Women’s Healthcare Month: How Addiction Affects Women Differently

Women's Healthcare and Addiction

In the past, men reported higher rates of addiction and substance use disorder than women, but the past few decades women have swiftly closed the gender gap. Today, men and women experience roughly equal rates of these issues. However, women’s rates of progression, experiences, reasons for use, and stigmas can vary greatly from their male counterparts. 


Addiction Progression in Women 

Scientific studies have found that women progress in addiction faster than men due to their physiology. This is particularly true with alcohol, which female bodies process differently. Because women have less of a particular stomach enzyme which helps break down alcohol, it remains in their system longer and leads to higher blood alcohol levels. One drink for a woman can have twice the physical impact of one drink for a man. When a woman is drinking often, this higher saturation of alcohol leads to dependence more quickly. It also leads to brain and organ damage more quickly than for men. 


Co-occurring Disorders in Women

Studies show that women are two times as likely to suffer from depression and anxiety as men. Self-medicating is a common theme with co-occurring disorders to manage uncomfortable feelings and often leads to abuse, dependence and addiction. Women are also more likely to experience suicidal thoughts and attempts than men. 

Furthermore, domestic and sexual trauma in women can lead to co-occurring disorders. Roughly one in three women will experience a sexual assault in their lifetime, a stat which is higher for women than it is for men. Women are more vulnerable to physical attacks and are more likely to experience child sexual abuse, incest, neglect in childhood, and domestic violence. A history of violent trauma is more common among women with drug addiction, often as a result of PTSD. In fact, one study found that as many as 6 in 10 women with addiction also have PTSD. 


Women’s Pain and Addiction

Women’s pain is less likely to be taken seriously by medical professionals than men’s pain, called Pain Bias. According to Harvard Health, women’s pain is more likely to be considered psychological rather than physical. One study found that women in emergency rooms in acute pain were less likely to receive painkillers than males in similar condition. 

Conversely, women are found to suffer more frequently and more intensely from pain and often require more medication to mitigate the effects. One study found that women needed twice the amount of morphine as males to receive comparable pain relief. Women are also more likely to have chronic and painful inflammatory and/or auto-immune conditions than men. Further, women’s reproductive health conditions can lead to significant pain such as Endometriosis which affects 1 in 10 women worldwide.

The lack of adequate pain management can lead women to seek pain relief elsewhere in the form of illicit substances or illegally-sold prescription medications on the street. 


Social Stigmas and Pressures for Addiction in Women

Women with children in particular experience social stigmas around addiction. They have been found to be less likely to admit they have a problem, to analyze their own alcohol or substance use habits. They are also less likely to speak to a friend or professional about their problem for fear of judgement.

Further, women with addiction who are pregnant are less likely to seek support. One study found that 25% of opioid addicted pregnant women went untreated. Researchers believe that shame and stigma play a role in their barrier to receiving help. 


Getting Help 

Women need and deserve proper support in treatment of Substance Use Disorder (SUD) and Addiction. Seeking help in a supportive, nurturing environment that also specializes in treating Co-occurring Disorders can help to make the changes needed to overcome addiction. 

If you or a loved one are struggling with drugs or alcohol, contact us today. We are here to listen and we are here to help.










4 Common Co-Occurring Disorders Accompanying Addiction

Dual Diagnosis occurring disorders

Mental health conditions can run hand-in-hand with drug and alcohol addiction. In a clinical setting, the terms co-occurring disorders or dual diagnosis describe a person who is struggling with substance use disorder and a mental health condition. 

It is estimated that 17.5 million Americans are struggling with a mental health disorder, and of those people, one in four are actively abusing substances or developed an addiction. Sadly, only half of those with co-occurring disorders actually receive treatment for their dual diagnosis. 

Research has shown that 34% of co-occurring disorder patients received mental health treatment without receiving addiction treatment. 2% received care for only an addiction. Meanwhile, only 12% actually received treatment that supported all their issues and disorders.

In other words, it can be a vicious cycle. Substance abuse is fueled by a mental health condition, or an underlying mental health condition is exacerbated by substance abuse. 

The most common mental health conditions seen with addiction are: 
  1. Depression
  2. Anxiety Disorders
  3. Post Traumatic Stress Disorder (PTSD)
  4. Attention Deficit Hyperactivity Disorder (ADHD)

However, these are not the only mental health disorders that occur with addiction. Overall, comprehensive treatment has the best outcome for dual diagnosis patients with co-occurring disorders. Only treating one, and not the other creates a roundabout effect. A patient who receives mental health treatment but not addiction treatment continues to use, which aggravates their mental health condition. A patient who receives addiction treatment but not mental health, struggles to remain sober. Therefore, this person, without proper care, is also more likely to relapse due to the effects of their mental health condition.

At Harmony Recovery Group, we help patients recover from addiction and co-occurring disorders through evidence-based treatment in a warm and supportive environment. If you or a loved one are struggling with cooccurring disorders or addiction in general, please do not hesitate to contact our admission specialists at 844-746-8836. We are here to help and support you. 

Read more about the relationships between mental health and addiction.

Relationship Addiction and Substance Abuse

Relationship Addiction and Substance Abuse | Recovery in Tune

A person who has a relationship addiction cannot function normally without being in a relationship and often feels incomplete. Moreover, the “addict” may stop taking care of themselves while in a relationship, and neglect any goals or purpose they might have had for their lives.

Like any addiction, relationship addiction can lead to many adverse consequences. A person can be addicted to relationships without even realizing it unless another person or other life event triggers the symptoms. Recognizing these symptoms is the first step in getting help, and if you or someone you know has experienced any of the following, you may want to consider seeking therapy and counseling.

Signs of Relationship Addiction

Many people with relationship addiction find themselves unable to end relationships, although there is emotional or physical abuse occurring. Deep down, they know that the relationship isn’t good for them, but any attempts to break free from it result in reconciliation. While they may experience intense feelings of love for the other person, they also sometimes feel devalued, and they, as well as the other person, may frequently question their self-worth.

Many relationship addictions are rooted in fear of being abandoned. Relationship addicts often fail to recognize that they are currently in a toxic relationship or look the other way. 

Having Multiple Break Up Cycles

One of the main signs of relationship addiction is going through many breakups and makeup cycles. In other words, the addict is unable to stick to their guns and stay away from the romance for an extended period. 

