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 In this edition of the Lotería and the CANS series, we wanted to focus on the card El Borracho (The Drunkard). In traditional Lotería decks, El Borracho is often portrayed humorously as he stumbles cartoonishly. But beneath the humor, there is something much heavier. For many youth and families we work with, substance use is rarely “just about substances.” It can be about numbing, survival, escaping, or carrying burdens that feel too heavy to hold alone. Alcohol is the most widely used and abused substance among teens. Approximately 1 in 5 high school students report drinking alcohol in the past 30 days. Additionally, 9 out of 10 adults with a substance use disorder began using substances before age 18. So it stands to reason that substance use conversations are important to have with the youth and families we serve. The Lotería cards can support us in having these conversations much more easily.  Within the CANS framework, substance use is not viewed in isolation. It exists within a larger story: trauma exposure, family stress, grief, community violence, cultural disconnection, mental health needs, peer relationships, and coping strategies. El Borracho reminds us to slow down and ask not just “what is the behavior?” but “what is the behavior doing for this youth?” From there, we can determine what their strengths and needs are and what action level is required from us. Youth who use substances are often quickly labeled as defiant, unmotivated, or reckless. But CANS invites us to use a different lens, one that is more curious, contextual and compassionate. For some, alcohol or drug use becomes a way to quiet intrusive memories, manage anxiety, cope with grief, or to feel something or feel nothing at all. For some youth, substances are introduced through family systems or community norms. For others, experimentation becomes a coping tool after trauma or chronic stress. Some youth are trying to survive environments where substance use has become normalized, expected, or even necessary for emotional protection. El Borracho as a Reflective Tool in Practice El Borracho can challenge us to move away from shame-based responses and toward deeper understanding. Lotería cards can create safety through symbolism. Sometimes, youth are more willing to talk about a character than directly about themselves. Instead of asking:
These kinds of reflective questions can create room for storytelling and honesty without immediately activating shame or defensiveness. These questions allow us as providers to learn about the people we serve, hear their stories, and understand their worldviews. Once we make the space to hear our client’s stories first, then we can move to actions and interventions. El Borracho can also help clinicians reflect on their own biases:
Substance use conversations matter deeply, especially with adolescents and transition-age youth. The more I work within CANS and TCOM, the more I appreciate how interconnected everything is. Substance use may connect to:
This is why a communimetric approach matters. We are not simply checking boxes or diagnosing problems. We are trying to understand the full picture of the youth’s life and how and when we should offer support. El Borracho reminds us that behaviors tell stories. Sometimes the story underneath substance use is: “I didn’t know how else to cope.” Harm Reduction, Hope, and Healing Working with youth around substance use requires balance. Accountability matters. Safety matters. And relationships matter too. Young people are more likely to engage when they feel:
Healing often begins when someone finally asks: “What happened to you?” instead of “What’s wrong with you?” El Borracho may appear unsteady, but he also reminds us of something profoundly human: people seek relief when pain feels unbearable. Our work is not only to reduce harm but to help youth build lives where they no longer need the escape. Looking Ahead As we continue exploring Lotería and the CANS together, we invite you to sit with El Borracho a bit longer. What assumptions surface for you? What stories are hidden beneath the behavior? And how might curiosity create more room for connection, healing, and hope? Behind every behavior is a need and behind every need is a story waiting to be understood. Footnote: While many of us may not be Certified Alcohol and Drug Counselors, it is still important that we develop a thoughtful understanding of a youth’s relationship with substances. Within the CANS framework, substance use is part of the larger story of a young person’s functioning, coping, environment, and support system. Our role is not necessarily to provide specialized treatment, but to notice patterns, ask meaningful questions, reduce shame, and recognize when additional support or referrals may be needed. When concerns rise above our level of training or are out of our scope of practice, collaboration and referral to specialized substance use-knowledgeable providers can be an important part of supporting the youth and family holistically.  Lotería is more than just a game; it’s a collection of symbols that mirror the many facets of our lives. Just like Loteria can help open up conversations that inform our CANS, Loteria can also help us. Today, we’re using iconic Loteria images to help you tune into the energy you need most right now. How to play: Take a deep breath, clear your mind, and look at the four cards below. Don’t overthink it! Let your intuition guide you to the image that "jumps out" or speaks to your current mood. Your chosen card reveals a personal affirmation designed to root your day in intention and strength. Which one is calling your name?
Affirmations 🌳 El Arbol (The Tree)
Everyone agrees that family is important; this APA article talks a little about it. CANS is a great tool to understand families. Using the CANS Caregiver Domain is vital because a child’s mental health is tied to the stability of their home environment. The domain highlights clear areas such as supervision, stress, mental health, substance use, and access to supports. When these needs are identified early, you can create a plan that strengthens safety and consistency at home. Without this information, services focus only on the child and miss the conditions that shape daily functioning. Other items in the Strengths Domain such as family strength, spiritual/religious, cultural identity, and community life can tell you about the strengths of the family system as well as those of the child/youth.
The CANS made these patterns clear. With that information, the team arranged weekly respite, connected her to a caregiver support group, and provided in‑home coaching to strengthen routines. She said, “I finally felt like people saw what I was carrying and what I was doing right.” These supports reduced her stress and improved consistency at home, which helped her grandson stabilize and engage more fully in treatment.
WestCoast Children’s Clinic recently held a training session that provided valuable insights into how to better engage with children, youth, and families by centering their unique developmental and cultural contexts. Trainer Bethany Blank, LCSW is a TCOM Human Services Program Specialist with the Idaho Department of Health and Welfare and shared both her professional and personal perspectives on navigating services with developmental needs.
Adapting Your Approach by Age and Need Engagement isn't "one size fits all.
The Heart of Engagement: Support, Not Judgment Ultimately, engagement is about building a shared vision. The goal of assessment is not to label or judge, but to determine where support is needed. By listening with empathy and being open to different perspectives, we can build the trust necessary for meaningful change.
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