Substance Use Disorders

Substance use disorders are mental health conditions where a person continues to use drugs or alcohol despite significant problems caused by their use. These disorders can range from mild to severe and can affect anyone, regardless of age or background. They are considered medical conditions, not moral failings or a lack of willpower.

 

Table of Contents | Jump Ahead

What Are Substance Use Disorders?

Understanding Addiction

Types of Substance Use Disorders

Risk Factors

Signs and Symptoms

Health Consequences

Diagnosis

Treatment Options

Recovery Process

Living in Recovery

Co-occurring Disorders

Special Populations

Prevention

Stigma and Discrimination

When to Seek Help

Related Terms

References

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What Are Substance Use Disorders?

A substance use disorder happens when someone keeps using alcohol or drugs even though it creates serious issues in their life. The disorder involves changes in the brain related to reward, stress, and self-control, which can last long after substance use stops. Substance use disorders vary in severity, from mild to severe, based on how many symptoms are present.

 

What may begin as voluntary use can turn into a compulsive need, where a person uses substances despite harm to their health, relationships, work, or other important areas of their life. These disorders are chronic, like diabetes or heart disease, requiring ongoing management, but recovery is possible with the right support and treatment.

 

 

Understanding Addiction

How Addiction Develops

• Initial use - Substance use often begins voluntarily, sometimes for curiosity, peer pressure, or to cope with stress
• Brain changes - Repeated use changes brain chemistry and structure
• Tolerance - You need increasingly larger amounts to achieve the same effect
• Dependence - Your body adapts to the substance and experiences withdrawal without it
• Compulsive use - Despite negative consequences, you feel unable to stop using

 

The Brain and Addiction

• Reward system - Substances activate the brain's reward system, releasing dopamine, a chemical linked to pleasure
• Learning and memory - The brain learns to associate substance use with pleasure and relief
• Decision-making - Areas responsible for judgment and decision-making become impaired
• Stress response - The brain's stress system becomes dysregulated
• Craving - Intense urges to use substances develop and can persist long after stopping

 

Addiction vs. Physical Dependence

• Physical dependence - Your body adapts to a substance and experiences withdrawal without it
• Addiction - Compulsive use despite harmful consequences, involving psychological and behavioural changes
• Can occur separately - You can have physical dependence without addiction (like with some prescription medications)
• Often occur together - Many people with addiction also have physical dependence

 

 

Types of Substance Use Disorders

Alcohol Use Disorder

Alcohol Use Disorder is the most common substance use disorder, affecting millions of people worldwide.

Symptoms

• Drinking more or longer than intended - Consistently drinking more than you planned

• Unsuccessful attempts to cut down - Wanting to reduce drinking but being unable to do so
• Time spent drinking - Spending a lot of time drinking or recovering from drinking
• Craving - Strong urges or desires to drink alcohol
• Neglecting responsibilities - Drinking interferes with work, school, or family obligations
• Continued use despite problems - Drinking even when it causes relationship or health problems
• Giving up activities - Reducing or stopping important activities because of drinking
• Risky use - Drinking in dangerous situations, like before driving
• Tolerance - Needing more alcohol to feel the same effects
• Withdrawal - Experiencing symptoms like shaking, sweating, or nausea when not drinking

Health Consequences

• Liver disease - Fatty liver, hepatitis, cirrhosis

• Heart problems - High blood pressure, heart disease, stroke
• Brain damage - Memory problems, cognitive impairment
• Cancer risk - Increased risk of several types of cancer
• Mental health - Depression, anxiety, increased suicide risk

 

Opioid Use Disorder

Opioid Use Disorder involves the misuse of prescription pain medications or illegal opioids like heroin.

Common Opioids

• Prescription opioids - OxyContin, Vicodin, Percocet, morphine, fentanyl

• Illegal opioids - Heroin, illicitly manufactured fentanyl
• Medication-assisted treatment - Methadone, buprenorphine, naltrexone

Signs and Symptoms

• Compulsive use - Unable to control opioid use despite wanting to stop

• Tolerance - Needing higher doses to achieve the same effect
• Withdrawal - Flu-like symptoms when not using opioids
• Neglecting responsibilities - Work, school, or family obligations suffer
• Risky behaviours - Sharing needles, unsafe sexual practices
• Social isolation - Withdrawing from family and friends
• Financial problems - Spending excessive money on opioids

Health Risks

• Overdose - Risk of respiratory depression and death

• Infectious diseases - HIV, hepatitis, from sharing needles
• Collapsed veins - From repeated injection
• Heart problems - Infections of heart valves and lining
• Mental health - Depression, anxiety, cognitive problems

 

Stimulant Use Disorders

Stimulant Use Disorders involve substances that increase alertness and energy.

