Tag: Depression

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Debunking the Rock Bottom Myth: A New Perspective on Addiction Recovery

The “rock bottom” myth suggests someone must hit a catastrophic low point before they recover from addiction. While pain and negative consequences can motivate change, it can be misguided and even dangerous to require this of everyone with an addiction. Many recover or start treatment without hitting their rock bottom. Staying connected to loved ones, work, and daily life often supports recovery.

Rock bottom is considered the ultimate low in someone’s life, like losing loved ones, money, status, freedom, and possessions. It can be a singular event or a cumulation of consequences. Everyone will have a different rock bottom, which makes the myth even less defined—one person may consider becoming homeless and unemployed rock bottom, another may consider getting divorced to be their rock bottom.

Viewing “rock bottom” as the only entry point into treatment can harm a person with addiction and their loved ones. Instead of waiting to reach rock bottom, they can take agency over their treatment journey and seek help whenever they feel it’s necessary.

What Is The Rock Bottom Myth?

The rock bottom myth views hitting “rock bottom” as a requirement1 for addiction recovery. It sees pain, grief, and negative consequences as motivators for going to and engaging in treatment. While this can be true and often is, not everyone needs to hit a breaking point to get treatment or want help. You certainly don’t need to reach rock bottom to deserve help. 

The rock bottom myth originated in the 12-Steps2 of Alcoholics Anonymous (AA), where hitting rock bottom was once a sign participants were ready to practice and commit to the 12 Steps (and recovery). Rock bottom was portrayed as a launching pad into recovery. If participants didn’t reach this point, they weren’t seen as being able to commit to recovery and/or recover fully.

More recently, the rock bottom myth has faded to make room for unique recovery journeys, motivations, and underlying causes of addiction.

The Dangers of the Rock Bottom Myth

Waiting to hit rock bottom and going through it as a prerequisite for recovery poses several dangers. The components of rock bottom can be dangerous in themselves, like homelessness or committing a crime. 

The rock bottom myth can also keep someone from getting treatment and continuing in their addiction, which harms their mind and body. Waiting for a flip to switch, an epiphany, or acute realization of being at rock bottom delays treatment and can contribute to denial.

Someone may hesitate to pursue treatment if they’ve not hit a clear breaking point. They may worry treatment professionals won’t take them or their needs seriously if they don’t have evidence of hitting rock bottom. This can delay treatment, cause shame, and deepen hopelessness. These feelings can even build into a crisis point.

Rethinking Recovery: Early Intervention and Support

Early intervention is found to be the most effective preventative measure2 against addiction and its consequences. It can prevent addiction from worsening to a breaking point, and the harms that come with that. Knowing you can get treatment at any point, not just at the end of your rope, can encourage people to seek treatment sooner. 

Recognizing signs of addiction can help you get treatment early. For example, you may notice you’re drinking every night and feel uncomfortable or ill when you try to stop. Even though it hasn’t affected your relationships, work, or finances, you still feel like something’s wrong. Getting treatment once you realize that can stop its progression and hitting rock bottom.  

Alternatives to the Rock Bottom Approach

Many avenues to recovery don’t rely on hitting rock bottom or anything close to it. You can find the motivation to heal and treat underlying symptoms through therapy, supportive relationships, and various community resources.

Therapies like cognitive behavioral therapy (CBT) and motivational interviewing can disrupt unhealthy thought patterns and teach healthy coping mechanisms. Exploring past events and trauma can also help you identify triggers, connect them to substance or behavioral addictions, and find new ways to cope.

Connecting to peer support and community resources prevents the isolation and loneliness that can feed into substance use. Stay close to friends and loved ones, and try joining an in-person or online group focused on recovery. Twelve-Step groups may be a good option for you, or you could attend non-12-Step groups like SMART recovery. You could also join non-recovery focused communities, like clubs or sport teams, to meet new people and grow your support network. 

These communities and support networks can jumpstart your recovery by offering a subjective view of your situation. For example, an honest conversation with a friend or family member may open your eyes to your need for treatment, before you start experiencing consequences. Listening to their concerns and ideas can inspire you to begin treatment with their support. 

Shifting Societal Perceptions on Addiction and Recovery

Addiction and mental health conditions aren’t fully understood by the public—unless it happens to them or someone they love. This misunderstanding can lead to prejudice and stigma, which can make it hard for anyone to admit to struggling with a mental health condition or addiction. This can hinder early intervention and land people at their rock bottom.

Awareness on addiction, mental health, and the realities of recovery can change how the public views these conditions. Rather than seeing it as something that must reach a certain drastic point for treatment, addiction can instead be seen as something you treat as soon as you notice symptoms, much like most illnesses or wounds. If addiction or mental health conditions were seen in this light, more and more people might feel willing to admit their struggles and seek treatment before it becomes consuming.

Thankfully, many efforts and organizations are actively working on making the public aware of the realities of addiction and mental health—and reducing stigma along the way.

  • To Write Love On Her Arms raises awareness for depression, suicide, self-injury, and addiction. They offer a message of hope and unity and donate to treatment efforts by selling merchandise. 
  • The Herren Project helps individuals and families find treatment with personalized support and scholarships to cover treatment costs. They’re founded by former NBA player Chris Herren, who recovered from addiction and seeks to reduce the stigma surrounding recovery, bring awareness, and provide hope.
  • Red Ribbon focuses on youth and drug use prevention in schools. They advocate for drug use prevention and recovery, hosting events to spread awareness and help more and more people commit to drug-free lives.
  • The Pan American Health Organization (PAHO) runs a mental health awareness campaign addressing stigma and discrimination. They encourage countries and people to #DoYourShare in reducing stigma and making treatment more accessible.
  • CALM’s “Suicidal doesn’t always look suicidal” campaign uses photos and videos of people before the took their own life to bring awareness to suicide, encourage treatment, and start much-needed conversations without shame or judgment.
  • State campaigns are often run by state governments and aim to bring awareness to addiction and help people connect to treatment. Search the internet for local campaigns or check community centers, libraries, and churches in your town or city.

How to Seek Help Without Hitting Rock Bottom

You don’t have to hit rock bottom to heal. If you’re experiencing symptoms of addiction or a mental illness and notice they have an effect on your life, ask yourself, “Do I want to keep living like this?” The answer can inform what you do next.

If you answer no, you can begin seeking treatment or implementing changes into your daily life. You can set up an appointment with your primary care physician, bring your concerns to them, and see what they recommend. Keep questions like these in mind to get a full understanding of your condition and treatment options:

  1. Do my symptoms and experiences fall under a diagnosis? If so, which one(s)? (This can help insurance cover the costs of treatment.)
  2. What lifestyle changes or new habits would you recommend to improve my symptoms?
  3. Do you recommend I start medication to manage my symptoms? If so, which one, and what are its side effects?
  4. What type of treatment or level of care would you recommend?
  5. Will I need a referral for my next steps in treatment?

Use Recovery.com to find treatment centers for your condition and preferences, filtering by insurance coverage, amenities, and location. 

Helping Someone Else

An open and non-judgemental conversation with a friend or loved one could save them from the life-altering effects of hitting rock bottom—and even save their life. 

You may notice a friend or family member acting differently; seeming ‘off.’ They may drink more often or get drunk more regularly. They may seem sad and view life through a suddenly cloudy lens. If you notice signs like these or just intuitively know something’s wrong, voice your concerns calmly, non-judgmentally. Here’s how that could look:

  • “I’ve noticed you seem down lately. Would you like to talk to me or someone else about it?” 
  • “I see you’ve been drinking more and more often. Do you think you might need help to stop?”
  • “I feel like you’ve been acting differently lately—you seem sad. Can I help you, or help you find help?”

Together, you can look into treatment options, just talk, or both. Your support and care can make all the difference. 

Bridging Rock Bottom With Early Intervention

You don’t have to hit your breaking point to heal. Though the rock bottom myth holds truths about motivation to change, it’s not necessary for successful recovery. Getting help as soon as you notice signs in yourself or someone else can be key to early intervention and healthy living.
Browse Recovery.com to find a treatment center that fits your needs.

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Rural Recovery: Challenges and Hope

Rural areas offer great benefits, like a slower pace of life, open fields, and close-knit communities. But what happens when they can’t provide the resources someone vitally needs, like addiction and mental health treatment? Lacking what many urban dwellers take for granted—access to resources—can endanger the billions of people living in rural communities worldwide. 

Thankfully, technology has opened new doors for rural areas. With just a phone or laptop and internet access, people can attend therapy online and even virtual rehab. Increased mental health awareness in small communities may also create new and improved resources for areas in desperate need.

To learn more about the healthcare challenges in rural areas and how providers navigate them, listen to our recent podcast episode featuring Dr. Jonathan Rosenthal!

Behavioral Health Challenges in Rural Areas

About 1/5th of rural Americans have a diagnosed mental health condition1. Urbanites make up close to the same. However, those in rural areas have more trouble accessing care and finding clinicians, as opposed to urban cities with multiple clinics and practices to choose from. 

Over 60% of rural Americans live in ‘mental health provider shortage’ areas1, with 65% of rural counties without psychiatrists. Waiting lists for therapy or more intensive care can extend for months. Limited mental health knowledge and stigma often prevent rural residents from seeking treatment at all. If they do, low availability often means they must choose the first provider they can get, whether they’re a knowledgeable fit or not. Personalized care can become more of a luxury than a necessity.

