Can I Tell My Therapist About Drug Use?

If you’re attending an addiction treatment program, professionals on the team will ask you about your drug and alcohol use.

In a private practice, however, therapists might not take a complete substance use history from every new client. So, if you don’t willingly disclose, they’ll likely never know.

Some people worry that if they share too much, they might find themselves in trouble with law enforcement. Others hold back because they’re scared their therapist might judge them harshly for using drugs now and then.

So, can you tell your therapist about drug use? Or is it too risky?

The short answer is this: You should be as open with your mental health care provider as possible. This includes your present and past drug/alcohol use.

What rules and regulations are there to protect your privacy when you do disclose? When can your therapist legally breach confidentiality? What’s the best way to volunteer information about your illicit drug use during therapy?

Read on to find out.

Patient-Therapist Confidentiality and Substance Use in NJ

Federal HIPAA privacy rules apply in the state of New Jersey, and the main purpose behind them is to protect the patient. Under these regulations, healthcare providers can’t disclose protected health information without a strong cause or a signed waiver.

Both mental health care and substance use are covered by the HIPAA regulations. So, your therapist is bound by confidentiality.

That’s a cornerstone of psychotherapy.

If clients couldn’t trust that the sessions are (and will remain) private, odds are they wouldn’t attend therapy at all. Even if they did, it would be extremely hard to get them to be emotionally secure enough to confide in their therapist.

The Ethical Aspect in Therapy

Even if therapists weren’t legally required to keep their sessions confidential, they wouldn’t go on revealing details about their clients to everyone.

There’s still the ethical aspect to think about, after all. In fact, licensed professionals might face disciplinary action if they breach the patient-therapist confidentiality without valid cause.

3 Situations Where a Therapist Might Break Confidentiality

In most cases, your therapist won’t tell anyone about the things you share in confidence, including details about your alcohol and drug use.

That said, there are some exceptions, and they have to do with your well-being and the safety of those around you.

1. You Plan on Using Drugs to Harm Yourself (Or Others)

One reason a therapist might be obligated to breach confidentiality is if they believe their client is a threat to themselves or others.

For instance, if they believe your plan on using drugs to self-harm or hurt someone else, they’ll have to notify the proper authorities.

2. Your Drug Use Is Putting Children at Risk

Even if you’re actions aren’t ill-intended, therapists could be required to report to authorities if they suspect child abuse.

Suppose they realize that one of their clients is leaving illicit substances within a child’s reach. In this case, social workers or CPS need to be involved.

3. Your Therapist Is Subpoenaed

If a court finds it necessary, professionals who offer counseling services might be required to disclose confidential client information.

5 Reasons to Disclose Your Drug Use in Therapy

Despite the exceptions to the HIPAA confidentiality rules, it’s still a good idea to talk to your therapist about your drug use.

Here’s why:

1. Your Therapist Needs to See You as a Whole Person

You might not want to share everything in therapy right away, but you have to be open and vulnerable.

Remember that psychotherapy is never a one-size-fits-all. The more your psychotherapist knows, the better they can understand you as a person, which will translate to more effective treatment overall.

Maybe your drinking (or drug use) stems from a deeper problem. Maybe it isn’t. Either way, it’s part of the package, and your therapist needs to hear about it.

2. A Good Therapist Won’t Judge

You might be worried that your therapist will judge you simply because you use illicit drugs. In reality, a therapist’s main focus is their client’s well-being. They’re not here to judge or arrest people for doing drugs.

Plus, an experienced mental health care professional has likely heard a little bit of everything over the years. You’re not going to be the first (or last) client to discuss their drug habits in therapy.

So, if you feel like your provider is judging you, it might be time to see a new therapist.

3. It Might Change the Diagnosis Altogether

When someone has both a mental health issue and a substance use disorder (SUD) at the same time, they’re considered a dual-diagnosis patient.

Dual diagnosis isn’t uncommon at all.

In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that at least one in four people suffering from a serious mental health condition also happens to have an SUD. It’s particularly common with depression, anxiety, and schizophrenia.

Both cognitive and dialectical behavioral therapies can be used to treat co-occurring disorders. But for the treatment to be effective, your therapist has to know that they’re tackling two problems rather than one.

It’s also worth noting that, sometimes, the symptoms of drug abuse look a whole lot like mental illness. The last thing you want is for your therapist to misdiagnose you just because you weren’t completely honest.

4. You Might Need More Than What Your Therapist Has to Offer

It’s generally a good idea to let healthcare professionals know that you’ve been using drugs. One compelling reason to do so is to help them adjust the prescribed medication accordingly to avoid drug-drug interactions.

Now, your therapist won’t prescribe medications for your mental illness at all since that’s a psychiatrist’s job.

So, if you do need more than just psychotherapy for your dual diagnosis, your therapist won’t be able to help. Instead, they have to refer you to a specialized psychiatrist.

5. Trust Goes Both Ways

Think of the therapeutic relationship as an alliance. It has to be built on a base of collaboration and trust. And to build trust, you need transparency and open communication.

The next time you decide to keep something from your therapist, consider that you might be making the treatment process more difficult.

How to Talk to a Therapist About Substance Use

Now that you know why disclosing substance abuse in therapy is a smart move, you might be wondering how to go about it.

Here are some tips to make the conversation easier:

1. When in Doubt, Ask

If you’re still worried about confidentiality, just ask your therapist in hypotheticals. For instance, you could ask them what drug use scenario would make them breach confidentiality.

2. Be Prepared to Give Details

Opening up can be hard, but it really helps to come prepared. Your therapist will most likely want to know:

• What drugs do you use, and do you mix substances?
• How often do you use drugs, and what triggers you to do so?
• How bad do the cravings get?
• When did you start using drugs?
• Have you tried to hide your drug habit from family members or loved ones before?
• What are your expectations, and are you open to the idea of rehab?

3. Brace Yourself for the Possible Outcomes

Your therapist might continue seeing you after altering the diagnosis and/or treatment plan. They might also refer you to a different psychiatrist/therapist who specializes in SUDs.

Know that this isn’t necessarily a bad thing. A healthcare professional who has helped lots of patients in similar conditions will be better equipped to handle your case.

In many addiction treatment centers, licensed therapists are part of the treatment team. They walk patients through the process, run group sessions, and help people identify their triggers. Even medication-assisted programs could use an experienced therapist on the team.

4. Set Boundaries

Perhaps your therapist will decide that you can still see them because they can handle your drug use issues. If that’s so, then you’ll want to discuss boundaries and expectations.

For instance, some therapists don’t appreciate it when clients show up to in-person appointments intoxicated or high. They might even reschedule the therapy session altogether because they believe it would be a waste of everyone’s time to continue.

Get the Psychotherapy You Need Today

If you’re seeing a therapist in their private practice, odds are they won’t know a thing about your drug use unless you tell them. Usually, it’s a good idea to volunteer the information simply because it can change the diagnosis and treatment direction.

Keep in mind that therapists aren’t here to judge or shame you. All they want is to help you get better, and that’s hard to do when you’re not completely honest.

Here at NJ Addiction Resources, we understand the importance of a therapeutic alliance for recovery. Our team can help you find a licensed therapist you can trust with your personal information.

Get in touch with us today for more details.