OVERVIEW
What brings people to therapy for this.
Most people who develop a problem with substances weren't looking to create one. They were looking for relief: from anxiety, from insomnia, from the pressure that doesn't let up, from something that happened a long time ago and never got worked through. The substance solved something, at least for a while. By the time it became a problem, there were usually two problems: the original one, and the new one.
That framing matters for the work. Not because it removes responsibility, but because understanding what the substance has been solving is the only way to actually address it. Willpower applied to a problem you don't understand tends to produce short-term abstinence and longer-term frustration.
According to SAMHSA's 2024 National Survey on Drug Use and Health, approximately 48 million Americans met criteria for a substance use disorder. Of those who needed treatment, roughly 80% did not receive it. The gap between need and help-seeking is significant, and it's not primarily about denial. It's about the barriers: stigma, uncertainty about whether the problem is "bad enough," not knowing what treatment actually looks like, and not wanting options that don't fit your life.
Some people arrive knowing exactly what they're dealing with. Others are less certain, aware that the drinking has gotten heavier, that the Adderall they're not prescribed is now essential, that they've tried to cut back more than once and couldn't. The presenting picture varies more than most people expect.
High-functioning substance use is its own category, and it's a common one. You're managing work, relationships, responsibilities. Nobody who knows you would describe you as someone with an addiction. And yet. The using is more than you'd admit to if someone asked directly. The attempts to stop or slow down have been quieter than the successes. The cost is starting to outweigh the relief, and something about that is getting harder to ignore.
People also come to this work for substances other than alcohol: cannabis that's become daily and harder to put down; stimulants used for performance that now feel necessary; opioids from a prescription that became something more; cocaine that was occasional and isn't anymore. The substance matters, but less than people think. The psychological structure underneath it tends to be more consistent across substances than the substances themselves would suggest.
IN SESSION
What the work looks like in session
Individual therapy for addiction and substance use focuses on the function the substance has been serving. That usually means exploring anxiety or stress that the substance has been managing, or emotional states that felt unmanageable without something to take the edge off, or a relationship with sleep or focus or social ease that became dependent on external help. The substance is the solution. Therapy works on the underlying problem.
This is not an abstinence-required approach. Some people come to this work wanting to stop entirely. Others want to understand what's driving the use before deciding what they want to change. Harm reduction i.e. reducing the costs and risks without necessarily eliminating the substance, is a legitimate goal and one we work with directly. Where you want to go is a conversation, not a requirement you walk in with already decided.
Individual therapy is appropriate for many presentations. For some people, those with significant physical dependence, or whose use has reached a point that warrants medical support, a referral to higher levels of care is the right next step, and we'll say so clearly if that's the case. Individual therapy can also work well alongside other support, including medication-assisted treatment when that's part of the picture.
COMMON QUESTIONS
What people ask about addiction therapy
Do I have to want to quit completely before starting therapy?
No. Ambivalence about stopping is not a barrier to starting therapy. It's usually part of what brings people in. The part of you that wants to change and the part that isn't ready to can both be present in the room. Therapy doesn't require you to have already resolved that conflict. In many cases, working through the ambivalence and understanding what you'd be giving up and why is a significant part of the early work.
I function well and nobody around me knows. Does that mean I don't really have a problem?
High functioning doesn't mean no problem. It means the costs haven't yet caught up with the external appearance. For a lot of people, the internal experience including the mental space it takes, the failed attempts to cut back, and the way it shapes decisions you'd rather it didn't, is where the real cost lives, even before anything visible breaks. The threshold for having a problem worth addressing isn't visible deterioration. It's that the pattern is causing you real distress or limiting what you're able to do and be.
Is individual therapy enough for addiction, or do I need a program?
It depends on the nature and severity of the use. For a significant number of people, individual therapy is sufficient, particularly when the use is not at a level that requires medical detox and when the person has stable functioning in other areas of life. For more severe presentations, individual therapy works best as part of a broader approach that may include medication-assisted treatment, intensive outpatient, or other structured support. The first conversation will help clarify what level of care makes sense for your situation specifically.