Primary care physicians (PCPs) often become the first and only line of defense for mental health conditions and substance use. While PCPs can prescribe medications and recommend next steps, they often don’t have the specialized training in mental health or addiction to educate and support patients properly.

A Top Challenge: Growing Suicide Rates in Rural Communities

Rural residents are twice as likely to die by suicide than urban residents1. Isolation, stigma, poverty, and an inability to access care contribute to the steadily growing rate of rural suicides. Timely access to care, crisis services, and increased awareness of mental health could lower the risk of suicide among rural residents, particularly veterans and young adults. 

Boundaries to Effective Care in Rural Communities

People in rural areas face several prevalent barriers to care, including limited availability of resources, long travel times to get to treatment, and stigma. 

Lack of Access

Here’s a story highlighting a common treatment scenario in rural communities, where the necessary treatment simply isn’t available:

  • Rosie has been struggling with severe depression and loneliness. After months of waiting, she finally got into therapy. Rosie thinks group therapy would help her feel less alone and stigmatized. Her therapist agrees, but tells Rosie they don’t have any groups in town. Rosie keeps going to individual therapy but misses out on an aspect of treatment she feels is crucial.

Not having access to is the biggest bar to effective care1. Often, those in rural communities simply don’t have clear or easy access to treatment (or any access at all) and thus don’t receive it. And when they do seek treatment, overwhelmed medical providers can only refer to whatever resources they have and hope availability opens up.

Rosie’s story is a poignant illustration of the challenges faced by those seeking mental health care in rural areas. After enduring a prolonged wait to receive therapy, she encounters another hurdle: the absence of group therapy options in her area, which she and her therapist agree could be vital for her recovery. This scenario highlights the disparity in mental health resources available in less populated regions and the significant impact it can have on those in need of comprehensive care.

Long Wait Times

Waiting time poses another barrier to care. Here’s a second scenario highlighting this:

  • Darren has a paralyzing fear of socializing and talking in groups. He feels something isn’t right and seeks out therapy, but hears he’ll have to wait at least five months to get in. To manage his symptoms in the meantime, Darren starts bringing alcohol with him to work and getting tipsy to deal with his social anxiety. 

With these long wait times, symptoms can worsen; patients could lose motivation and back out. Being unable to access care could lead to substance use as a way to cope with conditions like depression, trauma, or anxiety. 

Darren’s situation underscores the pressing challenges that arise from the lack of timely access to mental health services. Suffering from a paralyzing fear of socializing and speaking in groups, Darren recognizes the need for professional help and reaches out for therapy. However, he bumps into a discouraging five-month wait. In a desperate attempt to manage his escalating anxiety, Darren resorts to bringing alcohol to work, using it to lessen his discomfort in social situations. This scenario highlights the detrimental effects that can occur when immediate mental health support is unavailable.

Behavioral Health Illiteracy

People in rural communities may not know how to identify behavioral health issues1 or how to get treatment. Bigger cities and communities often have more programs and initiatives highlighting behavioral health treatment and broadening awareness.

Stigma

Without adequate knowledge of behavioral health conditions, stigma can make mental health challenges and addiction seem unimportant or weak, discouraging rural residents from seeking help. Living where everybody knows everybody, they may worry they’ll be judged if they try to get help or admit to a problem. 

Travel Times

Rural residents often have long drives to get to a treatment facility or clinic that meets their needs. Juggling the time spent on the road, work, and other personal obligations can delay care2 or keep them from seeking it altogether. Here’s a predicament a farmer may face when trying to get treatment:

  • Bill seeks out treatment for his alcohol use disorder and needs a psychiatrist to go to once a week. The closest psychiatrist to him practices an hour and a half away, which means he’ll be gone for almost four hours each time. But Bill runs his own cattle farm, and he needs to milk his cows every morning and ensure they’re fed. Leaving for 4 hours feels out of the question; he cancels his appointments and decides to deal with his symptoms alone. 

Solutions for Better Access and Support

Rural areas need more general physicians, therapists, and specialists to meet the rising demand for behavioral health services. Incentive programs in some states encourage new physicians to practice in rural areas1, which could steadily grow their workforce and improve access to care. Other solutions, many already in play, include:

Virtual Care

Virtual care uses the internet3 to connect patients and care providers virtually. Since COVID-19, virtual care has become more commonplace and can serve as a vital connection for rural residents and treatment providers. You only need a phone or laptop and an internet connection to access virtual care. You’ll use a secure online platform to conveniently meet with a doctor, therapist, psychiatrist, or other healthcare provider.

With virtual care, you don’t have to live in a certain city or near a therapist’s office. You can even attend residential rehab online and outpatient levels of care. And with a larger pool of providers and specialists to choose from, you can get into treatment faster and find care specialized to your needs. 

Incentives for Rural Providers

Some state governments have incentivized more healthcare providers1 to practice in rural communities. If they practice for a set number of years, they receive additional financial compensation. If every state had the funding for this initiative, it could repopulate the rural workforce with eager health and mental health providers.

Increased Behavioral Health Training

Additional training would benefit current rural providers1 and help them make better-informed decisions on patient care. Primary care physicians would understand all the available options, including virtual care and local crisis services for mental health and addiction. Some programs have started training non-professionals to provide peer support, which has had success in the rural Native Alaskan community.

Known and Accessible Suicide Prevention Strategies

Death by suicide occurs more commonly in rural populations1, especially in kids, young adults, and older adults. Social isolation and not knowing what support they have can lead to untreated crises. Many programs and crisis services do exist and specifically serve rural populations, like local crisis teams, but residents don’t often know they’re there.

Educating community members on their available crisis services and support programs could save lives. Community leaders could make their crisis services more prominent and accessible by posting them in daily newspapers and highlighting crisis hotlines like 988 (National Suicide Prevention Hotline). Schools, churches, and businesses could also spread the word to destigmatize mental health and inform residents of their resources.

Better Support for Physicians

Physicians and mental health professionals face burnout in all settings, but rural providers can end up shouldering high caseloads and pressure to treat more people than they reasonably can. Compassion fatigue and discouragement can drive providers to areas with better support, so providing support in rural settings could help them stay. Financial incentives could bring more practitioners to rural areas, also lightening the load for current practitioners. 

Psychological care, peer support, and financial benefits can help providers retain their well-being and compassion, essentially helping them help others.  

Future Goals and Ideas

In an ideal world, rural populations would have the same access to and knowledge of mental health and addiction care as urbanites. Virtual health would fill in the gaps, with more better-trained and better-supported providers meeting the high need and demand for behavioral healthcare. Awareness and education on behavioral health would reduce stigma and help people feel more comfortable asking for help. 

Low-Cost Clinics

Low-cost clinics, funded by grants or donations, could offer the affordable care many rural residents in poverty need. Staff at these clinics could educate patients on good mental and physical health, with free resources for improving their diet and creating healthier habits.

Funding Local Resources

Funding for local programs could strengthen community services, too, helping them offer more robust non-clinical services. For example, funds to a local crisis support unit could go towards hiring full-time staff with specific crisis training.

In rural areas and beyond, everyone who needs treatment should have a clear path to it and support along the way, whether from their doctor, family, other community members, or all three. 

Learn more about future goals and ideas in improving rural healthcare by listening to our recent podcast episode here!

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Beyond Paradise: Exploring The Realities of Rural Healthcare in Hawaii

We were thrilled to talk with Dr. Jonathan Rosenthal, a hospitalist from Kauai, Hawaii, about his 23+ years as a hospitalist and his unique experiences practicing in rural Hawaii. In our newest episode, Dr. Jonathan Rosenthal talks with hosts Dr. Malasri Chaudrey-Malgeri, Editor-in-Chief, and Cliff McDonald, Chief Growth Officer.

Listen to Dr. Rosenthal’s episode and hear from our previous guests here!

Finding a Fit as a Hospitalist

Dr. Rosenthal is a hospitalist in an intensive care unit (ICU). He sees people in the emergency room and admits them into hospital care, working with his patients daily until they’re ready to leave treatment. Dr. Rosenthal has been working as a hospitalist in the remote town of Kauai for almost 13 years, starting his career in urban Seattle.

Dr. Rosenthal came to Kauai seeking a better quality of life and settled in, now living on the island with his wife. Kauai’s rural setting means Dr. Rosenthal works at the only major hospital on the island. He and his other 5-7 coworkers balance the needs of the island’s hospitalized patients. 

Challenges Faced in Rural Populations

Dr. Rosenthal’s community faces distinct challenges, like not having access to care, poverty, health illiteracy, and unhealthy eating. He frequently encounters metabolic disorders like diabetes, obesity, and hypertension as residents don’t have the means or access to healthy foods. Meth use also runs rampant:

“​​I was blown away that, like how frequently, you would come across people who are using methamphetamine. It’s really rampant. It often leads to problems that I need to see them for.”

Dr. Rosenthal notes his community has no public resources for the issue of meth use, making awareness and treatment difficult. Finding affordable care also poses a challenge for impoverished residents. 

For the physicians, they face discouragement from a lack of resources and support. Compassion fatigue, burnout, and the grief of being unable to help everyone pose significant challenges for providers in Kauai and other rural areas.

Encountering Wide-Spread Addiction and Mental Health Concerns

Of patients Dr. Rosenthal sees from the ER, he estimates:

“Almost every single time if you have to be hospitalized and you’re under 40, maybe 90 percent of the time, you have some sort of substance abuse and/or mental health, usually both, problem accompanying whatever else is going on.”

As the first line of defense, the emergency room takes the primary load of cases involving addiction and severe mental health concerns. Dr. Rosenthal highlights the inadequacy of emergency treatment for long-term recovery, as patients receive treatment for symptoms but not underlying issues.

