, they keep getting on my case about it." Then it's like, "Yeah, that sounds like that sucks. So what do we need to do to get them off your case?" "Well, I guess I have to stop using for a while, but I'm not going to stop forever." Okay, I'm okay with that.

So that's kind of where I sit with denial. We can move through that, but it might take some time and I think it's really helpful to work with someone that we trust who can challenge us and get away with it, quite honestly, where we're not going to say, "Forget that therapist. I'm never going to go see them again." So that may take time building that trust for some people, a lot longer than for others.

Ellie Pike: 
Well, I think you just hit on the point that I was thinking about this whole time was it matters so much who you're talking to and if you really believe that they are non-judgmental, and that's how you led with. That's how you started our interview today was you love being a therapist, you love being a sounding board, and you love being able to come at it with like, "Hey, I'm not going to judge you. Let's just talk about it." And what it makes me think of is how I have an almost five-year-old daughter, and more recently we've been getting into conversations about, "Hey, did you do this?" And then she'll look at me and she'll lie to my face with a smile on her face.

And it used to frustrate me and then I realized, "Well, she's clearly in denial and not talking about this with me because she has a fear of a consequence happening. But if I can actually reward her for telling the truth, then she's more likely to tell the truth." If I can really show her I have a less judgmental stance than she's expecting, maybe she's more willing to actually face the reality.

And so I've been trying a different stance. And so recently I said, "Okay, listen, did you drop this everywhere, all over your floor and not pick it up?" And she would like to blame it on her brother. And I said, "You're not going to be in trouble if you just tell me the truth." And the look on her face was, "Really?" Surprise and delight. Like, "I'm not going to get in trouble?" I was like, "No, we're just going to come up with a solution together." And so now just in the last week, she started to tell me the truth a little bit more because she's just less worried.

And so I think about that risk and seeing the truth, right? There's always a little bit of a risk, but I think finding that person, whether it's a therapist or that non-judgmental best friend, whoever it can be who can help see that situation from the outside with a little bit more clarity than we can sometimes see it for ourselves, can be so, so freeing. So I just had to add that because to me, that's an adult lesson that my kid is learning.

So what are some of the warning signs that alcohol can be problematic? Let's dig in maybe to some of these specific substances or behaviors.

Leah Young: 
Yeah. So warning signs, there are the obvious ones, I think, right? And a lot of times that's where denial can come into play for some folks, because as long as I'm not ticking off the obvious ones that everybody knows would be a problem, then it's not a problem. So it could be things like racking up DUIs or friends deciding that they're done speaking to us or hanging out with us, getting kicked out of our home, getting fired, our grades start slipping, calling in late to work, showing up stoned. I mean there are so many that most people would say, "Yeah, that's a problem." Very few are going to argue it.

And then there are others, and we can get into, like you said, some of the specific details. I mean it's interesting when I think about the substances and how we categorize them as a society, for sure. I mean I can't speak to other parts of the world because I don't live there, but I think about how, for example, with cannabis, there's this mentality, and my patients talk about it all the time. They always say, "Leah, I need to get away from this idea that it's "just" weed." And one of the things that I often point out is that I have yet, and I've been doing this a long time, have anybody come to me like, "Leah, it's just heroin." Nobody uses the word just in front of pretty much any of the other substances, quite honestly. Sometimes with alcohol, and I think part of that is the legality, right? It's legal and it's socially acceptable, but for the most part, cannabis is the only one that I hear people saying that.

So sometimes we get an even higher level of denial. There's this kind of mythology out there that you can't become addicted to cannabis. And so, one of the obstacles that my folks who use cannabis and have identified it as being problematic have is that they have a lot of friends or family members telling them, or society at large, telling them, you can't be addicted to that. And so basically, I've had a lot of people sitting there in my rooms feeling like there's something wrong with me that I got addicted to the substance you can't get addicted to.

And the word that I spread when I do presentations to whomever is, "Please don't argue with people if they tell you they're addicted to something. Let's not invalidate that experience for them. If they say that something's a problem, if they say that it's addictive, let them have it." Right? Part of the issue that sometimes folks come across is there's this fear that if my friend says, "Hey, I think I'm dependent on this drug that we do together," what does that say about me and my use?

And so I think that sometimes that's where it comes from. I don't think there's ill intent behind people arguing that, but this is one of the things with cannabis is we can absolutely become dependent on it. So let's talk about any of the substances. If I'm waking up and the first thing I need to do is use a substance, I'm probably dependent on it. It doesn't necessarily mean that it's causing problems otherwise for me, but a drink first thing in the morning, rolling over and lighting up that first cigarette or joint, those kinds of things, it's because sleeping was too much without, so I need to use.

