Matt Green

Matt Green For over 45 years, Matt Green has helped patients with Substance Use Disorder enter recovery & live a healthy sober life. In my 45 Years of clinical experience

Coming soon : A new book written by Matt - giving you an inside look at the mind of an addict.

05/31/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 37

Does Trauma Create Delusion in the Mind of the Addict?

A 30 year old patient who has been coming to our clinic for the past nine months recently had his final disposition in court. He had originally entered treatment because of a car accident as the result of being under the influence of crack co***ne. He was arrested for the driving accident as well as possession of an illegal substance. The court sentenced him to 1 year of probation and to continue mandatory treatment at our clinic.

The patient’s original intention for entering treatment was at the suggestion of his attorney in order to influence the court to give him a less severe “sentence” or disposition. The patient has a history of violence, anger and substance abuse/dependency. The patient has been attending treatment and now believes that he has a problem with addiction and is grateful for being referred to our clinic.

The patient has been attending and working well with all but one member of his treatment team. That one clinician is the only male treater. The patient refuses to attend his treatment sessions. The patient says that he hates this treater and can’t stand being in the same room with him. The patient does not give any specific reason for this reaction.

Upon entry into our clinic program, the patient talked about his family and how as a young man, his father would physically hit him repeatedly when his father was drunk. The patient had his nose broken repeatedly by his father. Despite this type of violence, if any disparaging words were said about his father, the patient would defend his father, dispute the criticism, and talk about how much he loved and respected his father.

The male treater, on the team, is the most skilled, seasoned and experienced treater at the clinic. Why does the patient have this reaction? Does the patient really hate the male clinician, or does the clinician represent, in the patient’s mind, his father when the male therapist walks into the room? Please comment.

# ClinicalInsights

05/25/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 36

What is my “addict” really thinking?

It was a bright sunny New England spring day. About 70 degrees outside. My 16 year old patient woke up for school after an evening of fighting with his parents because he refuses to stop smoking ma*****na. His parents have taken away all access to money and online contact with friends until he agrees to stop smoking.

My patient goes through his usual morning routine before school, eats his usual cereal for breakfast as his mother is preparing his lunch in the kitchen, collects his lunch, says goodbye to mom; dad has already left for work and heads out the door.

Today, for my patient, is different however. Heading out the door to walk to school, he turns in the opposite direction and catches the first train into the city. Once in the city, my patient stops at the bank and withdraws $500 from a savings account that is just in his name, almost depleting all his money and heads to the airport. My patient decided during the fight with his parents the night before that he was going to leave home.

Once at the airport, my patient bought a one way ticket to Chicago leaving that morning, got on the plane, and it took off, on time. Landing at O’Hare airport at about 10:30am (Chicago time), my patient debarked and entered the airport terminal. He stood there watching people rush by him into restaurants, airline gates and restrooms. “This is a very busy airport” he thought, and then it struck him! “What am I going to do now?”

With no solid plan in mind, armed with half the money he took out of the bank, my patient went back to the ticket counter, purchased a one way ticket back to Boston, and landed in Boston at about 3pm, Boston time. He made his way back home and when he got home his mother asked him how school was. My patient replied, “It was fine” and he made his way up to his bedroom.

Do we ever know what is in our “addicts” innermost thoughts?
Please comment.
# ClinicalInsights

05/17/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 35

Do Addicts Care about the people they love?

One of my 16 year old patients walked into the group. I admit that I am not an expert in clothing fashion. I knew however that what my patient was wearing must have cost a lot of money.

He was wearing what most people would call a warm up suit, all in blue, a jacket that zipped down the front and long pants with a gold stripe down the side of the leg. There was a logo on the waist of the pants but it was not familiar to me. The suit was shiny like silk. Around his neck were two gold chains one thicker than the other with a large gold cross hanging from one of the chains with what looked like a diamond in the middle. He wore a baseball cap that looked new with no logo on it. His sneakers were white with no marks on them also looking new. He strutted in like he owned the building and sat down.