Ideas and Solutions for All Rural Communities

Dr. Rosenthal notes Kauai actually has one of the highest life expectancies in America, but a large subset of the population are “still quite unhealthy” and don’t have access to healthy foods, as most of Kauai’s wealthier residents do. Nutrition education could go a long way in re-shaping eating habits and lowering the high rate of metabolic disorders.  

As for the addiction concerns his community faces, Dr. Rosenthal says, 

“We need to come up with some sort of public health system that will incentivize people to get clean and stay clean. And to be healthy in general.”

Dr. Rosenthal dreams of opening a low-cost clinic for impoverished residents to get affordable care and pick up fresh fruits and vegetables. Healthy food in his hospital’s cafeteria would also improve access to healthy foods. Showing residents what healthy foods they could buy with constrained budgets and providing cooking classes would educate residents and encourage healthier eating. 

Virtual addiction and mental health services can also make care more accessible for rural patients, as they’d only need a device and internet access to get treatment. Services like these could lighten the burden for Kauai’s emergency rooms and providers like Dr. Rosenthal. Making these resources known through community outreach plays a vital role in patient education and people using their resources.

Listen to Dr. Rosenthal’s episode on The Recovery.com Podcast to hear about his inspiring work and ideas. 

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The Untold Power of Compassionate Care: Addressing Stigma with Dr. Ishant Rana

In our recent podcast episode, Recovery.com was thrilled to talk with Dr. Ishant Rana, Clinical Director at Alpha Healing Center. We explored the weight of stigma in India and how rehabs like Alpha Healing Center actively shift from punitive approaches to compassionate, personalized care. Dr. Ishant describes the impact he sees and ways the behavioral healthcare system could improve even further. 

Listen to Dr. Ishant Rana’s podcast episode here. 

Building Experience and Understanding

Dr. Ishant Rana has practiced clinical psychology in India for over 13 years. He graduated from the National Institute of Mental Health and Neurosciences in Bangalore, India. He’s worked across a variety of focuses, including addiction, personality disorders, psychosis, depression, and anxiety. Dr. Rana joined Alpha Healing Center as Clinical Director, impressed with their multifaceted programs and respectful, non-stigmatized approach to care.

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Alpha Healing Center combines medical and psychological care, helping clients safely detox and receive the mental healthcare they need. They use advanced services like neurofeedback and repeated transcranial magnetic stimulation (rTMS) to heal addiction’s underlying causes, all while providing comfortable living spaces and an atmosphere of support and camaraderie.

Making a Difference with Personalized Treatment And Education

Dr. Rana’s work at Alpha Healing Center leverages multiple forms of therapy, medical services, and holistic practices to create personalized care plans for each patient. Alpha Healing Center treats both addiction and underlying mental health concerns, helping Dr. Rana and his colleagues provide the comprehensive care needed. 

Dr. Rana believes everyone needs and deserves help, especially people with substance dependence who may otherwise be seen as “too difficult.” His work at Alpha Healing Center allows him to provide the compassionate care needed to overcome stigma and impose the empowering possibility of recovery. He’s found psychoeducation to be a particularly powerful tool in disputing stigmas around addiction, including myths like:

  • Addiction is caused by a lack of willpower; enough willpower treats addiction
  • Relapses mean treatment failed
  • Someone with an addiction must also have a personality disorder

Science-backed truths educate patients and their loved ones, helping them heal as a unit.

Future Directions and Hope for Communities

As Dr. Rana outlines in his podcast episode, accurate addiction education can benefit both the person suffering and their loved ones. Psychoeducation teaches the truths about addiction and mental health conditions, helping communities view those with addiction in a more helpful light. Rather than being shunned or disgraced, those with addiction could instead receive support and encouragement to attend treatment. 

Fortunately, this is already happening in India and worldwide, especially as younger generations set the standard for mental health awareness and non-stigmatized care. As families and individuals learn more about addiction, they become more equipped to support their loved ones and pursue treatment with hope compassionately. Dr. Rana says,

“So people are getting better, they’re learning more, but I think we have to go a long way,” says Ishant.

Like recovery itself, education and awareness are journeys. Practitioners like Ishant Rana and Alpha Healing Center combat stigma and change viewpoints in hundreds of lives through their caring, evidence-based care, creating an approach that leaves a lasting impact.

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What Are Eating Disorders? Types, Symptoms, and Treatment

Eating disorders are illnesses defined by disturbances in eating patterns1 and food intake. They also include a preoccupation with body image, calories, and weight. People of any age, sex, gender, and background can develop an eating disorder. Someone with an eating disorder (also called ED) may avoid certain foods or restrict their diet, exercise excessively, use laxatives, or vomit after eating. 

Eating disorders are often an expression of the emotional pains in conditions like depression, trauma, and anxiety. Someone may develop an ED as a way to punish or gain control over themselves. Eating disorders can also develop due to genetic predispositions and social factors. Someone with an ED runs a higher risk of physical health complications, mental health decline, death, and suicide. 

A blend of therapy, weight restoration, and nutritional counseling can not only treat symptoms of an eating disorder, but heal its underlying causes for life-long recovery.

Listen to our podcast to learn more about eating disorder and addiction recovery from Recovery.com’s Chief of Staff, Amanda Uphoff. 

What Are The Causes of Eating Disorders?

Multiple factors can cause eating disorders1, including genetic predispositions, peer influence, mental health conditions, and bullying. Behaviors and personality dispositions can also lead to an eating disorder and affect what types of eating disorders may develop.

Types of Eating Disorders

Eating disorders take many forms, from restricting diets, purging, and a blend of both. Healing exists for each kind of eating disorder and its potential health complications.

Anorexia Nervosa

Anorexia nervosa causes someone to restrict their food intake2, exercise compulsively, and intensely fear weight gain. Someone with anorexia will often have a distorted body image, leading them to feel constantly overweight and in a pursuit of thinness. Anorexia has a very high mortality rate compared to other mental illnesses due to the health effects of emaciation (extreme thinness) and risk for suicide.

Anorexia is more common in females2 and occurs most often in adolescence or early adulthood. Someone with anorexia often won’t recognize their low weight, which can make it difficult for them to understand the severity of their condition and agree to treatment. As they progressively lose weight, severe health complications and other symptoms can arise, including:

  • Feeling cold all the time
  • Irregular periods or no periods at all, which can lead to infertility
  • Constipation
  • Tiredness and fatigue
  • Low and irregular heart rate
  • Shallow breathing or feeling out of breath
  • Dry skin and brittle nails
  • Bone thinning
  • Organ failure
  • Heart and brain damage

Co-occurring conditions like depression and anxiety often contribute to the development of anorexia2, as does growing up overweight, having parents or blood relatives with anorexia, and being body shamed by peers or loved ones. Suicide is the second leading cause of death for people with anorexia1, following death from health complications caused by undereating and excessive exercise.

Early intervention, weight restoration, and therapy can reverse the effects of anorexia and teach the coping tools needed for long-term recovery, helping patients navigate day-to-day stressors and heal their relationships with food—and themselves.

Bulimia Nervosa

Bulimia nervosa is defined as a pattern of binge eating and purging3. Binge eating involves eating large meals or many high-calorie foods in one sitting, often with the inability to stop. Purging is used to compensate for the binge and prevent weight gain. Someone may purge through self-induced vomiting, using laxatives, excessive exercise, or fasting. Binge-purging can quickly become a self-feeding cycle.

Bulimia nervosa occurs most commonly in young women1. It can develop due to brain abnormalities, social influence, and mental health conditions. Bulimia can lead to weight loss and symptoms like:

  • Irregular periods
  • Throat and mouth pain from the stomach acid in vomit
  • Tooth damage and erosion, also from stomach acid
  • Stomach pain and bloating
  • Fatigue
  • Dehydration from purging
  • Imbalanced electrolytes

Unlike anorexia, someone with bulimia may not appear underweight; they can even look overweight. That’s why clinical evaluations and examinations are important for diagnosis and treatment of bulimia. A doctor will check their patient’s vital signs, ask questions related to binge or purging behaviors, and check for inflammation in the mouth and throat to diagnose bulimia nervosa and start treatment.

Therapy can address the underlying causes of bulimia and teach skills to manage binge-eating, while weight restoration and nutritional care can improve physical health.

Binge-Eating Disorder

Someone with binge-eating disorder will binge on food, but not purge afterwards1. Binge-eating often includes a lack of control and inability to stop eating, which can cause someone to eat large meals. They may feel sick after binging and gain weight over time, potentially becoming obese. 

Binge-eating disorder can affect men and women of all ages. It can lead to extreme weight gain, shame, and secretive habits to conceal binging behaviors. Other symptoms include:

  • Eating very quickly
  • Eating despite feeling full or not hungry
  • Stomach pain due to overeating
  • Eating alone or in a secret location to hide eating habits
  • Lying about eating habits
  • Frequent dieting to try to control weight gain
  • Bloating

Therapy can help someone with binge-eating disorder learn to control binging and find comfort in other activities. Personalized eating plans and exercise regimes can also reduce weight at a safe, comfortable pace.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID causes avoidant or restrictive eating habits4. Someone with ARFID may avoid certain food groups, like carbs, or specific foods, like ice cream. They may also restrict their eating and not meet their required calorie intake. ARFID differs from other eating disorders in that body image and fear of weight gain don’t contribute to food habits; rather, someone may avoid or restrict food simply because they don’t like it.