Instead, the addict always reconciles with their partner, although they realize it is probably not in their best interest to do so. This can occur even though the person with relationship addiction was the one who was wronged in some way. In fact, that person is often the one who initiates the reconciliation.

Multiple breakups is likely a sign that the relationship is not working, or that one or both individuals cannot or will not change their behaviors in order to bring about harmony. A healthy relationship can be resurrected from more than one breakup, but this usually does not occur at such an extreme level.

Having a Lack of Self-Control

Relationship Addiction and Substance Abuse | Recovery in Tune

Just like a person who is addicted to drugs or alcohol, a relationship addict does not typically exercise self-control. They do not have control over a new relationship, and they can easily transition from one relationship to the next without pause.

For example, a relationship addict may learn that their partner is having an affair, and instead of summoning up self-esteem and dignity, they keep begging their partner to stop the infidelity. Whether or not the other person obliges, this is not power—this is an inability to ensure that a relationship is offering oneself the respect one deserves.

There Is Little Life Outside of the Relationship

Many relationship addicts give way too much of themselves, and their partner may even feel suffocated. Not unlike other kinds of addiction, relationship addiction has negative effects on many different areas of a person’s life, such as losing interest in hobbies, jobs, family, social life, etc. 

Instead, all attention is focused on the relationship, even when the other partner exhibits a lack of interest in the relationship or is disrespectful or hurtful. All is lost for the sake of maintaining the relationship. And ironically, the relationship addict can feel very lonely and empty inside despite being in a relationship. 

Thinking That Sex = Love

People who are addicted to relationships may often confuse sex for love. They may allow themselves to be used for sex, thinking that sexual intimacy is the same thing as love intimacy. For example, a partner may be abusive emotionally or physically, and then resolve this problem by initiating sex. While sex and love can certainly co-exist, sex is not a replacement for love, even in the context of an intimate relationship.

Obsessive Thinking About The Relationship

A person who has an addiction to a relationship is continuously thinking about the relationship and over-analyzing it. They may be wondering how they appease the other person or change themselves in some way to make their partner love them more. 

Even while at work or talking to family and friends, they are continually thinking about the relationship or discussing it with others. Serious problems can arise from this obsessive thinking because the person can’t focus on anything else or deal with other issues.

Making Excuses for Wrong Partners

It’s not uncommon for relationship addicts to make excuses for the partner’s bad behavior. They may say something like, “Well, I know I complain about him being abusive, but I stay with him for all the times when he’s good to me.” Unfortunately, people who are addicted to relationships tend to attract the wrong kind of partners—often those who are narcissistic, unfaithful, and use manipulation to keep the other person in line.

Moreover, relationship addicts will frequently drive away good partners because of their obsessive behavior, neediness, or general lack of self-worth and self-esteem. Instead, they will settle for another person who is less than deserving to feel needed and be in a relationship. Their fear of abandonment is enough to keep these individuals in a bad relationship because they think that it is better than being alone.

Relationship Addiction and Substance Abuse | Recovery in Tune

Low Self-Esteem and Self-Defeating Behaviors

Addicts of any kind tend to have self-esteem problems. These problems may cause the addictive behavior, and the behavior itself tends to lower their self-worth as they engage in it. Also, because they are prone to attracting the wrong people, their partners fuel their lack of confidence and inflict emotional abuse intended to keep them in their place.

Sometimes, however, a person can become addicted to a relationship that drags them down from an attitude that was much more positive. They soon find themselves behaving in ways they never before imagined, from a place that is desperate, exhausting, and lonely. Others will notice this decline and speak up, but the person in the addictive relationship will continue to make excuses for their partner and possibly isolate themselves from family and friends for this reason.

Substance Abuse in an Unhealthy Relationship

Many of the same factors that contribute to a person being a relationship addict may also compel a person to drink or use drugs in excess. Childhood trauma or a fear of abandonment, emotional dysregulation, and many other mental health problems are found among both those who have relationship issues and people who engage in substance abuse.

Other times, relationship addiction can lead a person to turn to drugs or alcohol to self-medicate away negative feelings about themselves and their lives. Conversely, people with substance abuse issues may become involved in bad relationships because their overuse of drugs and alcohol is problematic, and a person seeking stability may very well be scared away by this fact.

Regardless of which behavior came first, both problems tend to exacerbate each other, leading to an ever-increasing cycle of relationship problems and escalating substance abuse.

Getting Help for Addiction

Recovery in Tune is a specialized addiction treatment facility that offers comprehensive programs, in both outpatient and partial hospitalization formats, designed to treat all aspects of a person’s mental health and well-being. Severe emotional problems, such as those related to relationship addiction, need to be addressed in conjunction with substance use disorders to prevent relapse and ensure a person is stable enough to maintain long-lasting sobriety.

If you are suffering from addiction to both substances and relationships, contact us today! We are committed to ensuring that each person we treat receives the very best care available and are given the tools they need to reclaim their lives for good!

⟹ READ THIS NEXT: Trauma Recovery and Addiction

Selective Eating Disorder and Addiction

Selective Eating Disorder and Addiction | Recovery in Tune

Selective eating disorder, which is also known as avoidant/restrictive food intake disorder (ARFID), affects thousands of people in the U.S. People with this disorder are extremely picky in their food choices, as they fear certain types of food. ARFID often occurs in children, but adults can also be affected. Adults with ARFID tend to have a minimal range of foods that they will eat, sometimes less than 20.

ARFID is different from anorexia and bulimia, and the individual’s selectiveness stems from concerns that do not generally involve weight loss or weight control. Common fears experienced by people with ARFID are that food temperature will not be appropriate, choking may occur, and that they will become sick, especially when consuming new foods.

There are three primary types of ARFID, which include the following:

Lack of interest, in which the person has a genuine lack of interest in eating food, and they may tend to get full quickly.

Sensory avoidance, in which the person has issues with the taste, texture, temperature, and smell of many foods.

Fear of aversive consequences, in which the person fears illness, choking, nausea, or that an allergic reaction will result from eating.

