Online Therapy for SUD in Washington
Judgment-free telehealth support for alcohol use, opioid addiction, cannabis use, dual diagnoses, and more — wherever you are in Washington State.
Something shifted, and you noticed it. Maybe you've been drinking more than you planned to. Maybe a prescription became something you needed just to feel normal. Maybe you've tried to cut back a dozen times and it keeps not working — and the shame around that is starting to feel heavier than the substance itself. Substance use disorder isn't a character flaw. It's not a sign that you're weak, or broken, or beyond help. It's a complex, chronic condition with real neurological roots — and it almost always starts as a way to cope with something painful.
At Freesia Therapy Collective, our licensed therapists provide specialized telehealth treatment for substance use disorder across Washington State. We work with people at every stage: those who are still figuring out whether they have a problem, those in early recovery, and those who've been navigating addiction for years. We don't require you to be sober before starting. We don't require you to want sobriety at all. We start where you are.
What Is Substance Use Disorder — and Is What I'm Experiencing SUD?
Substance use disorder (SUD) is a medical diagnosis that describes a pattern of use that significantly disrupts a person's life, despite ongoing consequences. It's not defined by how much you use or how often — it's defined by impact.
You might be experiencing SUD if:
- You've tried to cut down or stop, and haven't been able to
- Cravings or urges to use are increasingly hard to ignore
- Substance use has started affecting your relationships, work, or health
- You need more of a substance than you used to in order to feel its effects
- Withdrawal symptoms appear when you go without
- You're spending more time using, recovering from use, or obtaining the substance
- You feel guilt, shame, or secrecy around your use — but keep going anyway
These experiences are more common than most people realize, and they don't mean you've failed. They mean you deserve real support.
Harm Reduction: You Don't Have to Want Sobriety to Start Therapy
Harm reduction is a well-researched, evidence-based framework that prioritizes keeping people safer — rather than demanding immediate abstinence as the price of admission to care. It treats people as capable adults who can make meaningful choices about their own lives when given accurate information, real support, and a therapeutic relationship built on trust.
At Freesia, harm reduction isn't a last resort. It's a core part of how we practice. Some of what that looks like in session:
- Working toward your goals — whether that's reducing use, eliminating one substance while moderating another, or moving toward full sobriety
- Helping you understand your own patterns without shame or confrontation
- Equipping you with safety strategies that reduce the risk of overdose or serious harm
- Exploring what needs the substance is meeting — and finding ways to meet those needs differently
For clients dealing with polysubstance use (using more than one substance, often in combination), harm reduction is especially important. The risks associated with mixing substances — including depressants with stimulants, or alcohol with opioids — require a clinician who understands those dynamics without flinching.
How We Treat Substance Use Disorder at Freesia
Our clinicians draw from a suite of evidence-based approaches, tailored to where each client is in their relationship with substances.
Motivational Interviewing (MI)
A collaborative, non-confrontational method for exploring ambivalence. Change rarely happens in a straight line, and MI honors that. It helps clients clarify what they actually value, what's getting in the way, and what kind of change feels genuinely possible.
Cognitive Behavioral Therapy (CBT)
CBT works by identifying the thought patterns, beliefs, and situational triggers that feed substance use cycles. Clients learn to recognize warning signs, interrupt automatic responses, and develop healthier coping strategies that actually hold up under stress.
Dialectical Behavior Therapy (DBT)
Particularly valuable for clients whose substance use is connected to emotional dysregulation, trauma, or impulsivity. DBT builds concrete skills in four areas: distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.
Trauma-Informed Care
Because substance use and trauma are deeply intertwined, all of our work is conducted through a trauma lens. That means understanding the roots of coping patterns, moving at a pace the client can tolerate, and building safety before diving into what's most difficult.
Somatic Therapy
Substance use often begins as a nervous system solution — a way to regulate overwhelming emotion, numb stored trauma, or escape a body that doesn't feel safe — and somatic therapy addresses that root directly, helping clients build the capacity to tolerate and move through difficult internal states without relying on substances to do it.
Why Telehealth Is a Good Fit for Addiction Therapy
For many people with substance use disorder, the barriers to seeking help are enormous — stigma, scheduling, transportation, childcare, not wanting to be seen walking into a treatment center. Telehealth removes most of those barriers.
You connect with your therapist by secure video from wherever you are in Washington — Seattle, Tacoma, Spokane, Vancouver, or anywhere in between. Sessions feel like real therapy, because they are.
There's also something worth naming: for people managing shame around substance use, starting therapy from the privacy of your own home can lower the threshold enough to actually begin.
Alcohol Use Disorder: When Drinking Stops Being a Choice
Alcohol is the most widely used substance in the U.S. — and because it's legal, social, and normalized, alcohol use disorder is often the last thing people recognize in themselves.
Signs that drinking may have crossed into disorder include losing track of how much you drink, routinely drinking to manage stress or sleep, experiencing physical symptoms when you go without, and finding that you need alcohol to feel okay rather than just to feel good.
Alcohol use disorder exists on a spectrum — from mild to severe — and treatment doesn't have to mean total abstinence, at least not right away. Our therapists work with clients to clarify their relationship with alcohol, reduce harm, and build toward goals that are meaningful to them.