ARFID was commonly thought of as a childhood disorder, like a more severe version of picky eating. But physicians saw adults experiencing symptoms too, and moved to shift the diagnosis to both children and adults. 

Symptoms of ARFID include:

  • Avoiding food groups or types of food suddenly and dramatically
  • Eating much less than usual
  • Eating fewer and fewer foods because they no longer sound appetizing
  • Weight loss
  • Reduced interest in food and meal times
  • Low/no appetite
  • Stomach and digestive problems

Treatment for ARFID often includes therapy to work through food avoidance and identify foods someone will enjoy eating. Weight restoration and nutritional care may be needed, but not always. 

Other Specified Eating or Feeding Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED)

You can think of OSFED as a mix of eating disorder symptoms5 that don’t fall under anorexia nervosa, bulimia nervosa, or binge-eating disorder. A patient with this diagnosis may partially meet the requirement for one or more ED diagnoses. OSFED recognizes disordered behaviors and negative relationships with food as a hindrance on daily living, mental health, and physical health.

Similarly, UFED encapsulates eating disorder behaviors and symptoms that may not have a distinct classification. Some scholars and physicians debate the helpfulness of UFED and OSFED5, and instead suggest a singular term of ‘mixed eating disorders’. This term could offer more clarification for those diagnosed with it.

The symptoms of OSFED and UFED can vary widely, but typically include:

  • Restrictive diets; not eating certain foods
  • Purging behaviors (vomiting, excessive exercise, using laxatives)
  • An obsession with size and weight
  • Body dysmorphia

Therapy and possible weight restoration can help someone with OSFED or UFED heal short and long-term.

Pica

Pica is defined as eating non-food items or substances6, like mud or chalk. To diagnose, the person must be older than 2 and eating non-foods outside of cultural or societal norms. Pica can accompany disorders like schizophrenia, obsessive compulsive disorder (OCD), or trichotillomania (compulsively pulling out hair). It commonly occurs in intellectually impaired patients, children, and pregnant women. One study found 28% of pregnant women experienced pica6 during their pregnancy. 

Pica doesn’t have a direct cause6, though it’s been theorized that iron and zinc deficiencies can cause cravings for non-foods7. Pica can also be fueled by curiosity—most people may wonder about eating non-foods or want to, but they realize they shouldn’t. Intellectually impaired people and children may lack this reasoning and eat non-foods regularly. Children may also resort to non-foods to survive in neglectful or abusive environments.

Common pica ‘foods’ include:

  • Dirt and clay
  • Ice
  • Charcoal
  • Coffee grounds
  • Eggshells
  • Paper
  • Flaking paint (which can lead to lead poisoning)
  • Rocks, bricks, and cement
  • Plastic (plastic bags, containers, chunks)

Rumination

Rumination syndrome describes habitually regurgitating food8 and swallowing it or spitting it out. It usually happens 10-15 minutes after eating and can last up to two hours. Unintentional stomach and diaphragm tension can cause regurgitation. It happens without nausea and retching, but can cause stomach pain. Once someone learns how to do it, it can become habitual, like burping.

Symptoms of rumination syndrome include:

  • Weight loss
  • Malnutrition
  • Teeth erosion
  • Electrolyte imbalances
  • Abdominal pain

Rumination can co-occur with conditions like depression, anxiety, obsessive compulsive disorder (OCD). It can be a symptom of an eating disorder or occur alongside one. Treatment often includes breathing exercises to relax the diaphragm, behavioral therapies, and other relaxation methods to practice after meals. Staying relaxed can prevent the over-tightening of the stomach and diaphragm that allows rumination.

Treatment for Eating Disorders

Eating disorder treatment1 often includes a blend of behavioral therapies, nutritional counseling, medically supervised weight restoration, and medications. Treatment aims to address the ED’s symptoms and underlying causes, like anxiety, stress, depression, or trauma. Therapists work in 1:1, group, and family settings to help patients heal their relationship with food, navigate co-occurring conditions, and develop a relapse prevention plan.

Behavioral Therapies for Eating Disorders

Cognitive behavioral therapy (CBT) for eating disorders1 addresses binging, purging, and restrictive behaviors. It teaches coping tools and helps patients identify and change untrue beliefs about food, their body, and self-image.

Dialectical behavioral therapy (DBT) helps in similar ways, but focuses more on accepting thoughts and emotions and living with their potential discomfort—without restricting, binging, or purging. It centers on mindfulness, helping patients experience emotions without trying to change or limit them.

Behavioral therapies often occur alongside medications (like antidepressants or antipsychotics), medical care, and nutritional counseling.

Medical Care and Monitoring

Medical care may take place in an inpatient or outpatient setting, depending on each patient’s presentation and how underweight they may be. Weight restoration aims to safely restore weight until patients reach a healthy base weight. It focuses on physical health and safety, but restoring weight can also restore cognitive functioning.

Weight restoration9 can be done via feeding tube, nutritional supplements, and meal monitoring to ensure patients eat full meals. Other medical services may include heart monitoring, medications, and potential life-saving measures in the case of heart failure or other organ failures.

In an inpatient setting, patients receive 24/7 care and monitoring. This may be necessary for severely underweight patients and/or those who refuse to eat due to an eating disorder. Nurses and clinical staff monitor vital signs and track weight. In an outpatient setting, care and monitoring may be available, but not 24/7. This can fit the needs of someone at a stable weight, but needing ongoing therapeutic care and monitoring.

Nutritional Counseling

In nutritional counseling, a certified nutrition counselor assesses current eating habits10 and identifies dietary changes. They help create meal plans, educate on the importance and effects of good nutrition, and help patients with eating disorders change how they view food. For example, they may explain the benefits of feared food groups and “fear foods” to lower the fear and negative associations someone may have.

Nutritional counseling can disprove untrue beliefs or fears about food and help patients feel more comfortable eating new/more foods, complementing behavioral therapies and  weight restoration.

What to Expect When Seeking Treatment

What happens when you seek treatment for an eating disorder? It varies for everyone, but you can expect your appointments with therapists and medical providers to follow general structures.

Medical Providers

You’ll typically meet with your primary care physician (PCP) first to start the treatment process, then see specialists at their referral. In this initial appointment, you and your doctor will discuss what you’ve been experiencing and struggling with. Based on your discussion, you can ask questions like:

  • Do my symptoms meet the diagnostic criteria for an eating disorder?
  • What treatment do you recommend?
  • What level of care do you recommend for my symptoms and their effect on my life?
  • What can I do to take care of myself at home?
  • Will I be put on medication? Which one, and what are its side effects?

Your doctor will likely provide physical evaluations, checking your mouth, throat, stomach, and your heart rate, among other vital signs. These evaluations can reveal and confirm health concerns, potentially leading to additional lab testing or other functional tests. Your doctor will use the results of their evaluations to determine the best next steps for you.

At the end of your appointment, you’ll likely leave with referrals to specialists, therapists, or a plan to start intensive care in an inpatient or outpatient setting. In severe cases, a PCP may send you directly to an emergency room.

Therapists

Your first therapy session for eating disorder recovery often covers your history with eating disorders and general information about yourself. You’ll talk about what brought you into treatment, and depending on how much time you have, you may take assessments to help your therapist better understand your mental state and personality. Future sessions cover current and past issues more in depth, focusing on the thoughts and beliefs behind eating disorders, identifying triggers, and learning coping tools.

Overall, think of your first session as your therapist getting to know you, and you feeling comfortable with them. If you don’t find the right therapist on your first try, that’s okay. You’re encouraged to connect with new therapists if your current one doesn’t feel like the right fit. 

Lifestyle Strategies and Habits to Manage Eating Disorders

Lifestyle changes and new habits can help manage eating disorders. Remember to seek professional treatment as your first step in recovery, using new habits and lifestyle changes to complement your recovery and form your relapse prevention plan. 

Prioritize Good Sleep

Good sleep can help your mind and body work their best. This benefits your recovery and well-being as a whole. Try these tips to improve how long you sleep and your sleep quality:

  1. Create a nighttime routine that you enjoy and look forward to—purposefully wind down and prepare for sleep the same way each night to train your brain.
  2. Make sure your bedroom is a calm space focused on sleep. Don’t use it to work, eat, or scroll social media.
  3. Dim your lights an hour or longer before bed to trigger your natural circadian rhythm and make you feel sleepier.
  4. Get sunlight in the morning and evening, ideally the sunrise and sunset. You could take morning and evening walks, or sit outside on your porch to view and feel the sun. This can regulate your circadian rhythm.

Practice Stress-Reduction Strategies

Effective stress reduction strategies can vary person-to-person. You can identify what works for you in therapy, or you may already know from past experience. Keep one or two methods in mind to use as-needed, or work some of these examples into your weekly schedule: 

  • Drawing
  • Meditation
  • Talking to a friend or loved one
  • Journaling
  • Baking or cooking
  • Knitting, crocheting, or sewing
  • Taking a walk
  • Spending time in nature

Build and Connect With Support

Connect often with your support network as you undergo treatment, walk your recovery path, and live in long-term recovery. Your support network could include family, friends, and people at your work or place of worship. Keep them up-to-date on your treatment journey and how they can support you.

Friends and family can offer their support and keep you accountable. For example, they may catch or point out potential behaviors you’ve reverted back to, or new habits that could lead to an ED recurrence. 

