In the twelve-step program, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension

Since 1935, generations of problem drinkers have been aided by Alcoholics Anonymous, the fellowship group comprised of alcoholics helping other alcoholics. In 1953, the group Narcotics Anonymous was founded, based upon the same principles as AA. Since that time, over 200 other fellowship groups have been formed to address a plethora of addictions – Sexaholics Anonymous, Cocaine Anonymous, Gamblers Anonymous, Overeaters Anonymous, and the like.

These programs have helped hundreds of thousands of people overcome their Substance User Disorders. They’ve helped repair families and friendships. They’ve also helped people become the best possible versions of themselves. All of these programs follow a version of “The 12 Steps of AA” – the guiding principles outlining how to recover from compulsive, out-of-control behaviors and restore manageability to one’s life. After all, that’s what an addiction is, compulsive, out-of-control behavior. And the goal of recovery is to restore manageability to one’s life. Here are the 12 Steps of Alcoholics Anonymous, with an explanation of the significance of each step. Use this information to help yourself or someone you love to get clean. No one needs to remain addicted to alcohol. The 12 Steps are one of the best ways to achieve the goal of sobriety.

Introduction to the 12 Step Program

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.

Substance use disorder (SUD) experts are quick to say that a person has to admit there is a problem before recovery can truly begin. But the First Step of the 12 Steps of AA means more than this – it means finally rejecting the denial and self-deception that so often accompanies SUD and once the suffering addict/alcoholic realizes THAT, they can be more receptive to the idea that they will need help to recover. There are two crucial words in the First Step:

Powerless – This means that the person has lost control over their consumption of drugs and/or alcohol. They no longer can regulate when or how much they consume. The addiction is in charge.

Unmanageable – This means that the drinking/drug use is having a negative impact on the rest of the person’s life

The First Step

2. Came to believe that a Power greater than ourselves could restore us to sanity.

There are two considerations for the Second Step of the 12 Steps of AA. First and foremost, the Second Step is about HOPE. Rather than being resigned to a hellish downward spiral of addiction, a person comes to understand that recovery IS possible. In other words, although the struggling addict/alcoholic has no control over THEIR compulsion, that doesn’t mean that there is not a solution. So the second consideration of this Step is that it is possible to gain strength, inspiration, and guidance from something outside of and greater than one’s self – IF stubborn ego can be laid aside. In other words, when you can temporarily make yourself subordinate to someone or something that is helping you, it is possible to be guided in the right direction.
That’s because alcoholism is, by its nature, a selfish behavior. It’s not selfish in the moral sense. But it does focus on only meeting the needs of the self. When the self is no longer the highest priority, it’s easier to stop drinking.

Some people are put off by the idea of a higher power. But AA isn’t a religious organization. The higher power doesn’t have to be God or any specific interpretation of God. In fact, there’s an entire AA group that’s focused on secular help. It’s called Secular AA. It could be fate, karma, or anything else. The point is that you need to find a source of inspiration to help you stay sober. There’s also a list of secular AA meetings. The group realizes that there may not be a secular AA meeting near you. That’s why they also offer online secular AA meetings. This shows that you do not need to be religious to follow the 12-step program.

The Second Step

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

The first two Steps were about reflection – but the Third Step of the 12 Steps of AA is about action. At its simplest, the Third Step means deciding to get out of your own way. For some non-religious people, the Third Step can be problematic, which is why “God as we understood Him” is important. Your Higher Power does not have to be a deity. It can also be the recovery process itself, the innate strength of human nature, your support system, or the fellowship you receive from other addicts/alcoholics. The exact nature of your Higher Power is personal – it only has to be something outside of and greater than yourself in which people can place their faith. This helps people look outside themselves. As a result, they are less likely to give in to their demons.

The Third Step

4. Made a searching and fearless moral inventory of ourselves

In this step, you continue to eliminate opportunities for denial by taking an honest – and sometimes uncomfortable – at yourself, your behavior when drinking/using, and the effect it has, both on yourself and upon others. Why is this so important? Before you can ever attempt to change your behaviors and attitudes, you have to know what needs changing. This inventory is not just about finding out your weaknesses – those things that need changing. It is also about uncovering your strengths – those positive traits that you can expand upon. Your personal inventory must be:

Fearless – as you face the truth about yourself that you may not like. But only by acknowledging your faults can you take steps to correct them.

Searching – as you sincerely take time to examine your thoughts, words, and deeds. To this end, it is a good idea to write your inventory down.

Moral – as you weigh those thoughts, words, and deeds against an objective standard of what is right against your own selfish desires.

The Fourth Step

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

This step is absolutely necessary after a moral inventory. A person who has taken an unflinching look at the harm that their addicted behaviors have done can sometimes be tormented by that knowledge. Without productive relief, that torment can lead to old, destructive ways of coping – drinking and using. Talking to someone else can help alleviate negative feelings of shame and guilt. When you unburden yourself of the weight of your past, you free yourself up to move forward unimpeded. Often, people will find that they are not so unique in their imperfection.

The Fifth Step

6. Were entirely ready to have God remove all of these defects of character

This is one of the more difficult Steps of the 12 Steps of AA because it is the culmination of everything that has come before. This is where you let go of those behaviors and attitudes that are holding you back. The reason that this step is so difficult is that often, those behaviors and attitudes that are being let go have been the only ways to cope that you have ever known. Sometimes, it means relearning a whole new way to interact with the world. After all, alcohol shapes the world for many alcoholics. The nature of the addiction means they’re always thinking about alcohol. That means that changing requires hard work. People need to admit to themselves that they’re ready for that hard work. This Step is not about perfection – it is about getting better. Throughout the course of recovery, you will find yourself repeating the Sixth Step several times. That’s because no one is perfect. But that doesn’t mean that people shouldn’t try to improve. Any addict can overcome their addiction.

The Sixth Step

7. Humbly asked Him to remove our shortcomings.

This Step is very much like the Third Step, but it is more specific. Now that a moral inventory has been completed, we see ourselves as we truly are, both the good and the bad. The truth is many of our shortcomings are intertwined with our addictions. And, because we are powerless over the addiction, we are often just as powerless to overcome our shortcomings on our own. This is where the key concept of Step Seven of the 12 Steps of AA – humility – comes in. When we are humble, we admit when our way of doing things isn’t working and when we need help to overcome specific problems in our lives. There are three reasons why humility is so important in this Step:

- It allows us to recognize the severity of our defects. Without that humility, it is possible that we will underestimate or minimize the impact of our actions.
- It allows us to recognize our own limits. We have to be humble enough to understand that alone, our intellect, our reasoning, and our willpower are not enough to overcome our addiction.
- It allows us to comprehend the enormity of our Higher Power’s ability to transform our lives.