Symptoms of Selective Eating Disorder

The following signs and symptoms may be associated with a person who as ARFID:

  • He/she has a very short list/menu of acceptable foods from which to choose.
  • He/she may only eat food with similar characteristics, such as being crunchy or in liquid form.
  • He/she has strong preferences in food preparation methods.
  • He/she avoids broad categories of food, such as vegetables, fruits, or sources of protein.
  • He/she frequently eliminates certain foods permanently.
  • He/she may be underweight and malnourished.
  • He/she may have nutritional deficiencies, such as those involving iron, and vitamins A and C.
  • He/she becomes upset or stressed when around unfamiliar or undesirable foods.
  • He/she only eats a small selection of “safe” foods, such as those enjoyed in childhood (e.g., grilled cheese sandwiches, chocolate milk).

These fears and food limitations will often adversely affect social interactions and behaviors. Like people with anorexia or bulimia, people with ARFID may not wish to attend certain events in order to avoid exposure to various foods. They may also be ashamed of their condition and try to conceal it from others.

Risks and complications associated with ARFID may include:

  • Co-occurring anxiety and panic disorders
  • Failure to gain weight or weight loss
  • Gastrointestinal problems
  • Malnutrition
  • Developmental delays in children

Causes of Selective Eating Disorder

Like most mental health conditions, ARFID doesn’t have one precise cause. Instead, it is believed to be a product of several factors, including those that are biological, social, emotional, and environmental in nature. Moreover, a person who is already genetically predisposed to an eating disorder may be triggered by something in their environment, such as exposure to a traumatic event.

And, because other mental illnesses, such as anxiety and depression, may involve disrupted patterns of eating, these may also be present. In fact, eating disorders and mood disorders are both frequently underpinned by similar emotional issues.

Selective Eating Disorder and Addiction | Recovery in Tune

Selective Eating Disorder and Addiction

Eating disorders and addiction to drugs or alcohol frequently go hand-in-hand. People with mental health conditions such as ARFID may be more likely to abuse substances as a means to self-medicate. Unfortunately, this method eventually fails, and the person not only continues to suffer from mental illness, they now have a co-occurring substance use disorder, as well.

Furthermore, addiction causes further emotional dysregulation and tends to make many of the symptoms of mental disorders worse. Emotional issues and escalating substance abuse can propel a person in a vicious cycle that is seemingly endless unless they receive an effective medical intervention.

Finally, eating disorders are thought to be a kind of behavioral addiction in and of themselves. Behavioral addiction and substance abuse affect similar parts of the brain, such as those responsible for feelings of satisfaction, pleasure, and reward. For this reason, people who experience a behavioral addiction may be more likely to engage in other addictive and compulsive behaviors, such as substance abuse.

Treatment for ARFID and Addiction

Fortunately, recovery from both eating disorders and addiction to drugs or alcohol is possible! Both of these conditions do, however, require highly-specialized, long-term treatment facilitated by medical and mental health professionals. An approach that addresses all aspects of a person’s emotional and physical well-being is most effective, as failure to address a mental health disorder in conjunction with substance abuse will likely lead to a relapse involving either condition.

If you are a loved one is struggling with substance abuse and an eating disorder, please reach out to us. Recovery in Tune specializes in the treatment of co-occurring conditions such as these. We offer personalized, comprehensive programs, in both outpatient and partial hospitalization formats, designed to provide clients with the tools and support they need to recover fully from both mental illness and addiction.

You don’t have to suffer alone any longer—contact us today to discuss treatment options! Discover how we help people get on the road to recovery and foster the fulfilling lives they deserve!

⟹ READ THIS NEXT: Trauma Recovery and Addiction

Trauma Recovery and Addiction

Trauma Recovery and Addiction | Recovery in Tune

In the United States, 61% of men and 51% of women report experiencing at least one traumatic event in their life. People who experience post-traumatic stress disorder (PTSD) and have been exposed to traumatic events are at a heightened risk of developing an addiction to drugs or alcohol.

Many people with addictions use substances to self-medicate in an attempt to relieve symptoms of anxiety, guilt, shame, fear, depression, and other emotionally painful symptoms associated with trauma. Many of these symptoms are linked to increased stress and the inability to regulate thoughts and feelings following a traumatic experience. 

Traumatic experiences are usually the result of disturbing and harmful events, such as sexual, physical, or emotional abuse, violence, extreme poverty, military conflict, or natural disasters. Another reason trauma and addiction often occur together is the fact that the affected individuals’ lifestyle may place him or her in dangerous situations more frequently than that of a non-addicted person. 

Having sketchy acquaintances, dangerous neighborhoods, drunk driving, and other factors commonly linked to drug and alcohol abuse may expose substance abusers to trauma via assaults, crime, accidents, violence, and abuse. There may also be biological components that make a person more susceptible to PTSD as well as addictive tendencies. 

Therapeutic Elements of Trauma Recovery

Methods for addressing both a substance use disorder and the associated trauma have been found to improve long-term positive client outcomes.

Elements of trauma recovery treatment often include the following:

  • Grief counseling
  • Support groups
  • Individual therapy
  • Group therapy
  • Exposure or desensitization
  • Pharmacotherapy, or medications to mitigate symptoms
  • Holistic practices, such as mindfulness techniques, relaxation, and yoga
  • Coping skill development, including emotional regulation skills and cognitive restructuring

Trauma-Focused Therapy

Trauma-focused therapy is one of the most effective ways to help a client to progress from merely coping to living life fully and freely without the need to use drugs or alcohol. This approach recognizes that a person’s substance abuse is a method of coping with devastating emotions, interfering memories, fear, grief, or feeling unsafe or under threat. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are six main principles of trauma-focused care:

  • Safety
  • Trustworthiness and transparency
  • Peer Support
  • Collaboration and mutuality
  • Empowerment, voice, and choice
  • Cultural, historical, and gender Issues

Safety should be a priority in any approach to trauma recovery. A trauma recovery therapist devises ways to assist the client in managing flashbacks or intensely upsetting responses before examining how trauma has played a vital role in the client’s life.

Trauma Recovery and Addiction | Recovery in Tune

Core Tenets of Trauma-Focused Therapy

1) Acknowledge the survivor’s need to be informed, respected, and optimistic about recovery.

2) Identify the correlation between trauma and addiction.

3) Cooperate with family and friends of the survivor and human services agencies to promote empowerment and resiliency.

The therapist works continuously while helping the client find resources and connections with supportive institutions and individuals. Trauma recovery enables clients to better deal with situations that contributed to substance-using behavior in the past.

Trauma-focused therapy for substance abuse involves the following five objectives:

1) Designing a respectful, caring, and safe environment for the therapy.

