An Interview with an Addiction Counselor: Dr. Holly Sawyer

Ph.D., MS, LPC, CAADC, NCC; Founder of Life First Therapy

Dr. Holly Sawyer

Dr. Holly Sawyer is an LPC and CAADC in Philadelphia. She has worked in the field of addictions and mental health for five years and as a college-level instructor for 11 years. Her experiences with college students struggling with mental health and substance abuse issues motivated her to pursue counseling. Dr. Sawyer teaches, provides counseling to patients with co-occurring disorders, and educates people about mental health and substance abuse stigmas. Dr. Sawyer advocates for the decriminalization of drug-related crimes and operates Life First Therapy.

Question & Answer

How did you get to where you are today?

I am a licensed professional counselor and I’m also a certified advanced alcohol and drug counselor. I’ve worked with mothers, and women, mothers, and children. I’ve worked in methadone clinics and I’ve worked in coed outpatient facilities. I’ve been in the field of addiction for about five years now. And I also have a private practice serving with professional women of color, but I’m also focused on substance abuse and recovery. And I’m located in Philadelphia.

What drew you to focusing on addiction counseling?

When I went into my master’s program, I initially wanted to go into mental health, but there was such a high need for people specializing in drugs and alcohol. I noticed that a lot of the students who I was teaching, whether in undergraduate, graduate, or adult education, were having a lot of co-occurring issues. By that I mean they had mental health issues and were using substances to cope, or they had substance issues and they used that to minimize their mental health issues.

I feel that women of color are underrepresented in the field — and it’s hard to find a therapist who can relate to being a person of color in the work environment, facing microaggressions and similar conflicts.

You also focus on helping women of color work through depression and anxiety related to their careers without using substances?

Exactly. A lot of the professionals I see happen to be black and Latina women, and they may suffer from depression or anxiety or other issues. They may feel like they don’t have the proper coping skills, so they’ll turn to substances. I’m the person who says, "Hey, no, let’s develop some coping skills together so you don’t have to turn to substances." I also have people who have lost their jobs [because of substance abuse], or their employers have found out [about their addiction problem] and they’re suggesting they should get help. The type of clients I have varies, but I’m focused on making sure that they are not using substances to cope with anything that’s work- or mental health-related.

Why did you want to focus on creating an environment for women of color?

I feel that women of color are underrepresented in the field — and it’s hard to find a therapist who can relate to being a person of color in the work environment, facing microaggressions and similar conflicts. This has been part of my experience, too, when I’ve gone to therapy, so I felt it was important to create that space.

Can you describe the stigmas faced by racial minorities when they seek help for addiction and mental health issues?

On one end, some people say, "You’re crazy if you’re going to seek a therapist." But not everyone who sees a therapist has been diagnosed with mental health issues. On the other end, people say, "There’s nothing wrong with you. You’re OK. Why don’t you just drink it away, or take this pill, or pray it away?" They generate these stigmas because therapy is not really supported or seen as normal in communities of color.

Do you think the stigmatizations are specific to certain minorities, or is it a broad issue?

I think these stigmas are there across all minorities, though they may be a little different.

Aside from these stigmas, what are other reasons preventing patients from seeking mental health and addiction treatment?

They don’t want to be labeled. They don’t want anyone to "find out" they have a problem. In communities of color, what happens in one’s household remains in one’s household. This has been passed down from generation to generation since slavery. Today, these very same secrets keep many people of color sick mentally, to the point they self-medicate and do not seek therapy.

What are some of the common ways that addiction starts?

Many addictions begin with a traumatic event — a trauma from childhood that wasn’t processed properly. Others begin in adulthood — someone [who was] prescribed Percocet after a surgery, for example, who never experienced addiction previously, but the painkiller use spiraled into opioid addiction.

Does the feeling of addiction ever go away? Are people ever "cured?"

There’s a debate about whether addiction is a disease or not. So if you’re coming from the disease school of thought, then it can be managed in the way that diabetes can be managed, but not necessarily cured. So, for example, if I have diabetes, does it go away? No, but it can be managed.