Types of Stimulants

• Cocaine - Powder cocaine, crack cocaine

• Amphetamines - Methamphetamine, prescription stimulants like Adderall
• Other stimulants - MDMA (Ecstasy), synthetic cathinones (bath salts)

Effects and Risks

• Cardiovascular problems - Heart attack, stroke, irregular heartbeat

• Neurological effects - Seizures, brain damage, cognitive impairment
• Psychiatric symptoms - Paranoia, hallucinations, violent behaviour
• Physical deterioration - Extreme weight loss, dental problems, skin issues
• Overdose risk - Can cause hyperthermia, heart failure, stroke

 

Cannabis Use Disorder

Cannabis Use Disorder involves problematic marijuana use that causes significant impairment.

Symptoms

• Tolerance - Needing more cannabis to achieve desired effects

• Withdrawal - Irritability, sleep problems, decreased appetite when not using
• Unsuccessful quit attempts - Trying to stop or reduce use but being unable to
• Time spent using - Spending significant time obtaining, using, or recovering from cannabis
• Neglecting activities - Giving up important activities because of cannabis use
• Continued use despite problems - Using despite physical or psychological problems

Health Effects

• Respiratory problems - Chronic cough, bronchitis from smoking

• Cognitive effects - Memory problems, difficulty concentrating
• Mental health - Can worsen anxiety, depression, or trigger psychosis in vulnerable individuals
• Motivation - Reduced motivation and goal-directed behaviour
• Dependence - About 9% of users develop dependence

 

Sedative, Hypnotic, or Anxiolytic Use Disorders

These disorders involve misuse of medications prescribed for anxiety, insomnia, or seizures.

Common Medications

• Benzodiazepines - Xanax, Valium, Ativan, Klonopin

• Sleep medications - Ambien, Lunesta, Sonata
• Barbiturates - Less commonly prescribed today

Risks

• Dangerous withdrawal - Can cause seizures and be life-threatening
• Overdose risk - Especially when combined with alcohol
• Cognitive impairment - Memory problems, confusion
• Falls and accidents - Increased risk due to sedation
• Tolerance and dependence - Can develop quickly with regular use

 

 

Risk Factors

Biological Factors

• Genetics - Family history of substance use disorders increases risk
• Brain development - Adolescent brains are more vulnerable to addiction
• Mental health conditions - Depression, anxiety, ADHD, and other conditions increase risk
• Trauma history - Physical, sexual, or emotional abuse
• Medical conditions - Chronic pain or other medical issues

 

Environmental Factors

• Family environment - Growing up with substance use or abuse
• Peer influence - Friends who use substances
• Availability - Easy access to substances
• Stress - High levels of stress or traumatic experiences
• Socioeconomic factors - Poverty, unemployment, lack of opportunities

 

Social and Cultural Factors

• Cultural attitudes - Acceptance of substance use in your community
• Media influence - Glamorization of substance use
• Social isolation - Lack of social support and connections
• Discrimination - Experiencing racism, homophobia, or other discrimination
• Early exposure - Starting substance use at a young age

 

 

Signs and Symptoms

Behavioural Changes

• Neglecting responsibilities - Problems at work, school, or home
• Social isolation - Withdrawing from family and friends
• Risky behaviours - Driving under the influence, unsafe sexual practices
• Legal problems - Arrests, DUIs, or other legal issues
• Financial problems - Spending excessive money on substances
• Secretive behaviour - Hiding substance use from others
• Changes in social circle - New friends who also use substances

 

Physical Signs

• Changes in appearance - Weight loss or gain, poor hygiene
• Sleep problems - Insomnia or sleeping too much
• Bloodshot eyes - Red or glassy eyes
• Dilated or constricted pupils - Depending on the substance
• Tremors or shaking - Especially during withdrawal
• Frequent illness - Weakened immune system
• Injuries - Unexplained cuts, bruises, or burns