Humility allows us to come to the realization that there is something greater than both ourselves AND our addiction. And, because it IS greater, that Higher Power can restore us to sanity.

The Seventh Step

8. Made a list of all persons we had harmed and became willing to make amends to them all

The Fourth Step was about personal house cleaning, but the Eighth Step of the 12 Steps of AA is about social house cleaning. It is about recognizing the wreckage that you have left in your wake while you were actively addicted. In order to continue moving forward, you have to acknowledge the role you may have played in hurting others. When you become willing to repair the damage you have done, you again reduce the destructive pain, anger, hurt, and resentment that addiction causes. This step also helps people work on the guilt they feel. Remember, guilt can cause people to turn back to drinking. Confronting that guilt makes it easier to stay sober. It also helps remind people of the harmful effects of their drinking.

Making a list of the wrongs someone’s committed helps them to understand the importance of changing. It’s easy to overlook one or two events. But when a person sees a list of the times that their drinking has hurt someone, it gives them more motivation to change. In this way, the Steps work together again. Understanding the effects that a person’s drinking has on those around them helps them make decisions based on overall good. That’s instead of making decisions based only on themselves. This helps stop the cycle of addiction. It is the willingness to make amends that is important because as you will see in the Ninth Step, it is not always possible to make reparation.


The Eighth Step

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

Like so many other interlocking Steps, the Eighth Step of the 12 Steps of AA was chiefly about contemplation, while this Step is about action. Now that we know what we have done and who we have done it too, we have to take action to right our wrongs. This is a difficult, but necessary Step. Difficult, because “direct” means face-to-face and in person. This may seem strange in a world dominated by text messages and email. People need the courage to ask for forgiveness. Asking forgiveness in person requires even more courage. We have to face those we have wronged, take responsibility for the harm we have caused, and try to make up for that harm in some tangible way.

Making amends is more than just apologizing. It also means trying to undo the damage. That means repaying old debts, whether they’re monetary or otherwise. It is necessary because it starts to clean up the messes we have left behind. Since recovery is all about moving forward, making amends for the wrongs we have done lets us “balance our books”, so we owe nothing from our addicted past. It allows us to have a fresh start. A word about “wherever possible” – Sometimes, reconnecting personally with someone we have harmed in the past can reopen old wounds or cause difficulties in someone else’s current life. For example:

- Seeing an ex in person can cause them embarrassment or problems in their current relationship.
- A person you may have physically harmed might be traumatized by your presence.
- Confessing to some criminal act you may have committed does not mean implicating others.
- In such instances, it may be better to write a letter acknowledging the past harm, expressing the willingness to make amends the other person may deem necessary, and asking for forgiveness.

This step requires that we (1) apologize, (2) try to repair our wrongs, and (3) ask for forgiveness. It does NOT require that the other person grant that forgiveness. In fact, some people may not be willing to forgive. A recovering alcoholic needs to accept that. This is one of the ways that the steps work together. When someone is comfortable with another person’s right to refuse forgiveness they demonstrate that they’re able to cope with the world. When we are sincere, but direct amends for forgiveness are not possible, we should simply “let go” of the burden we have been carrying around and resolve to do better in the future in our interactions with others.

The Ninth Step

10. Continued to take personal inventory and when we were wrong, promptly admitted it.

The tenth step of the 12 Steps of AA is about continued growth and vigilance. In essence, is about laying the foundation for our future. When we are continually honest with ourselves, it is much easier to recognize triggers, behaviors, and attitudes that could result in a relapse. This step helps to re-enforce the lessons and practices of the other steps. People constantly try to improve themselves instead of giving up. It also helps prevent people from making justifications to drink again.

Everyone’s familiar with these justifications. “I’ve been sober for 3 weeks, so I can have a drink.” This mindset isn’t possible with a constant moral inventory. Instead, the self-assessment helps people see when they’re wrong before they act, rather than afterward. These justifications can lead to a slippery slope. “I can have one drink because I’ve been sober for three weeks” becomes “Two drinks isn’t that bad.” This can easily lead to “Well, I’ll just party tonight and stop again tomorrow.” This situation is especially true for alcohol. Booze hurts decision-making. Once someone has some alcohol in them, they’re more likely to make decisions that serve only themselves. That can lead to relapse.

Admitting when we are wrong allows us to continue moving forward in humility, without the denial and self-deception that addiction brings about. This type of honesty is essential to recovery. After all, if a person has a problem, then ignoring that problem won’t make it go away. Just like ignoring a leaky roof won’t keep water out of the house. It also prevents us from accumulating more emotional baggage that can slow down our recovery. It encourages people to always try to be their best selves. They may not always succeed. But just trying makes their lives better and makes the world around them better. Perhaps the best thing that an ongoing personal inventory does is keep us “on track”. It keeps us from straying too far from our path of recovery. It gives people a way to focus on improving themselves. This approach means they’re less likely to fall back into alcohol abuse. That’s because they focus on getting better instead of trying to numb their pain.

The Tenth Step

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

This is a spiritual Step, but people who have reached this point have usually come to terms with the “God” language the 12 Steps of AA contains. In other words, they have already formed their own personal concept of a Higher Power. For some, GOD is an acronym that stands for “Good Orderly Direction” – the path that they want their life to take. For others, it can even stand for a “Group Of Drunks/Druggies” – the fellowship they receive from others in their AA/NA meetings. “Prayer and meditation” means making a conscious effort to improve our understanding of the path that our Higher Power has for us. To be more specific, prayer means TALKING to our Higher Power – sharing our burdens, admitting our wrongs, asking for help, and expressing our gratitude. Meditation, on the other hand, means LISTENING to that same Higher Power – putting aside our own egos and desires in order to understand what we should be doing.

The Eleventh Step

12. Having had a spiritual awakening as a result of these Steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

This Step of the 12 Steps of AA is at once self-serving and selfless. For yourself, there are few things that you can do that can better serve your own sobriety than by working with others who are still struggling. Being of service to others has several benefits:

- It reminds you of where you once were and where you no longer want to be.
- It helps hold you accountable.
- It gives you a sense of purpose.
- It keeps you from becoming complacent in your recovery.
- It enhances your fellowship with others.
- It allows you to be of benefit to other struggling alcoholics/addicts. 

