Welcome back to Your Clinical Supervisor's Couch podcast, and I'm your host, Kayla Das.
In today's episode, Stephanie McAlister, registered clinical counselor, addiction Research project coordinator and lab manager and owner of Virtual Connect will share strategies for how to support clients through addiction treatment.
Hi Stephanie. Welcome to the show. I'm so glad to have you here today.
Hey, Kayla, I'm so happy to be here. Thank you for hosting me.
Stephanie, before we dive into today's episode, please introduce yourself and tell us a little bit about your practice journey, especially as it relates to addiction treatment.
Awesome. Of course. As you shared, my name is Stephanie McAlister and I am a registered clinical counselor. I'll go into kind of my educational background first. So I did a bachelor's degree in psychology and criminology, and then I completed my master's in counseling. And I live in two worlds right now that.
Overlap and can be really beneficial to pull from each. So in my one world, I own the company Virtual Connect and operate as a clinical counselor. And then in my other world, I coordinate a project of an addictions trial across Canada that is looking at preventative interventions for substance use treatment. And now I do wanna start by prefacing that this research has come out internationally in the UK, the United States and Australia. It's the PreVenture Research Project.
Now, what I am currently working on is still in the beginning stages of finalizing. So anything that I will speak to today will be about research that's already been published in other places internationally. And the preface is on prevention research. And so I've lived in the prevention world and then I've also lived in the kind of addictions treatment world and the after fact as well as working in a detox facility. And I conducted a project there as well.
So living in both worlds has given me a lot of experience and a lot of information on what's helped and what doesn't help with addiction treatments.
Amazing. And I'm so grateful that you're here on the podcast today because when we think of our roles as therapists and counselors. Addiction sometimes comes hand in hand with some of the issues that our clients are experiencing. When it comes to addiction trainings and services for therapists to build our skills and our knowledge I actually haven't really seen a whole lot out there. So I think that this is a really timely conversation, especially for the Your Clinical Supervisor's Couch podcast because a lot of our new therapists may come across clients who are experiencing addictions and, need that support. So I just love that we're talking about that.
Before we discuss supporting clients through addiction treatment, can you share what we can learn from prevention research specifically on the topic?
Yes, of course. So I'll speak specifically to what I've been looking at and again research that's already published internationally in other locations outside of Canada.
The PreVenture research project looks at four key personality traits that are associated with an increased risks of engaging in substance use. That would include negative thinking, anxiety sensitivity, sensation seeking, and impulsivity. Preface is that individuals who engage in substance use do so as a means of kind of a coping mechanism based on their personality trait. And so what that also means is that the reason somebody engages in substance use varies based on kind of which one of their dominant personality traits. And where this research is really helpful is that you don't need to be engaged in substance use in order to receive some help and receive some treatment.
And I think as a counselor, like we see people after the fact, right? And so I could see where it's like, how does this connect? But I do think that this can really inform, the why. Why do people engage in substance use? What are the motives? What are the factors that started this? Because when we're trying to deal with a problem, we need to get to the root of it, right? And get to, okay, where is this coming from? And I think a lot of addictions research specifically is very, after the fact. And like I said, I did work in a detox facility. In that world I talked about, okay, what do you need for recovery? What are the things that are important? And a lot of what I found in that research was actually peer support. Peer support and help.
Whereas in this kind of prevention side of things, it's looking at which personality traits are most at risk of experiencing substance use and what coping mechanisms can be implemented in order to support people who are at an increased risk of substance use.
You've already mentioned this, as therapists and counselors, we often see our clients after the fact. So when the issue is already presenting itself. So how is this research something that can be integrated or used in a counseling or therapy setting?
I love that question and I think I'm gonna get really practical because I remember when I was in school, something that kind of drove me crazy is there was all these theories and things that came out and it was like, okay, so then how do I do this with clients? And I think as you advance in your career, it's easier to make those connections.
But I'm gonna break it down and I just wanna preface that I am gonna come from both places of the PreVenture research and then the after effect research that I've looked into. So I think the first and foremost with an addictions lens is empowering people. And it needs to start with a conversation about what they would like in their life.
And I'm gonna be realistic, most people are not coming into counseling being like, oh, there's a chance I'm gonna struggle with addictions one day. Most of the time when someone comes into counseling, it's become a problem. And so I think that starting there and starting there from a place of okay, what is your goal? What does that look like? Is it a harm reduction approach? Is it abstinence, is it this specific substance I'm having a problem with, but these other things I don't have a problem with. And I think it's really getting very clear on the client's goals and then where they're at.
