| Substance | Effect on Body | Risk During Massage |
|---|---|---|
| Alcohol | Dilates blood vessels, impairs balance, dulls pain | Increased bruising, risk of falls, poor consent |
| Opioids | Depresses central nervous system, dulls pain perception | Risk of injury from deep pressure, breathing issues |
| Stimulants | Raises heart rate, causes agitation or paranoia | Cardiovascular stress, unpredictable behavior |
| Cannabis | Alters perception, impairs coordination | Increased risk of dizziness, disorientation |
| Sedatives | Lowers blood pressure, causes drowsiness | Risk of fainting, reduced awareness |
About Substance Abuse in Therapists?
Here’s something we don’t talk about enough: therapists can struggle with substance misuse, too. Our profession is physically demanding, emotionally taxing, and often underpaid or undervalued. Some therapists may turn to alcohol, painkillers, or other substances to manage stress or chronic pain.
If you find yourself:
-
Needing alcohol or drugs to unwind after every shift
-
Using substances before or during work
-
Noticing your performance or professionalism slipping
…it’s time to pause and seek help. There’s no shame in admitting you need support, and it’s essential for your well-being and your clients’ safety.
Boundaries: The Key to Ethical Practice
When you suspect a client is under the influence, your instinct might be to “just get through the session.” After all, you don’t want to upset them, lose a client, or feel awkward. But in these situations, clear boundaries are your best friend.
It’s okay to reschedule. In fact, it’s necessary. A simple, professional statement like:
“For your safety, I’m not comfortable proceeding with the session today. Let’s find a time when you’re feeling your best.”
…shows respect, care, and professionalism.
Documentation: Your Professional Lifeline
Every therapist should treat documentation as their best defense and strongest ally. If you have concerns about a client’s impairment, record objective facts—not opinions.
Instead of writing “client seemed drunk,” you might note:
“Client arrived with noticeable odor of alcohol, slurred speech, and unsteady gait. Client stated they had drinks before session. Session was rescheduled.”
Accurate, objective notes protect you if the client later disputes your decision.
Communicating with Compassion
The way you handle conversations about substance use can make or break the relationship. Here are a few tips:
-
Stay calm, warm, and professional.
-
Focus on safety: “My priority is your well-being.”
-
Avoid judgmental language.
-
Offer resources if they’re open to it, like the SAMHSA National Helpline (1-800-662-HELP).
Remember: you’re not diagnosing or treating substance use. Your role is to recognize red flags, maintain safety, and refer when needed.
The Legal Side: Know Your Responsibilities
Depending on where you practice, your state may have specific rules about treating impaired clients. Many states, like Florida and New Jersey, require therapists to refuse or reschedule treatment if a client is unable to give informed consent.
Massage therapy boards also expect therapists to report colleagues who are impaired on the job if client safety is at risk. Failing to act could mean disciplinary action for you, too.
Self-Care: You Matter, Too
Therapists are helpers by nature, but you can’t pour from an empty cup. Chronic stress can sneak up on you, and self-care isn’t just about bubble baths and vacations. It means:
-
Setting clear work-life boundaries
-
Seeking support when needed
-
Getting adequate rest
-
Prioritizing your mental and physical health
Remember: healthy therapists provide better care.
What If It’s a Colleague?
Spotting signs of substance abuse in a coworker can feel uncomfortable. Should you stay quiet? Say something?
If you believe client safety is at risk, you have a professional and ethical obligation to act. Start with a private, compassionate conversation: “I’ve noticed you don’t seem like yourself lately. Is everything okay?” Document your observations and follow your workplace policies or state guidelines for reporting if necessary.
Why Continuing Education Matters
Understanding substance abuse isn’t a one-time lesson. Laws, best practices, and social norms evolve. Regularly updating your education on ethics, safety, and professional standards keeps you confident and compliant.
That’s why Niel Asher Education offers a full collection of Ethics and Safety CE courses tailored to massage and manual therapists. These courses go beyond checking a box—they empower you with practical knowledge you can use every day. Explore the collection here: NAT Ethics & Safety Courses.
Case Scenarios: Bringing It All Together
Let’s apply what we’ve learned with a couple of short scenarios:
Case 1: The Strong Scent
Your afternoon client, who usually arrives relaxed, comes in smelling strongly of alcohol. Their eyes are glassy, and they admit to “just a couple of drinks.” What do you do?
-
Politely but firmly reschedule the session.
-
Document objective observations.
-
Follow up with the client if appropriate.
Case 2: The Overworked Therapist
You notice a colleague frequently late, disheveled, and avoiding eye contact. Clients mention they seem distracted. What’s your responsibility?
Key Takeaways
-
Substance abuse affects your clients, your colleagues, and your profession.
-
Recognizing signs and setting boundaries protects everyone.
-
Clear, objective documentation is your best defense.
-
Self-care isn’t optional—it’s essential.
-
Continued education keeps you informed, compliant, and confident.
Final Thoughts
Substance abuse is more common than you might think, and as massage and manual therapists, we must face it head-on. By understanding how it affects our clients and ourselves, we can protect our practices and provide the safe, compassionate care every client deserves.
Education is your strongest tool. Commit to ongoing learning with trusted resources like Niel Asher Education’s Ethics and Safety Courses and take your professional practice to the next level.
You’ve got this—and your clients are counting on you.
