Your therapist is trying to help you. This therapist may be your methadone doctor, psychiatrist, family doctor, counselor, psychotherapist,etc. In any case, they are trying to help you. In order to help you, they need all the information that you can give them. If you hold back some information, they may be missing some very important things that could affect your care. It is to your benefit to have full disclosure with your therapist.
In my methadone practice, the biggest area of dishonesty is cheating on urine drug screens (UDS). If you used street drugs, and are worried about losing carries, be reassured that you only lose one carry, and get it back the following week if your UDS is clean. However, if you get caught cheating, you lose all your carries, and cannot get a new carry for one full month. If you cheat a second time, then you lose all carries and cannot get a new carry for three months. This would also seriously erode the trust between you and your doctor. It takes a long time to regain this trust.
It is much better just to be honest, lose the carry for one week, and move on. If you think about it, cheating on your UDS can seriously compromise your recovery.
Being honest about what drugs you are using has other benefits. Addiction is all about dishonesty to yourself. “I can use once and it will be okay,” “I didn’t use that much,” “it isn’t a problem.” These are things that people tell themselves. Even though you may not fully believe it, telling yourself these things downplays the seriousness of your condition. If you lie to your therapist, you can more easily lie to yourself. In order to fully recover, you need to stop lying to yourself most importantly. Not lying to your therapist will help you in not lying to yourself.
Another benefit of honesty is showing your therapist how serious you are in getting better. I have seen many patients come in and tell me “my UDS screen is faulty because it is showing that I did not use, but I did.” They know full well that they will lose a carry by telling me this, even though the UDS is negative. When I mention this, the reply I get is “I know, but I really want to get better.” This speaks volumes. The reason you lose a carry for using drugs is so that you associate a negative consequence with using street drugs. It is for your benefit alone. It is very important that you understand this.
Some people see the therapist as an adversary. They want to “get one over on them.” They may figure that if they can get past the therapist, then they are doing well. They may be embarrassed about using, and don’t want to disappoint therapist. They may think that the therapist will get angry if they tell them that they used recently. Your therapist is not the police. Your therapist is not a parent. Your therapist is not your friend. Your therapist is a professional who is trying to help you in the best way they can with the information that you give them. If you see your therapist as an adversary, then in all likelihood they will not be able to help you.
Your therapist is your ally. Be honest, tell them all the street drugs that you use – even if they don’t ask you – and don’t hold back. Only then can your therapist fully help you. That is the goal, your therapist wants to help you.