Meeting Clients Where They Are: Crafting Effective Substance Use Disorder Treatment Approaches

Next Generation: SUD

March 3, 2025

Tom O’Connor, Co-Author & Publisher

Belinda Bickford, Co-Author & Substance Use Disorder Clinician

Topic

Revolutionary Thinking is a way of thinking that challenges the status quo and advocates for radical change. Revolutionary thinkers question how things have always been done.  They challenge the status quo and existing political structures.  Revolutionary thinkers are open-minded and don’t accept ideas second-hand. They support abrupt, rapid, and drastic change.  

The specifics of every person’s substance use disorder (SUD) journey are different, but for most people, the path to recovery follows a similar trajectory: a “bottom” followed by a decision to take action; the initial, often traumatic physical and mental adjustment to life without the substance; the gradual establishment of maintaining substance abstinence; and advanced recovery.

I am honored that Belinda Bickford is joining us on this issue and describing her SUD journey in a small rural northern Wisconsin town where everybody knows everybody and everything about everybody.  According to Belinda, northern Wisconsin has postcard-pretty landscapes that hide some ugly truths regarding substance use disorders because of the shame that attaches a stigma to SUDs.

In my research work, I have found the most revolutionary thinking comes from those who have experienced SUDs and co-occurring mental health disorders.  Therefore, I wish to seek out as co-authors more of those who have suffered from SUDs and successfully undergone recovery and treatment. I believe individuals in substance use disorder recovery are in the best position to move SUD treatment forward through rapid and drastic changes. 

Additional Information For You

According to Belinda Bickford,

When Your Counselor’s Been There

I used to count shots, hits, milligrams.  Now I count days of not using meth, opiate, benzos, and collections of other substances, what I used to think were “fun” treats. And between those two realities, I found myself on both sides of the counselor’s desk – the first as a client trying to keep my shit together.

The person you are counseling today might have been the person who watched you stumble out of the local bar five years ago or read about your criminal enterprises in the local newspapers. Running into your old drinking buddies regularly on the town sidewalks. That’s not just awkward; playing on both sides of the desk is humiliating.  Living here, where the nearest treatment center might be an hour’s drive away, and everyone’s cousin’s friend’s sister has “that problem,” we face unique challenges.  The isolation can be suffocating.  The resources? Sometimes, they can feel as sparse as parking spots during hunting season.

But here’s where my double life gives me a perspective that no one else has in the community I serve.  I know both the desperation with SUD and the hope of recovery from the inside out.  As a client, I’ve sat in those uncomfortable chairs, fighting the urge to bolt. I’ve also sat in the counselor’s chair, watching someone else fight the same battle.

Let me tell you something: they don’t teach you how to attain a bachelor’s degree in addiction counseling and substance abuse – sometimes the most powerful thing you can offer someone isn’t your professional expertise – it's your humanity, also having a substance use disorder in long-term recovery. Being a counselor with a SUD past means constantly walking between professional boundaries and the authentic connection of once being there in the same position as your clients.

After a stint as someone with SUD, Belinda became a substance use disorder counselor with a passion for helping others find their path to recovery at the Family Health Center of Marshfield’s Alcohol and Drug Abuse Recovery Center and an Adolescent/Adult Accountability Coach for IGNTD, an innovative online addiction platform. Belinda received a Bachelor of Arts (BA) in Addiction Counseling and Substance Abuse from Ottawa University.

Belinda’s first job was as a Treatment Specialist at the Wisconsin Department of Corrections. According to Belinda, 

I mastered the delicate area of drill sergeant-style rehabilitation (because nothing says “recovery” quite like being barked at to get your life together). I found myself sitting in my first staff meeting at a residential treatment center, armed with my personal recovery experience and the rigid structure that only working in corrections can drill into your mind. Talk about culture shock—I'd traded my corrections clipboard for a treatment center's manual of absolutes, only to find they had more in common than anyone would care to admit.

The message being hammered home was crystal clear: abstinence or death, SUD is a lifelong disease, and if you even think about deviating from this doctrine, you might as well hand your clients their relapse on a silver platter with a side of "I told you so." Coming from a system where control was currency, I thought I'd seen it all - but trading one absolutist approach for another felt like switching seats on the Titanic. Still incredibly green in what I was doing, I had that dangerous combination of enough personal experience to think I knew something and enough influenced mindset to think the structure could fix everything.

When we treat SUD as merely a primary condition, we miss the forest for the trees. The story of SUD is often written long before the first drink or drug - in childhood trauma, in generational patterns, in systemic inequities, and in the complex web of human suffering. Recent research supports this view, suggesting that viewing SUD solely as a chronic brain disease can limit treatment options and increase stigma.

