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

Moderation is everything. Learn about the effects of Alcohol.

Learn about the effects and the health risks of alcohol consumption.

Alcoholic drinks have different amounts of alcohol in them. Beer is about 5% alcohol, although some beers have more. Wine is usually 12% to 15% alcohol. Hard liquor is about 45% alcohol. Alcohol gets into your bloodstream quickly. The amount and type of food in your stomach can change how quickly this occurs. For example, high-carbohydrate and high-fat foods can make your body absorb alcohol more slowly. Certain types of alcoholic drinks get into your bloodstream faster. Stronger drinks tend to be absorbed faster. Alcohol slows your breathing rate, heart rate, and how well your brain functions. These effects may appear within 10 minutes and peak at around 40 to 60 minutes. Alcohol stays in your bloodstream until it is broken down by the liver.

The amount of alcohol in your blood is called your blood alcohol level. If you drink alcohol faster than the liver can break it down, this level rises. Your blood alcohol level is used to legally define whether or not you are drunk. The legal limit for blood alcohol usually falls between 0.08 and 0.10 in most states. Below is a list of blood alcohol levels and the likely symptoms:

0.05 -- reduced inhibitions
0.10 -- slurred speech
0.20 -- euphoria and motor impairment
0.30 -- confusion
0.40 -- stupor
0.50 -- coma
0.60 -- breathing stops and death

You can have symptoms of being drunk at blood alcohol levels below the legal definition of being drunk. Also, people who drink alcohol frequently may not have symptoms until a higher blood alcohol level is reached.

The Effects of Alcohol

Alcohol increases the risk of:

- Alcoholism
- Falls, drownings, and other accidents
- Head, neck, stomach, colon, breast, and other cancers
- Heart attack and stroke
- Motor vehicle accidents
- Risky sex behaviors, unplanned or unwanted pregnancy, and sexually transmitted infections (STIs)
- Suicide and homicide

Drinking during pregnancy can harm the developing baby. Severe birth defects or fetal alcohol syndrome are possible.

Health Risks of Alcohol

Alcohol

Learn about some tips to drink responsibly, if you choose to drink alcohol.

If you drink alcohol, it is best to do so in moderation. Moderation means the drinking is not getting you intoxicated (or drunk) and you are drinking no more than 1 drink per day if you are a woman and no more than 2 if you are a man. A drink is defined as 12 ounces (350 milliliters) of beer, 5 ounces (150 milliliters) of wine, or 1.5 ounces (45 milliliters) of liquor. Here are some ways to drink responsibly, provided you do not have a drinking problem, are of legal age to drink alcohol, and are not pregnant.

Never drink alcohol and drive a car. If you are going to drink, have a designated driver, or plan an alternative way home, such as a taxi or bus. DO NOT drink on an empty stomach. Snack before and while drinking alcohol. If you are taking medicines, including over-the-counter drugs, check with your health care provider before drinking alcohol. Alcohol can make the effects of many medicines stronger. It can also interact with other medicines, making them ineffective or dangerous or make you sick.

If alcohol use runs in your family, you may be at increased risk of developing this disease yourself. So, you may want to avoid drinking alcohol altogether. CALL YOUR HEALTH CARE PROVIDER IF:

- You are concerned about your personal alcohol use or that of a family member
- You are interested in more information regarding alcohol use or support groups
- You are unable to reduce or stop your alcohol consumption, in spite of attempts to stop drinking

Moderation

You can take steps to increase your safety in situations where drinking may be involved. These tips can help you feel safer and may reduce the risk of something happening. Though it is best to stay safe while under the influence of alcohol, it’s important to remember that sexual assault is never the victim’s fault, regardless of whether they were sober or under the influence of drugs or alcohol when it occurred.

1. Keep an eye on your friends.
If you are going out in a group, plan to arrive together and leave together. If you decide to leave early, let your friends know. If you’re at a party, check in with them during the night to see how they’re doing. If something doesn’t look right, step in. Don’t be afraid to let a friend know if something is making you uncomfortable or if you are worried about their safety.

2. Have a backup plan.
Sometimes plans change quickly. You might realize it’s not safe for you to drive home, or the group you arrived with might decide to go somewhere you don’t feel comfortable. Keep the number for a reliable taxi company saved in your phone and on a piece of paper in your wallet and try to have cash on hand. It is also a good idea to download a few different rideshare apps on your phone. Having multiple options helps ensure that you will be able to get a ride home or to a safe location, even if the app you typically use is not functioning. To help keep your phone charged so you can stay in communication with friends or call a ride, consider bringing an external cell phone charger that can be used without an electrical outlet. 