 

Psychological Signs

• Mood swings - Rapid changes in mood or emotional state
• Paranoia - Unrealistic fears or suspicions
• Anxiety or depression - Worsening mental health symptoms
• Irritability - Increased anger or frustration
• Lack of motivation - Loss of interest in activities
• Cognitive problems - Memory issues, difficulty concentrating
• Personality changes - Becoming a different person when using

 

Social Signs

• Relationship problems - Conflicts with family, friends, or partners
• Work or school problems - Absenteeism, poor performance
• Loss of friends - Old friends avoiding you
• Family conflicts - Arguments about substance use
• Social isolation - Avoiding social situations where you can't use
• Lying - Being dishonest about substance use

 

 

Health Consequences

Physical Health Effects

• Cardiovascular problems - Heart disease, high blood pressure, stroke
• Liver damage - Hepatitis, cirrhosis, liver failure
• Lung problems - Respiratory infections, lung disease, cancer
• Brain damage - Cognitive impairment, memory problems
• Infectious diseases - HIV, hepatitis, from sharing needles
• Overdose - Risk of coma, brain damage, or death
• Malnutrition - Poor eating habits and nutrient absorption

 

Mental Health Effects

• Depression - Persistent sadness and hopelessness
• Anxiety - Excessive worry and fear
• Psychosis - Hallucinations, delusions, paranoia
• Cognitive impairment - Problems with memory, attention, and decision-making
• Increased suicide risk - Higher rates of suicidal thoughts and behaviours
• Worsening of existing mental health conditions - Substances can make other mental health problems worse

 

Social Consequences

• Relationship breakdown - Divorce, family estrangement
• Employment problems - Job loss, difficulty finding work
• Financial difficulties - Debt, bankruptcy, poverty
• Legal problems - Arrests, imprisonment, criminal record
• Housing instability - Eviction, homelessness
• Child custody issues - Loss of parental rights

 

 

Diagnosis

Substance Use Disorders are diagnosed by qualified healthcare professionals using specific criteria.

 

Diagnostic Criteria (DSM-5-TR)

A substance use disorder is diagnosed when at least 2 of the following occur within a 12-month period:

Impaired Control

• Using more than intended - Taking larger amounts or for longer than planned

• Unsuccessful attempts to quit - Persistent desire or unsuccessful efforts to cut down
• Time spent - Great deal of time spent obtaining, using, or recovering from a substance
• Craving - Strong desire or urge to use the substance

Social Impairment

• Failure to fulfil obligations - Substance use interferes with work, school, or home responsibilities

• Continued use despite social problems - Using despite persistent social or interpersonal problems
• Giving up activities - Important social, occupational, or recreational activities given up because of use

Risky Use

• Use in hazardous situations - Recurrent use in physically hazardous situations

• Continued use despite physical/psychological problems - Using despite knowing it causes or worsens problems

Pharmacological Criteria

• Tolerance - Need for increased amounts to achieve desired effect or diminished effect with same amount

• Withdrawal - Characteristic withdrawal syndrome or substance taken to avoid withdrawal

 

Severity Levels

• Mild - 2-3 symptoms present
• Moderate - 4-5 symptoms present
• Severe - 6 or more symptoms present

 

Assessment Process

• Clinical interview - Detailed discussion of substance use patterns and consequences
• Medical examination - Physical exam and laboratory tests
• Psychological assessment - Evaluation of mental health and cognitive functioning
• Social assessment - Review of family, work, and social functioning
• Substance use history - Detailed history of all substance use

 

 

Treatment Options

Detoxification

• Medical supervision - Safe withdrawal from substances under medical care
• Medication management - Medications to reduce withdrawal symptoms
• Monitoring - Continuous monitoring for complications
• Duration - Usually 3-7 days, depending on the substance
• Not treatment alone - Detox is just the first step, not complete treatment

 

Medication-Assisted Treatment (MAT)

For Opioid Use Disorder

• Methadone - Long-acting opioid that prevents withdrawal and craving

• Buprenorphine (Suboxone) - Partial opioid agonist that reduces craving and withdrawal
• Naltrexone (Vivitrol) - Blocks the effects of opioids