What he talked about while in the group was very surprising. I had met with him and his single mother a week prior to understand what the most helpful treatment plan would be for him. Her complaint was that he was smoking pot daily, coming home late at night and missing school. She thought he might have a drug problem. Mom told me that she cleaned houses to make ends meet and they were living in a small one bedroom apartment with federal funds subsidizing the rent.

I asked him to talk about himself by introducing him to the group. He said he hated school which is why he didn’t go. He said he had a job which had him delivering packages to people around the city. He would pick up the packages from a man with instructions to where they were to be delivered. The man would pay him in cash, usually several hundred dollars. He said why should I go to school when I have $40 thousand dollars in $20 dollar bills under my bed. I asked him if his mother knew about the money and he said no and he had no intention of telling her.

Where do we go from here? How do addicts define love? Please comment.

05/10/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 34

The Symptoms of the Condition of Addiction is Not just about Drugs and Alcohol

The telephone at the office rang on a Friday afternoon. The voice on the other end said, “Matt is that you?” I responded yes and asked who was calling. The voice on the other end identified himself as John who was calling. My answer was that I was happy to hear from him, but since I have been practicing over 40 years, he must understand that I have worked with quite a few John’s in my time. I asked for more specific information. John then apologized acknowledging the assumption that I would know him just from his name. John then went on to say that he had been a patient about 10 years earlier with a significant alcohol problem. He spent about 16 months in treatment at our clinic where he stopped drinking, was introduced to AA and left treatment feeling much better than when he started. I remembered John acknowledging that to him and then asked him if he had started drinking again. John reported that he had been clean and sober since leaving treatment 10 years earlier and still attended AA. I told John how wonderful that was for him but I still didn’t understand why he was calling.

John then told this story. “ I came home from work the other day and my wife greeted me at the door and without hesitation she said that she wanted a divorce. This was shocking to me, so I looked her square in the eye and told her that I was surprised to hear this. I asked her why she wanted a divorce given they lived in this big beautiful house, they had just gone on vacation together a month earlier and most importantly, I had not picked up a drink in over 10 years. “

His wife’s response was the wake-up call he didn’t see coming: “You aren't drinking, but you're working 18 hours a day. We no longer have a relationship.”
John had put down the bottle and picked up the briefcase. He had swapped one symptom for another to avoid the same underlying feelings. Addiction is a condition; substances are just the symptoms.
What do you think? Please comment.

05/03/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 33

The Power Struggle Between Parents and their Teenage Children

A woman in her 50’s lives at the end of a cul de sac with her 17 year old son. She divorced her husband years earlier because of his drinking. Her staying in the house was part of the divorce agreement.
There are 4 other houses at the end of her street with a beautiful grass area and a few trees and park benches in the middle of the circle.

The young often stays out late at night, going late to school the next day and when he comes in the house there is the pungent odor of ma*****na surrounding him.

Mom has pleaded with her son for months to stop his behavior, setting rules that are routinely broken and he clearly tells her he doesn’t care. Mom is embarrassed to ask for help.

Finally, she consults with his school guidance counselor who recommends she see a local drug and alcohol counselor. After her third appointment and failed attempts to include her son in the sessions, the counselor recommends that she ask her son to leave the house and not return until he is ready to seek treatment.

It is a bold and risky intervention but mom is at her wits end. One day, after her son has left the house to go to school, mom packs his clothes in a suitcase and puts it out on the front porch. She then calls a locksmith who comes and changes all the locks on the outside of the house. Mom waits for her son to come home.

About 4pm, her son climbs the stairs to the front porch and sees the suitcase next to the door. He tries to enter the house but cannot. He starts banging on the door, yelling for his mother to open the door. The banging gets louder and louder and mom is sitting on the floor inside the house with her back up against the door and tears in her eyes. She yells through the closed door telling her son when he agrees to treatment she will let him back in. As the banging gets louder, mom calls her counselor who hears the commotion through the phone and talks with mom begging her not to let him in. Finally the banging stops, mom looks out the window and her son and the suitcase are gone.