Sometimes, a still-suffering person will trust you above others, because you understand what they are going through. You have insights that may allow you to help when no one else can.
When you share your story, others may be inspired by your successful ongoing recovery – to the point that they are finally able to regain their own sobriety.

It is important to understand that addiction is incurable and lifelong. Recovery requires vigilance and work, one day at a time, for the rest of your life. You’ll find yourself repeating the 12 Steps of AA over and over again as a means of safeguarding your sobriety. No, the 12 Steps of AA are not a cure for your addiction – they are guiding principles is that allow you to restore sobriety, sanity, and serenity to your life.

The Twelfth Step

The 12 Step Program

Learn about what happens after the 12 Step Program.

This is a really good question. After you’ve gone through the 12 Steps of AA, you want to know, what happens next? You should know that this is not the end of the road for you. You should actually take one of two directions. Once you’ve gone through the 12 Steps of AA, you may need to go through them again. It’s possible that there were some issues that you needed to work out in your life, but you didn’t. Perhaps you couldn’t because of some rough relationships from your past.

Don’t feel you’re ready to quit AA just because you’ve gone through the 12 Steps of AA one time. You may need more time to think about the different steps you’ve just learned. You may need additional time to put them into practice in your own life. This relates to the Steps themselves. The Tenth Step is all about taking a continued moral inventory. That means a person must be honest with themselves. If that person isn’t ready to move on, then they need to start working the steps again. 

The other direction you may want to consider is to become a sponsor yourself. Think back to the time when you first started Alcoholics Anonymous. It’s possible that the 12 Steps of AA seemed entirely foreign to you. You’re thankful for your sponsor, who helped to see you through each step and support you. Someone else may need you to do that for them.

No matter which path a person chooses, they’re never done with the program. Instead, they use it as a way to help control their lives. Remember, recovery is about making your life manageable again. The 12 Step program gives people a framework to do that.

What Next?

After the 12 Step Program

The 12 Steps of Recovery

The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture.

The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture. The early initiatives for people who were gay focused mostly on men. So, in an attempt to draw attention to issues specific to gay women, "lesbian" is often listed first. People who are bisexual or transgender have been traditionally left out of, or underrepresented in, research studies and health initiatives. It is now considered standard to include these two groups along with gay men and lesbians.

What is the Meaning of LGBT?

According to researchers Susan Cochran and Vickie Mays, sexual orientation includes the following dimensions: 

- sexual attraction
- sexual behavior
- sexual fantasies
- emotional, social, and lifestyle preferences
- self-identification

What is Sexual Orientation?

The term "gay" has traditionally been used to represent a diverse group of people who are attracted to people of the same gender or are in a relationship with someone of the same gender. It is important to recognize, however, that different groups within the gay community exist, and that the term "gay" is not all-inclusive.

For example, transsexuals and some people who are bisexual do not consider themselves to be gay. Also, research has found that men who have had relationships with other men do not always identify themselves as gay. There is also a tremendous ethnic diversity among our lesbian, gay, and bisexual communities, and this contributes to the different perceptions of the term "gay." 

Heterosexual, or straight, refers to people whose sexual and romantic feelings are mostly for the opposite gender: Men who are attracted to women, and women who are attracted to men.

Homosexual, or gay, refers to people whose sexual and romantic feelings are mostly for the same gender: Men who are attracted to men, and women who are attracted to women.

Lesbian refers to women who are homosexual.

Bisexual or "bi" refers to people whose sexual and romantic feelings are for both genders.

Transgender is an umbrella term that encompasses a diversity of gender expressions including drag queens and kings, bi-genders, crossdressers, transgenderists, and transsexuals.

Transvestites are people who like to dress like members of the opposite sex.

Transsexuals are people who feel that their anatomical sex does not match the gender with which they identify.

Bigender refers to people who define themselves as having the behavioral, cultural, or psychological characteristics associated with both the male and female genders.

Transgenderist describes someone who is gender variant or transgresses gender norms as part of their lifestyle or identity.

Definition of Terms

Introduction

LGBT individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs. Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights.

Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals and have long-lasting effects on the individual and the community. Personal, family and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals

Why Is LGBT Health Important?
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long healthy lives. The many benefits of addressing health concerns and reducing disparities include reductions in disease transmission and progression, increased mental and physical well-being, reduced health care costs, and increased longevity.

Lesbian, Gay, Bisexual, and Transgender Health

In order to effectively address LGBT health issues, we need to securely and consistently collect SOGI information in national surveys and health records. This will allow researchers and policymakers to accurately characterize LGBT health and disparities. Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part, because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.

Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

- Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits
- Lack of laws protecting against bullying in schools
- Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders
- Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:
- Safe schools, neighborhoods, and housing
- Access to recreational facilities and activities
- Availability of safe meeting places
- Access to health services

Understanding LGBT Health

A number of issues will need to continue to be evaluated and addressed over the coming decade, including:

- Nationally representative data on LGBT Americans
- Prevention of violence and homicide toward the LGB community, and especially the transgender population
- Resiliency in LGBT communities
- LGBT parenting issues throughout the life course
- Elder health and well-being
- Exploration of sexual/gender identity among youth
- Need for an LGBT wellness model
- Recognition of transgender health needs as medically necessary

Continuing Issues in LGBT Health

LGBT Health

LGBT Community

Learn about conquering recurring nightmares.

Discover how to reduce the frequency and severity of recurring nightmares.

Practice relaxation techniques each night before you go to bed.

Step 1

Choose a recurring nightmare you would like to work on. This will be your target nightmare.

Step 2

Choose a changed ending for the nightmare. The change should occur BEFORE anything traumatic or bad happens to you or others in the nightmare. Essentially, you want to come up with a change that will prevent the bad outcome of the usual nightmare from occurring. The more unusual and out-of-the-ordinary the change is, the more effective this protocol may be. For example, you might become a person with superhuman powers (e.g., invisibility, ability to fly) who is able to escape to safety or fight off attackers.

Step 3

Write down the full nightmare with the change.

Step 4

REHEARSAL + RELAXATIONS: Practice rehearsal of the nightmare by visualizing the entire dream with the change each night before practicing relaxation techniques.

Step 5

Visualize the entire dream with the change, and practice relaxation, as often as possible during the day.

Step 6

The Protocol

Instructions for Nightmare Protocol

Discover how you can help someone you know who may be struggling.