2) Promoting an understanding of the association between existing mental health problems, such as trauma and emotional disorders, and addiction.

3) Encouraging self-compassion and self-respect to combat the unavoidable guilt and shame associated with addiction and mental health conditions related to trauma.

4) Helping clients to develop healthier solutions to the issues they have identified.

5) Locating other supportive resources, such as recovery groups like Alcoholics Anonymous.

Breaking the Cycle of Addiction

Drug and alcohol addiction is not something that people choose to happen. Instead, substance abuse is often a desperate attempt to cope with stress, anxiety, depression, and flashbacks or numb unpleasant thoughts and feelings.

From a healthy person’s perspective, substance abuse may seem incomprehensible and a terrible decision. However, people who are struggling with addiction both need and deserve compassion and support to overcome this adversity and heal both emotionally and physically.

Addictive Behavior Is a Survival Strategy

Experimentation with drugs or alcohol often starts as occasional use that is enjoyable or exciting. Addiction is often born as a survival strategy. Moreover, the individual uses substances to get through each day because of the way it makes them feel or to avoid certain undesirable feelings. 

Using substances is a means in which to numb or self-medicate distressing thoughts and feelings. It is also a misguided way of running from disturbing memories that have become difficult to control. 

Self-medication is a desperate attempt to disconnect from one’s own negative thinking, painful emotions, and disturbing mental images. Essentially, alcoholics and drug addicts are engaging in an ineffective form of self-treatment in an effort to cope with unresolved grief, distress, and suffering.

Recognizing the Need for Treatment

Trauma Recovery and Addiction | Recovery in Tune

Many people, at some point, decide to drink or use drugs occasionally and socially. They may or may not take the experience of trauma into consideration when they do this. While most people who drink moderately or use low-level drugs like marijuana do not develop severe addictions, many do. 

Furthermore, those who have experienced trauma or have emotional problems are at a higher risk of becoming an alcoholic or addict. A person should be able to feel comfortable in their own skin without having to numb or escape thoughts and emotions. If they are unable to do so, it’s time to start examining underlying issues that are contributing to the substance abuse.

A person may have a dependence that would benefit from treatment, even if he or she doesn’t engage in substance abuse every day. Warning signs that a person’s substance abuse habits need to be addressed with professional treatment include the following:

  • Repeated binging or drinking/using to excess
  • Drinking or using drugs for longer or more intensely than originally intended
  • Feeling the need to be drinking or using drugs to socialize
  • Drinking or using drugs despite feeling ill
  • Engaging in drunk or drugged driving
  • Normalizing or glamorizing using behavior
  • Drinking or using drugs to control one’s mood
  • Drinking or using drugs to help manage emotions or quell psychological pain
  • Loved ones confront the user about the damage to the relationship
  • Engaging in compulsive, substance-seeking behavior despite the incurrence of adverse consequences
  • Drinking or using drugs upon waking or having a “hair of the dog”
  • Attempting to conceal alcohol or drugs and their use from others
  • Isolating behavior or socializing with a new group of friends
  • Neglect of self-care, such as bathing, leading to a disheveled appearance

Getting Help for Trauma and Addiction

Sometimes, years of self-medication using drugs or alcohol have effectively dulled traumatic memories, so on the surface, the addiction appears to be the only problem. A person who has suppressed traumatic experiences may be motivated to become and remain sober, only to find other addictive or unhealthy behaviors eventually replace alcohol or their drug of choice. And, once these feelings come flooding back, relapse is a serious concern.

Persons suffering from PTSD and survivors of traumatic events need to have these issues addressed in addiction treatment. By neglecting this aspect of a person’s mental well-being, recovery from substance abuse is undermined, and the person is much more likely to return to active addiction.

Harmony Treatment and Wellness offers an integrated approach to addiction treatment that simultaneously addresses all aspects of mental and emotional health. Our caring and skilled staff are committed to ensuring that each client receives all the tools and support they need to overcome addiction and relieve the symptoms of mental illness.

If you are motivated to break free from the vicious cycle of addiction and improve your physical and psychological well-being, contact us today—we are here to help!

Alcohol and Depression

Alcohol and Depression | A Vicious Cycle | Recovery in Tune

Alcohol and Depression: A Vicious Cycle – The abuse of alcohol and depression are closely correlated. Many people who experience depression, especially those who have not been properly diagnosed and treated, turn to alcohol in an attempt to feel better or numb the pain. In fact, at least 30%-40% of alcoholics also suffer from a depressive disorder.

Unfortunately, heavy alcohol consumption ends up having the opposite effect. Alcohol is a central nervous system (CNS) depressant that reduces activity in the brain and body. Studies have revealed that alcohol use increases both the duration and the intensity of depressive episodes. It also increases the likelihood of having suicidal thoughts.

Alcoholism can lead to the development of other stressors in life, such as financial, legal, and family problems that exacerbate depression. Moreover, if a depressed person than turns to alcohol in an effort to make themselves feel better, a vicious cycle has begun that can be extremely difficult to break.

Alcoholism can result in depression in many circumstances. Prolonged alcohol abuse can dramatically alter and rewire the brain, as well as affect other chemical balances in the body. This is especially true regarding the brain’s neurotransmitters—chemical messengers that regulate emotions and other important bodily functions. These widespread changes can ultimately lead to depression.

Alcohol Addiction

Prolonged, heavy alcohol consumption can lead to alcohol use disorder (AUD). Alcohol use disorder is hallmarked by problematic drinking and includes a broad spectrum of instances of alcohol abuse.

Some symptoms of alcohol use disorder include:

  • Considerable time spent drinking
  • Neglecting other activities to drink
  • Having cravings for alcohol
  • Repeatedly drinking too much or for too long
  • Continuing to drink despite adverse effects on relationships
  • Continued drinking despite emotional consequences, such as depression


Alcohol and Depression | A Vicious Cycle | Recovery in Tune

Depression is a potentially serious mental health disorder that is characterized by persistent feelings of sadness, hopelessness, or worthlessness. It can infiltrate every aspect of an individual’s life and dramatically affect those around them. It often leads to problems with friends and family as well as difficulty in the workplace. Depression increases the risk of developing other health conditions and places the person at a higher risk for suicide.

Unfortunately, depression is a remarkably prevalent disorder. According to the American Psychiatric Association (APA), it affects about one in every 15 people.