For Alcohol Use Disorder

• Naltrexone - Reduces craving and blocks euphoric effects of alcohol

• Acamprosate (Campral) - Reduces withdrawal symptoms and craving
• Disulfiram (Antabuse) - Causes an unpleasant reaction when alcohol is consumed

For Smoking Cessation

• Nicotine replacement - Patches, gum, lozenges

• Bupropion (Zyban) - Antidepressant that reduces craving
• Varenicline (Chantix) - Reduces craving and blocks nicotine effects

 

Behavioral Therapies

Cognitive Behavioural Therapy (CBT)

• Identifying triggers - Learning what situations, emotions, or thoughts trigger substance use

• Developing coping skills - Learning healthy ways to deal with stress and triggers
• Changing thought patterns - Identifying and changing thoughts that lead to substance use
• Relapse prevention - Developing strategies to prevent return to substance use

Motivational Interviewing (MI)

• Exploring ambivalence - Helping you explore mixed feelings about changing

• Building motivation - Increasing your desire and confidence to change
• Supporting self-efficacy - Believing in your ability to change
• Collaborative approach - Working together rather than being told what to do

Contingency Management

• Rewards for sobriety - Receiving rewards for negative drug tests or meeting treatment goals

• Immediate reinforcement - Rewards given immediately after positive behaviours
• Increasing motivation - Using external rewards to build internal motivation
• Evidence-based - Strong research support for effectiveness

12-Step Facilitation

• Introduction to 12-step programs - Learning about Alcoholics Anonymous, Narcotics Anonymous

• Working the steps - Guidance through the 12-step process
• Sponsorship - Connecting with experienced members for support
• Spiritual component - Addressing spiritual aspects of recovery

 

Treatment Settings

Outpatient Treatment

• Individual therapy - One-on-one sessions with a counsellor

• Group therapy - Treatment with others in recovery
• Family therapy - Involving family members in treatment
• Intensive outpatient - More frequent sessions while living at home
• Flexibility - Allows you to maintain work, school, or family responsibilities

Residential Treatment

• 24-hour care - Round-the-clock supervision and support

• Structured environment - Highly structured daily schedule
• Intensive therapy - Multiple therapy sessions per day
• Peer support - Living with others in recovery
• Length of stay - Typically 30-90 days

Sober Living Homes

• Transitional housing - Safe, substance-free living environment

• Peer support - Living with others in early recovery
• Structure and accountability - Rules and expectations for residents
• Bridge to independence - Gradual transition back to independent living
• Ongoing support - Connection to treatment and recovery resources

 

Support Groups

• Alcoholics Anonymous (AA) - 12-step program for alcohol addiction
• Narcotics Anonymous (NA) - 12-step program for drug addiction
• SMART Recovery - Self-management and recovery training
• Refuge Recovery - Buddhist-based recovery program
• LifeRing - Secular recovery support
• Women for Sobriety - Support specifically for women

 

 

Recovery Process

Stages of Change

• Precontemplation - Not yet considering change
• Contemplation - Thinking about change but ambivalent
• Preparation - Planning to make changes
• Action - Actively making changes
• Maintenance - Sustaining changes over time

 

Early Recovery (0-90 days)

• Physical healing - Body begins to recover from substance use
• Emotional volatility - Mood swings and emotional ups and downs
• Cognitive fog - Difficulty concentrating and making decisions
• Sleep problems - Disrupted sleep patterns
• Cravings - Strong urges to use substances
• Social adjustment - Learning to socialise without substances

 

Ongoing Recovery (3 months - 1 year)

• Improved physical health - Continued physical recovery
• Emotional stability - More stable moods and emotions
• Clearer thinking - Improved cognitive function
• Relationship repair - Working to rebuild damaged relationships
• New coping skills - Developing healthy ways to handle stress
• Identity formation - Discovering who you are without substances

 

Long-term Recovery (1+ years)

• Sustained sobriety - Maintaining abstinence from substances
• Personal growth - Continued development and self-improvement
• Meaningful relationships - Building healthy, supportive relationships
• Purpose and meaning - Finding purpose and meaning in life
• Helping others - Often involves helping others in recovery
• Ongoing vigilance - Continued attention to recovery maintenance

 