That night, mom goes up to her bedroom to get some rest. The window next to her bed looks out onto the front of the house and the small park in the middle of the circle. As she looks out the window, she sees her son lying down on the park bench in full view of her window. Mom begins crying again.

For one month, mom sees her son sleeping on the park bench outside her bedroom window. One day there is a knock at the door. Mom sees her son at the front door and immediately calls her counselor; what should she do? The counselor advises her not to let him in but to ask what he wants. Son says he is ready to go to treatment.

I’d love to hear from my colleagues. Where is the line between abandonment and a life-saving boundary?

04/26/2026

Inside the Mind of an Addict

Thoughts, Comments, Observations- Number 32

How Fragile is an Addict’s Sobriety?

It is a beautiful spring evening in New England. I am walking up a circular driveway and in front of me is a beautiful Congregational Church. Its steeple is tall, pointing to the sky. I enter the side door of the church as I have been invited to many times and instead of traveling down stairs to the church basement which is the usual case, I step up two small flights of stairs and enter a beautiful social hall. As I look around, I am at the back of the hall and in front of me is a crowd of about 100 people sitting in portable bridge chairs listening to a speaker at the podium in the front of the hall. Hanging from the podium as is the case at most of these meetings is the familiar blue banner with gold trim, “Let Go, Let God”. Around the room are other similar banners, “First Things First”; “A Day At A Time” hanging from the windows.

A man comes up to me holding a styrofoam cup with steam coming from it. He says welcome to me and hands me the cup of coffee. I take it and find a seat at the back of the hall. My patient made eye contact with me and smiled.

In a room of 100 people, amidst banners reading “First Things First,” he did something that silenced the crowd. When they called for the "one-day chip"—the token for those just starting their journey—he stood up.

The room went cold. We all feared the worst: Had he slipped?

He then stepped to the podium to receive his one year medallion and said: “I’m taking a one day chip because I always want to remember that staying sober is a day at a time.”

It was one of the most powerful displays of humility I’ve ever witnessed. But in the world of recovery, humility doesn't always guarantee safety. Powerful words from my patient who is 17 years old.

The story does not end here. One year later, at the end of his first year of college, my former patient and his friends are celebrating their college year. A game that they sometimes play requires them to get drunk and open the elevator door on the top floor of their dormitory. As the elevator car travels up the shaft to the top, they hop on the roof of the car and then travel down the shaft to the basement. It is called elevator surfing. The elevator door is opened and my former patient leaps into the shaft to reach the roof of the car, but the car has not traveled to the top floor yet. My former patient’s body is then found lifeless at the bottom of the shaft.

Tragic, Very Sad, Overwhelming Traumatic, Fragile. Please comment.

04/19/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 31

Have you had your Spiritual Awakening?
How do people connect with their addiction?

A single woman in her early 50’s lives with her elderly father in the house she grew up in. Each night when she comes home from work, she sees the door to the basement open and hears radio music and smells pipe smoke coming from the basement.

As she makes her way down the stairs she sees a lamp lit on a table next to the rocking chair where her father is sitting. The music is playing, her father is smoking his pipe and drinking vodka out of the bottle. He sits there rocking and drinking until he passes out and daughter then helps him to bed.
For years, the ritual was the same:
The basement door open.
The sound of the radio.
The smell of pipe to***co.
Her father, rocking in his chair, drinking until he passed out.
The daughter pleaded with her father to stop drinking; he simply cannot. One day as the daughter enters the house after work her father is sitting in the living room staring out the window. The miracle happened, he stopped drinking and daughter was thrilled. Months go by and then the sad news; father has been diagnosed with cancer.
That night, the daughter came home to the familiar smells and sounds. Her heart sank. She went to the basement, expecting to see the bottle. Instead, she found her father, sober and resolute. When she looked at him, he said: “I thought about it. But if I die and my gravestone says ‘He died a drunk,’ I don’t want that to be my legacy.”
His reasoning changed on why we do what we do:
We spend our lives building our reputation, but we define our Legacy in our hardest moments.
It’s not just about how we start. It’s about how we choose to finish.