The APA states that an individual can be diagnosed with depression if they present with some of following symptoms for at least two weeks:

  • Sadness
  • Loss of interest in activities
  • Erratic sleep patterns
  • Insomnia
  • Fatigue
  • Feelings of worthlessness
  • Concentration problems
  • Suicidal thoughts
  • Feelings of guilt

The development of depression is related to a multitude of different factors. Some people are genetically prone to depression. Personality can also play a role, as those with low self-esteem or who are more likely to be negative are also more likely to develop some level of depression.

In addition, environmental factors, especially those in childhood, play a fundamental role in the development of depression. While all of these factors can contribute to the likelihood that a person will experience depression, their presence does not guarantee he or she will get the disorder.

How Depression Leads to Alcohol Abuse

Some people drink alcohol in an attempt to cope with their depression. People can be attracted to the sedative and euphoric effects of alcohol as a kind of self-medication that distracts them from continual feelings of sadness. While alcohol may temporarily alleviate some symptoms of depression, it ultimately serves to exacerbate the condition when used on a chronic basis.

Alcoholism is associated with a myriad of adverse effects on nearly every aspect of life. As a person begins to encounter financial and legal consequences as a result of alcohol abuse and their relationships start to incur damage, depression can worsen. This fact often results in a disturbing cycle of alcohol abuse as a means to self-medicate symptoms of depression.

All the while, though, the depression is actually worsening with continuous use. Some people have overlapping genetic predispositions that make them more susceptible to both the abuse of alcohol and depression. What’s more, the onset of one disorder can trigger the other.

Those with depression who use antidepressants to manage the condition can experience additional adverse effects due to alcohol abuse. Alcohol consumption makes antidepressants less effective, and the depressant effects of the alcohol will further exacerbate the now inadequately managed depression.

How Alcohol Abuse Leads to Depression

Alcohol and Depression | A Vicious Cycle | Recovery in Tune

While depression can place an individual at a higher risk of developing an alcohol problem, the inverse is equally common. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), depression can manifest and increase while a person is suffering from alcoholism. As noted, this increase in depression can then result in more drinking, thus continuing this cycle from the other side.

According to one study, individuals dealing with either alcohol use disorder or depression double their risk of developing the other condition. Furthermore, the researchers concluded that this phenomenon is not merely a correlation. Indeed, alcohol use disorders and depression are bound up in a reciprocating causal relationship.

The study also found that alcohol abuse is more likely to cause major depression than the other way around, though the causality could go in either direction. There were links found between the neurophysiological and metabolic changes brought about by alcohol abuse and the mechanisms for depression to occur. Altogether, the findings demonstrated that abuse of alcohol puts an individual at a significantly higher risk to develop depression than that of a person who is not abusing the substance.

It is clear that alcohol abuse can cause depression, and depression can also contribute to alcohol abuse. This relationship can be cyclical, and a person can get caught up going back and forth between abusing alcohol and then using alcohol to try to relieve the resulting depression.

This can prove to be a challenging set of co-occurring conditions to address, and professional help is direly needed. If a person encounters feelings of depression as a result of alcohol abuse, it’s likely that these symptoms will subside some time after alcohol use has ceased.

Treatment for Alcohol Abuse and Depression

Alcoholism and depression can both be harrowing predicaments. For a person suffering from both conditions simultaneously, though, life can be especially troubling and often results in much poorer outcomes. Fortunately, due to the frequent co-occurrence of depression and alcohol abuse, many addiction treatment centers, such as Recovery in Tune, are clinically prepared to treat both disorders concurrently.

Integrated treatment is the most effective way to achieve recovery from both disorders. If only one condition is treated without addressing the other, relapse is highly likely.

Cognitive-behavioral therapy and counseling are two of the most effective ways to combat both alcoholism and depression. We offer these services in intensive-outpatient and outpatient formats and may include medication-assisted therapy to aid in recovery from both conditions. Our highly-trained staff of addiction specialists is dedicated to providing every client with the knowledge and support they need to fully recover and foster the healthy and satisfying lives they deserve.

If you or someone you love is suffering from alcohol abuse and depression, contact us today. Discover how we help people escape the clutches of addiction and enjoy long-lasting wellness and sobriety!

What Is Meth Induced Psychosis?

Meth Psychosis | Recovery in Tune Addiction Treatment

What Is Meth Induced Psychosis? – Methamphetamine (meth), also known as crystal meth, speed, or ice is a dangerous, addictive, and potentially life-threatening drug. It is most often found illicitly on the street after being produced in clandestine labs in the U.S. or abroad by drug cartels. Meth is created from ingredients derived from cough and cold medications (pseudoephedrine) and is combined with household chemicals and highly explosive materials such as red phosphorus.

Meth is a central nervous system stimulant, meaning that effects include accelerated heart rate and increased energy, in combination with a euphoric high. These effects are primarily produced by a massive increase in dopamine, a neurochemical responsible for feelings of pleasure and reward. Meth psychosis, when it occurs, is among the most dangerous outcomes of routine meth use.

Meth Induced Psychosis

According to the American Psychiatric Association, psychosis is defined as an episode in which a person is experiencing both hallucinations and delusions. A hallucination is frequently visual or auditory, and the term refers to something that is seen, heard, or otherwise sensed by a person that is not perceived by others.

Occasionally people encounter hallucinations that are gustatory (tasting something that isn’t there) or tactile (feeling something that isn’t there). These perceptions can manifest as a result of drug use or mental health conditions such as dementia, bipolar disorder, or schizophrenia.

Delusions are also a hallmark symptom of psychosis and involve the person holding beliefs that aren’t true, at least not objectively by others. Delusions can include paranoia, such as the belief that the person affected is being closely watched by the police or FBI. They may also include beliefs centered around certain elements that have nothing to do with them, contending that these things are targeted at them specifically (e.g., a song playing on the radio).

During meth psychosis, the individual may firmly believe that other people are out to get them, or that everyday objects are spying on them, equipped with surveillance devices. Another symptom of meth psychosis is increased aggression, which can occur as the person’s brain loses the capability to regulate impulses appropriately. When people use meth routinely, they also tend to lose their ability to respond rationally to events happening around them, and this effect can result in aggression and violence.

When people are extended meth users, they may also begin to exhibit behaviors that parallel those of someone with obsessive-compulsive disorder, engaging in certain actions repeatedly, such as cleaning at a frenzied pace or excessively washing hands. This effect can also contribute to some of the sores that are apparent on the face and bodies of meth users, caused by scratching or picking at skin.

