Problems involving substance use can manifest in many different ways — but they are not uncommon. Surveys by the Substance Abuse and Mental Health Services Administration have found that as many as 1 in 6 Americans may have a substance use disorder (SUD) during a given year. Unfortunately, only about 1 in 4 people with a substance use disorder get treatment. Stigma and shame are often barriers, and sometimes people just aren’t aware of the range of effective treatment options now available.
As part of an ongoing health education collaboration between Spring Health and Highmark Health Digital Magazine, I interviewed Nicole Roger, MFT, a licensed behavioral health therapist whose specialties include substance use disorder. We hope our conversation will help reduce stigma and provide readers with a better understanding of substance use disorder and treatment.
Dr. Amy Cirbus: Nicole, tell us about yourself. How did you find your way to the mental health field, and develop a specific interest in substance use disorder?
Nicole Roger, MFT: As a licensed marriage and family therapist (MFT), my journey into mental health has been both personal and professional. My initial curiosity about substance use disorder stemmed from its prevalence in my family. As I educated myself about SUD treatment, I was shocked to discover the lack of education, resources, and empathy available for those struggling. To gain hands-on experience in treating SUD, I accepted a role as a case manager for the State Bar of California Lawyer’s Assistance Program. In this position, I supported attorneys dealing with addiction and co-occurring mental health disorders. Many of my clients, despite being highly intelligent and successful, faced significant barriers to accessing appropriate care, often waiting weeks or months for higher levels of treatment. Learning about the systemic issues in SUD care inspired me to advocate for better support and resources for individuals in need.
My interest in how technology can expand access to care, particularly for SUD, ultimately led me to Spring Health, where I combine my therapeutic background with my commitment to improving mental health accessibility. I focus on providing innovative mental health solutions to organizations and advocate for the importance of mental wellness in the workplace. My goal is to empower individuals and communities to prioritize mental health and foster resilience.
Dr. Amy Cirbus: Can you explain how the phrase “substance use disorder” differs from words that some people may be more familiar with, like abuse or addiction?
Nicole Roger, MFT: If we start with different stages of substance interaction, "use" refers to any consumption of a substance. "Misuse" means using a substance in unintended ways, like taking more than prescribed. "Disorder" indicates a pattern of misuse that interferes with daily life, making it diagnosable. "Abuse" is an outdated term, once used to describe harmful substance use. "Addiction" is a chronic brain disorder characterized by the inability to stop despite harmful consequences.
Mindful language is essential. Terms like "abuse" can be stigmatizing. Using person-first language, like "a person with a substance use disorder," promotes empathy, reduces shame, and reinforces that this is a medical condition, encouraging those in need to seek help.
Dr. Amy Cirbus: How does someone know if they have a problem or can benefit from treatment?
Nicole Roger, MFT: Recognizing patterns and their impacts is key. Many people don't realize they have a problem until substance use starts affecting various aspects of their lives. Signs may include using more than intended, difficulty cutting back, or preoccupation with using. I encourage people to reflect on how substance use influences daily life — how it affects your work, relationships, and responsibilities.
Physical and mental health issues can also signal a need for treatment. Even infrequent use can become problematic if it disrupts well-being or control. There are screening tools that assess severity, but recognizing how substances consume your mental energy is often the first step. If you feel guilt, others express concern, or negative impacts increase, seeking help is strongly recommended.
Dr. Amy Cirbus: What are the causes or risks of developing a substance use disorder?
Nicole Roger, MFT: The causes are multifaceted, involving biological, psychological, and environmental factors. Genetic predisposition increases vulnerability, but it doesn’t guarantee the development of SUD. Trauma is a significant risk factor; those who have experienced trauma often turn to substances to cope with overwhelming pain. This creates a strong link between SUD and past trauma.
Mental health issues, like anxiety or depression, also play a role. Many people self-medicate with substances, which can actually worsen symptoms over time. That’s why it’s essential to treat both mental health and substance use together.
Environmental factors, such as chronic stress or peer influence, can also increase risk. People in high-pressure situations may turn to substances as a coping mechanism, and peers can normalize substance use behavior.
To be clear, though, having risk factors does not always lead to the development of SUD. Many people with risks don’t develop problems, while others without clear factors might. Support systems and coping skills significantly impact managing these risks.
Recognizing risk factors helps us understand vulnerability, but we must also focus on supporting those struggling. Addressing underlying factors like trauma and mental health can lead to more effective and compassionate care.
Dr. Amy Cirbus: What are some of the different types of treatment available?
Nicole Roger, MFT: Treatment for SUD varies widely, offering many options for individuals.
Outpatient therapy allows individuals to attend sessions while managing daily life, with flexibility from weekly sessions to intensive day programs.
Telehealth has transformed treatment access, allowing individuals to participate in therapy from home. This flexibility reduces barriers, making it easier to seek help when needed.