Opioid Use Disorder: Treatment That Meets You Where You Are
Opioid use disorder — whether involving prescription painkillers, heroin, or synthetic opioids like fentanyl — carries some of the highest risks of any substance use pattern, including overdose. It also carries some of the most severe stigma, which keeps people from asking for help.
What often gets missed is how opioid dependence develops. For many people, it begins with a legitimate prescription and a body that responds to pain relief the way human bodies are designed to respond. Dependence isn't a moral failure — it's a predictable neurological outcome of extended opioid exposure.
Therapy for opioid use disorder works best alongside medication-assisted treatment (MAT) when appropriate. Our therapists collaborate with prescribers when relevant, and our approach draws from Motivational Interviewing, CBT, and harm reduction frameworks to address not just the substance — but the pain, trauma, or dysregulation underneath it.
Cannabis Use Disorder: More Than "Just Weed"
Cannabis is legal in Washington State, widely used, and widely misunderstood when it comes to dependency. Because it's legal and culturally normalized, many people don't recognize when their use has crossed into disorder territory — or feel dismissed when they bring it up.
The DSM-5 defines cannabis use disorder as a pattern of use that leads to clinically significant impairment or distress. A diagnosis requires two or more of the following within a 12-month period:
- Using more cannabis than intended, or over a longer period than planned
- Persistent desire or repeated unsuccessful efforts to cut down or stop
- Spending significant time obtaining, using, or recovering from cannabis
- Strong cravings or urges to use
- Use that continues despite problems at work, school, or home
- Continued use despite social or relationship problems
- Giving up important activities or hobbies to use
- Using in situations where it's physically risky
- Continued use despite knowing it's causing or worsening physical or psychological problems
- Tolerance — needing more to achieve the same effect
- Withdrawal symptoms when stopping
That last point surprises many people. Cannabis withdrawal is real, and can include irritability, sleep disruption, appetite changes, and anxiety — which often drives people back to using before they've had a chance to assess whether they want to stop.
Cannabis use disorder exists on a spectrum from mild to severe, and it frequently co-occurs with anxiety, depression, and trauma — sometimes because cannabis was being used to manage those conditions in the first place. Our therapists approach cannabis use without judgment and without assumptions about what your goals should be.
Kratom: A Legal Substance With Real Addiction Risk
Kratom is showing up more and more in our conversations with clients — and most people are surprised to learn it carries genuine dependency risk. It's sold legally in Washington at gas stations, smoke shops, and online, in forms ranging from gummies and capsules to tea and powder. That accessibility makes it easy to underestimate.
According to the National Institute on Drug Abuse (NIDA), kratom is derived from the leaves of Mitragyna speciosa, a tropical tree native to Southeast Asia, where it has been used for centuries in herbal remedies. In the United States, however, the FDA has not approved any use of kratom, and it has been banned at the state level in several states — though not currently in Washington.
What makes kratom unusual is that it can act like two different substances depending on the dose. At lower amounts, users often report stimulant-like effects: increased energy, alertness, and elevated heart rate. At higher doses, the effects shift toward opioid-like responses: pain relief, sedation, and confusion. That dual nature is part of what makes it hard to categorize — and part of what makes dependency sneak up on people.
Kratom use can lead to:
- Drug cravings and compulsive use patterns
- Withdrawal symptoms when stopping
- Liver problems with heavy or prolonged use
- Overdose — including fatal overdose in documented cases
Approximately 1.7 million Americans ages 12 and older reported using kratom as of 2021 (SAMHSA). While the DSM-5 does not yet include specific diagnostic criteria for kratom use disorder, researchers are actively studying its addictive compounds and withdrawal profile. The absence of a formal diagnosis doesn't mean the problem isn't real — it means the research is still catching up to what clinicians are already seeing.
If you're using kratom regularly, it's worth examining why — and whether your use is causing problems you've been minimizing. As with any substance, family history of substance use or mental health concerns is relevant context.
At Freesia, we help clients navigate their relationship with kratom without judgment. Your goals guide the treatment plan.
If you're concerned about a kratom overdose or poisoning, contact Washington Poison Control: call 1-800-222-1222 or text 206-526-2121. For emergencies, call 911.
Dual Diagnosis and Co-Occurring Disorders: When Mental Health and Substance Use Overlap
The clinical terms dual diagnosis and co-occurring disorder describe the same reality: a mental health condition and a substance use disorder present at the same time in the same person. According to SAMHSA, 21.1 million adults in the U.S. were living with a co-occurring disorder as of 2024 — making this the rule, not the exception, among people seeking SUD treatment.
And yet it's still routinely undertreated, because most systems are set up to handle one or the other.
Substances often become a way to manage what mental health treatment hasn't addressed — to quiet racing thoughts, lift persistent numbness, or just get through the day. The problem is that self-medication tends to make the underlying condition worse over time, which increases the need to use, which increases the mental health burden. It's a cycle that's very hard to interrupt without treating both sides together.
Which came first — the mental health disorder or the SUD?
