Whether it has a name yet or not.

You do not have to have decided anything before you call. Not that you are quitting, not that it is a problem, not what to call it. Plenty of useful work happens with someone who is still genuinely undecided, and pretending otherwise just means people wait another two years.

What we actually look at

Substance use is almost never only about the substance, and it is also never not about the substance. Both of those are true and the work holds them at the same time.

So we look at what it does for you. Not rhetorically. Specifically: which hour of which day, what it replaces, what becomes unbearable without it. That is not an indulgent question. Until you know what job it is doing, taking it away just leaves the job undone.

• The actual pattern, hour by hour, without editing
• What it is managing: pain, sleep, anxiety, memory, boredom, grief
• What has already worked, including the attempts you consider failures
• The relationships it is running through
• Whatever came first, if something did

On relapse

If it happens, it is information, and I would rather hear about it in week two than learn about it in month six. Nobody gets discharged from here for using. The only thing that genuinely ends the work is not telling me what is going on, because then we are both working on a fiction.

If you are already in a program

Good. Twelve-step, medication-assisted treatment, an IOP, a sponsor, a church group, all of it is compatible with this. I am not going to ask you to choose between them and me, and I am not going to spend our hour relitigating whether your program is the right one.

What I do not provide

This is outpatient therapy, not detox and not medical management. Withdrawal from alcohol or benzodiazepines can be dangerous and needs a physician. If that is where you are, tell me on the first call and we will sort out the right order of operations.

If you are in immediate danger or thinking about harming yourself, call or text 988, or call 911. The Colorado Crisis Line is 1-844-493-8255, or text TALK to 38255.