Discover the warning signs for someone who may be struggling.

There is no typical suicide victim. It happens to young and old, sick and well, rich and poor. But, fortunately, there are some common warning signs which, when acted upon, can save lives. Here are some signs to look for:

- Talk about committing suicide
- Have trouble eating or sleeping
- Experience drastic changes in behavior
- Withdraw from friends and/or social activities
- Lost interest in hobbies
- Prepare for death by making out a will and making final arrangements
- Give away prized possessions
- Have attempted suicide before
- Have a recent severe loss
- Be preoccupied with death and dying
- Lose interest in his or her personal appearance
- Increase usage of alcohol or drugs

Warning Signs

What should you do if you think someone you know might be suicidal?

Contact:

A community mental health agency,
- A private therapist
- A school counselor or psychologist
- A family physician
- A suicide and crisis center

Contact

DO:
- Be aware
- Learn the warning signs
- Get involved
- Become available
- Show interest and support
- Ask if he or she is thinking about suicide
- Be direct
- Talk openly and freely about suicide
- Be willing to listen
- Allow expression of feelings
- Accept the feelings
- Be non-judgemental
- Offer empathy, not sympathy
- Offer hope that alternatives are available, but do not offer glib reassurance. It only proves you don't understand
- Take action
- Remove means
- Get help from persons or agencies specializing in crisis intervention and suicide prevention

DON'T
- Don't debate whether suicide is right or wrong, or if feelings are good or bad
- Don't lecture on the value of life
- Don't dare him or her to do it
- Don't give advice by making decisions for someone else or tell him or her to behave differently
- Don't ask "why". This encourages defensiveness
- Don't act shocked. This will put distance between you
- Don't be sworn to secrecy. Seek support

Ways to be Helpful

What To Do?

Helping Suicidal Friends

Volunteering is a win-win situation - it improves your mood and helps other people out!


Learn about volunteering benefits and opportunities.

Dummy Title: Part 1 - video

Part of being a great volunteer is loving what you're doing. Find something that you're passionate about or something that inspires you, and then find a need in your community. There are dozens of reasons why you should volunteer - you just need to find the one that feels right.

20 GREAT REASONS TO VOLUNTEER:
- Help others
- Make a difference
- Find purpose
- Enjoy a meaningful conversation
- Connect with your community
- Feel involved
- Contribute to a cause that you care about
- Use your skills in a productive way
- Develop new skills
- Meet new people
- Explore new areas of interest
- Meet good people
- Impress your mom
- Impress yourself
- Expand your horizons
- Get out of the house
- Make new friends
- Strengthen your resume
- Feel better about yourself

Why Volunteer?

VolunteerMatch
Idealist.org
Network for Good
Points of Light Volunteer Opportunities
Points of Light’s HandsOn Network
Peace Corps
AmeriCorps
Senior Corps

Places to Find Volunteering Opportunities

Volunteering 101

Volunteering

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. Learn about many of the substance use disorders that MAT is designed to address. MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are clinically driven and tailored to meet each patient’s needs. Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium.

Learn about some programs and therapy used for MAT.

Opioid treatment programs (OTPs) provide MAT for individuals diagnosed with an opioid use disorder. OTPs also provide a range of services to reduce, eliminate, or prevent the use of illicit drugs, potential criminal activity, and/or the spread of infectious disease. OTPs focus on improving the quality of life of those receiving treatment. OTPs must be accredited by a SAMHSA-approved accrediting body and certified by SAMHSA. The Division of Pharmacologic Therapies (DPT), part of the SAMHSA Center for Substance Abuse Treatment (CSAT), oversees accreditation standards and certification processes for OTPs. Learn more about the certification of OTPs and SAMHSA’s oversight of OTP Accreditation Bodies. Federal law requires patients who receive treatment in an OTP to receive medical, counseling, vocational, educational, and other assessment and treatment services, in addition to prescribed medication. The law allows MAT professionals to provide treatment and services in a range of settings, including hospitals, correctional facilities, offices, and remote clinics. Learn more about the legislation, regulations, and guidelines that govern OTPs. As of 2015, OTPs were located in every U.S. state except North Dakota and Wyoming. The District of Columbia and the territories of Puerto Rico and the Virgin Islands also had OTPs in operation.

Opioid Treatment Programs

Under federal law, MAT patients must receive counseling, which could include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services. Learn more about these treatments for substance use disorders.

Counseling and Behavioral Therapies

In 2013, an estimated 1.8 million people had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy. MAT also includes support services that address the needs of most patients. The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to:

- Improve patient survival,
- Increase retention in treatment,
- Decrease illicit opiate use and other criminal activity among people with substance use disorders,
- Increase patients’ ability to gain and maintain employment,
- Improve birth outcomes among women who have substance use disorders and are pregnant. 

Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse. Learn more about substance misuse and how it relates to HIV, AIDS, and Viral Hepatitis. Learn more about common comorbidities that occur with substance use disorders.

MAT Effectiveness

SAMHSA’s Partners for Recovery Initiative produced a brochure designed to assist MAT patients and to educate and inform others. This Medication-Assisted Treatment Know Your Rights Brochure – 2009 presents and explains the federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving MAT for opioid addiction. Under the Confidentiality Regulation, 42 Code of Federal Regulations (CFR) 2, personally identifiable health information relating to substance use and alcohol treatment must be handled with a higher degree of confidentiality than other medical information.

MAT and Patient Rights

FDA has approved several different medications to treat opioid addiction and alcohol dependence. A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability. Medications used in MAT for opioid treatment can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.

Medications Used in MAT

Programs and Therapy

Learn about the different medications used during Medication Assisted Treatment.

Methadone tricks the brain into thinking it’s still getting the abused drug. In fact, the person is not getting high from it and feels normal, so withdrawal doesn’t occur. Learn more about methadone. Pregnant or breastfeeding women must inform their treatment provider before taking methadone. It is the only drug used in MAT approved for women who are pregnant or breastfeeding. 

Methadone

Like methadone, buprenorphine suppresses and reduces cravings for the abused drug. It can come in a pill form or sublingual tablet that is placed under the tongue.

Buprenorphine

Naltrexone works differently than methadone and buprenorphine in the treatment of opioid dependency. If a person using naltrexone relapses and uses the abused drug, naltrexone blocks the euphoric and sedative effects of the abused drug and prevents feelings of euphoria.