3. Know what you’re drinking.
Don’t recognize an ingredient? Use your phone to look it up. Consider avoiding large-batch drinks like punches that may have deceptively high alcohol content. There is no way to know exactly what was used to create these drinks.

4. Trust your instincts.
If you feel unsafe, uncomfortable, or worried for any reason, don’t ignore these feelings. Go with your gut. Get somewhere safe and find someone you trust, or call law enforcement. 

5. Don’t leave a drink unattended.
That includes when you use the bathroom, go dancing, or leave to make a phone call. Either take the drink with you or throw it out. Avoid using the same cup to refill your drink.

6. Don’t accept drinks from people you don’t know or trust.
This can be challenging in some settings, like a party or a date. If you choose to accept a drink from someone you’ve just met, try to go with the person to the bar to order it, watch it being poured, and carry it yourself.

7. Check in with yourself.
You might have heard the expression “know your limits.” Whether you drink regularly or not, check in with yourself periodically to register how you feel. If you think you have had too much, ask a trusted friend to help you get water or get home safely. Remember, if someone offers you a drink, you can always say no.

8. Be aware of sudden changes in the way your body feels.
Do you feel more intoxicated than you are comfortable with? Some drugs are odorless, colorless, and/or tasteless, and can be added to your drink without you noticing. If you feel uncomfortable, tell a friend and have them take you to a safe place. If you suspect you or a friend has been drugged, call 911, and tell the healthcare professionals that you suspect you or a friend has been drugged so they can administer the right tests.

Quick Tips to Help You Stay Safe

Responsible Drinking

Alcohol Safety

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

Introduction

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

Intensive Outpatient Treatment (also known as IOP for "Intensive Outpatient Program") is a primary treatment program recommended in some circumstances by a clinical and medical assessment.

Learn about IOPs and common questions regarding IOPs.

IOP may be recommended for those who do not need medically supervised detox. IOP can also enable people in recovery to continue their recovery therapies following successful detox, on a part-time yet intensive schedule, designed to accommodate work and family life. Start rebuilding your personal life and mending your important family ties right away, when you live at home and participate in intensive outpatient treatment. With the Intensive Outpatient Treatment program, you are able to establish a foundation for long-term recovery support in your local community right from the start of your treatment, instead of waiting until you return from living away in a rehab center.

In the Intensive Outpatient Program, you receive services primarily through group therapy but are also assigned an individual therapist you will meet with on a weekly basis while in treatment. Groups are small and generally do not exceed 10 people, allowing for a safe environment. Many different areas and topics are covered in the IOP. Including:

- Post-Acute Withdrawal Syndrome Or PAWS
- Relapse Prevention Skills
- How to Manage Urges and Cravings
- Understanding the Brain Chemistry of Addiction
- Progression of the Disease of Addiction
- Introduction To the Twelve Steps
- Spirituality
- Stages of Change
- Focus On Co-Occurring Disorders and the Effects On Addiction and Recovery
- A Family Education Program

Depending on your needs, you may be referred to additional comprehensive mental health treatment or training in how to increase healthy life skills or employment counseling.

What Sort of Therapies and Activities are Involved?

When you first start our IOP you will have daily “work” with us so we can help you through the shakiest times of your recovery. As you become stronger and don’t need such intense professional support, you will have shorter sessions, less often. This is sometimes called a “step down” system since you are effectively “stepping away” from our support as you become more independent. Of course, our professional staff remains available and ready to assist you at any time in your treatment.

What is the "declining intensity" program?

Your important initial clinical assessment will determine your suitability for the IOP treatment program. In some situations, detox may be required. If medically supervised detox is required, you will learn the specifics of that requirement for your custom treatment plan, and you will be referred to available professional detox services that are a fit for your situation, prior to starting the IOP program. You will also receive important, helpful counseling about your needs and treatment options as part of your assessment.

Do IOPs include detox?

At an inpatient treatment facility, you live in a residential area, usually a shared dorm room, under the rules and governance of the operators of the center. Each treatment center is unique with its own set of requirements, but you generally give up control of your day-to-day life while in treatment. Travel is sometimes required for inpatient treatment, and sometimes travel is desired. For example, some people choose to go to Florida for inpatient rehab and live in a treatment facility for the duration of their rehab. For the typical rehab experience lasting 30 days, this can mean a significant time away from work, family, and personal obligations. With an outpatient program like the IOP offered by The Counseling Center at Freehold, you continue to live at your own home. You remain in control of your own life. You can still go to work or get a job, and begin rebuilding your personal life, with the help and support you receive from the program. You are responsible for participating in the treatment programs at the local Counseling Center, according to your scheduled treatment plan. In the Intensive Outpatient Program, you continue your life with support from the local clinical, emotional, and peer support systems provided by the IOP.

