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Can I talk to my therapist HONESTLY about drugs and alcohol?

The short answer is yes, and it’s critically important.

The longer answer is…there are definitely some misconceptions that therapists report illegal activity. Therapists are only mandated to report child abuse and maltreatment, and have the right to report an individual if their behavior is dangerous to themselves, or others, or the property of others (this is a New York State standard). Drug and alcohol use rarely meets those criteria. In the absence of legal concerns, patients may minimize reported drug and alcohol consumption due to shame, distrust, or their own denial.

Despite this, it is imperative that you tell your therapist about your drug and alcohol consumption, and that you are honest about this. These substances affect your behaviors and your mental processes, and as an extension, often have strong explanatory power when considering issues and outcomes in your life.

Without understanding which experiences took place under the influence of substances, or while recovering from substance use, a mental health care professional will likely misdiagnose you. The symptoms of substance use, as described by patients, often are identical to the symptoms of mental health disorders, such as mood disorders, psychotic disorders, and/or depression. Moving forward with an incorrect diagnosis, the provider will be unable to properly treat you, causing you to waste your time and money on treatment that cannot be effective. Furthermore, there are certain mental health interventions that are contra-indicated in cases of substance use.

There are mental health professionals who specialize in working with people who use substances. Some of these practitioners work toward helping their patients discontinue use of substances, while others subscribe to a harm reduction model, aimed at reducing negative consequences from use. If you are using substances, it is in your best interest to work with clinicians who are familiar with the substances you are using, and to make sure their goals are aligned with yours.

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