Relapse Prevention

• Identifying triggers - Knowing what situations, emotions, or people trigger cravings
• Developing coping strategies - Having specific plans for dealing with triggers
• Building support network - Maintaining connections with supportive people
• Ongoing treatment - Continuing therapy, support groups, or other treatment
• Healthy lifestyle - Exercise, nutrition, sleep, and stress management
• Mindfulness and self-awareness - Staying aware of thoughts, feelings, and behaviours

 

 

Living in Recovery

Building a Sober Life

• New routines - Developing healthy daily and weekly routines
• Sober activities - Finding enjoyable activities that don't involve substances
• Healthy relationships - Building relationships with people who support your recovery
• Meaningful work - Finding purpose through work, volunteering, or other activities
• Personal growth - Continuing to learn and develop as a person
• Spiritual development - Exploring spiritual or philosophical beliefs

 

Managing Challenges

• Stress management - Learning healthy ways to cope with stress
• Emotional regulation - Developing skills to manage difficult emotions
• Relationship issues - Working through problems in relationships
• Work or school stress - Managing pressures without using substances
• Financial problems - Dealing with financial consequences of addiction
• Legal issues - Handling legal problems related to substance use

 

Maintaining Recovery

• Ongoing treatment - Continuing therapy, medication, or support groups as needed
• Regular self-assessment - Checking in with yourself about your recovery
• Support network - Maintaining connections with people who support your recovery
• Healthy lifestyle - Continuing to prioritise physical and mental health
• Avoiding high-risk situations - Staying away from people, places, and things that trigger cravings
• Having a relapse prevention plan - Knowing what to do if you feel like using

 

 

Co-occurring Disorders

Many people with substance use disorders also have other mental health conditions.

 

Common Co-occurring Conditions

• Depression - Persistent sadness and loss of interest
• Anxiety disorders - Excessive worry, panic attacks, or phobias
• PTSD - Trauma-related symptoms and flashbacks
• Bipolar disorder - Extreme mood swings between mania and depression
• ADHD - Attention and hyperactivity problems
• Personality disorders - Persistent patterns of thinking and behaviour
• Eating disorders - Problematic eating behaviours and body image issues

 

Integrated Treatment

• Dual diagnosis treatment - Treating both substance use and mental health conditions simultaneously
• Coordinated care - Having treatment providers work together
• Medication management - Careful use of medications for mental health conditions
• Specialised programs - Treatment programs designed for people with co-occurring disorders
• Comprehensive approach - Addressing all aspects of your health and well-being

 

 

Special Populations

Adolescents and Young Adults

• Brain development - Adolescent brains are still developing and more vulnerable to addiction
• Risk factors - Peer pressure, experimentation, risk-taking behaviour
• Family involvement - Parents and family crucial in treatment
• School impact - Substance use affects academic performance and social development
• Prevention focus - Emphasis on prevention and early intervention

 

Women

• Unique factors - Hormonal influences, pregnancy considerations, trauma history
• Barriers to treatment - Childcare needs, stigma, fear of losing custody
• Specialised treatment - Women-only programs that address specific needs
• Trauma-informed care - Addressing history of physical, sexual, or emotional abuse
• Pregnancy and parenting - Special considerations for pregnant women and mothers

 

Older Adults

• Underrecognised - Substance use problems are often overlooked in older adults
• Prescription drug misuse - Higher rates of prescription medication problems
• Medical complications - More serious health consequences due to age
• Social isolation - Loneliness and isolation can contribute to substance use
• Treatment considerations - May need modified treatment approaches

 

LGBTQ+ Individuals

• Higher rates - LGBTQ+ individuals have higher rates of substance use disorders
• Minority stress - Discrimination and stigma contribute to substance use
• Barriers to treatment - Fear of discrimination in treatment settings
• Specialised treatment - LGBTQ+-affirmative treatment approaches
• Community support - Connection to LGBTQ+ recovery communities

 

People with Disabilities

• Higher risk - People with disabilities have higher rates of substance use disorders
• Accessibility - Need for accessible treatment facilities and services
• Specialised needs - Treatment must address disability-related issues
• Medication interactions - Careful consideration of medication interactions
• Support services - May need additional support services

 

 