What is the difference between inpatient and outpatient?

Common Questions about IOPs

Intensive Out Patient Programs

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

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

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?

S.U.D affects a family's well-being in many aspects. Often, physical, psychological, and financial health are compromised.

Learn how S.U.D affects all members of a family.

Every single person in an addict’s immediate family (and at times extended family) is affected in some way by the individual’s substance abuse. Addiction impacts a family’s finances, physical health, and psychological wellbeing. In recent years, our society has moved further and further away from the traditional nuclear family. There are single-parent homes, blended families, and homes headed by grandparents, just to name a few family unit variations. Each of these family structures and more will affect the addict’s overall impact on the family. If young children are a part of the family, their ages must also be factored into the effect of substance abuse. The same can be said for older adults who have adult children.

The severity of addiction and the type of substance dependence also factor into the overall impact of addiction on a family. Addiction impacts a family’s finances, physical health, and psychological wellbeing Lastly, each addict’s situation is different, which means that each family’s situation is unique. This makes it impossible to assign a universal causal relationship between substance abuse and family functioning. It is worth noting that in most families, the impact of addiction is overwhelmingly negative, with few exceptions.

Addiction and Family Roles

Learn about how addiction affects families in various family roles.

In every family unit, each person plays a role (or multiple roles) to help the family function better and to maintain a level of homeostasis, stability, and balance. When substance abuse is added to this dynamic, the family roles naturally shift to adjust to the new behaviors associated with drug or alcohol use and to continue maintaining order and balance. Including the addict, there have been six roles developed to understand how the family functions around the substance abuser. They are “the enabler,” “the mascot,” “the hero,” “the scapegoat,” “the lost child” and “the addict.

The Enabler
This role is often assumed by a non-addicted spouse or an older child in single-parent homes. The enabler takes care of all of the things that the addict has left undone, including taking care of finances, ensuring children get to school, and making justifications for the addict in social and business situations. The enabler is frequently in denial about the severity of the addict’s problem and will continually make excuses for him or her.

The Hero
This role is generally assumed by an older child in the family who overachieves and appears confident and serious. Heroes take on responsibilities in the home that seemingly exceed their developmental stage, often assuming parental roles. The hero is obsessed with perfection, which makes the role increasingly difficult to maintain as the addiction progresses and responsibilities continue to mount.

The Scapegoat
This is the child in the family who habitually misbehaves and displays defiant tendencies in the face of authority. These individuals often get into trouble in school and at home. As these children move toward adulthood, many get into trouble with the law as well. These behaviors are reflective of a poisonous and chaotic atmosphere in the house.

The Lost Child
The person in this role is isolated from other members of the family and has trouble developing relationships as a result. The lost child has difficulty in social situations and often engages in fantasy play to distract themselves both emotionally and physically from the negative home environment.

The Addict
Many chronic substance abusers feel great shame, guilt, and remorse about the pain and distress they’ve caused their families. However, there are also many addicts who do not want to cease their substance abuse, causing great anger and resentment throughout the family. When these roles are established during childhood, they become behavioral patterns that continue to play out and evolve throughout adulthood. The late development of an addiction (when adult children are present) creates another set of issues, as many family roles have already been firmly set. The blurred line between parent/child relationships and parent/friend relationships also makes the situation more difficult to remedy.

Among all of the family members who are impacted by an addict’s disease, perhaps no one suffers as much as children. The effects of living with an addicted parent can be felt long after childhood and well into adulthood. Parental alcoholism and drug addiction can create poor self-image, loneliness, guilt, anxiety, feelings of helplessness, fear of abandonment, and chronic depression in children. Maternal substance abuse during pregnancy can also lead to a host of behavioral and developmental disorders in children.

One in five adult Americans lived with an alcoholic relative at some point during their childhoods. Overall, these individuals are at a greater risk for behavioral and emotional problems when compared to children of non-alcoholics. Children of alcoholics are four times more likely to develop alcoholism than individuals who were not raised by alcoholics. They are also more likely to have difficulty dealing with stress and highly likely to marry an alcoholic or abusive spouse later in life. The financial damage of addiction can also lead to a child being undereducated and malnourished. Children of alcoholics and other substance abusers are also likely to grow up in a highly unstable home. Children in these situations are unable to determine which parent they will get (sober or intoxicated) on a moment-to-moment basis and are often left to fend for themselves at times when adult supervision would be considered necessary.