04/12/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 30

How Do we define what is Helpful and what is not? How do you handle an unintended favor?
On Fridays, I usually keep my office door open to the waiting room. It’s a small gesture, but it allowed an old friend to walk in when she had nowhere else to turn.
She was facing a family crisis and needed guidance navigating the intersection of the legal system and mental health. I didn't "fix" her problem—I simply listened and connected her to the right legal professional.As she whipped away her tears she said to me, “ I never thought I would be in your office asking you to help me, but here I am.” She told me that her son, whom I knew and was a sophomore in college, was in trouble. He and some friends had been partying one evening at school and found themselves stopped by the police and arrested for possessing controlled substances illegally. They were taken in handcuffs and brought to the police station where my friend needed to post bail for him in order to bring him home. It was the first time he was arrested and in trouble like this. She was scared but knew of my work and that I had a lot of experience with my patients and the court system. She was asking for my help.
I called an attorney friend of mine who I have worked with over the years, and who has referred some of his clients to me for treatment. I knew he had represented some clients in the same court system where my friend’s son was arrested. The attorney said he would make some calls and get back to me.

One week later, on a Friday, I answered the phone and the voice on the other end introduced himself as a detective in the police department where my friend’s son was arrested. He told me he was familiar with the case and would look into it for me after receiving a call from the attorney who was a friend or mine. I told him I appreciated his help and he then hung up the phone.
Two weeks later my friend stopped by my office with a smile. the case was dismissed due to a procedural anomaly. My friend was overcome with gratitude, crediting me for the "miracle."
The crisis has passed, the legal burden is gone, and her son has a fresh start. I told her that I didn’t do anything but make a call and wondered if this outcome was helpful or not? Was it the result of an unintended favor?
I would be interested in your opinion.

04/05/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 29

When Can I Stop Saying I’m Sorry?
8 Years Sober. 0 Years Forgiven.
One of my patients hasn't touched a drop of alcohol or a gram of co***ne in 2,920 days.
Yes, my patient’s behavior when his addiction was active was sneaky and manipulative. He would go up to bed after his wife was asleep making the excuse that he had work to do. He would spend that time, drinking alcohol, and using co***ne as well as looking at po*******hy on his computer and occasionally inviting prostitutes to the house while his wife was sleeping in the middle of the night. His wife had no idea what was going on for more than 10 years. Finally at a routine doctors appointment her doctor discovered that she had a sexually transmitted disease and then the “cat was out of the bag”
He’s done the work.
But every day at 6:00 PM, he walks through his front door and enters a courtroom. His wife is the prosecutor. His 10-year-old secrets—prostitutes, STDs, and a decade of masterful gaslighting—are the evidence.
He asks: "When can I stop saying I’m sorry?" The reality? Maybe never.
In recovery, we talk about "making amends." But we don't talk enough about the Permanent Shadow. You can stop the behavior today, but you cannot delete the trauma you planted in someone else’s mind a decade ago.
Is 8 years of "doing the right thing" enough to buy a peaceful dinner? Or is some damage simply beyond the reach of a calendar?
Is there a statute of limitations on an apology? Or does the clock only start when the victim finds out the truth?
Tell me what you think?

03/29/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 28
Headline: When is it time to give up?
The wet stain on the chair.
I’ll never forget the moment I realized our patient had relapsed. She walked out of the group session, leaving a trail of the very thing she was fighting to escape.
Nine months of treatments, sober houses, and "renewed motivation" later... we are back at square one.
We had a patient do everything "right." 12 hours of IOP a week. Perfect attendance. AA meetings daily. Then, she showed up so intoxicated she didn't realize she was in a room full of people.. And yesterday, the call came: She’s drinking again.
Her father asked me the hardest question in medicine: “What do we do now?”
In the world of addiction, "giving up" isn't an option, but "changing the strategy" is a necessity. Sometimes, our clinical "success" isn't a straight line—it’s just staying in the fight.
How do you advise a family when the 'proven' methods keep failing?

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