Naltrexone

FDA approved naloxone, an injectable drug used to prevent an opioid overdose. According to the World Health Organization (WHO), naloxone is one of a number of medications considered essential to a functioning health care system.

Naloxone

Disulfiram is a medication that treats chronic alcoholism. It is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. This drug is offered in tablet form and is taken once a day. Disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an hour or more.

Disulfiram

Acamprosate is a medication for people in recovery who have already stopped drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consumes illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.

Acamprosate

When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This allows people with alcohol addiction to reduce their drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, and take medications.

Medication Assisted Treatment

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, or shame.


People often try many different ways to get rid of their negative thoughts, including distractions, diversions, or ‘drowning their sorrows’ only to later mentally beat themselves up for being still stuck in their negativity. It can feel like a real internal battle. These are common strategies that attempt to stop the thoughts and numb the pain in the short term but they only make things worse in the long term. It doesn’t fix the problem at its core. The research shows that struggling with, arguing with, trying to drown out, or push away unhelpful thoughts only amplifies them and makes things worse. If you are struggling with negative thinking, it is possible to turn things around, cultivate inner peace, and live a rich, meaningful, and fulfilling life. Read on to find out how.

Ineffective Ways People Try to Stop Negative Thinking

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, shame, etc. Once we learn to recognize and identify negative thought patterns as they occur, we can start to step back from them. This process of stepping back from thoughts is called ‘cognitive defusion.’ In cognitive defusion, we learn to see the thoughts in our head as simply that—just thoughts. Not reality. You see, when we are fused with our thoughts (cognitive fusion) we tend to take our thoughts very, very seriously. We believe them. We buy into them and we obey them. We play them out. When we are not fused with our thoughts—when we can step back into cognitive defusion, then we do not take our thoughts too seriously. We hold them lightly. We only listen to them if we find them valuable or helpful.  We certainly don’t take our thoughts to be ‘the truth’ and we don’t automatically obey them or play them out. We see our thoughts as simply bits of language that pass through the mind. Mental events if you will, that move through the mind all the time just like the weather passes through the sky. We have a choice in how we choose to respond to them. An example to illustrate the difference between cognitive fusion and cognitive defusion is this...imagine waking up one day and looking out the window and seeing rain. It’s possible that a thought might come into your head that says “what a dreadful day”. Now is it true that the day is dreadful? No, of course not, it is simply raining. However, if you believe the thought “what a dreadful day”, in other words, if you are stuck in cognitive fusion (literally fused with the thought) then guess what you will probably have? That’s right, you will probably have a dreadful day! In other words, if you believe a thought like that, it can generate what we might call negativity. It’s completely normal to have negative thoughts! It’s part of our evolutionary history. There is nothing wrong with you. We all have minds that have evolved to be constantly on the lookout for problems and dangers, so most of us have minds prone to have many negative thoughts. The problem is not that we have negative thoughts. The problem comes when we believe our thoughts are true. When you are no longer entangled in thoughts they lose their grip on you and lose their power to generate unpleasant emotions. Imagine you’re laying in bed in the morning, you look out the window and you see that it’s raining and once again the thought arises “what a dreadful day”. If you are not fused with the thought (you don’t buy into it) then your experience would be like this. You’re watching the rain falling, then you also watch the thought (as simply a mental event) “what a dreadful day” arise and fall away just like the rain is falling and since you don’t take it seriously or believe it, it generates no negativity, passes by easily and you’re free to lay there relaxed and at ease, enjoying the pitter-patter of the rain on the roof. As you can see, the ability to recognize unhelpful thinking and step back from it is incredibly liberating! It can change the quality of your whole day and indeed your whole life.

Recognize and Take a Step Back

“My life has been full of terrible misfortunes, most of which never happened”. ~ Michel de Montaigne

Worry is when the mind projects into an imagined future and conjures up scenes and thoughts about what could go wrong. Here it often creates ‘what if’ scenarios. Sometimes it takes the form of imagining or expecting that bad things will happen or that nothing good will ever happen for you. You might fret about your health deteriorating, your relationship going downhill, your car breaking down or your career being ruined—even though nothing has actually happened yet. You might focus on the lack in your life and believe that nothing will ever get better for you. Stress-related to your financial future, the welfare of your children or your partner leaving you fit into this category.

Anxious Thoughts and Worry

Do you have a harsh inner critic? Are you always trying to whip yourself into shape, mentally beating yourself up for not being good enough yet? Are you on a mission for perfection?
Another pattern of negative thought is to constantly criticize and self-improve because you’re not good enough yet. You may be very harsh on yourself, focusing on all of your weaknesses and perceived flaws. Likewise, you may extend this habit of criticism to others in your life. This can be the cause of tremendous strain on relationships. Negative self-talk and self-criticism often result in low self-esteem and a lack of confidence. One way some people cope with low self-esteem is to compensate for these feelings by attaining status, achievements, and recognition. Others may feel completely debilitated by feelings of unworthiness, becoming depressed, or even suicidal. There is nothing wrong with having goals and aiming to get fitter or healthier and the like—we can simply choose to do those because they are good for us or we want to stretch and grow. It’s a very different headspace to be doing those things because we don’t feel like we’re enough yet. When the mind continuously hones in on what is wrong with yourself (and your life) and disassociates from what is going well and is good, we can become stuck in negativity.

Criticism and Self-Beating

Ruminating on mistakes made in the past often creates feelings of shame, guilt, and negativity. Feelings of worthlessness may arise when you play over and over in your mind, ‘bad’ choices or ‘wrong’ actions you feel you have made. There is nothing ‘negative’ about simply reflecting on past experiences. This is how we can learn, grow and mature as people. Negativity arises when you dwell on a situation repeatedly with no real intention to learn and grow–but instead, you are self-beating or wishing things were different instead of being accepting of things as they are.

Regret and Guilt

The Patterns

Learn how to break free from negative thought patterns.

