FEBRUARY 2014 NEWSLETTER

Urban Life Counseling Center, Inc. 220 South Harrison Street East Orange, NJ 07018 (973) 667-7053 (973) 667-7050 fax www.urbanlifecounselingcenter.weebly.com

Dealing with Substance Abuse

Putting Back The Pieces

Substance Abuse & Mental Health

Substance Abuse and Co-Occurring Disorders

When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and its even more difficult when youre also struggling with mental health problems, but there are treatments that can help. With proper treatment, support, and self-help strategies, you can overcome a dual diagnosis and reclaim your life.
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Understanding dual diagnosis or cooccurring disorders

In a dual diagnosis, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function, handle lifes difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other and interact. When a mental health problem goes untreated, the substance abuse problem usually gets worse as well. And when alcohol or drug abuse increases, mental health problems usually increase too.

Admitting you have a dual diagnosis or cooccurring disorders

Just remember: substance abuse problems and mental health issues dont get better when theyre ignored. In fact, they are likely to get much worse. You dont have to feel this way. Admitting you have a problem is the first step towards conquering your demons and enjoying life again.

What comes first: Substance abuse or the mental health problem?

Addiction is common in people with mental health problems. But although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.

Alcohol or drugs are often used to self-medicate the symptoms of depression or anxiety. Unfortunately, substance abuse causes side effects and in the long run worsens the very symptoms they initially numbed or relieved. Alcohol and drug abuse can increase underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, drug or alcohol abuse may push you over the edge. Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or trigger new symptoms. Alcohol and drug abuse also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective.

Consider family history. If people in your family have grappled with either a mental disorder such as depression or alcohol abuse or drug addiction, you have a higher risk of developing these problems yourself. Consider your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Look at symptoms when youre sober. While some depression or anxiety is normal after youve stopped drinking or doing drugs, if the symptoms persist after youve achieved sobriety, you may be dealing with a mental health problem.

Review your treatment history. Have you been treated before for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa? Signs and symptoms of alcohol abuse or substance abuse
If youre wondering whether you have a substance abuse problem, the following questions may help. The more yes answers, the more likely your drinking or drug use is a problem.

Recognizing co-occurring disorders or dual diagnosis

It can be difficult to diagnose a substance abuse problem and a co-occurring mental health disorder such as depression, anxiety, or bipolar disorder. It takes time to tease out what might be a mental disorder and what might be a drug or alcohol problem. Complicating the issue is denial. Denial is common in substance abuse. Its hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit the problem.

Have you ever felt you should cut down on your drinking or drug use? Have you tried to cut back, but couldnt? Do you ever lie about how much or how often you drink or use drugs? Have your friends or family members expressed concern about your alcohol or drug use? Do you ever felt bad, guilty, or ashamed about your drinking or drug use? On more than one occasion, have you done or said something while drunk or high that you later regretted? Have you ever blacked out from drinking or drug use? Has your alcohol or drug use caused problems in your relationships? 3

Has you alcohol or drug use gotten you into trouble at work or with the law? Signs and symptoms of common cooccurring disorders
The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

Recovery depends on treating both the addiction and the mental health problem
Whether your mental health or substance abuse problem came first, recovery depends on treating both disorders.

Common signs and symptoms of depression

Feelings of helplessness and hopelessness Loss of interest in daily activities Inability to experience pleasure Appetite or weight changes Sleep changes Loss of energy Strong feelings of worthlessness or guilt Concentration problems

There is hope. Recovering from co-occurring disorders takes time, commitment, and courage. It may take months or even years b ut people with substance abuse and mental health problems can and do get better. Combined treatment is best. Your best chance of recovery is through integrated treatment for both the substance abuse problem and the mental health problem. This means getting combined mental health and addiction treatment from the same treatment provider or team. Relapses are part of the recovery process. Dont get too discouraged if you relapse. Slips and setbacks happen, but, with hard work, most people can recover from their relapses and move on with recovery.