The best thing I can do is minimize. So, for someone with an addiction, let’s just say to alcohol, their minimization will basically be them just no longer drinking. You manage by going to NA and AA meetings. We go through our NA steps, we get a sponsor, we get the support, we go to treatment — that’s how we manage our addiction. Because if we don’t, then we’ll remain active in the disease.

Do you feel like the only solution is sobriety?

I had a client with severe alcohol addiction who felt like she could go out with her family and have just one drink, but one drink was never enough. She would spiral back to her addiction. I don’t think there’s a safe space for someone to use because if they could use safely, they wouldn’t be addicted. You can’t just safely just — "oh, I’ll just have a drink. I’ll just have a joint," or, you know, "I’ll go to the bar. I won’t drink with my friends, but I’ll sit around and I’ll be social."

Can anyone become addicted? Or is it just people with certain personality traits?

We are all recovering from an addiction to something — it doesn’t have to be a drug. It can be a process addiction, like gambling, sex, or food. Any time you obsessively use something that prohibits you from functioning normally and it has negative consequences, then there’s an addiction there.

What does it look like when someone is using healthy coping mechanisms?

The healthiest way to cope is definitely having a strong support system. You need to find a peer support group specific to your addiction. If you feel triggered, like you want to seek out your addiction, you can make those phone calls or attend those meetings that take you off the ledge. A lot of people don’t think of that as the main coping, and some people do, and they feel like, "OK, it makes me feel better when I’m around others who have gone [through this] or know exactly what I’m feeling, and what this feels like when I’m feeling triggered to go into my addiction." I think support groups need to be coupled with therapy, whether group or individual.

Does shame play a large role in addiction?

Sure. Those of us not in addiction don’t know and can’t understand those who are addicted. Because we’re not educated, we shame — we judge. And we don’t take the time to really understand the loved one who is in an active addiction and what that looks like and what’s going on. You have people who have a closet addiction and won’t tell a family member because of that fear of judgement — that fear of shame.

Was it always easy for you to relate with clients? How did you develop empathy for clients?

I have family members with addictions, so that was definitely a frame of reference for me. My foundation, if you will. That knowledge, that hands-on experience, helps you understand addiction even better. You don’t have to be an addict to help an addict, but if you have been exposed to it in some regard, I do think that it does allow you to be that much more empathetic and understanding.

What is the best part about the work you do?

The clients, because they are there — they’re trying. And they may not get it the sixth time, or the seventh — sometimes it takes three years for one year of recovery. They’re human, they’re optimistic, and they want to be resilient and build the strength. They look to you to help. Being tasked with that is huge, but we’re doing it as a team effort. That’s the best.

What is the hardest part about the work you do?

The hardest part is when the disease takes over even after you’ve done a lot of work collaboratively. Just last month, I lost three clients within 30 days to the opioid crisis. Going to the funerals is hard, seeing someone you were just having a laugh with. The hardest part is watching them slowly die.

What’s something you wish people knew about addiction?

There’s no safe way to be an addict. I want people to educate themselves about addiction, to minimize their shame and judgment. Do you have to enable their addiction? No. Do you have to support it? No, but there are ways you can still love the person.

The healthiest way to cope is definitely having a strong support system. You need to find a peer support group specific to your addiction.

What’s your advice to people who love someone who is struggling with addiction?

Find a way to support them that doesn’t enable them, but helps them stay sane. Set clear boundaries with them. Don’t give them cash if you know they’ll use it to feed their addiction, but offer them a shower or a hot meal or something for their kids if they need it. Express your love and concern. Offer to support them by attending a recovery meeting or going to an outpatient clinic with them. Let them know you’re here.

How can America better treat people with addictions?

Decriminalize how we treat people with addictions. I think if you invest in more recovery centers that are not underfunded — that can actually help the people who are walking through the door — that would be more helpful than just saying, "hey, I’m locking you up for five years." I’m not saying make drugs legal. I think we have to look at the person in addiction who commits the crime and treat them as a whole person. Invest in recovery clinics to help them, not in prisons. We’re only looking at the criminal act.

Look at why they committed the crime?

Yes. Yes. Yes. Someone in active addiction may commit a crime to feed their habit. Why not start with recovery and therapy efforts before sentencing them?

Note: Our conversation has been edited for length and clarity.