Medication-assisted treatment (MAT) is a whole-person approach that combines medication with counseling, particularly for opioid or alcohol use disorders. Medication can reduce cravings and withdrawal symptoms, facilitating engagement in recovery. Just to be clear, some people get counseling and do well without taking medication, and getting medication for a substance use disorder does not necessarily require counseling. The combination, MAT, can be very effective, but it’s just one option.
Inpatient rehab programs offer structured environments for those needing intensive support. These programs typically last 30 days or longer and provide 24/7 medical supervision. Partial hospitalization programs are another option, offering daily treatment while allowing individuals to return home.
Cognitive Behavioral Therapy helps individuals understand thoughts, feelings, and behaviors, empowering them to challenge negative patterns. Motivational Interviewing is a technique that enhances motivation to change by resolving ambivalence and meeting individuals where they are.
Peer support groups, like Alcoholics Anonymous (AA) or SMART Recovery, provide community and shared experiences, fostering mutual support in recovery.
Ultimately, the key is finding a treatment plan that fits the individual’s unique needs and lifestyle. What works for one person may not work for another, and that’s perfectly okay. The goal is to provide a range of options that empower individuals to take charge of their recovery journey.
Dr. Amy Cirbus: Can someone get treatment and still work?
Nicole Roger, MFT: Absolutely! A common misconception is that individuals struggling with substance use disorder must put their lives on hold to receive treatment. If you look at Spring Health’s program, for example, it is designed to provide recovery options that fit seamlessly into members’ lives, allowing them to continue to work, care for their families, and stay engaged in their communities. Our Licensed Care Navigators, trained in the American Society of Addiction Medicine criteria, help us provide early outreach and proactive, personalized support — detecting needs early and triaging members to the appropriate level of care, including outpatient programs that can be done from home.
Dr. Amy Cirbus: What typically keeps people from getting treatment?
Nicole Roger, MFT: Stigma is a significant barrier. Shame and fear of judgment often prevent people from seeking help. Substance use disorder is a medical condition, not a moral failing, yet negative perceptions persist.
Another misconception is that treatment requires a long-term commitment, such as a month in rehab. In reality, treatment is individualized — some may need only outpatient therapy or a few sessions per week.
Access to care also presents challenges. Financial concerns, lack of insurance, and geographical barriers can hinder treatment. However, telehealth and virtual care have made support more accessible, often at lower costs.
Denial is common — people may question whether their substance use is severe enough to need help. They may downplay its impact or wait for conditions to worsen before seeking treatment.
Ultimately, fear, shame, and misinformation hold people back, but increasing awareness and flexible care options are making treatment more accessible. You don’t have to wait for a crisis to seek help; support is available at every stage of the journey.
Dr. Amy Cirbus: What can someone do if they’re worried about a loved one or friend?
Nicole Roger, MFT: Approach the situation with empathy. Start by expressing concern from a place of care, like asking how they’re doing and genuinely listening. Frame your concerns positively — for example, “I’ve noticed you seem a bit down lately, and I want to make sure you’re okay.” This encourages dialogue without placing blame.
If they’re receptive and you’re able, offer to help them find resources or accompany them to an appointment. Suggesting small steps, like exploring support groups, can feel less overwhelming than committing to full treatment right away.
Remember, you can’t force someone to seek help — they need to be ready to take that step. Your role is to provide support and encouragement while also protecting your own well-being by setting healthy boundaries. Supporting someone with substance use disorder can be emotionally draining, so prioritize and practice self-care and consider engaging in therapy for yourself or joining a support group for loved ones. Doing this can help you stay grounded, avoid burnout, and be a more effective support for your loved one.
Proactively educating yourself about SUD and available resources will help facilitate productive conversations. Encourage open communication and be patient, as change takes time. Your ongoing support is vital to their journey, but equally important is tending to your own emotional health throughout the process
Dr. Amy Cirbus: What can we all do to help reduce the stigma of SUD, so more people reach out for help?
Nicole Roger, MFT: I love this question, because there’s so much all of us can do!
Stigma around SUD often stems from misunderstanding and judgment, which can make it difficult for people to seek help. To reduce this stigma, we need to shift the conversation from blame to compassion and education. As I said previously, SUD is a medical condition, not a moral failing — it affects the brain, behavior, and overall health, just like any other chronic illness. When we frame it as a health issue and emphasize that recovery is possible, we create an environment where people feel supported rather than shamed.
Getting back to being mindful of the language we use, simple choices like saying “a person with a substance use disorder” instead of “addict,” can help reinforce dignity and humanity. Finally, sharing stories of recovery and showing visible support for those in treatment or recovery can be incredibly powerful. When we approach SUD with empathy, education, and openness, we create a culture where reaching out for help feels not only safe but encouraged.
By: Dr. Amy Cirbus
Originally Posted: February 12, 2025 on Highmark Health
Nicole Roger, MFT is the Director of Clinical Partnerships, Spring Health.
This article was first published in Highmark Health Digital Magazine and is used with permission.
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