Anger, physical pain, and reckless behavior (especially in men) Common signs and symptoms of mania in bipolar disorder

Feelings of euphoria or extreme irritability Unrealistic, grandiose beliefs Decreased need for sleep Increased energy Rapid speech and racing thoughts Impaired judgment and impulsivity Hyperactivity

Peer support can help. You may benefit from joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous. They give you a chance to lean on others who know what youre going through and learn from their experiences. How to find the right program for cooccurring disorders or dual diagnosis
As with a substance abuse program, make sure that the program is appropriately licensed and accredited, the treatment methods are backed by research, and there is an aftercare program to prevent relapse. Additionally, you should make sure that the program has experience with your particular mental health issue. Some programs, for example, may have experience treating depression or anxiety, but not schizophrenia or bipolar disorder. There are a variety of approaches that treatment programs may take, but there are some basics of effective treatment that you should look for:

Anger or rage Common signs and symptoms of anxiety

Excessive tension and worry Feeling restless or jumpy Irritability or feeling on edge Racing heart or shortness of breath Nausea, trembling, or dizziness Muscle tension, headaches Trouble concentrating

Insomnia Treatment for co-occurring disorders or dual diagnosis

Treatment addresses both the substance abuse problem and your mental health problem. You share in the decision-making process and are actively involved in setting goals and developing strategies for change. Treatment includes basic education about your disorder and related problems. You are taught healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships. 4

Treatment for dual diagnosis or cooccurring disorders

Helping you think about the role that alcohol and other drugs play in your life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential, nonjudgmental, and not tied to legal consequences. Offering you a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss your own use of alcohol and drugs. Helping you become involved with supported employment and other services that may help your process of recovery. Helping you identify and develop your own recovery goals. If you decide that your use of alcohol or drugs may be a problem, a counselor trained in integrated dual diagnosis treatment can help you identify and develop your own recovery goals. This process includes learning about steps toward recovery from both illnesses. Providing special counseling specifically designed for people with dual diagnosis. This can be done individually, with a group of peers, with your family, or with a combination of these. Source: SAMHSA

ders or dual diagnosis

As with other addictions, groups are very helpful, not only in maintaining sobriety, but also as a safe place to get support and discuss challenges. Sometimes treatment programs for co occurring disorders provide groups that continue to meet on an aftercare basis. Your doctor or treatment provider may also be able to refer you to a group for people with co -occurring disorders. While its often best to join a group that addresses both substance abuse and your mental health disorder, twelve -step groups for substance abuse can also be helpfulplus theyre more common, so youre likely to find one in your area. These free programs, facilitated by peers, use group support and a set of guided principlesthe twelve stepsto obtain and maintain sobriety. Just make sure your group is accepting of the idea of co occurring disorders and psychiatric medication. Some people in these groups, although well meaning, may mistake taking psychiatric medication as another form of addiction. You want a place to feel safe, not pressured.

Self-help for co-occurring disorders or dual diagnosis

Getting sober is only the beginning. Your continued recovery depends on continuing mental health treatment, learning healthier coping strategies, and making better decisions when dealing with lifes challenges.

Treatment programs for co-occurring disorders or dual diagnosis

The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services offers an extensive listing of licensed, certified drug treatment facilities. Similar treatment facilities are also available in other parts of the world. See References and Resources below for links.

Recovery tip 1: Recognize and manage overwhelming stress and emotions

Learn how to manage stress. Stress is inevitable, so its important to have healthy coping skills so you can deal with stress without turning to alcohol or drugs. Stress management skills go a long way towards preventing relapse and keeping your symptoms at bay.

Treatment programs for veterans with cooccurring disorders

Veterans deal with additional challenges when it comes to cooccurring disorders. The pressures of deployment or combat can exacerbate underlying mental disorders, and substance abuse is a common way of coping with unpleasant feelings or memories. Often, these problems take a while to show up after a vet returns home, and may be initially mistaken for readjustment. Untreated co-occurring disorders can lead to major problems at home and work and in your daily life, so its important to seek help. Veterans often benefit from treatment and support from specialized programs that address the unique stresses veterans face. To learn more, see References and Resources below.