Find Eating Disorder Treatment

Treatment for all types of eating disorders is an essential start in recovery. A personalized blend of therapy, nutritional counseling, and medical care can restore physical health and heal underlying causes and conditions. You can hear a first-account story of eating disorder recovery by listening to the episode with Amanda Uphoff on Recovery.com’s podcast.

To find eating disorder treatment, you can browse our list of treatment providers and compare services, pricing, and reviews to find the best center for your or a loved one’s needs. 

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The Necessity of Seamless Care in Improving Education: Insights from Dr. Dana Battaglia

We were honored to talk with speech-language pathologist, educator, and TEDx speaker Dr. Dana Battaglia on our recent podcast episode. Hosted by our Editor-in-Chief and clinical psychologist, Dr. Malasri Chaudhery-Malgeri, we discussed the special education system as a whole, where it can improve, and resources for parents.

Tune into this episode for a deep dive into adolescent mental health, how schools navigate their ever-increasing needs, and how seamless mental health and learning support can help students thrive.

Listen here on your favorite podcast platform.

Bringing Experience and Passion to Special Education

Dr. Dana Battaglia is a wife and mother passionate about effective communication and equal-opportunity learning. 

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To the special education system, she brings vast knowledge and experience with literacy disabilities, autism spectrum disorder, and communication. In her current work as Chair of the Committee on Special Education at the Westbury Union Free School District, she determines if students have a disability. To have a disability, students must fall under one or more of the 13 educational classifications, which include autism, emotional disorders, and speech impairments. Dr. Battaglia has worked as an Associate Professor and Clinical Coordinator at the Genesis/Eden II Programs.

Reactivity vs. Proactivity in Special Education

Dr. Battaglia outlines the need for proactive care, saying, “…by the time they get to me, a student is really in disarray if they truly do have a disability.” Students come to her only after they’ve experienced academic difficulties, which then gets treatment rolling.

However, Dr. Battaglia notes that the system has improved in the last twenty years. Mental health is recognized as an important aspect of student health, opening up doors to comprehensive treatment for both students and their parents. But by the time students have their needs recognized, their well-being and academic success have often already been affected.

Rising Mental Health Needs and Emotional Disabilities

Mental health conditions and diagnosed emotional disabilities have been on the rise, Dr. Battaglia notes. She sees literacy disorders leading to addiction as a means to cope with academic stress. COVID-19 has also created spotty, inconsistent education and classroom experiences, causing some students to fall behind socially and academically. 

Due to increased need, students who experienced sexual assault and abuse encounter long waiting lists for more intensive therapeutic environments. General mental health care often bumps into the same problem—unmet demand and wait times. 

Resources and Help Where Students Need It Most

Partnerships with clinics, psychiatrists, state programs, and community resources actively meet the needs of students with mental health conditions and learning disabilities. Though wait times and incongruent care can delay treatment, it is available and often highly effective. Asking for help is the first and most vital step. Dr. Battaglia says,

“What I have said to families is that in my 25-plus years of practice, I have never, ever seen a child die from an extra evaluation. Or getting extra therapy that maybe they didn’t need.”

Schools can offer help through on-site counseling and academic support, creating individualized education plans. They can also refer students to outside treatment to connect them to more effective and fast care. School staff and psychologists conduct home visits to ensure student safety, provide in-home instruction, and provide other forms of support to care for their students, including Parent Training and Consultation programs.

Support for Families

Parents have resources available to them, too. Parent Training and Consultations equip families with essential tools to support their children’s educational needs and treatment goals. Family groups connect parents and offer a space to share encouragement, which schools can connect parents to.

Solutions in a Dream World: Seamless Care 

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Dr. Dana Battaglia envisions seamless, integrated care in all schools and for all students. Each school would have psychologists, psychiatrists, social workers, speech pathologists, and special education instructors. Attentive care would identify mental health and learning challenges before they disrupt academics and a student’s overall well-being. Translators would be available for students of different cultures and countries, helping them assimilate into the classroom and new cultural expectations. Dr. Battaglia says,

“I would love to see a world where a teacher has opportunities to collaborate with a literacy specialist and a speech language pathologist, embedded in their day, with counseling support.”

Overall, students wouldn’t rely on a school’s limited resources and referrals to get treatment. Therapeutic treatment would instead take place where students already spend most of their time—at school. The first line of defense, though straggled now, would become more robust and capable of handling rising demands. 

With continued government support, this dream may soon become a reality, especially as educators and treatment professionals continue to advocate for their students’ well-being. 

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What Is Self-Harm and Why Is It Done?

*Trigger warning: This article includes details and discussions of self-harm.*

Self-harm is self-inflicted and harmful behavior done without the intent of death. Examples include cutting, burning, and bruising the skin. Picking at wounds and pulling hair may also be self-harm. 

Self-harm is often used to manage strong emotional pain, express intense emotions, and escape numbness. It’s not typically done to initiate suicide, but someone who self-harms is more likely to die by suicide1.

Understanding Self-Harm

Self-harm can be confusing and difficult to understand, whether you or a loved one do it. It can seem illogical—causing pain to escape the pain. Knowing the reasons behind it can help you support a loved one or learn more about how treatment can help you. 

Definitions and Forms of Self-Harm

Self-harm is defined as inflicting physical harm to yourself on purpose1. It’s more common in teens and women. Some people will only do it a few times; others may struggle to stop once they start. Media representation (TV shows or movies) commonly portrays self-harm as cutting the skin, but it actually takes many forms. Here’s some examples:

  • Burning the skin with matches, a lighter, or another source of fire. Chemical substances can also cause burns.
  • Punching or hitting to cause bruising or broken bones.
  • Scratching, piercing or cutting the skin with razors and other sharp objects.
  • Pulling out hair. 
  • Ingesting toxic substances, like drugs, high doses of medications, and chemical cleaners to inflict harm.
  • Any self-inflicted behavior intended to cause physical harm. 

Though self-harm can cause injuries that need medical treatment (and even life-threatening injuries), it differs from suicide attempts in that the person does not intend to die. Suicide attempts are often intended to cause death, while self-harm is used as a coping tool. 

For example, someone may cut deeper than intended, requiring immediate medical care for a wound that could have killed them. This differs from a suicide attempt because they did not make that cut with the intention or hope to die.

The Psychology Behind Self-Harm

Self-harm commonly occurs as a way to cope with overwhelming emotions2, including anger, grief, and numbness. It’s also frequently used as a tool for self-punishment. Some people self-harm to gain attention and help from others (also called a cry for help). Others may self-harm for all 3 reasons. In any case, they need and deserve help.

Self-harm also serves as an emotional outlet2 and provides a sense of control. It can provide a more continuous distraction from intense emotional pain, as the inflictor often needs to bandage and care for their recurring wounds, which also offers a sense of control and can provide nurturing not otherwise received. 

Though it seems counterintuitive, self-harm can release endorphins3 as the body responds to pain. This can spike your adrenaline and improve your mood, which offers an escape from numbness and a break in intensely low mood. But it’s only temporary. 

Addressing The Stigma Around Self-Harm

The stigma surrounding self-harm claims it’s a sign of weakness and attention-seeking, which can cause people to feel ashamed and unwilling to ask for help. Cuts, scars, and bruises also don’t align with most beauty standards, which can cause further shame. 

Shame can cause a cycle of self-harming, as continuous harm reinstates shame, which can cause ongoing self-harm. Hiding injuries and crafting cover-up stories can also fuel shame and cause even greater stress, which can feed the cycle.

To break through the stigma, you can practice empathy and compassion—towards yourself and others. Educate yourself on self-harm to better understand its causes; this can help you approach conversations about getting help with greater confidence and compassion. You can also advocate for yourself or others by correcting common misconceptions about self-harm. Discuss it as a symptom of overwhelming pain, not an inability to cope with it. If people don’t understand and are not willing to try, you can leave them out of your journey.

Factors Contributing to Self-Harm

Self-harm isn’t usually the first way people try to manage strong emotions and cope with pain. People may even seek treatment but ultimately not get the relief they need. And since self-harm can offer momentary relief or distraction, stopping may sound pointless and daunting—why quit something that works? Fear can then contribute to repeated self-harm: fear of giving up potentially the only coping tool you have.

Treating underlying conditions, beginning treatment as soon as possible, and catching the signs early can prevent self-harm and the fear of letting it go. 

Emotional Distress and Mental Health Disorders

Conditions like depression, anxiety, trauma, and borderline personality disorder can contribute to and cause self-harm as a symptom. Here’s why:

Pre-existing mental health conditions can largely contribute to and cause self-harm, but so can your environment, the people around you, and the media you take in.

Environmental and Social Influences

Bullying, family dynamics, and peer pressure can lead to self-harm. Media may also create curiosity around self-harm, which could lead to experimentation, and then a habit that becomes hard to break. Some TV shows and movies geared toward teens vividly show (and often romanticize) self-harm. This can prompt teens to replicate the behavior or see it as the only way to deal with negative emotions. 

Similarly, and especially for teens in middle or high school, being in a peer environment where self-harm is normalized and romanticized can lead to experimentation. Teens may self-harm to fit in, to relate to their friends, or to gain sympathy from classmates (which is often a genuine cry for help). Bullying can cause self-harm as a way to cope with emotional pain and as a form of self-punishment.

Signs and Symptoms of Self-Harm

If you’re worried about a loved one or a friend self-harming, you can keep a few warning signs in mind as you note their physical and emotional changes. If you do notice any signs, try to keep your questions gentle and centered on concern. Make sure your emotional state invites vulnerability. Though distressing, self-harm and the causes behind it are treatable.

