First Sessions

What Should I Expect in My First Therapy Session for Substance Use?

Starting therapy for substance use can feel like stepping into the unknown. Whether you've been thinking about it for a long time or just recently decided to seek help, it’s totally normal to have a mix of feelings — nervousness, fear, hope, skepticism, or even shame. The truth is, walking into that first session is a brave and powerful step toward healing. If you're wondering what it’s actually going to be like, that is totally normal. Let’s break it down.

1. You don’t need to have it all figured out

Many people assume they need to walk into therapy with a clear story, a diagnosis, or some kind of roadmap. You don’t. Your first session isn’t about impressing anyone or proving anything — it’s about starting a conversation. You don’t need to know “why” you’re using substances or have a perfect timeline of events. Just show up. That’s enough.

Therapists know that substance use doesn’t exist solely on its own. It often overlaps with things like trauma, anxiety, depression, grief, or even just the exhaustion of everyday life. Your therapist’s job isn’t to judge you — it’s to help you unpack what’s been going on and figure out how to move forward, at a pace that feels doable.

2. The first session is about TRUST

Your therapist is probably going to ask questions, but not in an interrogation kind of way. They might ask about your history with substances, what led you to reach out for help, and what you’re hoping to get from therapy. This is the beginning of a relationship, and relationships take time to build.

You’re allowed to say, “I don’t know” or “I’m not ready to talk about that yet.” A good therapist will respect your boundaries and meet you where you are. The goal isn’t to get your whole life story in one hour — it’s to begin creating a safe, honest space where you can be yourself, even if you’re feeling messy or unsure.

3. Yes, please talk about other things outside of substance abuse! 

Many people enter therapy thinking the conversation will only revolve around drugs, alcohol, or behaviors they want to change. But often, substance use is just one piece of a much larger puzzle. Maybe it’s how you’ve been coping with anxiety. Maybe it’s how you numb out after difficult relationships. Or maybe it’s the only thing that’s helped you get through chronic stress or burnout.

A good therapist will be curious about you as a whole person — your relationships, emotions, past experiences, strengths, and values. They’ll want to understand how substances have fit into your life and what might need healing or support beneath the surface.

4. You’re the driver of the process 

One of the biggest misconceptions about therapy is that it’s something done to you. In reality, therapy is a collaborative process. You get to speak up about what’s working or not working, what feels helpful, and what feels overwhelming. If you're not ready to stop using substances completely, you can say that. If you’re not sure what your goals are, that’s okay too. I like to think that a client is the driver and the therapist is the navigator holding the map. 

Some therapists use harm reduction approaches, which means the focus isn’t necessarily on abstinence but on reducing the negative impact of substance use in your life. Others may be more aligned with traditional recovery models. The key is finding someone whose style matches your needs and values, and it’s okay if it takes a few tries to find the right fit.

5. It’s normal to be overly emotional or completely numb

Your first session might bring up unexpected emotions. You might cry. You might feel relief. You might feel nothing at all. All of that is normal. Opening up about your relationship to substances, especially if there’s shame or pain tied to it, can be emotional. But you're not alone in this.

A skilled therapist knows how to sit with you in that discomfort without rushing you. They’ll help you build emotional tools over time so that you don’t have to rely on substances to navigate hard feelings.

6. It’s just the first step, and that’s okay! 

The first session is important, but it’s just the beginning. Healing is not a straight line. You might feel better after one session or more confused than ever — both are valid. The important thing is that you showed up. You took a step toward something different.

Therapy for substance use isn’t about being “fixed.” It’s about learning how to feel more like yourself again, reconnecting with your values, and figuring out what a meaningful, healthy life looks like for you.

So if you’re preparing for your first session, know this: you’re already doing the hard part. You’re showing up. You’re being honest with yourself. And even if it feels awkward or heavy, you’re not alone in it.

Takeaways:
If you’re starting therapy for substance use, give yourself credit. It’s not easy to ask for help. But long-term recovery in whatever form that takes for you, begins with small steps. And showing up to that first session? That’s a big one.