Know your triggers and have an action plan. If youre coping with a mental disorder as well, its especially important to know signs that your illness is flaring up. Common causes include stressful events, big life changes, or unhealthy sleeping or eating. At these times, having a plan in place is essential to preventing drug relapse. Who will you talk to? What do you need to do? Recovery tip 2: Stay connected

Get therapy or stay involved in a support group. Your chances of staying sober improve if you are participating in 5

Group support for co-occurring disor-

a social support group like Alcoholics Anonymous or Narcotics Anonymous or if you are getting therapy.

Follow doctors orders. Once you are sober and you feel better, you might think you no longer need medication or treatment. But arbitrarily stopping medication or treatment is a common reason for relapse in people with co-occurring disorders. Always talk with your doctor before making any changes to your medication or treatment routine. Recovery tip 3: Make healthy lifestyle changes

Practice relaxation techniques. When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce symptoms of stress, anxiety, and depression, and increase feelings of relaxation and emotional well-being. Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more stressed or anxious. Exercise regularly. Exercise is a natural way to bust stress, relieve anxiety, and improve your mood and outlook. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days.

mental illness and substance abuse can be painful and isolating. Make sure you're getting the emotional support you need to cope. Talk to someone you trust about what you're going through. It can also help to get your own therapy or join a support group. Set boundaries. Be realistic about the amount of care you're able to provide without feeling overwhelmed and resentful. Set limits on disruptive behaviors, and stick to them. Letting the co-occurring disorders take over your life isn't healthy for you or your loved one. Educate yourself. Learn all you can about your loved ones mental health problem, as well as substance abuse treatment and recovery. The more you understand what your loved one is going through, the better able youll be to support recovery. Be patient. Recovering from a dual diagnosis doesnt happen overnight. Recovery is an ongoing process that can take months or years, and relapse is common. Ongoing support for both you and your loved one is crucial as you work toward recovery.

http://www.helpguide.org/mental/dual_diagnosis.htm

Get enough sleep. A lack of sleep can exacerbate stress, anxiety, and depression, so try to get 7 to 9 hours of quality sleep a night. Helping a loved one with co-occurring disorders or dual diagnosis
Helping a loved one with both a substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be long. The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you dont lose yourself in the process.

Seek support. Dealing with a loved one's dual diagnosis of 6

Overcoming Drug Addiction

Drug or Substance Abuse Treatment, Recovery, and Help

When youre struggling with drug addiction, sobriety can seem like an impossible goal. But recovery is never out of reach, no matter how hopeless your situation seems. Change is possible with the right treatment and support, and by addressing the root cause of your ad-

diction. Dont give upeven if youve tried and failed before. The road to recovery often involves bumps, pitfalls, and setbacks. But by examining the problem and thinking about change, youre already on your way.

Drug addiction treatment and recovery 1: Decide to make a change

For many people struggling with addiction, the biggest and toughest step toward recovery is the very first one: deciding to make a change. Its normal to feel conflicted about giving up your drug of choice, even when you realize its causing problems in your life. Change is never easyand committing to sobriety involves changing many things, including:

Once youve made the decision to challenge your drug addiction, its time to explore your treatment choices. As you consider the options, keep the following in mind:

Theres no magic bullet or single treatment that works for everyone. When considering a program, remember that everyones needs are different. Drug addiction treatment should be customized to your unique problems and situation. Its important that you find a program that feels right. Treatment should address more than just your drug abuse. Addiction affects your whole life, including relationships, the way you deal with stress career, health, and psychological well-being. Treatment success depends on developing a new way of living and ad who you allow in your life dressing the reasons why you turned to drugs in the first what you do in your free time place. It may have been because of an inability to manage how you think about yourself stress, in which case youll need to find healthy ways to handle stressful situations. Commitment and follow-through are key. Drug addiction You may wonder if youre really ready for all that change or if treatment is not a quick and easy process. In general, the you have what it takes to quit. Its okay if youre torn. Recoverlonger and more intense the drug use, the longer and more ing from addiction is a long process, one that requires time, intense the treatment youll need. But regardless of the commitment, motivation, and support. As you contemplate your treatment programs length in weeks or months, long -term situation, the following tips can help you make the decision. follow-up care is crucial to recovery. There are many places to turn for help. Not everybody reThinking about change quires medically supervised detox or an extended stint in Keep track of your drug use, including when and how much rehab. The level of care you need depends on your age, you use. This will give you a better sense of the role the addrug use history, and other medical or psychiatric condidiction is playing in your life. tions. In addition to doctors and psychologists, many clergy members, social workers, and counselors offer addiction List the pros and cons of quitting, as well as the costs and treatment services. benefits of continuing your drug abuse. As you seek help for drug addiction, its also important to get Consider the things that are important to you, such as your treatment for any other medical or psychological issues youre partner, your kids, your career, or your health. How does experiencing. Your best chance of recovery is through integrated your drug use affect those things? treatment for both the substance abuse problem and the mental Talk it over with someone you trust. Ask the person how he health problem. This means getting combined mental health and or she feels about your drug use. addiction treatment from the same treatment provider or team. Ask yourself if theres anything preventing you from changing. What are some things that could help you make the change?

Preparing for change: 5 key steps to addiction recovery

1. Remind yourself of the reasons you want to change. 2. Think about your past attempts at quitting, if any. What 3. 4. 5.
worked? What didnt? Set specific, measurable goals, such as a quit date or limits on your drug use. Remove reminders of your addiction from your home and workplace. Tell friends and family that youre quitting and ask for their support.

Drug addiction treatment and recovery 3: Reach out for support

Dont try to go it alone. Whatever treatment approach you choose, having a solid support system is essential. The more positive influences you have in your life, the better your chances for recovery. Recovering from drug addiction isnt easy, but with people you can turn to for encouragement, guidance, and a listening ear, its a little less tough.

Drug addiction treatment and recovery 2: Explore your treatment options

Lean on close friends and family Having the support of friends and family members is an invaluable asset in recovery. If youre reluctant to turn to your loved ones because youve let them down before, consider going to couples counseling or family therapy. Build a sober social network If your previous social life revolved around drugs, you may need to make some new connections. Its important to have sober friends who will support your recovery. Try taking a class, joining a church or 9

a civic group, volunteering, or attending events in your community. Consider moving in to a sober living home Sober living homes provide a safe, supportive place to live while youre recovering from drug addiction. They are a good option if you dont have a stable home or a drug-free living environ- While getting sober from drugs is an important first step, its only the beginning of the recovery process. Once sober, the ment to go to. Make meetings a priority Join a recovery support Exercise releases endorphins, relieves stress, and group and attend meetings regularly. Spending time with promotes emotional well-being. Try running in people who understand exactly what youre going place, jumping rope, or walking around the block. through can be very healing. You can also benefit from the shared experiences of the group members and learn Step outside and savor the warm sun and fresh air. what others have done to stay sober. Enjoy a beautiful view or landscape. Yoga and meditation are excellent ways to bust stress and find balance. Play with your dog or cat, enjoying the relaxing touch of your pets fur. Put on some calming music. Light a scented candle. Even once youve recovered from drug addiction, youll still have to face the problems that led to your drug problems in the first Breathe in the scent of fresh flowers or coffee place. Did you start using drugs to numb painful emotions, calm beans, or savor a scent that reminds you of a favoryourself down after an argument, unwind after a bad day, or ite vacation, such as sunscreen or a seashell. forget about your problems? After you become sober, the nega Close your eyes and picture a peaceful place, such as tive feelings that you used to dampen with drugs will resurface. a sandy beach. Or think of a fond memory, such as For treatment to be successful, and to remain sober in the long your childs first steps or time spent with friends. term, youll need to resolve these underlying issues as well. Make yourself a steaming cup of tea. Look at favorite family photos. Conditions such as stress, loneliness, frustration, anger, shame, Give yourself a neck or shoulder massage. anxiety, and hopelessness will remain in your life even when Soak in a hot bath or shower. youre no longer using drugs to cover them up. But you will be in a healthier position to finally address them and seek the help you need.