The financial damage of addiction can also lead to a child being undereducated and malnourished.
Going to school and having three meals a day is not as important as an addict’s next score. Basically, a person who grows up in a home with one or more addicts is often robbed of important aspects of his or her childhood. When illicit substances are involved, children are often unfairly exposed to illegal activities and may in some cases be asked to aid in these activities by lying about what their parents are doing. Additionally, parents abusing any substance are more likely to be involved with divorce, mental illness, unemployment, and legal problems, severely compromising their abilities to effectively parent.

Children of Substance Abusers

Substance abuse and committed relationships do not make for a very cohesive mix. Especially in relationships where only one partner has a substance abuse problem, alcohol and drugs can ruin a marriage or long-term relationship. Alcoholism has been linked to higher divorce rates, and one partner’s addiction can lead to the other partner having to shoulder an unfair share of the household responsibilities. A relationship with two addicts allows each partner to feed off of and enable the other. When both spouses are equally addicted to drugs or alcohol, it may not increase the chance for divorce, but the household’s atmosphere will become much more toxic as a result.

One sober partner can at least try to keep the house in order and encourage the substance abuser to see the help. A relationship with two addicts allows each partner to feed off of and enable the other. This too will likely lead to the slow deterioration of the relationship, as both addicts will be primarily focused on feeding their addictions rather than cultivating the relationship or handling any household responsibilities. Codependency is also an issue that often arises in spouses of substance abusers. The concept of codependency became widely popular during the 1980s. Broadly, it refers to an individual who is overly involved with another person to the point of dysfunction. Early on, the term was often reserved for the wives of alcoholics and drug addicts who relied on their husbands for financial wellbeing. Though codependent people are usually spouses, anyone who has an established relationship with an addict can become codependent.

Spouses of Substance Abusers

No matter how old a parent’s kids are, discovering that your children have an addiction problem can be an unpleasant, rude awakening. It may cause mothers and fathers to question their parental abilities or decisions they’ve made. Parents of addicts, much like children of addicts, often blame themselves for the development of the substance use disorder. For teenagers and adolescents struggling with addiction, the problem can be perceived as being potentially more dangerous, with the child not evenly fully matured and so much of his or her life left ahead. This is also a critical time for addiction to be stopped before its grip is too strong.

- Nine out of 10 Americans who meet the criteria for addiction began smoking, drinking or using other drugs before age 18.
- 75 percent of all high school students have used an addictive substance. One in five of those students meet the criteria for addiction.
- 46 percent of all high school students currently use an addictive substance, with 33 percent of them meeting the criteria for addiction
- 10 percent of all youth aged 12 to 17 are current illicit drug users.
- An estimated 6 percent of 16- and 17-year-olds and 17 percent of 18- to 20-year-olds reported driving under the influence of alcohol within the last year

At least when parents have teens and adolescents who have substance use disorders, they have some level of power in that they control the finances and the household
This power can be wielded to get them to accept treatment and cease substance abuse. With parents of adult addicts, however, the ability to impose consequences for substance abuse or the unwillingness to seek treatment is greatly diminished. This holds even truer when the parents live separately from the addicted daughter or son. When the addict has young children, the grandparents or other extended family members are often the ones who pick up the slack in parental duties. According to the U.S. Census, the number of children being raised by their grandparents skyrocketed from 2.4 million in 2000 to 4.9 million in 2010. Two of the primary causes of this are addiction and mental disorder.

Parents of Alcoholics and Drug Addicts

Family and S.U.D.

Being in a community organization has positive impacts on your mental health. Learn about the benefits of a community.

It is a well-known fact that physical activity and a nutritious diet can improve health and well-being. Most of us know that we are supposed to eat more vegetables and consume fewer fats, that we need at least 30 minutes of exercise per day, and that we need to engage in strength training and recreational activities to maintain our physical health. While these things are undeniably good for us and do contribute to being healthier and reducing chronic disease, it’s important to note that these recommendations don’t cover every aspect of health and wellness. In addition to being physically healthy, we also need to consider the mental components of health and wellness.