Warning Signs of Self-Harm

If you’re a parent, a teacher, a sibling, or a concerned friend, you can keep a lookout for the following signs of self-harm in someone you care about.

  1. Suddenly spending time alone, usually in a shut or locked room. This could be their bedroom, bathroom, or another area of your house. 
  2. Unexplained injuries, cuts, or burns.
  3. Taking or hoarding first-aid supplies. 
  4. Finding blood on their clothes, sheets, and used first-aid supplies (like gauze or bandages).
  5. Wearing full-coverage clothes and seeming particular about not revealing their arms, legs, stomach, or other areas they’re normally okay with showing. This may be especially noticeable in the summertime (like wearing a hoodie in hot weather). 
  6. Items like razor blades, knives, lighters, or other self-harm tools going missing in your home. You may find them tucked away into a hiding place in their room or bathroom. School lockers can also hide supplies.
  7. Behavioral changes like seeming down, tearful, and hopeless.
  8. Acting withdrawn and unfocused in social and family situations.
  9. Flinching or seeming in pain when certain parts of their body are bumped or touched. 

Starting The Conversation and Next Steps

Remember: noticing these signs may mean your loved one needs help, but with that help, they’ll learn to heal. Keep that in mind as you bring your concerns to light. You can start with gentle questions about their behaviors and items you may have noticed go missing, like self-harm tools and first-aid supplies. You may ask something like,

“I’ve noticed you seem very down and that you spend a lot of time in your room. I’ve also found band-aid wrappers hidden in the trash. You aren’t in trouble if you say yes, but I want to know if you are hurting yourself.”

If your loved one answers yes, they have been hurting themselves, you may need to see the wounds to make sure they don’t need medical attention. If they’re unwilling to show you but agree they need treatment, you can offer to take them to urgent care or the emergency room. 

If they don’t need immediate medical treatment, you can discuss getting help in other ways. Acknowledge and validate their pain, avoid judgment, and encourage them with the vast array of treatments available to people who self-harm (like therapy, peer support groups, virtual care, outpatient care, and even residential rehabs). When they’re ready, you can help them take the first steps into treatment.

Depending on your relationship, you may be able to control their environment in the meantime. If you’re the parent of a child who self-harms, for example, you may gather and hide all your knives, razors, lighters, and other self-harming tools as a preventive measure. You can also set rules about alone time (like limiting it to an hour a day, keeping their door open, or requiring frequent check-ins) to keep a closer eye on them and their behaviors. 

In some cases, alone time may not be safe in any sense. Consider going to the emergency room to get admitted to a psychiatric hospital, where your loved one receives continuous monitoring in a safe environment. 

Support and Treatment Options

Many forms of treatment and therapy can help you or your loved one heal from self-harm and its underlying causes. 

Professional Help and Therapies

Behavioral therapies address the unhealthy or inaccurate thoughts and emotions leading to behaviors like self-harm. Examples include:

  • Cognitive behavioral therapy (CBT), which addresses and challenges the emotions causing self-harm, like anger, shame, and grief. Using CBT, a therapist will help their patient determine the validity of their thoughts, prevent spiraling, and reshape their thought patterns. 
  • Dialectical behavioral therapy (DBT) helps manage intense emotions and teaches tools for coping and resilience. Rather than challenging or changing thoughts, DBT helps patients accept the thought and manage how they respond to it. For example, someone experiencing intense emotions may respond with a coping tool they learned in therapy, not with self-harm.
  • Problem-Solving Therapy8 uses skill and attitude training to see problems as solvable, promote rationalization, and reduce impulsivity. This therapy can be especially helpful for adolescents with depression, suicidality, and self-harming behaviors.

Self-Care Strategies and Coping Mechanisms

Alongside professional help, you can also practice self-care strategies and at-home coping mechanisms for self-harm. Here are a few of those strategies and practices you can try:

  • The ice-cube method: Hold an ice cube in your hand (or your mouth) when emotions become intense and overwhelming. The cold ice cube serves as a neurological distraction9 and can give you mental clarity. Relief and clearer thinking can then prevent self-harm.
  • Exercise: Fitness can serve as a distraction8 and an action. Let out emotions through weight-lifting, boxing, running, or taking a walk. 
  • Drawing/doodling: Making shapes, lines, or drawings can release emotions and give a sense of accomplishment. You can make angry slashes with your pen over the page, slowly color in shapes, or draw lines over and over. You can even add words and combine journaling with doodling.
  • Busy your hands: Whether you have to sit on them, play with a fidget toy, or simply run them over textured fabric, keeping your hands busy can help distract you until the urge to self-harm fades.
  • Tear something apart: Rip up paper, food, or something you’re okay with tearing. This serves as a distraction and an emotional outlet, which can prevent self-harm by satiating the need to do so.
  • Tell someone: Let a trusted friend or family member know when you feel the urge to self-harm. They can keep you company (even virtually) and keep you accountable by checking in. You don’t even have to specifically mention self-harm, just let them know you need support.
  • Remove yourself from your environment: Physically step away from your current environment and the potential self-harm tools within it. Ideally, you could go on a walk to get outside and separate from your home or other living environment. If you can’t, move to another room or seek company with a family member.
  • Make your environment as safe as you can: As you feel able, remove, destroy, or throw away self-harm tools. Give your stash to someone to get rid of. Tell a trusted family member to hide or lock up other self-harm tools in your home. These could include knives, shaving razors, and other sharp tools.
  • Be kind to yourself: The recovery journey for self-harm isn’t a straight line. You may go one, two, even 10+ days (or months) without self-harming, but end up doing it again. That’s okay. Don’t see it as failing, rather as a bump in your road to recovery—and you’re still on the road. Remind yourself of that often.

Self-care strategies can reduce your overall stress and promote wellness day-to-day. Here are a few techniques you can try:

  1. Set aside time to relax and do something you enjoy. Schedule yourself an hour each night (or however long you can) to read, meditate, craft, or call a friend.
  2. Stay hydrated and incorporate more whole foods into your diet to fuel and nourish your body.
  3. Get outside to soak in sunlight and Vitamin D—try walking through your neighborhood, taking your dog to a park, or sitting on your balcony.
  4. Prioritize good sleep. Follow a nighttime routine and try to wake up at the same time each morning to even out your sleep cycle.
  5. Move your body through exercise, yoga, playing with a pet, or taking walks. You could also take up new sports or hobbies like hiking, swimming, and rollerblading.

Prevention and Building Resilience

Changing the narrative around self-harm and offering education can prevent teens and adults from using it as a coping tool. To combat the glamorization of self-harm, schools, peers, and teachers can instead educate vulnerable teens on the realities of self-harm and what it means for their health. 

Knowing your treatment options can also serve as a prevention tool, as someone may not feel drawn to self-harm if other sources of relief are readily available (like therapy, support groups, or crisis services). The earlier schools and other organizations can make these resources available, the better.

Find Help and Hope

Understanding self-harm is the first step towards offering the necessary support and compassion to those in need. It’s about looking beyond the behavior and recognizing the underlying pain, offering a helping hand in their journey toward healing. Remember, with the right approach and resources, recovery is not just a possibility but a reality. 

If you or someone you know is struggling with self-harm, seek help from a professional to navigate the path to recovery together. You can also find rehabs with self-harm treatment by browsing Recovery.com.

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Hope in Recovery: Navigating the Journey With Optimism and Resilience

Hope is talked about so broadly in recovery circles that it often comes across as cliché. But hope is not just a fluffy feeling. It’s a powerful force that gives you the motivation to change your life and the strength to sustain those changes.

In the depths of addiction and depression, hope often gets lost. Finding it again is a pivotal experience that can change your journey for the better. We’ll explore the science-backed proof behind the power of hope in recovery, and hear stories from people for whom hope was a driving force for lasting change. 

Understanding the Dimensions of Hope

Research consistently shows a strong correlation between hope and positive recovery outcomes. 

Cognitive Aspects of Hope

Hope isn’t just blind optimism; it’s a powerful cognitive tool that’s tied to our thoughts and beliefs. “Hoping is a human capacity with varying affective, cognitive, and behavioral dimensions,” say researchers on the cognitive aspect of hope1 among patients dying of cancer. 

Hope helps us think more positively. Framing challenges as opportunities for growth, and focusing on past successes as proof of your strength, grows your confidence in your ability to succeed. 

Hope helps you set goals and work toward them—and that’s an important part of charting your course to recovery. As you progress, achieving your goals, however small, reinforces your sense of accomplishment and belief in yourself. And that goes a long way in empowering you to regain control of your life. 

Emotional Aspects of Hope

The recovery journey is full of significant challenges. It forces us to face avoided aspects of ourselves and confront our deeply held fears. Hope is what allows us to get through those times without giving in to despair. 

Sticking with the process when times get tough builds your resilience and emotional intelligence. Through that process, you’ll grow your ability to understand the emotional complexity of life. You can hold both things to be true at once: acknowledging the reality of your current situation and knowing that it can change. 

Hope gives us the persistence that recovery requires.

Social Aspects of Hope

Hope thrives in connection. Surrounding yourself with positive people who believe in your ability to heal keeps you on track toward your recovery goals. 

Addiction is often called a disease of isolation.2 Recovery, on the other hand, is a chance to build community with those who share your struggles and support you on your path. These connections provide a safe space to talk through your challenges, celebrate your wins, and receive encouragement during trying times. 

Seeing others’ success in recovery gives us hope that the same is possible for us. 

“Just because you feel awful at a given time does not mean you won’t feel happy and hopeful at a later stage.”

