Rethinking “Self-Sabotage” in Substance Use Treatment

Behaviors often described as “self-sabotage” in substance use treatment are frequently misunderstood, including by well-intentioned providers. What may look like resistance, lack of motivation, or noncompliance is often a rational response to fear, shame, untreated emotional and mental symptoms, or past experiences where change led to harm rather than safety.  

This workshop challenges common provider assumptions and reframes self-defeating behavior through a strong motivational interviewing and harm reduction lens. Participants will explore how misinterpretation of ambivalence, relapse, or ongoing use can unintentionally stall recovery. The training also emphasizes medication as a legitimate and often necessary first-line intervention, rather than a last resort, particularly when clients lack the stability needed for behavioral change.  

Using case examples and practical clinical language, this workshop focuses on helping providers improve accuracy, reduce dropout, and support meaningful progress by breaking harmful patterns without blaming or mislabeling the people they serve. 

Objectives:

• Identify how behaviors commonly labeled as “self-sabotage” in substance use treatment are often misinterpreted responses to fear, untreated symptoms, or limited capacity for change.
• Apply motivational interviewing and harm reduction principles to better understand ambivalence, ongoing use, and resistance without pathologizing or moralizing client behavior.  - Describe the role of medication as a valid and evidence-based first-line treatment for substance use disorders, particularly when emotional and physiological instability interfere with behavioral change.
• Use practical clinical language and strategies that support safety, engagement, and forward movement in recovery without requiring perfection or premature abstinence. 

About Andra Gomez, LADC-MH:

Andrea Gomez is a licensed mental health and substance use counselor and the founder of AXG Services Inc., a private practice based in Oklahoma City. She holds a Master’s degree in Clinical Psychology from Bond University in Australia and has more than 20 years of experience working in mental health, substance use treatment, and forensic and psychosocial evaluations.  

Andrea began her professional career in 2005 and has worked across a range of settings, including community mental health, treatment courts, program administration, and private practice. Her clinical and evaluative work includes psychotherapy, substance use assessments, Department of Transportation Substance Abuse Professional evaluations, DUI and ADSAC assessments, and specialized immigration-related psychosocial evaluations.  

Born in Bogotá, Colombia, Andrea has lived and studied in South America, Australia, Belgium, and Korea before establishing her home in the United States. She is fluent in English and Spanish and brings a strong multicultural and systems-informed perspective to her work, particularly when serving immigrant and justice-involved populations.  Andrea is known for her practical, ethically grounded approach and her ability to navigate complex systems while maintaining clarity, professionalism, and advocacy for those she serves.