We would also want to take a look at, yes, we can look at quantity and we can look at frequency. And yes, there's something to be said when my folks come in, they're like, "Well, I'm not drinking in the morning and I don't drink every day." That's good. And that is also a way of, again, differenting myself out. As long as I'm not doing those things, it's not a problem. So a question that comes up for a lot of people in this regard is what we consider the "harder" substances. If somebody uses cocaine, does that automatically mean that they have a problem with cocaine? No. I'm going to be quite frank with you. I have known people who have used it once, twice, maybe three times in their life, and it's been like years in between and nothing major happens. They just use a little bit and they're experimenting or they're maybe not making great decisions or whatever. I don't recommend it by any means, but quantity and frequency doesn't automatically imply problem or no problem. It can be helpful data, but it's not the only thing I'm going to rest my case on.

Intention behind use. I think that's a big indicator if something is problematic. When people are saying to me, "I use to numb out. I use to fall asleep. I use to manage my anxiety. I'm using so that I can forget. I'm using so that I can feel something." Some of us use because it allows us access to our feelings. If we're using the substance as a primary way to achieve another state, I would say we have the tendency for that to become a problem in the future.

Ellie Pike: 
So, sometimes using can be a way of coping with a mental health issue like anxiety or depression or trauma. I think it's also really important to think about the impact that using a behavior or a substance can have on mental health. So flipping it the other way around, can you speak to that a bit? And what are some of the common symptoms that you see?

Leah Young: 
I think about the more socially kind of used substances like weed, like alcohol, et cetera. You think about, a lot of times people use those things because it makes them feel less anxious. That's what those substances do is they decrease feelings of anxiety pretty effectively. We can't deny that substances, they work. They do the trick. The problem is that they don't tend to be sustainable. So, in terms of mental health, I get a lot of folks using to manage their anxiety, to quell their anxiety. And it gets tricky, right? Because all of their friends are using too in those situations, and that's helping manage their maybe social anxiety, for example. So, it's co-signed by society at large. We even call alcohol is the social lubricant and those kinds of things. So we even have cute little names for those.

The problem with that is let's say drinking alcohol, in particular, does reduce feelings of anxiety, but in the long run, what it does is it makes anxiety worse. Part of it is that we're like, we're squashing that anxiety instead of learning how to cope with it and deal with it, which makes anxiety feel scarier and scarier and scarier as time goes on. And then we have things like cannabis, for example, which again, in the moment can make us feel less anxious. But over time, what we're seeing is it actually makes anxiety worse. And that's through research, but that's also through patients that I've worked with for a long time and have said, "Initially, I smoked weed because it made me feel better and I wasn't feeling as anxious and I could be around my friends or I could go do this or that or the other thing." And over time, they find themselves kind of withdrawing a little bit more, isolating a little more, feeling more and more anxious.

Does that mean that that's going to happen to every single person who uses cannabis for example? No, but that also depends on, well, biology, but also quantity, frequency. In terms of mental health, a lot of substances depress, are actual depressants. The neurochemical cascade that happens in our brain because it's almost like a flash flood ripping through our brain and it just disrupts the neurochemicals. Serotonin is greatly impacted by certain substances, and some of us already are working with a deficit of being able to produce it on our own or whatever it might be.

Same thing with dopamine. And so when our brain is already not utilizing those neurochemicals the way it could be or would be in order for us to be functioning without the diagnosis. And then you throw substances into the mix. But I get it, right? Because the substance gives me some temporary relief that's very real and usually very quick. But some of my folks who are risk averse, they're like, "Well, if that's going to impact me this way in the long run, then I'm not willing to take that risk." And I have other people where we're so desperate in that moment to just feel better, we don't care about the long-term consequences. So that's kind of where I would go with that. Of course, ask if you need a little bit more information.

Ellie Pike: 
I really appreciate the perspective of short-term and long-term. And one big word that keeps coming up for me throughout this conversation is it depends, right? It depends. Impact depends on the person, the use, the intent, the everything. So along those lines, I know a lot of folks are self exploring and asking questions around sobriety and there's a term out there about sober curiosity, and I was wondering if you could just define what that is and lead us into that conversation.

Leah Young: 
So, it took me a while to really understand the sober curious movement and understand its benefits and seeing what was driving some of my patients away or where they would dig their heels in, and then when change was actually happening. And so, I always tell the folks I'm working with, I'm like, "Listen, full transparency. You're here for mental health. You're here for eating disorders. Would I rather you simply chose to be abstinent moving forward? Yes, absolutely. That would be my preference because if you remove substances from the situation, they can't cause any problems. However, not everyone is going to be able to do that."

The lovely thing about the sober curious movement, it was really born out of these dry January kind of things that were becoming popular for a bit, and people just being sick and tired of everything they did having to involve substances. Do we always have to be drinking while spending time with each other? Do we always have to be smoking weed? Can we do something else that doesn't involve that?