Anthony, who was hospitalized for severe mania and psychosis, describes how he eventually found hope in accepting support from others:3 

Earlier in my illness I felt like I was being badgered against my will and complained a lot and saw things negatively, whereas once I started to believe that other people could help me feel better and had good intentions I started to perceive my situation in a more positive and hopeful way. I began to look at opportunities for the future rather than concentrating on regrets and resentments. We often see self-reliance as a good thing; with mental illness it is hard to accept sometimes that we cannot fix things ourselves and that there is nothing wrong in needing and accepting the help of others.

Hopelessness is a main feature of struggles with mental health and addiction. But Anthony reminds us that feeling doesn’t last forever. “For anyone suffering from a similar condition,” he says, “I would say that just because you feel awful at a given time does not mean you won’t feel happy and hopeful at a later stage.”

Strategies for Cultivating Hope

Hope has clear benefits for recovery. So how can you invite more of it into your life?

Setting Realistic Goals

According to scientists, “Hope is commonly divided into two constructs:4 agency, defined as goal-directed energy, and pathways, defined as the ability to create paths to a goal.”

In other words, hope can be broken down into 2 parts:

  1. Agency: Putting in the effort to achieve your goal
  2. Pathways: Creating the strategies you need to succeed

To feel hopeful about recovery, you need the drive (agency) and a plan (pathways) to feel confident about reaching your goals.

Hope naturally grows when you feel a sense of accomplishment. Setting realistic goals is a great way to do that:

  • Start by identifying your long-term goals. What does success in recovery look like for you? 
  • Then, break these down into smaller, achievable milestones. 

For example, instead of setting a vague goal like improving your sleep, you can aim to go to bed 30 minutes earlier 3 nights a week. As you achieve these smaller goals, celebrate your progress! These victories are the building blocks of long-term success, and each one reinforces your self-belief. Setbacks are a normal part of the journey, but progress is made via consistent, small steps over time. 

Seeking Inspiration

Hope thrives on inspiration, and we need input to feel inspired. 

Look for stories of recovery. Documentaries or memoirs of people who overcame addiction offer powerful messages of possibility. The universal stories of humanity found in literature and art speak to us in ways the soul understands. 

The most powerful inspiration, however, often comes from those closest to us. Talk to friends or family members who have faced challenges and emerged stronger. Surround yourself with positive influences that ignite your inner light and remind you of how bright your future can be.

Building a Supportive Community

If your close relationships are strained, you can also find community in group therapy, recovery communities, or support groups (in-person or online) that connect you with others on a similar path. Witnessing others’ struggles and triumphs is a powerful reminder that you’re not alone. 

Therapy is a confidential space to explore challenges, develop coping mechanisms, and build emotional resilience. A qualified therapist can also help you navigate setbacks and cultivate a positive outlook as you stay focused on recovery.

You can also seek mentorship from someone with more time in recovery. Their guidance, encouragement, and lived experience can be invaluable assets on your journey. Some recovery communities, like 12-Step groups, build mentorship into their program. 

Hope and Mental Health Recovery

Anyone who’s lived with depression, anxiety, and other mental health conditions can tell you how hopeless life can feel. Hope gives us a way out of the darkness. 

One depression survivor, Eileen, describes how hope was the turning point in her recovery journey5 after falling into a deep depression due to burnout from parenting 3 children while working full-time: 

I was unable to laugh, have fun and it even got to the stage where I was unable to get of bed. I was deemed unfit for work. I felt that I was beyond curing, if a doctor has said I am never going to work again what hope have I of becoming better again.

But her family’s hope restored her own.

Thankfully my family held on to the hope that one day I would come back to my old self. Through time I began to see that there was hope for me to recover.

That hope empowered her to complete courses in mental health that not only helped her understand her own condition, but set her on a path toward helping others.

Hope empowers us to bravely confront the negativity in our life and transform it into something positive.

Hope in Addiction Recovery

Hope plays a critical role in all stages of recovery: from detox, to treatment, to long-term sobriety.

As you progress through your healing experience, hope bolsters your commitment to healing work and learning the skills that support long-term recovery. 

One study of people recovering from opioid addiction found that people with more hope had lower relapse rates6 after completing detox. 

Another study shows that hope plays an important role in people’s readiness for recovery.7 “Hope appears to be an important associate of contemplation toward change and appears to be required for action,” say researchers. They add that “hope also appears to be an important factor of coping in recovery.”

On the path to long-term sobriety, hope gives us the strength to manage cravings and overcome setbacks. While not a guarantee of success, it’s a reminder to stay focused on the fulfilling life you’re building. 

Hope and Physical Health

Hope also plays a powerful role in overcoming health challenges. Research consistently shows a link between optimism and positive health outcomes.8 People with a hopeful outlook tend to have stronger immune systems, experience less pain, and adhere better to their treatment plans.

Hope motivates us to practice healthy behaviors like eating well, exercising, and taking prescribed medications. By believing in your body’s ability to heal, you actively participate in your recovery journey.

Overcoming Setbacks With Hope

The road to recovery is rarely linear. Setbacks are inevitable, and we need to learn to navigate them without losing hope.

Recognizing and Accepting Challenges

Instead of viewing a setback as a sign of total failure, you can use the lessons you learn from it to strengthen your commitment to recovery.

Setbacks are opportunities for growth, because they help us identify areas for improvement. Did you miss a support group meeting? Perhaps scheduling reminders would be helpful. Were you overwhelmed by cravings? Explore management techniques or reach out to your sponsor for support.

By acknowledging the setback and strategizing to avoid it in the future, you transform a potential pitfall into a stepping stone on your path forward. Hope empowers you to learn from your experiences and cultivate optimism, so you can move forward with renewed determination.

Resilience and Perseverance

Challenges inevitably arise on the path to recovery. Here’s how you can persevere when life feels daunting: 

  • Practice self-compassion. While we often believe that self-criticism helps us improve, evidence shows that shame blocks our growth.9 Everyone makes mistakes—it’s part of being human! Treat yourself with kindness as you keep moving forward. 
  • Focus on progress, not perfection. Take time to recognize how far you’ve come. Each step forward is a testament to your strength.
  • Lean on your support system. Surround yourself with people who unconditionally have your back. Share your struggles openly and let their encouragement guide you through tough times.
  • Maintain healthy habits. Prioritize sleep, exercise, and healthy eating. Taking care of your physical health strengthens your mental well-being, allowing you to confront challenges with a clear mind.

Resources for Fostering Hope

Plenty of resources are available to help you generate hope as you navigate mental health and addiction recovery. 

Books

Podcasts

  • The Recovery Elevator shares uplifting recovery stories and practical advice for those on their healing journey.

Websites

Professional Help

Counseling and therapy equip you with strategies for managing the stress, anxiety, and negative thought patterns that often impede hope. Therapists can also help you develop healthy coping strategies to get through life’s challenges without using harmful substances or behaviors.

By tapping into professional support and resources for self-help, you can cultivate the hope you need to build the life you want.

Learn about your options for mental health treatment and reach out to a provider directly today.

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How to Navigate Mental Health and Addiction After Treatment

Recovery is an ongoing journey, and intensive treatment arms you with essential tools. After treatment, continuing to use these tools and learn new ones can sustain lasting recovery. Aftercare planning can give you resources for success.

Aftercare, also called continuing care, can reduce relapse rates, help you stay sober, and enable you to lead a healthy, fulfilling life1. You and your care team will create an aftercare plan detailing treatment options, support groups, and lifestyle habits to follow post-residential care. Your aftercare plan will be tailored to your unique needs, ensuring personalized recovery. 

Transitioning Out of Treatment

Completing intensive treatment is a milestone to celebrate; however, transitioning back to daily life after addiction or mental health treatment comes with a unique set of changes and manageable challenges. These obstacles can be broad and vary from person to person, but understanding them can help you navigate this phase more effectively. 

One of the most significant difficulties in this transition is applying lessons learned in treatment to your daily tasks. Without proper guidance, it may be difficult to maintain these skills when you’re no longer in a trigger-free environment. Other challenges include rebuilding relationships, finding a safe home environment, and financial stability2—fortunately, the skills you learn and practice in aftercare can address all of these.

Aftercare services are a vital part of a successful transition and allow you to continuously practice coping techniques and stay connected in recovery. Although your recovery is your responsibility, multiple avenues of support can assist your journey.

Types of Post-Treatment Support

Each of these support options plays a vital role in addressing different aspects of recovery and relapse prevention. 