Drug addiction treatment and recovery 5: Keep triggers and cravings in check

Drug addiction treatment and recovery 4: Learn healthy ways to cope with stress

Relieving stress without drugs

Drug abuse often stems from misguided attempts to manage stress. Many people turn to alcohol or recreational drugs to unwind and relax after a stressful day, or to cover up painful memories and emotions that cause us to feel stressed and out of balance. But there are healthier ways to keep your stress level in check, including exercising, meditating, using sensory strategies to relax, practicing simple breathing exercises, and challenging self-defeating thoughts.

brain needs time to recover and rebuild connections that have changed while addicted. During this time, drug cravings can be intense. You can support your continued sobriety by making a conscious effort to avoid people, places, and situations that trigger the urge to use:

Strategies for quickly relieving stress without drugs

You may feel like doing drugs is the only way to handle unpleasant feelings, but its not. You can learn to get through difficulties without falling back on your addiction. Different quick stress relief strategies work better for some people than others. The key is to find the one that works best for you, and helps you calm down when youre feeling stressed and overwhelmed. When youre confident in your ability to quickly de-stress, facing strong feelings isnt as intimidating or overwhelming.

Make a break from old drug buddies. Dont make the mistake of hanging out with old friends who are still doing drugs. Surround yourself with people who support your sobriety, not those who tempt you to slip back into old, destructive habits. Avoid bars and clubs, even if you dont have a problem with alcohol. Drinking lowers inhibitions and impairs judgment, which can easily lead to relapse. Drugs are often readily available and the temptation to use can be overpowering. Also avoid any other environments and situations that you associate with drug use. Be up front about your history of drug use when seeking medical treatment. If you need a medical or dental procedure done, be up front about your history and find a provider who will work with you in either prescribing alternatives or the absolute minimum medication necessary. You should never feel ashamed or humiliated about previous drug use 10

or be denied medication for pain; if that happens, find another provider. Use caution with prescription drugs. Stay away from prescription drugs with the potential for abuse or use only when necessary and with extreme caution. Drugs with a high abuse potential include painkillers, sleeping pills, and anti-anxiety medication.

ing activities and a sense of purpose, your addiction will lose its appeal.

Coping with drug cravings

Sometimes craving cannot be avoided, and it is necessary to find a way to cope:

Get involved in some distracting activity. Reading, a hobby, going to a movie, exercising (jogging, biking) are good examples of distracting activities. Once you get interested in something else, youll find the urges go away. Another effective response to a drug craving is eating (but be careful what you eat, as eating junk will only add stress and inches to your waistline). Talk it through. Talk to friends or family members about craving when it occurs. Talking about cravings and urges can be very helpful in pinpointing the source of the craving. Also, talking about craving often helps to discharge and relieve the feeling and will help restore honesty in your relationship. Craving is nothing to feel bad about. Urge surf. Many people try to cope with their urges by gritting their teeth and toughing it out. But some are just too strong to ignore. When this happens, it can be useful to stay with the urge until it passes. This technique is called urge surfing. Imagine yourself as a surfer who will ride the wave of your drug craving, staying on top of it until it crests, breaks, and turns into less powerful, foamy surf. Challenge and change your thoughts. When experiencing a craving, many people have a tendency to remember only the positive effects of the drug and forget the negative consequences. Therefore, you may find it helpful to remind yourself that you really wont feel better if you use and that you stand to lose a lot. Sometimes it is helpful to have these benefits and consequences listed on a small card that you keep with you. Adapted from: The National Institute on Alcohol Abuse and Alcoholism

Pick up a new hobby. Do things that challenge your creativity and spark your imaginationsomething youve always wanted to try. Adopt a pet. Yes, pets are a responsibility, but caring for an animal makes you feel loved and needed. Pets can also get you out of the house for exercise. Get involved in your community. Replace your addiction with drug-free groups and activities. Volunteer, become active in your church or faith community, or join a local club or neighborhood group.

