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Maybe. Maybe not. I'm much more interested in questions like: Is it getting in the way of something you want? Is it helping you cope with something that feels otherwise unmanageable? Are there consequences you don't like? Are you worried about it? Are other people worried about it? Or are you simply curious about the role substances are playing in your life?

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Those are all good enough reasons to talk about it.

 

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Nope.

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People use substances for all kinds of reasons: pleasure, connection, ritual, sleep, pain relief, appetite, escape, curiosity, or because being inside their own brain for a while is fucking exhausting.

Some substances, including marijuana, can also have legitimate therapeutic or medical uses. That doesn't mean every substance is safe in every situation or that something can't become harmful simply because it also helps you.

 

Sometimes both things are true.

 

It helps me sleep.

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Okay. That's real.

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I'm also uncomfortable with how much I need it to sleep.

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That's real, too.

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We don't have to decide whether your substance use belongs in the “good” or “bad” box before we can get curious about your relationship with it.

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Substance use usually makes sense somehow.

 

Instead of starting with “Why won't you stop doing this destructive thing?” I want to understand what problem the substance has been solving.

 

Maybe it quiets your thoughts. Maybe it helps you sleep. Maybe it makes social situations tolerable. Maybe it numbs trauma memories, loneliness, shame, or grief. Maybe it gives you energy. Maybe it's part of how you connect with other people. Maybe you just really fucking like it.

 

Understanding the function of substance use doesn't mean ignoring its consequences. It means recognizing that asking someone to give up a coping mechanism without understanding why they needed it in the first place isn't particularly helpful.

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I mean, yeah, kind of.

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You don't have to perform recovery for me. You don't have to promise abstinence. You don't have to make your goals match mine.

 

That might mean continuing to use. Using less. Using differently. Finding ways to use more safely. Pursuing abstinence. Returning to use after a period of abstinence. Or being completely unsure whether you want anything to change at all.

 

My job is to give you a space where we can be honest about what you're using, what it's doing for you, what it might be costing you, and what - if anything - you want to change.

 

There are times I'll be concerned about your safety, and I'll tell you when I am. There are times I may challenge you. But I'm not the substance-use police, and you don't lose the right to make choices about your own body because you walked into a therapist's office.

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Medication is treatment. Full stop.

 

If methadone, buprenorphine, naltrexone, or another medication is part of what keeps you healthy and helps you build the life you want, I'm not going to ask when you plan to “get off of it” as though medication is somehow cheating at recovery.

 

There isn't extra credit for doing this the hardest possible way.

 

I don't prescribe these medications, but I'm happy to support your treatment and work alongside the medical professionals who do.

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Harm reduction means we start with where you are—not where I, your family, a treatment program, or anyone else thinks you should be.

 

We'll get curious about patterns, triggers, benefits, consequences, and what you actually want your relationship with substances to look like. Sometimes that means reducing harm. Sometimes it means changing how or when you use. Sometimes it means building other ways to cope so a substance doesn't have to do quite so much work for you. Sometimes the goal is abstinence.

 

And sometimes you're not ready to change anything yet.

 

You can still come to therapy.

 

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You don't need to have a recovery goal figured out before you reach out. Schedule a free 15-minute consultation, tell me a little about what's going on, ask whatever questions you have, and we'll see if working together feels like a good fit.