According to the National Institute of Mental Health (NIMH), mental illness affects approximately 13 million American adults each year. Mental health plays a major role in people’s ability to maintain good physical health and participate in health-promoting behaviors. People who are mentally healthy are happier, have lower levels of depression and anxiety, maintain healthier relationships with others, and feel that they are making a contribution to society. Several studies support the idea that more green space (e.g., community parks) results in greater mental health for communities. A recent study from England’s University of Exeter titled Longitudinal Effects on Mental Health of Moving to Greener and Less Green Urban Areas illustrates just how important parks are for long-term mental health and well-being. The study determined that people who moved to urban areas with more green space reported higher mental health scores — meaning they were happier and had lower levels of depression and anxiety. Interestingly, the study also showed that the mental health scores continued to improve each year for the duration of the study. In the United States, another study titled “Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin” found similar results. This study examined the relationship between environmental green space and mental health in both urban and rural areas and found that “higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety, and stress.” Both of these studies provided significant evidence that parks have a positive impact on the mental health of their communities.

Recreation and Mental Health

Parks can help to improve mental health in a variety of ways, from simply providing the actual green space for people to engage in their natural surroundings to facilitating programs like tai chi, yoga and qigong classes that engage the mind and body, to sponsoring and developing neighborhood gardens that reduce stress and anxiety. Many park and recreation agencies already foster programs that help support mental health. The San Diego Park and Recreation Department provides “open-space parks” within their community. These parks provide community members with opportunities to engage in nature through hiking, walking, biking and other activities. In addition to the open-space parks, San Diego offers popular tai chi and yoga classes in their parks and community centers. Tai chi, an ancient Chinese practice, uses a combination of physical movements, deep breathing, focus, and energy flow to reduce stress and anxiety. With these open-space parks and through its classes, San Diego’s community is experiencing both physical and mental health benefits.

Engagement Activities

Gardening is another tool that parks can use to help stimulate mental health. Researchers have found that gardening can help to lower blood pressure, reduce stress, increase brain activity and produce endorphins. The Portland, Oregon, Parks and Recreation Department’s community gardens program has offered gardening opportunities since 1975. The program provides the chance for community members to garden, volunteer, engage socially with neighbors, learn from other cultures and give back to the community. Heading into its 40th year, the program features 50 community gardens located throughout the city with more than 2,180 individual garden plots. The program is facilitated by four staff members and more than 2,300 annual volunteers. Another large part of their garden program, Produce for People, provides produce for food pantries in an effort to help combat Portland’s high poverty rate. In 2014, Produce for People donated 36,545 pounds of produce to food pantries across the city. Both San Diego’s and Portland’s efforts to provide environments and programming that encourage mental health are prime examples of how park and recreation agencies across the country can make a difference.

Community Gardening

Get Involved in Your Community

Community Recreation

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

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

How do you move forward with your career goals?

Brainstorm where to improve your skills and hone your craft for advancing your career.

Not sure what you want to do? Your first step is to understand who you are and what you want – both from your work and your life. Here are some key questions you can ask yourself to help decide on your next steps.

Who am I?

Whether you’re mid-career or still in study, you need to approach any career move in the same way. Your first step is to understand who you are and what you want – both from your work and your life. Consider your interests, skills, values, and qualities. You should also ask yourself:

- What am I good at?
- What do I like to do in my spare time?
- What have I achieved already?
- What things am I passionate about?
- What are my interests? Knowing what your interests are can help you plan or change your career.  If you are able to find an environment that suits your interests, you are likely to be happier in what you do.
- What are my values? Knowing what is important to you in a job can help you narrow down your career options, and finding a career that fits with your values can help you feel more satisfied in your work.
What are my skills? Working out what skills you have, then matching them to different jobs, can open up career options you may never have thought of. Think of examples of the skills you've learned in work and other areas of your life such as sport, community work, and hobbies.
Where am I? The people around you and your personal circumstances also play a part in your career choices. Being aware of this will help you in your decision-making.

Things to consider include:
Family expectations
perhaps your parents have a strong opinion about what career you should choose, or what course you should study.

Your commitments
sporting or community group activities could mean you have to be free at certain times, or you may have other commitments such as needing to look after or financially support family members.

Your career readiness
If you’re just starting out, you may be willing to spend more time and effort on training or studying than if you’ve been working for 15 years already.

Obstacles or challenges:
Maybe you feel your age is a barrier to moving into a new job, or maybe you live in a rural area where there are fewer training or study options.

Where do I want to be?
Where do you see yourself in five years' time, and beyond? 
What do you want to be doing, and what do you want to be like as a person? 

