Substance Abuse Doesn't Mix with Assessment

I do not evaluate any individuals or couples who have active ongoing substance use problems because that substance is like another entity in your life that impacts your personality, behaviors, thoughts, and judgments, as well as how you relate to people. If there is an active substance use problem, the assessment will only be able to diagnose the substance use problem because that will overshadow anything else that may be going on.

I’m not a drug addict! What do you mean by substance abuse?

The term "substance" means anything that you can take into your body that is then able to alter your cognitions/behaviors/emotions - this includes alcohol, marijuana/THC, other recreational drugs, and some prescription medications. The term "substance abuse" means that you are using the substance in an appropriate way and it is causing problems in your life.

What is an acceptable level of use?

Acceptable levels of use will really vary from person to person and can depend on your physical size, ability to metabolize the substance, co-occurring medical problems, and impact on your life.

However, there are some agreed-upon generalities regarding alcohol.

First, Let’s get on the same page regarding the size of a “serving” of alcohol:

• Beer: 12 ounces (one small can – 2.6 inches wide and 4.8 inches tall)

• Wine: 5 ounces (25% of a typical red wine glass and 45% of a typical white wine glass)

• Liquor: 1.5 ounces (about 1 finger-width high on a typical tumbler)

People who were assigned female at birth should not exceed 7 servings per week (and 3 servings on any given day).

People who were assigned male at birth should not exceed 14 servings per week (and 4 servings on any given day).

Signs that substance use may be a problem

The following are some red flags that might indicate that your level of substance use is becoming problematic:

• Consistent use of the substance in a manner that is more than you had planned (either frequency or amount)

• Repeated difficulty with attempts to decrease use

• Cravings of the substance (thinking about when you might be able to drink/smoke/etc., looking forward to the end of the work day so that you can use the substance)

• Continued use of the substance even though it is impacting your work or relationships, loved ones want you to cut back/stop, and people are expressing concern about your use

• Unsafe behaviors; doing activities you should not do while under the influence due to safety concerns (e.g., driving, heavy machinery)

• Continued use of the substance despite psychological or medical problems (that are caused by or worsened by the substance use)

  
  

Substance abuse doesn't mix with assessment

Long-term and/or consistent use of substances can cause a lot of changes that can interfere with an assessment or psychotherapy. It is similar to the difficulty that might happen if your glasses are smudged and you’re trying to see something. You can sort of tell what’s out there, but everything is filtered through this smudge, which then makes everything unclear.

Similarly, substance use causes everything to be filtered and we cannot get a bead on what is happening at a deeper level, underneath the substance, because we can’t get past that smudge! The substance “smudge” does things like change how you react to anxious worries, change how frustrated you get, change your motivation to enact change in your life, etc.

As a result, in an assessment, we end up with a lot of data that is potentially contradictory and not a cohesive picture. In psychotherapy, we end up with little-to-no progress and a lot of frustration for everyone involved (unless you are also treating the substance use problem).

See FAQs for more information about Dr. Dug's processes and logistics.