Prevention

Primary Prevention

• Education - Teaching about the risks of substance use
• Skill building - Teaching coping skills and decision-making
• Environmental changes - Reducing availability and access to substances
• Policy interventions - Laws and regulations to reduce substance use
• Community programs - Community-based prevention programs

 

Secondary Prevention

• Early identification - Screening for substance use problems
• Brief interventions - Short counselling sessions for at-risk individuals
• Referral to treatment - Connecting people to appropriate treatment
• Family interventions - Working with families to address substance use
• School-based programs - Prevention programs in schools

 

Tertiary Prevention

• Treatment - Providing effective treatment for substance use disorders
• Relapse prevention - Helping people maintain recovery
• Harm reduction - Reducing the negative consequences of substance use
• Recovery support - Ongoing support for people in recovery
• Reintegration - Helping people reintegrate into society

 

 

Stigma and Discrimination

Understanding Stigma

• Public stigma - Negative attitudes and beliefs held by society
• Self-stigma - Internalised shame and negative beliefs about yourself
• Structural stigma - Discrimination in policies, laws, and institutions
• Impact on treatment - Stigma prevents people from seeking help
• Impact on recovery - Discrimination makes recovery more difficult

 

Reducing Stigma

• Education - Teaching people about addiction as a medical condition
• Language matters - Using person-first language (person with addiction, not addict)
• Sharing stories - People in recovery sharing their experiences
• Media representation - Accurate portrayal of addiction and recovery in media
• Policy changes - Laws and policies that reduce discrimination

 

Self-Advocacy

• Know your rights - Understanding legal protections against discrimination
• Speak up - Advocating for yourself and others
• Seek support - Connecting with others who understand your experience
• Focus on recovery - Concentrating on your health and well-being
• Challenge stereotypes - Showing that people in recovery are valuable members of society

 

 

When to Seek Help

Warning Signs

• Loss of control - Unable to limit or stop substance use
• Neglecting responsibilities - Problems at work, school, or home due to substance use
• Relationship problems - Conflicts with family and friends about substance use
• Health problems - Physical or mental health issues related to substance use
• Legal problems - Arrests or legal issues related to substance use
• Financial problems - Spending excessive money on substances
• Tolerance - Needing more of the substance to achieve the same effect
• Withdrawal - Experiencing symptoms when not using the substance

 

Getting Help

• Talk to your doctor - Primary care physicians can provide initial assessment and referrals
• Contact a treatment centre - Many facilities offer free assessments
• Call a helpline - National and local helplines provide information and referrals
• Attend a support group meeting - Many groups welcome newcomers
• Reach out to family or friends - Let trusted people know you need help

 

Crisis Situations

• Overdose - Call 911 immediately
• Suicidal thoughts - Call 988 (Suicide & Crisis Lifeline)
• Detox needs - Medical supervision may be needed for safe withdrawal
• Mental health crisis - Contact crisis services or go to the emergency room

 

Resources

• SAMHSA National Helpline: 1-800-662-4357
• National Suicide Prevention Lifeline: 988
• Crisis Text Line: Text HOME to 741741
• Alcoholics Anonymous: aa.org
• Narcotics Anonymous: na.org
• SMART Recovery: smartrecovery.org
• Find a helpline, suicide hotline, or crisis line in your country: https://www.therapyroute.com/article/helplines-suicide-hotlines-and-crisis-lines-from-around-the-world
• Find an emergency ambulance number in your country: https://www.therapyroute.com/article/ambulance-emergency-numbers-worldwide-list-by-therapyroute

 

 

Related Terms

• Addiction - Chronic disease characterised by compulsive substance use
• Withdrawal - Physical and psychological symptoms when stopping substance use
• Tolerance - Need for increased amounts to achieve desired effect
• Detoxification - Process of safely removing substances from the body
• Recovery - Process of change to improve health and live a self-directed life

 

 

References

Cleveland Clinic. (2024). Substance Use Disorder (SUD): Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud

American Psychiatric Association. (2024). What Is a Substance Use Disorder?. https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

Centres for Disease Control and Prevention. (2024). Treatment of Substance Use Disorders. https://www.cdc.gov/overdose-prevention/treatment/index.html

NCBI. (2024). Chapter 5—Specialised Substance Abuse Treatment Programs. https://www.ncbi.nlm.nih.gov/books/NBK64815/

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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions about mental health concerns.