And so, on the one hand, you have your people who try on sobriety or abstinence for a period of time. It might be for a month, it might be for a year, whatever it might be. And sometimes those folks choose to continue with that. Sometimes they choose to reintegrate substances. Sometimes they do so successfully, sometimes they do not. And the other piece of sober curiosity is it might also be for people who are trying to moderate. You don't have to be choosing to be completely sober in order to explore the sober curious thing. So, for example, if I was going out three, four nights a week with all my friends and three, four nights a week we were using, and I want to become sober curious, that's something that I'm interested in. Now, maybe one night a week I go out and drink with my friends. We go out dancing on Saturday night and you have a couple drinks, but the other three times when we go out, we do something that doesn't involve substances. So it is a bit of moderating, but it's just kind of not relying on it as much.

And sober curiosity is not going to work for everyone. And I just want to make sure I'm clear about that. However, if I'm working with someone and I can see, based on the collection of issues that have come with their drinking or their use, that they are somebody who should not drink or use anymore, I'm not them. I can't make them not do it. So I would rather work with them to collect more data so that they then make the decision sooner rather than later to make those changes. So, I'm a big fan of sober curiosity for a lot of people and not for everyone.

Ellie Pike: 
I like how you describe it as collecting data, like every day is an experiment. Just gather more data and then look at it and assess what's working? What's not working? And to me, that just makes it a little bit more objective rather than subjective. And you can see a lot if you examine patterns over time or impact over time.

So, we are going to have a part two of this podcast episode, and I'm really thrilled that we can bring more to our listeners about this. But if someone has just listened to this episode and they're like, "I am a little bit more curious, I would've liked a little bit more support," what are some initial steps that you would recommend for them, just if they're at the beginning of their journey of like, "Hey, is this a problem for me or not?"

Leah Young: 
So definitely you can explore the sober curious movement. You just Google it and it'll come up. You can get the book, you can read the many, many, many articles out there on it, and listen to the podcast, et cetera. So that's one way to kind of hear what other people are doing. You can try a sober support meeting if you want to. I know some people are willing to do that. There's Recovery Dharma, there's Smart Recovery, there's every kind of 12-step meeting out there possible, there's Celebrate Recovery, there's LifeRing, there's so many different approaches and Moderation Management is another resource for people.

And again, not everyone's going to be able to moderate, but that could be a nice place for folks to start because it can give some very specific tools, and we can get into that actually in the next episode, of how do I start to collect that data in order to inform my decision about what I need to do moving forward? Which is one of my favorite things to do with folks.

So, yeah. And I mean, of course, you can always explore the idea of sobriety too and read any of the recovery focus books. There's also a book called Over the Influence, which is a pretty methodical way of doing harm reduction if folks are interested in that. And the idea is, if I've done all of the things in this book and I'm still not able to moderate, then I may be somebody who needs to consider complete abstinence.

And so I really appreciate that understanding, that this isn't going to work for everybody and let's be methodical about it, let's collect data, let's get those things in the columns that help me determine what my next steps need to be.

Ellie Pike: 
Well, thank you so, so much. This has been an amazingly thoughtful and just incredible episode just for anyone exploring substance use and behaviors. So, looking forward to our next episode as well.

Leah Young: 
Me too.

Ellie Pike: 
Let's return to the original question we set out to answer at the top of today's show. How do you know if your substance use behaviors are a problem? I like how Leah is not too caught up in diagnostic criteria, but instead turns the question back on us. What makes you even ask how much is too much? If your use of alcohol, drugs, or another substance is significant enough that you're asking whether it's a problem, then it probably is. Why wait until it's an even bigger issue? The time to do something could be now.

Stay tuned for episode two of our conversation with Leah. Look for it in your podcast feed soon. We'll dig into more regarding moderation and abstinence and where to look for support. Also, check out our show notes today for helpful links about substance use disorder, including support groups, other podcasts, books, and more.

Thank you for listening to Mental Note Podcast. Our show is brought to you by Eating Recovery Center and Pathlight Mood and Anxiety Center. If you'd like to talk to a trained therapist about the Substance-Related Addictive Disorders Program, please call them at (877) 850-7199. If you need a free support group, check out eatingrecovery.com/support-groups and pathlightbh.com/support-groups. If you like our show, sign up for our e-newsletter and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes. It helps others find our podcast.

Mental Note is produced and hosted by me, Ellie Pike, edited by Carey Daniels, and directed by Sam Pike. Till next time.

Presented by

Ellie Pike, MA, LPC

Ellie Pike is the director of alumni, family and community outreach at ERC & Pathlight Behavioral Health Centers. Over the years, she creatively combined her passions for clinical work with…

Presented by

Leah Young, LCPC

LEAH YOUNG, LCPC is a Clinical Manager at Eating Recovery Center and Pathlight Mood and Anxiety Centers. Leah has been with ERC Pathlight since 2016. Leah earned her Master’s from The Chicago School…