When a person experiences meth-induced psychosis, it may subside when they come down from the drug’s effects, but in some cases, it can persist longer than the high itself—perhaps for several days. Unfortunately, brain damage from chronic meth abuse can leave some users with psychotic episodes that persist long after they have stopped using the drug.

Meth Psychosis | Recovery in Tune Addiction Treatment

Causes of Meth Psychosis

But why does meth use incur a higher risk of psychosis when compared to many other drugs? Like other intoxicating substances, meth affects the brain’s intrinsic chemical balance. Moreover, when a person uses meth, that person is altering the homeostasis of his or her brain chemistry, which may ultimately trigger meth psychosis.

Meth use also causes the brain to unleash a massive flood of dopamine. After a time, intrinsic dopamine reserves are exhausted, and the body becomes unable to create more. Extended meth use overstimulates the brain’s temporal lobe, which is believed to induce psychosis. The amygdala is also affected, and when highly stimulated, it can produce a “fight-or-flight” survival reactions.

People who experience meth-induced psychosis encounter these symptoms because their brain chemistry is unbalanced, which can lead to the feeling that they are in danger and either need to flee or lash out. For many meth users, paranoid symptoms can onset within just a few months of drug abuse. In addition to brain stimulation in areas involved with the regulation of anxiety and emotions, using meth also impacts the prefrontal cortex and limbic system, which can result in impulsive actions, aggressive behavior, and violence.

It is important to stress that meth psychosis is not rare, and is often referred to as being spun or “tweaking.” In fact, it is quite common, and many people who engage in meth use will, at some point, encounter mild-to-severe psychotic symptoms. Research indicates that nearly two-thirds of meth users have experienced psychosis to some degree or another.

Treatment for Meth Addiction

Meth abuse and addiction is a devastating disease that can destroy the lives of those who use as well as families and friends, and treatment should be sought as soon as possible. Modern, comprehensive approaches include a combination of evidence-based services such as behavioral therapy, counseling, group support, health and wellness programs, and aftercare planning.

Recovery in Tune employs compassionate addiction professionals who deliver these services to clients with care and expertise. We provide patients with the tools, resources, and skills they need to achieve sobriety and enjoy long-lasting wellness throughout the remainder of their lives. Please contact us today and begin your journey now!

Generalized Anxiety and Addiction

Generalized Anxiety, Anxiety Disorders, and Addiction | Recovery in Tune

Generalized Anxiety, Anxiety Disorders, and Addiction – Anxiety is a natural reaction that is produced from the brain’s “fight or flight” response mechanism. For instance, people may feel anxious in dangerous situations or before making major decisions.

For some, though, anxiety is not merely a transient concern—it tends to be pervasive and may increase in severity over time. As a result, symptoms start to interfere with a person’s functioning and day-to-day activities and responsibilities such as academics, work, and relationships. What’s more is that many individuals with these conditions turn to drugs and alcohol to cope with the symptoms, which can lead them into a devastating addiction.

There are several different types of anxiety disorders, with generalized anxiety disorder being the most prevalent among them. Other disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobia-related disorders.

What Is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD), is a condition hallmarked by chronic anxiety and excessive worry and stress, even in situations where there is little to provoke it.

People who are diagnosed with GAD exhibit undue anxiety or distress on a regular basis for at least six months. These worries can be related to any number of issues, including health, work, social interactions, and everyday life circumstances. Indeed, this anxiety can, in turn, result in noticeable problems in many of these same areas of life.

GAD symptoms may include the following:

  • Feeling restless or on edge
  • Being easily fatigued
  • Being irritable or agitated
  • Feeling muscle tension
  • Having difficulty concentrating and focusing
  • Difficulty controlling anxious feelings
  • Feeling overwhelmed during tasks
  • Having insomnia or sleep disturbances

Other Anxiety Disorders Associated with Addiction

Panic Disorder

Panic attacks can be wholly spontaneous but are most often initiated by some particular fear of a situation, thing, or person, such as flying in an airplane during extreme turbulence.

Panic can be a very debilitating condition and is characterized by sudden, repeated episodes of intense dread and feelings of impending doom or having a lack of control. These feelings are often accompanied by physical symptoms comparable to death-like terror, including an accelerated heartbeat and palpitations, shortness of breath, chest pain, dizziness, sweating, crying, and trembling or shaking.

Obsessive-Compulsive Disorder

Generalized Anxiety, Anxiety Disorders, and Addiction | Recovery in Tune

Obsessive-compulsive disorder (OCD) is a condition characterized by chronic, unwanted thoughts and obsessions as well as compulsive, repetitive behaviors. These behaviors may include excessive hand-washing, cleaning, counting, neatly ordering everything in one’s environment, and the strict performance of routines in an effort to repress these thoughts.

Anxious feelings, however, only get a brief reprieve through the practice of these rituals, and yet, not performing them exacerbates anxiety. Moreover, a person with OCD experiences little or no pleasure from performing these behaviors and may only receive short-term relief from the stress caused by the intrusive thoughts associated with them.

Common symptoms of OCD include the following:

  • Germophobia, or a fear of germs or contamination, resulting in excessive washing
  • Unwanted or forbidden thoughts and feelings involving sex, religion, or self-harm
  • Aggressive thoughts aimed at oneself or others
  • Having things placed symmetrically or in a precise order, arranging things in an exact way
  • Repeated checking on things, such as frequently assuring oneself that the door is locked or that the oven is turned off
  • Compulsive counting

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a condition that can manifest after a person has lived through a psychologically catastrophic event in which physical or profound emotional harm occurred in some way. Such events include physical or sexual assault, childhood neglect, natural disasters, and military combat.

The feeling of fear and anxiety during and after a traumatic event is natural and serves the purpose of protecting us from harm. However, individuals with PTSD chronically experience these feelings during situations that are in reality non-threatening.

Signs and Symptoms of PSTD

Not every person who experiences trauma suffers from PTSD, and not everyone with PTSD has been directly exposed to a life-threatening event. For instance, some people can develop PTSD after the death of a family member or other loved one.

Symptoms usually onset within three months of the event, but sometimes lay dormant until years later. In any case, symptoms must persist for more than 30 days and be severe enough to interfere with relationships, academics, or career.