Set meaningful goals. Having goals to work toward and something to look forward to can be powerful antidotes to drug addiction. It doesnt matter what the goals arewhether they involve your career, your personal life, or your healthjust that they are important to you. Look after your health. Regular exercise, adequate sleep, and healthy eating habits help you keep your energy levels up and your stress levels down. When you feel good, drugs are much less of a temptation. The more you can do to stay healthy, the easier it will be to stay sober.

Drug addiction treatment and recovery 7: Dont let relapse keep you down
Relapse is a common part of the recovery process from drug addiction. While relapse is understandably frustrating and discouraging, it can also be an opportunity to learn from your mistakes and correct your treatment course.

What causes relapse?

Various triggers can put people at risk of relapsing into old patterns of substance use. Causes of relapse can differ for each person. Some common ones include:

Drug addiction treatment and recovery 6: Build a meaningful drug-free life

You can support your drug treatment and protect yourself from relapse by having activities and interests that provide meaning to your life. Its important to be involved in things that you enjoy and make you feel needed. When your life is filled with reward-

negative emotional states (such as anger, sadness, trauma or stress) physical discomfort (such as withdrawal symptoms or physical pain) positive emotional states (wanting to feel even better) testing personal control (I can have just one drink) strong temptations or urges (cravings to use) conflict with others (such as an argument with a spouse or

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partner) social pressures to use (situations where it seems as though everyone else is drinking or using other drugs) good times with others (such as having fun with friends or family) Source: Centre for Addiction and Mental Health

The important thing to remember is that relapse doesnt mean treatment failure. Rather than giving up, get back on the wagon as quickly as you can. Call your sponsor, talk to your therapist, go to a meeting, or schedule an appointment with your doctor. When youre sober again and out of danger, look at what triggered the relapse, what went wrong, and what you could have done differently. You can choose to get back on the path to recovery and use the experience to strengthen your commitment.

http://www.helpguide.org/mental/drug_abuse_addiction_rehab_treatment.htm

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Urban Life Counseling Center, Inc. 220 South Harrison Street East Orange, NJ 07018 (973) 667-7053 (973) 667-7050 fax www.urbanlifecounselingcenter.weebly.com

URBAN LIFE COUNSELING CENTER, INC. SERVICES

Mental Health Therapy: The treatment sessions include assessments, individual counseling and treatment plan assignments ranging from 12-48 weeks in length. Treatment clinicians will make referrals for additional services. Substance Abuse Counseling: The treatment sessions include assessment, individual and group counseling educational lectures, urine screening, and treatment plan assignments ranging from 12 -48 weeks in length. Treatment clinicians will make referrals for additional services. HIV Adherence Counseling: The treatment sessions include assessments, individual counseling and/or didactic educational support groups and life skills. This treatment will be done in conjunction with the primary physician. HIV treatment plans range from 12-48 weeks in length. Treatment clinicians will make referrals for additional services. Anger Management Counseling: The anger management program is a 12- week course, 8 weeks of didactic educational group and 4 weeks of individual counseling. Follow-up counseling is available for those who need additional counseling services beyond the initial 12-week program. Parenting Skills Counseling and Education: 16-week course in the agency sometimes followed by in home observations of parenting skills in action. In home parenting skills are available for those clients who are not ambulatory or who absolutely cannot get to the agency. Marriage & Family Counseling: The family counseling services include individual counseling with husband and wife and also with both husband and wife present. Family counseling will include individual counseling with all family members and family dynamics counseling with all family members present or combinations of family members together. Special situations that a family member is experiencing will be addressed tangentially. Family Counseling Plans range from 12 -24 weeks in length. Treatment clinicians will make referrals for additional services. Teen Counseling: 24 weeks group and individual counseling sessions addressing phases of life changes, peer pressure, gangs, delinquency, health awareness and life skills Career Planning Program; Aptitude Testing Life Skills Training Career Training Job Placement

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