This is one of the most common questions clients ask, and it's a genuinely important one. Research shows that individuals with a mental health disorder are at significantly higher risk of developing a substance use disorder than those without one. Unmanaged anxiety, undiagnosed ADHD, a mood disorder that's never been properly treated — these can all become indirect drivers of substance use.
But the relationship runs both ways. Chronic substance use can produce symptoms that look exactly like depression, anxiety, or psychosis. Disentangling what's driving what takes time, clinical skill, and a therapist who takes both seriously.
In practice, working through co-occurring disorders means asking the right questions together: Is this symptom coming from the substance use, or from an underlying mental health condition? Is the substance use a response to unmanaged mental health — or is it making an existing condition worse? These aren't questions with instant answers, but they're the ones that lead somewhere real.
What integrated treatment for co-occurring disorders looks like
At Freesia, we don't treat SUD and mental health as separate tracks that happen to run parallel. We work with both within the same therapeutic relationship — using a harm reduction framework to identify what's causing the most disruption in your life right now, and addressing that first before working toward the next layer. Stability before excavation.
For clients who also work with a prescriber or psychiatrist, we coordinate when appropriate. An integrated treatment team — therapist, MD or psychiatrist, and any other providers — creates a consistent message and approach, which research consistently shows leads to better outcomes than fragmented care.
Common co-occurring disorder combinations we work with include:
- SUD and depression or anxiety
- SUD and PTSD or complex trauma
- SUD and ADHD or mood disorders
- SUD and borderline personality disorder
- SUD and grief or major life transitions
- SUD and relational or family systems concerns
Risk factors for co-occurring disorders — including genetics, early exposure to substances or trauma, socioeconomic stress, and adverse childhood experiences — are also factors we explore in treatment, because understanding the roots of a pattern is part of changing it.
Who We Are: Licensed Clinicians with Specialized Training in SUD
Freesia Therapy Collective is a licensed group practice serving clients across Washington State. Our SUD specialists hold advanced credentials including LICSW, LMFT, LMHC, and SUDP designations — a state-recognized certification specifically for substance use disorder professionals. Several of our clinicians carry dual credentials, meaning they're trained in both mental health treatment and substance use disorder as distinct disciplines.
We are LGBTQIA+-affirming, culturally responsive, and committed to providing care that treats every client with dignity — regardless of where they are in their relationship with substances.
What Can I Expect from Therapy for Substance Use?
Here's what working with a Freesia therapist looks like in practice:
- Free 20-minute consultation — You talk with a clinician before committing to anything. No forms to fill out, no pressure.
- First session: getting to know you — Your therapist will want to understand your history, your goals, and what's brought you to therapy now. This is a conversation, not an assessment checklist.
- Building a treatment plan together — Your therapist will work collaboratively with you to identify what approaches make the most sense given your goals, history, and the substances involved.
- Ongoing work — Therapy for SUD is typically weekly to start. Sessions address what's happening in the moment alongside deeper patterns — the triggers, the beliefs, the relationships, and the unresolved pain that substance use has been managing.
We accept insurance and offer sliding-scale options. Learn more about fees and payments.
Our Therapists Specializing in Substance Use and Addiction:
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Frequently Asked Questions
...on Online Therapy for SUD
No — with Freesia Therapy Collective, you don’t have to commit to sobriety before beginning. Our approach includes harm reduction, which means we’ll work with whatever your goals are: reducing use, improving safety, managing triggers, or exploring change at your own pace.
Many clients come in uncertain, ambivalent, or just curious. That’s a completely valid place to begin.
Yes. We support clients using MAT (such as buprenorphine or naltrexone) and can coordinate with prescribers when appropriate. Therapy and MAT together produce better outcomes than either alone.
Yes. Our services are delivered via secure, HIPAA-compliant telehealth (video sessions), and you can join from the privacy of your home — whether you’re in a city or a rural area. Telehealth removes many common barriers to care (like travel, scheduling, or stigma) while preserving confidentiality and therapeutic safety.
Research consistently shows that telehealth therapy produces outcomes comparable to in-person treatment for substance use disorders. For many clients, telehealth is actually more accessible and sustainable over time.
Polysubstance use is common, and our therapists are trained to work with it. We’ll help you understand the patterns, the risks, and what harm reduction looks like given your specific situation.
We work with a wide range of concerns: alcohol or drug dependence, prescription misuse, binge drinking or chronic overuse, relapse prevention, co-occurring mental health issues (like anxiety, depression, or trauma), impulsivity or emotional dysregulation, shame, isolation, family or codependency issues, and recovery support after rehab or detox.
Our clinicians draw from evidence-based and client-centered modalities — including Harm Reduction, Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT) — to help you identify patterns, manage cravings and triggers, build coping skills, regulate emotions, and support relapse prevention.
Online therapy is for anyone who wants support — whether you’re questioning your substance use for the first time, exploring moderation or reduction, in early recovery, or have been living with addiction or co-occurring mental health issues for years. If you’re ready to connect with a therapist to examine your relationship to substances in a safe, nonjudgmental space, you may benefit.
No. Our entire approach is built on the premise that shame is not a therapeutic tool. You will not be lectured, pressured, or made to feel bad for where you are. Full stop.