Diagnosing Post-Traumatic Stress Disorder

To be diagnosed with PTSD, a person must present with each of the following for at least one month:

1. At least one reexperiencing symptom such as a flashback or nightmare
2. At least one avoidance symptom, such as avoiding places or events that remind the person of the experience
3. At least two reactivity or arousal symptoms, such as being easily startled or having explosive outbursts
4. At least two mood or cognition symptoms, such as having negative thoughts about oneself or the world, or having feelings like shame or self-blame

Generalized Anxiety, Anxiety Disorders, and Addiction | Recovery in Tune

Phobia-Related Disorders

A phobia is an intense fear of a specific object (e.g., needles or blood), a living thing (e.g., spider or snake), or situation (e.g., flying or being in a confined space). Anxiety may be considered normal in many of these circumstances, but people with phobias experience terror that is grossly out of proportion to a situation’s actual potential for danger.

People with a phobia may exhibit the following signs:

  • Having an illogical or unrealistic worry about being exposed to the object or circumstances they fear
  • Making a concerted effort to avoid the object or situation
  • Experiencing abrupt and intense anxiety when encountering the object or situation
  • Enduring unavoidable objects or conditions while experiencing severe anxiety and fear

Social anxiety disorder This condition, which is sometimes referred to as social phobia, is characterized by an intense fear of social situations or circumstances in which the person has to perform or speak in front of others. They worry that others will unfavorably judge behaviors related to their anxiety and that they will end up feeling humiliated.

Most people get nervous in the spotlight, but for individuals with social anxiety, their concerns can cause them to evade most normal social situations, including school, work, and even family gatherings. People with social anxiety can also suffer from agoraphobia, a condition that, in extreme cases, can result in a person being self-imprisoned in his or her own home.

Separation anxiety disorder This condition is hallmarked by a fear of being apart from a person or persons to whom one is emotionally attached. This condition is more prevalent in children, but adults can also experience it. The person worries that some harm or other adverse event will occur when their attachment figure is away, and this fear compels them to avoid being separated from this parent or caregiver.

Anxiety Disorders and Substance Abuse Treatment

Substance use disorders (SUDs) occur much more often in patients with anxiety disorders than those in the general population. Anxiety disorders, when left unaddressed, often lead people to experiment with intoxicating substances as a means to self-medicate. Symptoms induced by these substances, such as depression, irritability, and general malaise, often make anxiety disorders worse and can perpetuate a cycle of substance abuse and mental health struggles.

Addiction does not typically exist in a vacuum. Rather, it tends to co-exist with another mental health condition such as anxiety or depression. For this reason, a co-occurring mental illness must be addressed concurrently with substance abuse, and not treated as a separate entity.

Both anxiety and substance abuse can be treated through participation in an integrated, evidence-based program. Recovery in Tune offers comprehensive, outpatient addiction treatment that includes behavioral therapy, counseling, peer group support, health and wellness programs, and aftercare planning for the long-term maintenance of sobriety.

Recovery from mental health disorders and addiction is a lifelong process, but it can begin now with our help! Call us today and discover how we help people free themselves from the grip of addiction and begin to experience the healthy and fulfilling lives they deserve!

Impulse Control Disorders and Substance Abuse

Impulse Control Disorders and Substance Abuse | Recovery in Tune

Impulse control disorders (ICDs) are psychiatric disorders marked by impulsivity, or the failure to resist temptation, an urge or impulse, or the inability to resist expressing a thought.

Features of Impulse Control Disorders

Impulse control disorders are characterized by four primary features, which include the following:

  • The propagation of repeated adverse behaviors despite negative consequences
  • An increasing lack of control over performing these behaviors
  • Mounting tension or cravings to engage in these negative behaviors before acting on them
  • A sense of relief, satisfaction, or pleasure during or after performing these problematic behaviors

Males may be slightly more inclined to impulse control disorders than females, and these disorders may often co-occur with other mental health disorders or with issues involving substance abuse.

Types of Impulse Control Disorders

Impulse control disorders are usually diagnosed during the late teenage years or early adulthood. They may be considered behavioral addictions, as the lack of control, cravings, and release and rush produced by engaging in certain behaviors are strong indicators of addiction.

Different types of impulse control disorders are described as follows:

Intermittent Explosive Disorder

This disorder is identifiable by persistent tantrums, or explosive episodes, that are out of proportion to the situation. Impulsivity, aggression, violence, rage, verbal outbursts, threats, and physical harm to people or things may accompany an episode. These outbursts may only last about a half-hour and come about swiftly without warning.

Months may pass between significant episodes, although less significant outbursts may occur in between larger ones. These episodes may lead to legal or financial issues, put strain person’s interpersonal relationships, cause considerable stress, and result in problems at work or school.


Kleptomania is characterized by the Impulsive and unnecessary theft of things that are not needed. People may steal items and hoard them, give them away, or try to return them to receive money back. It is believed that the disorder is not about allocating the things stolen, but instead about a preoccupation with stealing and loss of self-control over this compulsion.

People who experience kleptomania may feel intense guilt or shame after the initial satisfaction of stealing wears off. Legal troubles due to theft are extremely common for individuals who struggle with kleptomania.

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A person who repeatedly and intentionally sets fires may suffer from pyromania. This disorder is characterized by an attraction to or obsession with fire and fire-setting paraphernalia, along with an obsessive need to start fires and feelings of satisfaction after doing so. These individuals do not set fires for any reason other than to satisfy their compulsion or to alleviate their increasing tension.

Conduct Disorder

Conduct disorder manifests as a repetitive and persistent pattern of behavior among children and adolescents in which the rights of other people or basic social norms are infringed. The child or adolescent likely exhibits these behavior patterns in a variety of settings, and they result in marked impairment in his or her academic, social, and family functioning.

Behaviors characteristic of conduct disorder include the following:

  • Aggressive behavior that results in or threatens harm to other people or animals, such as bullying, intimidation, physical fights, or animal cruelty
  • Non-aggressive conduct that may result in loss or damage of property, such as fire-setting or the willful destruction of another’s property
  • Deceitfulness or theft, such as breaking into someone’s house or car, or lying to or conning others

Getting Help for Co-Occurring Disorders

Those experiencing co-occurring disorders, such as impulse control and substance abuse use disorders, may not be willing to seek treatment on their own. Often, however, a loved one or family member may be able to help the person acknowledge the need for help and the potential benefits of undergoing a professional treatment program.