  1. Outpatient care: These programs allow you to live at home while attending treatment sessions. Programs can vary in intensity and frequency, from daily sessions to meeting twice a week. Outpatient programs usually include evidence-based therapies such as cognitive behavioral therapy (CBT) and psychoeducation.
  1. Sober living: Sober living provides a substance-free, supportive living environment for those transitioning out of residential treatment. Residents typically follow house rules, complete chores, and continue in outpatient care, therapy, and support groups while living there.
  1. Talk therapy: Weekly psychotherapy with a therapist can be helpful to continue skill building and work through stressors. During individual therapy sessions, you’ll likely engage in various therapeutic methods like dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT).
  1. 12-Step support groups: Programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) offer ongoing support through in-person and virtual meetings and a structured program of recovery steps. These groups provide a sense of community and mutual support from peers who are also in recovery.
  1. Non-12-Step support groups: Alternatives to 12-step programs, such as SMART Recovery, offer a non-religious approach to recovery and focus on self-empowerment and self-reliance. Peer support from those with similar experiences can maintain motivation in recovery3. Those healing from mental health concerns can find community in National Alliance on Mental Health (NAMI) support groups.
  1. Alumni Program: Your treatment center may provide an alumni program where you can bond with peers through in-person or virtual alumni meetings, sober events, or group trips. The program might include follow up check-ins and therapy sessions with a counselor, as well.
  1. Medication management: For some people, especially those recovering from opioid addiction, medication-assisted treatment (MAT) can be an effective component of post-treatment support.4 Medications like methadone, buprenorphine, and naltrexone can help manage cravings and withdrawal symptoms under medical supervision. Medication management for antidepressants, antipsychotics, and more can assist recovery for those with mental health concerns.
  1. Holistic and wellness-centered programs: Activities such as yoga, mind–body therapies, acupuncture, and meditation can be an effective way to manage addiction and mental health symptoms.5 Combining holistic modalities with evidence-based therapies can provide a well-rounded approach to care and an alternative way to heal. Additionally, proper exercise and nutritional counseling can support overall well-being and stress management in recovery.6

Building a Supportive Environment

Creating a support network with strong relationships is a foundational aspect of long-lasting recovery. Social support in recovery can reduce stress, increase self-efficacy, and motivate sobriety or remission.7 When you return home, you’ll want to connect with loved ones who supported you through the treatment process. Let them know how much their help and encouragement means to your recovery. Try your best to plan regular get togethers with friends and family, as avoiding isolation and bolstering these relationships can make recovery easier.

You may want to revisit relationships that were strained by your condition(s). This is an opportunity to practice the communication skills learned in treatment and show your growth, empathy, and patience. 

Your social circle should fully support your recovery efforts, contributing to a healthy home environment. You can also adjust other factors in your life that create a supportive living space, including removing triggers (such as substances), decluttering your home, practicing mindfulness, prioritizing sleep, and building a routine with meal times, exercise, and hobbies.  

Coping Strategies and Relapse Prevention

Recovery is something you actively engage in for the rest of your life. There may be times when you experience uncomfortable feelings and situations; however, with the right tools, you can navigate through uneasy moments. 

Triggers can look like stress from work, relationships, finances, and certain establishments. It may be smart to avoid bars or similar environments to prevent attending a high-risk situation. Recognizing these triggers and planning how to manage them can prevent relapse.

During treatment and after, you’ll practice using coping techniques, which can look like breathing exercises, regulating emotions through journaling, and saying “no” to situations that do not serve your recovery. It’s important to mindfully use coping skills in both uncomfortable situations and relaxed environments—that way, when a time arises when you need to use the skill, you’ve practiced it in low-stress times and feel comfortable using it.

You and your care team can create a personalized relapse prevention plan. This plan addresses potential triggers, outlines coping strategies, and identifies supportive resources, making it a cornerstone of successful long-term recovery.

Monitoring Progress and Adjustments

Although recovery is alinear, all healthy progress should be tracked and celebrated. To ensure that you’re engaging in activities that suit your current recovery needs, you can have regular check-ins with your healthcare providers. What may have worked in the beginning of your treatment experience might not serve you years down the road. You might find journaling about your 1 month, 1 year, and 5 year goals helpful. You can also write answers to questions such as:

  1. What were your main goals when you started the aftercare program? How well do you feel these goals are being met?
  2. In what ways have you changed since beginning your aftercare program? Consider habits, thought patterns, emotional responses, and relationships.
  3. What are the most significant challenges you’ve faced during your recovery process, and how have you addressed them? How has your aftercare program supported you in these challenges?
  4. What new coping strategies or skills have you learned through your aftercare program? How effectively are you able to apply these in real-life situations?
  5. In what areas do you feel you still need to grow or improve? How can your aftercare program or other resources assist you in these areas?

Staying flexible yet focused on your end goals can help you feel more fulfilled in your recovery. Every milestone, whether achieving one year of sobriety or simply having a good day, should be celebrated. Honoring your efforts can help you stay motivated and recognize how far you have come in your recovery journey. 

Protect. your long-term recovery: find a treatment provider who can support your unique needs.

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What to Pack for Rehab

As you prepare to enter treatment, you can use this packing list to ensure you have all the necessary items to help you begin your recovery journey. The treatment center may provide a packing list that you can cross-reference, and be sure to adhere to any guidelines they may have. 

The Essentials

Clothing Essentials

You will want to bring clothing that is comfortable, casual, and weather appropriate. Depending on the treatment center’s location, you may want to pack a variety of clothing items that account for temperature changes during the day and night. Be sure to include:

  • Tshirts
  • Long sleeve shirts
  • Shorts
  • Pants 
  • Sleepwear
  • Undergarments
  • Socks 

In treatment, dress should be modest and respectful. Pack items you feel comfortable wearing, and check the center’s dress code.

Toiletries and Personal Care Items

Some centers may provide a general array of toiletries, including shampoo, soap, conditioner, and toothpaste. But others won’t, so make sure you check to see what they’ll provide. Usually, you can expect to bring: 

  • Toothbrush and toothpaste
  • Shampoo and conditioner
  • Soap
  • Deodorant
  • Hairbrush
  • Feminine hygiene products
  • Moisturizer

Try to bring an appropriate amount of product for your program length. If you’re attending a long-term program, ask your admissions coordinator if restocks can be arranged. 

Some centers may not allow certain personal care products, such as shaving razors or products with alcohol (like mouthwash or germ killer). Be sure to ask the admissions team about what is allowed.

Comfortable Footwear

Consider packing footwear for both indoor and outdoor activities. Aside from a comfortable pair of shoes for day-to-day groups, check out the center’s schedule and amenities to see if you’ll need additional shoes to participate in certain activities. For example, if the treatment center has a basketball court, you may want to bring sturdy athletic shoes. If you will go on beach excursions, pack water shoes. 

Medications and Prescriptions

Having proper medication can be an important part of recovery. Your care team will discuss your current medications and medical information to see if medications may be a good fit for you. They can work with you to store medication and give it to you at the correct time. 

Throughout treatment, you may be prescribed new medications. If this happens, it’s very important that the team is aware of any medical conditions you have to avoid negative medication reactions. 

Be sure to double check with the admissions team if you can bring your digestive aids, allergy medication, vitamins, and supplements.

Important Documents

You’ll want to bring several important documents to treatment:

  • Passport or official personal identification
  • Insurance card
  • All current prescription medications, carried in their original, properly labeled pharmacy containers
  • A contact list of anyone you want to keep informed on the progress of your treatment
  • A credit card, debit card and/or checkbook
  • Enough cash to cover general store purchases and other incidental expenses

Organizing and printing all papers beforehand will help make the transition to treatment less stressful.

The “Nice to Haves”

Comfort Items and Mementos

Having something that reminds you of home can make you feel a little more comfortable throughout your recovery process. This might be a picture, blanket, stuffed animal, or a loved one’s gift. These can provide emotional support. 

Be sure to wisely choose your comfort items, as the program likely will not allow you to bring an excessive amount. 

Reading and Writing Materials

Throughout your recovery journey, you may discover that reading and writing can help you express and process your feelings. Bringing a book and journal to write in offers an opportunity to reflect in your downtime. In fact, reading and writing can reduce stress and ease depression symptoms1. 

You may choose to read self-help books such as The Mountain Is You2 and Atomic Habits3. If you’re attending mental health treatment, The Body Keeps the Score4 could educate your journey. A gratitude journal or a journal with prewritten reflection prompts such as The Addiction Recovery Skills Workbook5 could aid self-discovery in this monumental period of growth.

Fitness and Outdoor Gear

Good physical health plays a key role in successful addiction and mental health recovery. Exercise improves cardiovascular health, brain health, and immune system functioning, as well as reduces anxiety and depression symptoms6. The treatment center might provide physical activities to boost your well-being, so consider packing:

  • Athletic shoes
  • Fitness clothes
  • Sunscreen 
  • Bug spray
  • Personal equipment (if the facility has a tennis court, ask the admissions team if you can bring your racquet)

Electronics and Entertainment

Discuss the electronic policy with your admissions team before attending treatment. Some facilities will allow you to bring your phone and laptop to attend to work responsibilities during designated times. Other centers may keep your phone stored away during the day and allow you to use it after program hours. It’s possible the facility might have a strict no-electronics policy.

Many centers allow devices that just play music, such as an iPod. You can then bring headphones to listen to your music. 

If you’re attending a program with little to no electronic time, be sure to let loved ones know ahead of time. Centers will typically have a phone for patients to use.  

Whether or not you can bring your phone, laptop, or tablet, the focus of treatment is to heal. The majority of your time will be spent in therapy and activities to assist your recovery journey. 

Snacks and Non-Alcoholic Beverages

Proper nutrition and hydration helps keep your mind and body ready to heal in treatment. The center will tell you what meals are provided, what meals you have to cook, and what foods you need to buy while there. Some centers might allow you to bring some of your favorite nonperishable snacks, such as pretzels, granola, and fruit bars. Check with the admissions coordinator to see if this is an option.

What Not to Pack for Rehab

When planning for your stay in treatment, it’s also important to understand what’s generally not allowed in rehab:

  • All forms of drugs and alcohol
  • Prescription medications that are not a part of your approved treatment plan
  • Medications prescribed to another person
  • Pornography
  • Guns, knives, and other weapons
  • Opened, non-prescription medications
  • Alcohol-containing mouthwash, perfumes, or colognes
  • Nail polish and nail polish remover

Be sure to check with the treatment center if any other items are prohibited.