People trapped in negative thinking often say they feel hopeless because they often wrestle or argue with the thoughts or push them away, but the research shows that trying to struggle with thoughts in these ways just amplifies them as you may have noticed in your own life. What you resist persists. So how do you move through life in a way that is practical, peaceful, and authentic without getting stuck in negative thought patterns? Here is the first step. It’s a very powerful, simple, tried, and tested technique for untangling from thoughts without struggling with them. It’s called the ‘name it to tame it’ technique. "Name it to tame it" is a phrase coined by author and psychiatrist Dr. Daniel Siegel. Here are the basics of how ‘name it to tame it’ works: 

When an unhelpful thought pattern (and the associated emotion) arises you simply mentally ‘label’ the story. You’ve probably noticed many of our thoughts are repetitive and involve the same storylines. A story you could be telling yourself is, “Who am I to be putting myself out there teaching mindfulness. Aren’t you supposed to be perfect first!? Have it all totally together?!” This story is unhelpful so when thoughts come up along that storyline, you should simply take the mental note, “Ahhhh the ‘who do you think you are’ story is here again” and then let it go. By ‘let it go’ we simply mean, stop giving it all your attention and stop taking it so seriously. Realize it’s just a thought, not reality, then open your awareness to the world around you again—the birds in the trees, the sounds, the breeze. Get out of your head and into your life. As soon as you name the mental story or pattern, you have now stepped back from being caught up in it. In other words, you have initiated cognitive defusion. 

From a neuroscience perspective, when you name the thoughts you stop being hijacked by them from the negativity they create because you bring the smartest part of your brain online (the frontal cortex). The frontal cortex is reflective and helps you step back and get a greater perspective. You can do the same thing with emotions, naming them to tame them like “ahhh anxiety is here” or “oh shame has arrived”. When naming or labeling your thoughts or emotions, one important tip. Make sure when you mentally label, to do it in a soothing, kind tone of voice. This is important as it helps you to settle and invite compassion and soothing into that moment instead of aggression or struggle. We’re not going to battle with the mind here. We are gently training it into new neural pathways of peace and ease. At a biological level, when you ‘name it to tame it’ in a soothing voice you even get a squirt of soothing neurotransmitters in the brain! This brings feelings of calm and ease and comfort.

Getting Unstuck: The "Name It To Tame It" Technique

“Let us not look back in anger or forward in fear, but around in awareness.” ~ James Thurber

Notice that many negative thoughts mostly flow from two directions. The first is dwelling on the past—maybe you ruminate over mistakes, problems, guilt, and anything in your life that’s did not go the way you believe it should have gone. The second is worrying about the future—fear of what may or may not happen for yourself, others, or the planet.
This may take the form of stress over whether or not you will achieve certain goals or anxiety about the security of your finances or relationships. Or perhaps you may worry about getting old. Whatever your particular negative thoughts are, notice that in order to engage in negative thought patterns the mind needs to cast its focus mostly on the past or future. Either that or we judge and mentally label things in the present moment to be ‘bad’. When lost in negative thinking we tend to be so engrossed in thoughts that we completely lose touch with what is actually happening in the present moments of our lives. We miss the little pleasures of living each day. The sunlight on your skin, the taste of the food we’re eating, a real connection with someone we love while they are talking. When we’re lost on our heads we lose touch with the world around us... and we lose touch with ourselves. To become more present, and able to step out of negative thinking, one powerful method is to ‘come to your senses. To do this simply redirect your attention out of the thoughts in your head and bring your focus to your sense perceptions. Whether you’re in your home, at the office, in the park, or on a subway, notice everything around you. Use your senses to their fullest. Don’t get into a mental dialogue about the things you see, just be aware of what you’re experiencing at this moment. Be aware of the sounds, the scents, the sensation of the air on your skin, or the contact points with the seat beneath you. Be there fully in the moment. This is a form of mindfulness practice.

Research from Prof. Mark Williams from Oxford University showed that when difficulties arise in life many of us tend to get caught up in excessive unhelpful thinking.
Sometimes people try to stop constant unhelpful thinking but we don’t have to try to stop our thoughts. A more effective way to ease all that internal noise, Prof. Williams teaches, is to pay attention to our direct sensory experience. In this way, there’s simply little to no room left in our attention for all that excessive thinking. Coming to our senses calms the mind and grounds us in the present moment. Now, it’s not that we’re aiming to live completely immersed in our senses all the time. It’s appropriate to think when it’s useful of course. But we can use this awareness of our senses to the ground and center us in a greater awareness when we find ourselves caught up in negative thinking. It is actually almost impossible to be both deeply present in the moment in our senses and keep the negativity going! Try it out as an experiment and find out for yourself to see whether this is true.

Coming To Your Senses

Breaking Free

Breaking Negative Thought Patterns

Co-dependency, also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. 

Source: https://www.mhanational.org/co-dependency

Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship.

Co-dependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, co-dependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family.

Who Does Co-Dependency Affect?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

- An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
- The existence of physical, emotional, or sexual abuse.
- The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited.

Attention and energy focus on the family member who is ill or addicted. The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

What Is A Dysfunctional Family?

Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine - and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the co-dependent feels choice-less and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

How Do Co-Dependent People Behave?

Characteristics Of Co-Dependent People Are:

- An exaggerated sense of responsibility for the actions of others
- A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
- A tendency to do more than their share, all of the time
- A tendency to become hurt when people don’t recognize their efforts
- An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment
- An extreme need for approval and recognition
- A sense of guilt when asserting themselves
- A compelling need to control others
- Lack of trust in self and/or others
- Fear of being abandoned or alone
- Difficulty identifying feelings
- Rigidity/difficulty adjusting to change
- Problems with intimacy/boundaries
- Chronic anger
- Lying/dishonesty
- Poor communications
- Difficulty making decisions

Characteristics Of Co-Dependent People

The first step in changing unhealthy behavior is to understand it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.

A lot of change and growth is necessary for the co-dependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand co-dependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.

When Co-Dependency Hits Home

Learn about how to identify signs of co-dependency and how someone is treated for co-dependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.

1. Do you keep quiet to avoid arguments?
2. Are you always worried about others’ opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a “bad person” when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying “no” when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can’t do justice to any of them?

If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.

Questionnaire To Identify Signs Of Co-Dependency

Because co-dependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which co-dependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

How Is Co-Dependency Treated?

Identification and Treatment

Co-dependency

This module explains what Substance Use Disorder is and the symptoms associated with Substance Use Disorder.

“Substance Use Disorders - Mental Health Disorders.” Merck Manuals Professional Edition

Substance Use Disorder is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication.

Substance Use Disorder (SUD) occurs when a person's use of alcohol or another substance (drug) leads to health issues or problems at work, school, or home. Substance Use Disorders can develop whether or not a drug is legal, is socially acceptable, or has an accepted medical use (with or without a prescription). The terms "addiction," "abuse," and "dependence" have traditionally been used in regard to people with substance use disorders. However, those terms are all too loosely and variably defined to be very useful and also are often used judgmentally. Thus, doctors now prefer to use the more comprehensive and less negative term "substance use disorder."