Working with Native American communities opened my eyes to this reality in ways no textbook could. I've witnessed how historical trauma, poverty, and systemic barriers create perfect storms for SUD to take root. These experiences forced me to question the one-size-fits-all approach to recovery that dominates much of the treatment industry.

Breaking Down the Disease Model

The traditional disease model of addiction has served an essential purpose. It helped move us away from viewing addiction as a moral failing and toward treating it as a health issue. However, emerging perspectives challenge this model, pointing out its limitations in accounting for many people's diverse paths to recovery.

When we frame SUD solely as an incurable, progressive disease, we inadvertently create a narrative that can become a self-fulfilling prophecy. It's not that the disease model is wrong - it's that it's incomplete. SUD manifests differently in each person because its roots are unique to their life story.

Your Call to Action

According to Belinda Bickford,

The Power of Individualized Treatment

In my continued practice, I've learned that effective treatment isn't about adhering to a single methodology - it's about meeting clients where they are and crafting approaches that resonate with their lived experiences. Some clients thrive with traditional 12-step approaches, while others find healing through harm-reduction strategies. The treatment field increasingly embraces this spectrum of approaches, recognizing that recovery isn't one-dimensional.

This shift in perspective raises important questions:

• What if we viewed substance use disorder (SUD) not as the core problem but as a maladaptive solution to deeper issues?

• How might treatment change if we focused first on understanding what pain or trauma the substance use disorder is attempting to medicate?  

• What possibilities open up when we stop insisting on lifetime abstinence as the only valid goal?

A New Framework for Recovery

When we begin to see substance use disorder as a symptom rather than the primary disease, our entire approach to treatment transforms. Instead of focusing solely on stopping the substance misuse behavior, we can:

Explore the underlying trauma, anxiety, or depression that may be driving the substance use.

• Address systemic and environmental factors that contribute to substance use.

• Develop personalized recovery goals that match each individual's circumstances and readiness for change.

• Recognize that healing happens in stages and that progress isn't always linear.

This perspective doesn't minimize the seriousness of substance use disorder - instead, it expands our understanding of its complexity and the many paths to healing.

Moving Forward 

The gap between what we're taught and what we encounter in SUD treatment is about as wide as the Grand Canyon. But hey, that gap? It's not just space - it's where the magic happens. It's where we get to throw out the "my way or the highway" manual (which, let's face it, has sent too many people down that highway) and start writing some new chapters.

As someone who's walked both sides of this road—from being the person who needed help to be the person giving it, from being the client to a counselor—I've learned that the most powerful thing we can do is admit that sometimes we don't know what the hell we're doing. And that's okay! The moment we stop pretending to have all the answers is when we can start finding some treatment practices that work.

Here's the beautiful truth I've discovered along the way: recovery isn't about forcing yourself into someone else's box of substance use recovery. It's about finding your path to healing, even if it looks more like a drunk squirrel's trail than a straight line. (Spoiler alert: most authentic journeys look precisely like that drunk squirrel's trail, and that's perfectly fine.)

The future of SUD treatment isn't about finding the perfect method—if there was one ideal method, someone would have trademarked it and sold it for millions by now. It's about recognizing that everyone's journey is as unique as their fingerprint, trauma, and story. And yes, sometimes, that means throwing out everything we think we know and starting fresh.

So here's my invitation to you, whether you're struggling, recovering, helping others, or just trying to understand: 

• Let's get comfortable with being uncomfortable. 

• Let's embrace the mess of healing. 

• Let's acknowledge that sometimes the most professional thing we can do is admit we're all humans trying our best to figure this out.

Because at the end of the day, real healing doesn't happen in the rigid spaces of "must" and "should" - it happens in the beautiful, chaotic, sometimes hilarious space of "what if?" 

• What if we tried something different? 

• What if we listened more and preached less? 

• What if we treated people like people instead of problems to be solved?

And hey, if you're reading this and thinking your recovery doesn't look like what everyone told you, it should welcome you to the club. We meet at the intersection of Reality and Hope; there's always room for one more because the truth is, the only "right" way to recover is the way that keeps you alive, growing, and moving forward—even if that movement sometimes looks like a three-legged dog chasing its tail.

Here's to finding our way together, one beautifully imperfect step at a time. And remember—if your path to healing looks weird, you're probably doing it right. After all, the standard cookie-cutter treatment approach hasn't worked out so great for any of us so far, has it?