E.238 Part 1 Inside The Therapy Room: Addiction, Culture, And Trust

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The badge asks for everything, then hands you a shift change and a smile. We sat down with returning guest, licensed clinical social worker Alexis Silva, to dig into the quiet realities behind the uniform: why trust is scarce, why stigma is sticky, and how substance use becomes a steady companion long before it becomes a crisis. Alexis works almost exclusively with first responders, military, and veterans, and brings her own sobriety and family experience to the table. That honesty opens a door many are afraid to touch—because careers are on the line, documentation feels risky, and walking into a room where you don’t have to translate the language of the job can be the difference between shutting down and speaking up.

We break apart common myths: not every struggle is trauma from the job; for many, it starts with childhood adversity, genetics, and family patterns. Alcohol, THC, and benzos promise relief and steal sleep, fueling irritability, poor decisions, and conflict at home. We unpack the tipping point where use shifts from choice to maintenance—when your body drives the next drink—and why matching care to risk matters. Sometimes inpatient comes first, then outpatient therapy and groups, so progress isn’t crushed by daily stress. We also go beyond substances to behavioral addictions like gambling, tracing how the chase hooks into the same adrenaline circuits that make first responders so good under pressure.

Across the hour, we map practical steps you can use today: how to assess risk without shame, how to reset routines every few career years, what honest partner check-ins sound like, and how peer support and culturally competent clinicians reduce fear of being “the problem” at the station. If you’ve wondered whether your coping is helping or hiding, this conversation offers a clear path forward—grounded, direct, and built for people who don’t have time for fluff.

If this resonates, follow the show, share it with a teammate, and leave a quick review to help other first responders find it. Your story isn’t a liability—it’s a starting point.

If you want to reach Alexa, please go to https://www.psychologytoday.com/us/therapists/alexa-silva-chelmsford-ma/1140390

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