Substance Use Disorder

People usually progress from experimentation to occasional use and then to heavy use and sometimes to a substance use disorder. This progression is complex and only partially understood. The process depends on interactions between the drug, user, and setting. Drugs in the 10 classes vary in how likely they are to cause a substance use disorder. The likelihood is termed addiction liability. Addiction liability depends upon a combination of factors including how the drug is used, how strongly the drug stimulates the brain's reward pathway, how quickly the drug works, and the drug's ability to induce tolerance and/or symptoms of withdrawal.

In addition, substances that are legally and/or readily available, such as alcohol and tobacco, are more likely to be used first. As people continue to use a substance, they often see less risk in using it and may begin to increase their use and/or experiment with other substances. People's perception of risk also may be influenced by the social and legal consequences of use. During treatment of medical illness or following surgical or dental procedures, people have routinely prescribed opioids. If people don't take the whole amount prescribed, the drugs can end up in the hands of people who use them recreationally. This non-medical use has become such a large problem that many health care providers have responded by prescribing lower amounts of opioid drugs, encouraging people to safely store or dispose of any leftover drugs, and expanding prescription take-back programs

Causes of Substance Use Disorder

Causes of SUD

Learn about the similarities and differences with Mental Health Conditions and Substance Use Disorder

Mental health problems and substance use disorders sometimes occur together. This is because certain illegal drugs can cause people with an addiction to experience one or more symptoms of a mental health problem. Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication. Mental and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma. More than one in four adults living with serious mental health problems also has a substance use problem. Substance use problems occur more frequently with certain mental health problems, including Depression, Anxiety Disorders, Schizophrenia, and Personality Disorders.

Mental Health

Mental Health and SUD

Discover physical and behavioral symptoms of Substance Use Disorder.

- A drop in attendance and performance at work or school
- Frequently getting into trouble (fights, accidents, illegal activities)
- Using substances in physically hazardous situations such as while driving or operating a machine
- Engaging in secretive or suspicious behaviors
- Changes in appetite or sleep patterns
- Unexplained change in personality or attitude
- Sudden mood swings, irritability, or angry outbursts
- Periods of unusual hyperactivity, agitation, or giddiness
- Lacking motivation
- Appearing fearful, anxious, or paranoid, with no reason

Behavioral Symptoms

- Bloodshot eyes and abnormally sized pupils
- Sudden weight loss or weight gain
- Deterioration of physical appearance
- Unusual smells on breath, body, or clothing
- Tremors, slurred speech, or impaired coordination

Physical Symptoms

- Sudden change in friends, favorite hangouts, and hobbies
- Legal problems related to substance use
- Unexplained need for money or financial problems
- Using substances even though it causes problems in relationships

Social Symptoms

Symptoms

What is SUD?

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it.

Post-Traumatic Stress Disorder

The effects of post-traumatic stress disorder (PTSD) can be far-reaching and debilitating. The symptoms of PTSD can have a negative impact on your mental health, physical health, work, and relationships. You may feel isolated, have trouble maintaining a job, be unable to trust other people, and have difficulty controlling or expressing your emotions.

Learning healthy strategies for coping with PTSD is possible and can offer a sense of renewal, hope, and control over your life. There are a variety of areas in our lives that can be impacted by the symptoms of PTSD and, in order to work toward a healthy recovery, it is important to give attention to each area.

PTSD

If you have PTSD, you are at much greater risk of developing a number of other mental health disorders, including anxiety disorders, depression, eating disorders, and substance use disorders. For example, researchers have found that people with PTSD are about six times as likely as someone without PTSD to develop depression and about five times as likely to develop another anxiety disorder. People with PTSD are six times as likely as someone without PTSD to attempt suicide. High rates of deliberate self-harm have also been found among people with PTSD.

Why Healthy Coping Skills Are Important

If you are struggling with PTSD, it's possible that you can feel easily overwhelmed, fearful, and anxious. It is understandable that you would do whatever you can to avoid people, places, and things that could remind you of your traumatic experience. There are a couple of different types of triggers that people with PTSD can experience—internal and external.

Examples of internal triggers can include:
- Feeling lonely
- Anger
- Sadness
- Feeling Vulnerable
- Muscle tension
- Memories
- Or physical pain

Examples of external triggers include:
- New programs
- Movie or TV show
- Smells
- Anniversary
- Holidays
- Places that remind you of a specific event
- Certain people

Although it is understandable to want to avoid triggers it is important to remember that, depending on the trauma we experienced, we may not be able to avoid everything that could be a trigger. Rather than working to try and avoid, it is most helpful to find healthy ways to cope with triggers so that you can fully experience life again. Participating in a recovery or treatment program can help with this, as you learn to handle and navigate challenging situations and potentially triggering experiences.

Triggers

Trying to explain your experience to others can be challenging. Not only can it be difficult to talk with people about the traumatic event itself, but it can be even more challenging to describe to others some of the symptoms you have been experiencing since the event.

1. Educate Yourself and Others
People who struggle with PTSD often do so in isolation, finding it hard to reach out. In fact, they might not even realize that they are struggling with PTSD until the symptoms become nearly unbearable. In addition to educating yourself on the symptoms and treatment, it is important to seek out safe people to connect with who can support you in your recovery journey. By learning about the condition, you can have the words to more clearly explain to others what is happening for you and ask for what you need.

2. Find Supportive Connections
There are many resources offered in local communities and online that offer group-based support, such as support groups, classes, community meetings, and online groups. Connecting with others who are going through a similar experience can break down the walls of isolation and help you understand that you are not alone. Interacting with others who are in various stages of healthy recovery can be invaluable to you in your own healing journey. You can discover tips for coping, connect with specialized providers and learn about new and emerging treatment options.

3. Spend Time With People
It is common for people with PTSD to shy away from people, withdraw, and retreat. Fears, anxiety, anger, frustration, confusion, and the feeling of being overwhelmed are just some of the reasons why it might feel better to stay isolated than be around people. Spending time with supportive friends and family, however, can make a significant difference in your mood and outlook. Keep in mind that if you are sharing space with any family or friends, it is likely they already notice you struggling. Many times people don't know how to help or are afraid to say something for fear of causing more emotional pain. It can be helpful for all parties—both you and your loved ones—to have time to spend together. Some ways to spend time with others can include things like going for a walk, have morning coffee, play a card game, talk on the phone, or share funny stories If you don't feel ready to talk yet, you can also sit quietly in the same room to read a book or the newspaper. Simply sharing the same space quietly can feel comforting.