So if the goal is completely eliminating any substances in our lives and we're drinking every day, okay, is it gonna be a goal to cold Turkey, stop that? Is it gonna be a goal to each week we're gonna reduce what that looks like, right? And I think the starting point is figuring out what somebody would like and then getting to that place. And then I think through that process it's also identifying what supports are in their life.
And I think this is where, I know not everyone loves and agrees with it, but I do strongly believe that AA, NA and CA programs are so beneficial. Even just for the community aspect, right? The community piece of having people to connect with, having people who understand what you're going through as well as the reality of substance use and recovery is a very isolating process because you're in a position where you need to let go of everything that you knew before. And more often than not, we start to gravitate towards people who are also engaging in substance use. Because that's what we're doing, right? And so in order to go through recovery in the way that you want, more often than not, it means changing those old habits, changing those patterns, and that can be very isolating.
And I think how to integrate this prevention research into kind of treatments and supporting clinicians. I think a lot of that comes down to after this process has happened with clients, is starting to do the deeper work of, okay, so why? What led you to engage in substance use? What role did that fill? Because ultimately, at least from this prevention research, a lot of it shows that it's a coping mechanism. It's a coping mechanism, and it's something and I'm gonna use anxiety as an example because I think that is very common, right? You go out with friends and you're starting to feel anxious, and so your way of coping with anxiety is having a couple glasses of wine. We don't realize that in doing that. And in continuing to do that, what we're doing is we're telling our brains that this is how we deal with social anxiety.
Whereas, okay, what are other coping mechanisms that I can implement? I can go with a close friend, I can work through what parts of going into social settings cause me anxiety. And I honestly really like CBT approaches for this in that. Okay let's look at, what are the thoughts that happen when I walk into a room, when there's a bunch of people that I don't really know? What are the feelings that come up? And then what are my actions? And the actions piece is often what needs to be adjusted because the actions are more often than not okay, I'm gonna grab that second glass of wine. I'm gonna grab that third glass of wine to calm my nervous system. What can we replace there?
And I think as counselors, that's where we can come in is what can I replace? What can I do there as a means of then and shifting things, right? I don't need to bring wine to the social event. I can engage in the coping mechanisms that I've developed, right?
And I think these are very individuals, so I'm not gonna go into a lot of detail here, but I think everyone knows what I'm referring to. What's in your toolbox that you can pull out other than wine? So that would be the way I would look at the process of addressing substance use. And I think this research can go from a place of getting deeper and more long-term solutions, if that makes sense.
It does. And I know you mentioned a little bit about personality earlier, and if you're okay with it, I would love to deep dive a little bit into that. But the other thing that I thought of was society. Because in society having a glass of wine at a party is not only acceptable in some scenarios, is almost required we'll say. So for someone who is trying to, dig into their toolkit of strategies other than having a glass of wine, that could be really challenging because, the environment that we're in is here's your glass, let's unwind together. So yeah. So tell me a little bit about like, when you think of like the society impacts as well as I guess personality traits and things like that, like how do they play into this as well?
Yeah, that's a really good question. So I'm gonna break this down into two parts, and I'm gonna start with kind of the society impact. When I bring up coping mechanisms, that's part of what I mean. And I think a big thing that I've worked on with clients, and it goes back to that piece of okay, what are your goals and how much are you wanting to engage or not engage? And so if your goal is abstinence, I 100% agree with you. It is hard to walk into a party and be like, yep. I'm not drinking.
I'd like to think, and again, being a counselor, the people I associate with might have an impact on this. But it's becoming a lot more acceptable or it's not as pressured, I would say. With that being said, everyone associates with different people and I think developing coping strategies and things to deal with that. And that's part of it. What is my plan when I walk into this party and I say, I'm not having a glass of wine. Is it, ironically, and obviously I do a decent amount of addictions work, bubblies seem to be a thing that people go to. They bring their own bubblies. It's a can, it's something you can hold. It's something you're drinking with everybody else. There's just not alcohol in it. And so having that preemptive decision, right? What am I gonna do? I'm gonna go over to a family event where everyone's pouring wine and I'm trying not to drink.