Knowing your answers to questions like these can affect your career choices, for example:

Do you want a job that earns you a lot of money?
Do you want a job that will allow you a certain amount of free time, so you can continue to take part in other activities?
Do you like being in charge, giving advice, or having people come to you for help?

Thinking about what you want to be doing will help you with your career ideas, but so will thinking about how you will get there.
What's involved in getting to the place that you want to go? Are you prepared to take the necessary steps to get there?
Where can I go for help?

Once you've explored your own ideas about yourself and narrowed down some career options, it's good to talk through your thoughts with others. Bouncing your ideas off someone else can help things become clearer to you. Other people may also have some insights into your character or situation that you had not considered. Talk to people who know you well and who you can trust. Ask them what they think are your strengths and skills. These may include family/whānau, friends, church leaders, or teachers. If you have a part-time job or you do volunteer work, think about asking your employer which parts of the job they think you do well.

Questions to Ask Yourself

Being able to identify all the skills you have can open you up to more career options. It can also help you work out if you have any skill or knowledge gaps that can be addressed with further training.

What are skills? 
A skill is the ability to do something. We are not born with skills – we develop them through experiences in life and work. Skills can be simple, such as making toast, or more complex, such as playing a musical instrument.

What different types of skills are there? 
In the workplace, you will use a combination of different skills. These skills are employability skills, transferable skills, and specialist skills. Employability skills are the skills, qualities, and attitudes that employers say are essential for their workplace. The skills are Positive attitude, Communication, Teamwork, Self-management, Willingness to learn, Thinking skills, and Resilience.

A transferable skill is one that can be used in a variety of situations or jobs - you transfer them from one job to another. For example, being able to use a drill is a job-specific skill – but one that involves hand-eye coordination, which is a transferable skill. Examples include being able to motivate and organize others, being able to work with facts and figures, having good verbal and communication skills, and having accuracy and/or an eye for detail.

Specialist skills usually relate to a specific job or group of jobs.
Examples include fluency in a language, a heavy vehicle driver's license, and the ability to use specific computer programs and technical equipment.

Figure Out Your Skills

The seven essential employability skills are:

- Positive attitude
- Communication
- Teamwork
- Self-management
- Willingness to learn
- Thinking skills
- Resilience

Positive attitude
Having a positive attitude is like showing up to your team’s game ready to give it your best, excited, and ready to go even if the chances of winning are low and it’s going to be hard work.

Communication
You have good communication skills if you can listen well, you don’t swear at work or have a bad attitude, you can ask for what you want clearly and you’re not afraid to ask if you don’t understand something.

Teamwork
Teamwork is just like when you’re playing netball or performing in your band. You help each other to get what you want, you make sure you do your part, you get on with everyone and you respect your coach or manager.

Self-management
When you manage yourself you are in control of what you do and say in a way that doesn’t harm yourself or others. You turn up to school or work on time, in the right clothes, and ready to start, and people can rely on you.

Willingness to learn
Willingness to learn is showing that you’re happy to learn new things and what you need to know to do your job.

Thinking skills (problem-solving and decision making)
Using thinking skills means that if you see a problem, you don’t wait for someone else, you find a way to fix it.

Resilience
Resilience is accepting that life does get hard at times and does change. It’s about being able to change, ask for help, and keep going.

Skills Employers Are Looking For

Skills that you develop in your day-to-day life are often transferable skills - that is, skills that are useful to many types of jobs. Here are some examples:

Household activities
Activities that may help you develop skills include evaluating and purchasing food, furniture, and appliances; household maintenance, or repairing and maintaining cars; managing the household budget and general bookkeeping; planning and organizing parties, holidays, entertainment, and children's activities.

Skills you may develop include evaluation, analysis, and problem-solving skills; skill in doing precise, detailed, and accurate work; book-keeping, budgeting, and maths skills; skill in organizing and coordinating activities and other people.

Voluntary or community work
You may do things such as work as an elected officer of an organization, where you might chair meetings, organize speakers or events, do fundraising, keep books, write reports or make submissions on reports
teach or counsel children or adults; provide physical and/or emotional support for groups of people with disabilities or special needs. 

Skills you may develop include planning and organizational skills; writing skills, including report writing; problem-solving; people and communication skills; bookkeeping, budgeting, and maths skills.

Recreation and hobbies
Participating in and organizing sporting activities. Using creativity to produce floral art, fine arts, music, drama. Participating in clubs and organizations: environmental, religious, service, youth, etc.
Skills you may develop include planning, organizational skills, problem solving, and people skills

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