Social Coping Strategies

One of the most important ways to cope with PTSD—and many other conditions—is to take care of your mental and physical wellness. There are many strategies that can work together with your treatment to not only help you cope with PTSD but to strengthen your mind and body in ways that can benefit you in your everyday life.

1. Mindfulness
Because of the levels of stress, anxiety and overwhelm that people often experience with PTSD, finding time for prayer, meditation, and other mindfulness techniques can be helpful to calm our bodies and minds. If the thought of this is uncomfortable for you, keep in mind that there is no pressure to perform. Just beginning with one or two minutes per day of quiet mindfulness can feel like a victory. The goal of that time is to stay focused on the present without any threat of fear or judgment. Gradually add more time as you go, offering yourself moments to experience a sense of calm and learn how to balance yourself if you begin to feel overwhelmed or anxious.

2. Exercise
Just as it is important to learn how to calm your mind, it is also important to get your body moving. Taking time to enjoy the outdoors, get some fresh air, and move our bodies can be a helpful way to regulate mood and emotions. Research has shown that physical exercise can help our brains better cope with stress. In fact, psychologists suggest that just a 10-minute walk per day can offer benefits to our mood and help to relieve anxiety and depression. Here are some things to keep in mind as you get started: 

- Find an activity you enjoy
- Be consistent
- Listen to music or podcasts while you exercise
- Ask a friend to join you
- Be patient with yourself
- Drink plenty of fluids
- Make sure to dress for the weather

3. Participate in Counseling
Talking with a professional such as a counselor or therapist might feel a bit intimidating, but can be very helpful when you are struggling with PTSD. Having a trained person available to offer support and guidance in your recovery is a key element to long-term success. Find someone you feel comfortable with, that you find trustworthy and knowledgeable, and be consistent in attending your sessions. Counseling offices can offer a safe, calm space for you to process without any fear of having to perform or be judged. Being consistent in your participation is helpful to build on your progress, continue growing, and find healing.

4. Keep a Journal
Some people find it relaxing to journal their thoughts and have a consistent place to go back to in order to write and process their experiences. Research has shown that people struggling with PTSD can find benefit in keeping a journal, including decreasing flashbacks, nightmares, and intrusive memories, helping them slowly reconnect to people and places that they may otherwise want to avoid. Journaling can also aid in your counseling, as you can typically bring your journal to sessions as things come up that you would like to process. Talk with your therapist and see if this might be an option for you.

Emotional and Physical Coping Strategies

People with PTSD miss more days at work and work less efficiently. Certain symptoms of PTSD, such as difficulty concentrating and problems sleeping, may make it hard for you to pay attention at work, stay organized, or make it to work on time. To help navigate some of the challenges that PTSD can bring into the workplace, it can be helpful for you to talk with your employer about things that could help. Being willing to communicate is necessary for people to better understand your experience and to help you work around the challenges that you are facing. An example of things to mention might include:

- Asking for flexibility with scheduling
- Help in minimizing distractions
- Moments to regroup if you begin to feel overwhelmed
- Rearranging your workspace in a way that helps you feel safe
- Talk with your HR department about possible Employee Assistance Programs

Work Strategies

People with PTSD are more likely to have problems in their marriages than people without PTSD. Partners of people with the condition may be faced with a number of stressors that go along with caring for and living with someone with emotional challenges like that of PTSD. The sources of stress include financial challenges, managing symptoms, dealing with crises, loss of friends, or loss of intimacy. These can have a major negative impact on a relationship. Keep in mind that those closest to you might already recognize you are struggling and not know what to say or how to help. That doesn't mean they don't care, it simply means they don't know what to do. When we are experiencing symptoms like those of PTSD, it can feel like we are completely separated from people and going through the experience alone.

Be Honest About Your Needs
Take time to help your loved ones understand what you are experiencing and be honest about how they can help. Ask them to be patient with you and remember to be patient with yourself as well. Setting and maintaining healthy boundaries around time or personal space can be important in relationships. Learning how to trust people and asking for help can be significant obstacles, but are very important—especially with those who care for us most.

Carve Out Time 
Feeling isolated in our experience is a big part of dealing with PTSD. Moving away from people, shutting down, or staying hidden from important people in our lives can lead to more emotional pain and more debilitating symptoms. Take time to spend with loved ones and practice sharing space with them, interacting, and reconnecting. Nurturing these connections by carving out time to spend together is helpful for the relationship and beneficial to your recovery and healing.

Relationship Strategies

Coping Strategies

Coping with PTSD

We've all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Learn about the benefits of having a training partner!

Perhaps the best aspect of training with someone is that your partner provides instant accountability. We’ve all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Making plans with a training partner makes it much harder to cancel a workout as you know you’ll be messing up their plans too.

Accountability

It’s not uncommon to be overly critical when looking at workout progression. You may just be your own worst critic. A good training partner will always be able to look at your concerns through fresh eyes and give a healthy second opinion.

Outside Perspective

We humans (especially men, it seems) tend to work harder and perform better in competitive situations. Training with a partner can unlock your competitive drive no matter how chilled out you usually are. There’s nothing like a training partner looking great or making serious progress in the gym to fire up your desire to do better. One word of caution though: if your partner is considerably stronger or fitter than you, don’t be sucked into trying to perform the same workouts. Your partner won't progress, and you'll likely get injured. Instead, try to compete on degrees of improvement relative to your own current ability.

Healthy Competition

Those incorporating weightlifting into their training regime will benefit greatly from having a training partner who can act as a spotter on those big lifts. Depending on the type of training program you are using, reaching or approaching concentric failure on a set may be necessary to make progress. Having someone there to help control the weight means that you can push further than you could alone and have a safer workout. It’s common to hear people ask for a spot on the bench press, but it shouldn’t stop there: you can get more out of almost all free weight exercises with the help of a spotter.

You'll Be Able to Spot Each Other

One of the greatest parts of having a good training partner is the ability to share each other's successes. Setting training goals and edging closer and closer to their attainment alongside someone else is very motivating. It’s also a great idea to plan rewards together. A previous training partner and I used to book a weekend trip away to let our hair down each time we finished a 6-8 week training phase. It helps to balance all the hard work with a worthy reward.

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