So am I gonna bring this up before I get there? Am I gonna come up with my line? I always like to say, create your line. What is a line that you feel comfortable saying that you feel comfortable putting out there so that, it comes naturally when you get there. And so it's not this fumbling like I don't know what to say. I don't know what to do. And you feel awkward 'cause. Yeah, you're right. We live in a culture and a society where, specifically alcohol use is very normalized and yeah, very encouraged. And depending on what you're doing, almost pressured, right? And so having that line, being able to stay strong when it's already a hard thing for you to do. And to be honest, sometimes this also means separating yourself from certain scenarios that maybe, at least for a little bit until you're further along in your journey will then feel safe.
And so just to flip to your second question about personality traits I think it's important to note that the reasons people engage in substance use vary based on their personality traits. And just as like an example for individuals who maybe have higher traits of negative thinking or anxiety sensitivity, substance use is often used to mask feelings, right? We're trying to feel less depressed, we're trying to feel less anxious. And so that's why we're engaging in substance use, whereas those who have impulsivity, personality traits and sensation seeking personality traits, it's to enhance experiences, right? It's the sense of I don't really care. There's more thrill here, so I'm just gonna do it. And I think, again, like trickling back to the place of clinical work and how to address these things is for those who struggle with kind of negative thinking or anxiety sensitivity, developing alternative coping mechanisms to address those feelings when they come up.
And then for those with impulsivity and sensation seeking, a lot of it is, okay, let's slow down. Let's slow down. Let's think this through. Let's look at the repercussions, right? If I'm in a place where, oh, you know what? Screw it. I'm going to drink and then I'm gonna go do some donuts in a parking lot. 'Cause that seems like fun. Okay, let's break it down. What are the repercussions of that? Why is that something that could be a good idea, and why is that something that could be a bad idea? What are the long-term impacts? What are the short-term impacts? And I think breaking down those pieces from a clinical perspective are really helpful. And I think when you're working with clients, I always like to use realistic examples, right?
So if they have a scenario that they're like, yeah, this got me in a lot of trouble. Let's work through it. What were the things in the moment? Because we don't do things to cause ourselves harm, right? A lot of the time as human beings, we wanna feel comfortable, we wanna feel safe. And so sometimes the things we do bring us immediate gratification, but we don't think about okay, now what's the follow up to this? Does that answer your question of kind of the clinical side and then how personality factors play?
Absolutely. And I think, this goes into my next question of what are the roots of substance use and abuse? And you've talked about this, but if we could just kinda, list 'em or are there other components that we haven't discussed?
Yeah, I focused mostly on the personality trait piece, but I think there's a lot of variables and a lot of factors, and again, I reiterate this is why really getting into a discussion about where it started, as well as what is your goals when you're coming into counseling is so important for clinicians to focus on.
But I think just to zoom out a little bit, general substance use research, there's theories, obviously based on specific personality traits that I've discussed, there's genetic components that kind of make people more at risk or less at risk as well as like environmental factors, right?
I think if you've been in environments and looking back to certain jobs or certain times in my life where it was very socially acceptable to binge drink, a lot. And you don't see it as a problem until you're out of it. And if everyone around you is doing those things or you are associating with people who are doing those things to normalize them, I think that's something that people don't realize. It's, oh, is it everyone around me is doing this? Or am I choosing to associate with these people around me who are doing this because nobody wants to feel left out or like they're the only one.
And so I think there's a lot of reasons why people engage in substance use, which also means there's a lot of things that you can do to support and getting that information as a starting point. And I think in each area, right? If you know you have a genetic component where you're more at risk of engaging in substance use, what are your rules? And at least for me personally, like I know that's a reality.
And so I have rules for myself. I don't have substances more than three days in a row. That's my max. I will not drink three days in a row. And I also know, if I'm sad, if I'm angry, if I'm upset that's a hard rule. I don't ever wanna make that association and I don't ever wanna train myself that's the direction to go. Because once you do it, it's that coping mechanism piece, and I really, from a clinical place, I think that is what we need to focus on as clinicians, is how do we help our clients develop alternative coping mechanisms? Because if we're removing something, we need to replace it. And so if we're removing alcohol as the coping mechanism that we're using, what are we replacing it with? Does that answer what you were asking?
Absolutely, and you really broke it down into a very practical way, but I know in the back of people's minds is, are there specific interventions, modalities or techniques that I can include into my practice as well.
So are there specific interventions or techniques or even modalities that you find to be the most effective when supporting clients through addiction treatment?
