Substance Abuse

You do not need to call yourself an addict, or to have hit any kind of bottom, to take your use of alcohol or drugs seriously. If you are wondering whether it has become a problem, that question is reason enough to talk. I work with adults in Hollywood, Florida, and by secure video, in a setting that is direct, private, and free of judgment.

Substance use is a spectrum

Problems with alcohol and drugs do not fall into two neat groups. Some people drink or use more than they intend and cannot quite say why. Some go long stretches without trouble and then lose control. Others have had real consequences, or have tried more than once to cut back or stop. Treatment should fit where you actually are, not where a label says you should be.

How it can look

• Drinking or using more than you planned, or for longer than you planned.
• Promising yourself limits that do not hold.
• Turning to a substance to manage stress, anxiety, loneliness, anger, or feelings you do not know how to handle.
• Spending more time than you want thinking about using, planning around it, or recovering from it.
• Hiding how much you use, or minimizing it to other people or to yourself.
• Consequences in your relationships, work, health, finances, or legal situation.
• Repeated attempts to cut back that do not last.

Not all of these need to be true for it to be worth looking at.

Why capable people overlook it

Many people who are worried about their use are doing well on the surface. They hold demanding jobs, take care of others, and meet their obligations. That can make it easy to believe nothing is really wrong, because the usual evidence of a problem is missing. Meanwhile, the private cost may be growing: more effort spent managing it, more secrecy, more worry.

It is also common to measure yourself against the most extreme story you know and conclude you do not qualify. Whether your use is “bad enough” is not a requirement for therapy. How it affects you, and how you feel about it, is what matters.

What a substance may be doing for you

Alcohol and drugs usually serve a purpose, which is part of why they are hard to set aside. A substance may quiet anxiety, help you sleep, ease social discomfort, numb something painful, create a break from pressure, or offer a reliable reward at the end of a hard day. For some people, use is also a way of setting aside larger questions about who they are or what they want, and those identity and existential questions can become part of the work. Understanding the role it plays is not an excuse for it. It is often the key to understanding why change has been difficult.

Mixed feelings about change

Most people are of two minds. Part of you may want things to be different, while another part is not ready to give up what the substance provides, or doubts you can manage without it. I do not treat that as resistance to be overcome. It is an honest part of the picture, and we can take it seriously. You do not have to be certain about quitting to begin.

How psychotherapy may help

Therapy is individualized, and I do not assume everyone should follow the same path. Goals might include stopping entirely, cutting back, or first understanding your pattern better, and we can talk honestly about what is realistic and what is safe. Depending on what fits, our work may include:

• Looking at what alcohol or drugs do for you, and what they cost.
• Identifying triggers, situations, and patterns that lead to use.
• Exploring the emotional and relational circumstances around it.
• Working through ambivalence about changing.
• Understanding the consequences you have experienced or are worried about.
• Learning from past lapses or relapses without treating them as proof of failure.
• Addressing shame and secrecy.
• Looking at anxiety, depression, trauma, compulsive behaviors such as process addictions, or other concerns that may be occurring alongside use.
• Clarifying what you actually want to change.

I cannot promise sobriety or any particular outcome. If you are in recovery, therapy can work alongside other supports you already use, such as a recovery program, a physician, or a peer group. If trauma is part of the picture, I am EMDR-trained, and we can discuss whether it is appropriate for you and when.

When outpatient therapy is not enough

Outpatient psychotherapy is not appropriate for every level of substance use. Some people need more than weekly sessions can provide.

Withdrawal from alcohol, benzodiazepines, and some other substances can be medically dangerous. If there is a possibility that you could experience significant withdrawal, I may recommend medical evaluation before you reduce or stop using. Do not abruptly stop a substance with potentially serious withdrawal risks without appropriate medical guidance.

Some people need:

• A medical evaluation.
• Medically supervised withdrawal or detoxification.
• A higher level of care, such as an intensive outpatient, partial hospitalization, or residential program.
• Specialized addiction treatment.
• Additional recovery supports, in addition to therapy.

If we find together that you need more than I can offer, I will say so plainly and help you find appropriate care. In some situations, psychotherapy with me may be able to continue alongside specialized addiction treatment or a higher level of care, when that is clinically appropriate and the services can be coordinated effectively. I do not provide detox guidance or medical advice about withdrawal.

You might consider reaching out if

• You use more than you intend, or cannot reliably stick to the limits you set.
• You are worried about your use, even if no one else has noticed.
• You rely on alcohol or drugs to get through stress or difficult feelings.
• Substances take up more of your thoughts than you would like.
• Your use has affected a relationship, your work, your health, or your legal standing.
• You have tried to cut back and have not been able to.
• You are in recovery and want therapy in addition to your other supports.
• You are not sure your use is a problem and want someone to think it through with you.

Questions people often ask

Do I have to be sober to start?

No. You do not need to have stopped, or even to want to stop, in order to begin. We start from where you are.

Do I have to call myself an addict?

No. I do not use labels unless you do. What matters is what is happening in your life and what you want to be different.

Is my use bad enough for therapy?

There is no minimum. If it is on your mind enough to ask, it is worth talking about.

Do I have to go to AA or follow a twelve-step program?

No. Some people find mutual-help groups valuable and some do not. I will not require any particular model, and I respect what has worked for you. If you are already involved in a program, therapy can complement it.

Will I be expected to stop completely?

You decide what changes you are willing to make. My role includes being straightforward with you when I have concerns about your safety or when I believe additional care should be considered. Some people come to therapy wanting abstinence. Others are unsure what they want to change, or initially hope to reduce their use. We can talk openly about your goals while also considering safety and whether medical or specialized addiction care should be part of the plan.

What if I relapse or slip?

It happens, and it is useful to discuss openly. You will not be shamed or dismissed from treatment for it. We can look at what happened and what it tells us.

Is what I say confidential?

Talking with me about alcohol or drug use does not, by itself, mean that I contact your employer or family. What you discuss in therapy is confidential within the limits of the law and professional ethics, and I will explain those limits to you at the beginning of treatment.

What to expect at the start

We begin with a free 15-minute consultation. You can tell me what is going on and ask what you want to know, and we can decide together whether working with me is a good fit. If it is, the first session is a fuller conversation about your use, your history, what you have tried, your health, and your goals. I will ask about what you are using, how often, and the pattern of your use so I can better understand the risks involved and whether outpatient psychotherapy appears appropriate, or whether a medical or specialized addiction assessment should also be part of the plan. Sessions are 53 minutes, in person in Hollywood or by secure video.

My fee is $250 per 53-minute therapeutic hour. I provide superbills you may submit for possible out-of-network reimbursement; coverage depends on your plan. More detail is on the Fees & Insurance page.

If you are in immediate medical danger, experiencing a suspected overdose or severe withdrawal, or having a seizure or difficulty breathing, call 911 or go to the nearest emergency department. If you are experiencing a suicidal or mental health crisis, call or text 988.