How to Start Therapy for Substance Use

For most people, the thought of starting therapy for substance use doesn’t happen in one dramatic moment. It starts quietly.

For Jasmine, it was the Tuesday morning she stood in front of her bathroom mirror, mascara smudged, wondering why she couldn’t remember exactly how she’d gotten home the night before.
For Andre, it was sitting in his car outside his kids’ school, realizing he’d been hungover at every pickup for the past two weeks.
For Megan, it was catching herself pouring another drink even though she’d promised she’d only have one that night.

They didn’t all feel “ready.” In fact, none of them did. But the thought stuck: “Maybe I need help.”

That First Quiet Decision

Here’s the truth: you don’t have to wake up one day with unshakable certainty before starting therapy. Most people arrive still feeling conflicted. They’re not sure if they want to quit entirely. They’re not sure if they’ll be able to change at all.

That’s okay. Therapy isn’t a contract you sign for the rest of your life. It’s a place to explore the questions you’ve been avoiding.

Many therapists use Motivational Interviewing in those early conversations. It’s not a lecture or a checklist. It’s a back-and-forth that helps you answer questions like:

• What do I want my life to look like six months from now?

• What am I afraid might happen if I change?

• What would I want to feel more of if this habit wasn’t in the way?

Sometimes, simply speaking those answers out loud for the first time is enough to shift something inside you.

Finding the Right Person to Talk To

Once you’ve decided to give therapy a try, the next step is finding the person you’ll work with. This is where a lot of people get stuck.

Scrolling through online directories can feel like being lost in an endless catalog: dozens of photos, credentials, and phrases like “integrative approach” and “client-centered therapy.” It’s hard to tell what any of it means until you meet the person.

Here’s how different people handle it:

Jasmine wrote down three things she wanted in a therapist: experience with addiction, trauma-informed training, and evening appointments. Then she filtered her search to those criteria only.

Andre didn’t want to overthink it. He picked two therapists who seemed approachable, sent each an email, and decided to go with whoever responded first in a way that made him feel comfortable.

Megan asked a friend in recovery for recommendations, then looked those therapists up online.

And remember: you’re not auditioning to be their perfect client. You’re interviewing them too. You’re allowed to ask:

• Have you worked with people in recovery before?

• How do you usually approach treatment?

• What would our first few sessions look like?

Walking Into the Room for the First Time

That first appointment is often the hardest.

Jasmine almost canceled hers. She sat in her car outside the office, checking the time on her phone every thirty seconds, wondering if she could just reschedule. She told herself, You can always leave if you don’t like it. That thought got her through the door.

Andre chose a virtual appointment. He sat in his parked car so his kids wouldn’t overhear. Halfway through, he realized he’d been clenching his jaw for the entire first 20 minutes.

Megan found herself blurting out things she’d never said to anyone — not because she’d planned to, but because the space felt safer than she expected.

Most first sessions follow a similar rhythm: the therapist asks about your history with substances, what’s been going on in your life, and what you hope might change. You can share as much or as little as you want.

And if you leave thinking, I’m not sure this person is the right fit, that’s normal. Many people try one or two therapists before finding someone they click with.

Deciding Who to Tell (and How)

Not everyone announces they’ve started therapy — and you don’t have to either.

Andre told his wife right away because he knew it would help him stay accountable.
Megan told no one at first; she wanted to see how it felt before sharing.
Jasmine confided in one friend who had been through therapy before.

If you do tell someone, it can help to set boundaries: “I’d like your encouragement, but I’m not ready to talk about details yet.”

Figuring Out the Cost

The financial part isn’t glamorous, but it’s real.

Jasmine discovered her insurance covered therapy, but only if the therapist was in-network. She made a few calls and found someone she liked who met that requirement.

Andre didn’t have insurance. He ended up at a community clinic in Chicago’s North Side that offered sliding-scale rates based on income.

Megan found out her employer offered an Employee Assistance Program that covered six free sessions — just enough to get her started.

Adjusting as You Grow

Your needs will change as you go.

Jasmine started with individual therapy and later added group sessions to connect with others in recovery.
Andre focused on day-to-day coping skills for the first three months, then began exploring past events that had shaped his drinking habits.
Megan switched to a therapist with more experience in trauma work when she realized her substance use was deeply tied to old wounds.

The best therapy is flexible, it grows with you. You’re allowed to say, “I think I need something different now.”

For information on the different types of therapy that are most effective for substance use recovery, read here.

The Hardest Step Is Still the First One

Starting therapy for substance use isn’t about having the perfect words ready for your first session or knowing exactly what you want from the process. It’s about taking that first step, making the call, sending the email, checking your insurance or walking through the door.

And when you do, you’ll find you’re not the only one who’s been here. People like Jasmine, Andre, and Megan have stood where you’re standing. They took the first step, even with doubts, and found themselves in a process that changed their lives in ways they couldn’t have predicted.