Yes, I do. And I think in this one, there's two sides at the beginning when somebody comes in to focus on addictions and how to work through this. I think CBT is really helpful. Let's retrain those thoughts, feelings, and actions. I also think DBT is very good intervention to my point is the replacing the coping mechanisms.
And then I also feel like solution focused. Because that's what we're doing. We're trying to find solutions to this, right? We have to think about it. Again, in an ideal world, we would know, oh, maybe one day I'm gonna struggle with addictions. So I'm gonna come into a counselor preemptively. Chances are that's not gonna happen. So we're seeing people when it's already an issue, right? And so getting those practical, therapeutic modalities first.
And then I think for long-term things, it's going to the root of it, right? And I think something that I actually haven't mentioned that I think is very common is trauma. Trauma. And then we use substances to cope with those experience. And so I think as a starting point, those modalities that are very practical intervention CBT, DBT, solution-focused.
Once we see our clients starting to stabilize and they're able to go to that family gathering and. They feel confident saying I'm not drinking and they're at that place. Then we can move into deeper work of maybe it's emotion focused, it's acceptance and commitment therapy. It's EMDR counseling. Looking at, okay, what are the roots that got me to this place and how can I address those problems so that it's not leading into I'm engaging in substance use as a means of coping. And I think I keep going back to this word of coping, and I think we really need to look at substance use as a means of coping because that's what it is. No matter what you're coping with, we're trying to cope with something.
Absolutely. And I also think of motivational interviewing as well, because this goes back to really identifying where that person is in the stages of change. Are they in pre-contemplation? Are they in contemplation? And even another stage, which is beyond the scope of this episode, is preventing relapse, right? We talked about prevention, but we didn't necessarily talk about preventing relapse. And I think motivational interviewing does a really great job at that maintenance stage as well. So I think that's another technique that people can integrate with, of course, all of the other techniques that you've identified, and I would agree a hundred percent.
And just to add to that I think that it is when we talk about like relapse, because obviously that is something that does take place and this can be a full other episode, so I'll just touch on this briefly, but I think that's the piece of it, developing those coping mechanisms because that will continue to work. And then also doing that inner child work and doing that deeper work of okay, where did this come from? What am I trying to fill with this substance use? And something that I've always done with clients is look at relapse as an opportunity for learning. What happened? Where was there a hole? Where was there a gap?
And now, okay, how can we go back to that and work on finding other tools and strategies and interventions to help so that we know that relapse does happen. But if we can learn from it and not view it in a shameful way. I think that is a bit of a tricky one. There is a lot of shame and I've had clients who've had a lot of shame around that. Okay. Look yes, there was a relapse. Look at what this looks like. It was maybe a day relapse and you've stopped and you've realized and what did we learn from this? I think a learning opportunity is a good way to maybe phrase that.
I love that. Stephanie, if a listener is seeking an external referral for a client or someone they know or searching for addiction counseling, or maybe they themselves are looking for addiction counseling, Virtual Connect offers addiction counseling. Am I correct in saying that?
Yes, we do.
Can you tell us a little bit about your approach or organization and how a listener could connect to either make a referral or to book an appointment?
Absolutely. So I'll just give a little bit of a history. So Virtual Connect started as a cross Canada counseling platform with the goal of making counseling easily accessible to Canadians. Essentially who don't know where to start. And so our goal is to offer a space for people to come in.
They dunno what they're looking for in necessarily a clinician. 'cause I think something that I learned is for us. It's oh, like I think I'd like a DBT clinician. But if you haven't spent seven years in school, you might not know what that actually means. And so having the language to be like, yeah, I'm struggling with my drinking and I need some support. And so our goal is to pair individuals with counselors who are best suited to what their needs are. And that can be done in various ways.
So our website is www.virtualconnect.ca. And right on the front page there, there's a contact form you can fill out that I will then look at and reach out to clients if they're interested and get them paired with somebody on our team who is best suited to what they're looking for, as well as a quiz to fill out the information for what you're interested in.
So yeah, if anyone has any questions, you're also welcome to send me an email at info@virtualconnect.ca for general inquiries or client referrals.
So to either book an appointment or send a referral to Virtual Connect, head to their website at virtualconnect.ca, or you can simply scroll down to the show notes and click on the link.
Stephanie, thank you so much for joining us on the podcast today to discuss how to support clients through addiction treatment.
Thank you so much for having me, Kayla.
And thank you everyone for tuning into today's episode, and I hope you join me again soon on Your Clinical Supervisors Couch podcast.
Until next time, bye for now.