Treatment for ICD and Substance Abuse

In the case of comorbid disorders, a primary care provider, mental health practitioners, and addiction treatment professionals may all collaborate to develop an integrated treatment plan. This plan will be based on an assessment that will consider symptoms of both disorders, medical and mental health histories, and the individual’s treatment goals.

Outpatient programs can differ in their composition. Intensive outpatient programs are comparable to residential programs in structure and schedule during the day, the main difference being that the person returns to a private residence each night. Flexible outpatient programs can be designed to fit into a person’s schedule and life responsibilities.

Impulse control disorders and substance abuse can be treated with a variety of methods within a treatment program. Cognitive Behavioral Therapy (CBT) is a commonly used type of psychotherapy that helps individuals learn to modify harmful thought patterns and change them into more positive ones, which can also positively change one’s behavior.

CBT works on the regions of the brain that are impacted by an impulse control disorder and/or addiction. It teaches individuals experiencing these disorders new methods of coping and techniques for controlling impulses and managing triggers as they occur.

Individuals who suffer from an impulse control disorder and substance abuse are highly encouraged to seek professional treatment. We can help you reclaim the life you deserve, and provide you with the tools and support you need to maintain long-lasting sobriety and wellness! Contact us today!

The Link Between Attachment Disorder and Addiction

Attachment Disorder and Addiction | Recovery in Tune

The Link Between Attachment Disorder and Addiction – Attachment disorders are psychiatric conditions that can develop in young children who have problems with emotional attachments to others. Parents, caregivers, or physicians may recognize symptoms of attachment disorder in a child as early as age one.

Often, a parent brings the infant or child to the doctor with one or more of the following concerns:

  • Severe colic or feeding difficulties
  • Failure to gain weight
  • Detached or unresponsive behavior
  • Difficulty being comforted
  • Preoccupied and rebellious behavior
  • Inhibition or hesitation in social interactions
  • Being too intimate with strangers

Most children with an attachment disorder have had profound difficulties in early relationships, such as physical, sexual, or emotional abuse, trauma, or neglect. Some have experienced ineffectual care in an institutional environment or other out-of-home placement. Examples of out-of-home placements include residential programs and foster care.

Others have experienced traumatic losses or multiple changes in their primary caregiver. The exact cause of attachment disorders is unclear, but research posits inadequate caregiving as a possible cause. The physical, emotional, and social difficulties associated with attachment disorders may continue as the child grows up.

Types of Attachment Disorders

Children who have attachment problems can develop one of two types of disorders: Reactive Attachment Disorder or Disinhibited Social Engagement Disorder.

Reactive Attachment Disorder (RAD)

Children with RAD are less likely to socialize with others due to adverse experiences with adults during their early years. They have a hard time calming down when stressed and do not seek comfort from caregivers when upset. These children may appear to have little to no emotions when interacting with others and may seem unhappy, tense, sad, or frightened while engaging in normal activities with their caregiver.

Disinhibited Social Engagement Disorder (DSED)

Children with DSED do not appear apprehensive when meeting someone for the first time. Instead, they may be excessively friendly, and approach strangers to talk or even hug them. Younger children may even allow strangers to pick them up or feed them. When these children are placed in a strange situation, they often don’t check with parents or caregivers and may go with someone they do not know.

Understanding Attachment Disorder

Humans are biologically hardwired for social attachments, and infants possess an inherent survival mechanism to instinctively bond with caregivers. When a baby’s physical and emotional needs are met, he or she will develop secure bonds, learn to trust, communicate, and take steps toward autonomy.

Infants exclusively rely on adult caretakers for emotional regulation. When parents or other caregivers are both responsible and responsive, children are given the basis for the personal security required to learn emotional self-regulation.

On the other hand, babies that do not receive predictable and proper attention from caregivers are not able to establish secure attachments and thereby resort to looking for alternative ways to relieve their distress.

Determining how to comfort a crying infant can be challenging for any parent or caregiver. It’s believed that even the most dutiful parents are only able to accurately respond to a child’s needs about half the time. Therefore, it is possible that even well-intentioned caregivers can fail to respond as necessary for a child to develop secure attachments.

Furthermore, factors such as abuse, neglect, or trauma further jeopardize a child’s ability to form bonds. Unique traits characterize all forms of childhood attachment disorders, but all share a common feature in the child’s quest for extrinsic comfort and security.

Attachment Disorder and Addiction | Recovery in Tune

The Role of Addiction

So how exactly is attachment disorder related to addiction? As children grow and develop, they naturally become less reliant on caretakers. For those children with attachment disorders, however, the search for external emotional support and regulation persists into the teenage years, when many people face situations that are conducive to drug and alcohol use.

Since teenagers with attachment disorders have been seeking emotional control since infancy, they are particularly susceptible to eating disorders, or self-harming behaviors such as cutting, aggression, or hypervigilance. These young adults may also develop toxic relationships rife with manipulation or dependency.

For many young persons, drugs and alcohol can become an easily accessible and effective means of self-soothing. It is common for substance abusers to describe their first exposure to drinking or drugs as an extraordinary experience of contentment and well-being.

Psychoactive drugs and alcohol have compelling emotional effects. In the beginning, they can produce temporary feelings of euphoria that, over time, can propel addiction. People who suffer from attachment disorders internalize feelings of inadequacy and low self-esteem early in life that can manifest as a fear of intimacy later.

Moreover, drugs and alcohol may offer a panacea to adolescents seeking emotional comfort while learning to navigate awkward relationships.

Getting Treatment for Addiction and Attachment Disorder

Understanding the link between addiction and attachment disorders allows treatment centers such as Recovery in Tune to customize programs to the specific needs of each patient.

Drugs and alcohol foster withdrawal and detachment, and therefore, a critical part of recovery is developing trusting bonds with reliable people. Conversely, relationships that promote intimacy and honesty provide a framework for individuals in recovery, helping to repair and confront the patterns of isolation and avoidance commonly experienced during active addiction.

Our center employs caring and professional medical providers who specialize in addiction and mental health. Using an integrated approach, we collaborate to develop a comprehensive program that includes essential, evidence-based therapies such as psychotherapy, psychoeducation, counseling, and group support.

You can reclaim the fulfilling life you deserve, free from drugs and alcohol! Contact us today to find out how we can help!