The Benefits of Going to An Out of State Drug Rehab for Treatment

Attending a substance abuse treatment center close to home may sound like a smart, convenient choice. However, consider an out of state drug rehab before making a final decision. Explore all of your options and weigh the pros and cons of treatment at home versus rehab out of state.

Closer Isn’t Always Better for Substance Abuse Treatment

The best addiction treatment center may not be located in your neighborhood or city. Even if your local rehab offers high-quality treatment, it isn’t best for you if it doesn’t provide the care you need. For instance, if you’re struggling with a dependence on opiates or meth, a treatment center specializing in alcohol abuse won’t be the best solution. Or if you prefer a gender-specific program and the treatment center in your town offers co-ed treatment, it isn’t a good fit. Look at out of state drug rehabs in order to expand your treatment options. 

You’re Likely to Stay May Stay in Treatment Longer at an Out of State Rehab Center

Substance abuse treatment is challenging, and if you’re close to home, you may be tempted to drop out when things get rough, especially during the early days. Leaving on the spur of the moment is much harder when you’re attending an out of state rehab center. You can’t easily give into impulses; like hopping on a bus, or calling a friend for a ride. Things get smoother if you can hang in there through the rough patches. 

The longer you’re able to stay in treatment, the higher the chances of long-term recovery. According to NIDA (the National Institute of Drug Abuse), treatment of less than three months is of limited effectiveness, while longer time in treatment is recommended for a more positive outcome. NIDA also notes that most people who remain in treatment for an extended period are able to stop using drugs, improve their mental health, and move forward with life.

Out of State Rehabs May Offer Better Treatment Programs & Specialties

Treatment programs and specialties offered by out of state drug rehab centers vary substantially, so don’t limit yourself to only looking at what’s nearby You may prefer a rehab that focuses on a particular religion or one that centers treatment around a 12-Step program. Alternatively, you may be looking for a non-religious treatment center or one that offers 12-Step alternatives. You may benefit from a treatment facility that caters to business executives, adolescents, seniors, or LGBT individuals. 

If you have depression, bipolar disorder, or another mental health issue in addition to substance abuse problems, it’s essential to find an addiction treatment center where the staff is trained and experienced in dual diagnosis disorders. Treating two disorders at the same time is complex, and not all treatment centers provide the necessary mental health services on-site . 

In short, you may be more likely to get the care you need if you’re willing to travel.

Other Benefits of Seeking Addiction Treatment Out of State

Aside from increasing your chance of finishing treatment and expanding your program options, there are a few other benefits to exploring out of state rehabs.

Out Of State Rehabs May Have Shorter Wait Times for Admission

The decision to enter treatment is enormous and life-changing, and it’s best to get started as soon as possible. Even if you’re lucky enough to find the perfect treatment center close to home, it won’t do you much good if the waiting list is long. You’re much more likely to find a place with an opening if you look into out of state drug rehabs. 

It Puts Distance Between You and Distractions

Friends and family are wonderful, and they can be essential for your recovery. On the other hand, the people you love can also distract you from focusing entirely on treatment, especially if things aren’t going well on the home front. The distance of an out of state rehab allows you to direct your attention to recovery without stressing about constant anger, tension, and resentment at home. 

Sometimes, your loved ones mean well, but they may not understand how they’re enabling your addiction or neglecting your needs and personal boundaries. Recovery is especially difficult if somebody at home is still using drugs or alcohol. 

Although you may want to include your family in your substance abuse treatment plan, it may be beneficial to wait and begin family counseling after you return home. You may be hesitant to spend so much time away, but sometimes, a little time apart can help everybody see more clearly. This is something only you can decide. 

Traveling to an Out of State Addiction Center May Save You Money

If you live in a city with a high cost of living, addiction treatment is probably going to be substantially more expensive than in other areas of the country. Even after you factor in travel expenses, you may actually save money by traveling to an out of state drug rehab.

In some cities, most substance abuse treatment centers are resort-like facilities that cater to people with healthy bank accounts. A high-end treatment center is great if you can afford it, and it’s nice to have perks like a private room, daily massages, or a professional chef. A hefty price tag may buy many perks, but it doesn’t necessarily equate to better treatment. 

Change is Good for the Soul

Traveling to a rehab out of state removes you from old friends, familiar neighborhoods, and favorite hang-outs that might tempt you, especially in the early days of recovery. At an out-of-state drug rehab in a new environment, you’ll meet different people and new friends that share your desire to get well. You may find it’s easier to discuss your experiences and feelings with people with similar experiences, or who don’t know anything about the difficulties in your past. 

If you’re entering treatment in the dead of winter, a warmer climate might be a very welcome change. If you live where summer heat is punishing, consider an escape to a treatment center in the refreshing coolness of the mountains. Addiction treatment offers an opportunity for a fresh start at recovery, and traveling may give you a whole new outlook.

Privacy Matters

There’s no reason to be ashamed if you have a problem with substance abuse; addiction is a chronic disease that can happen to anybody. You may feel okay about sharing your plans to enter addiction treatment, or you may prefer to keep it private, especially if there’s a possibility your job or reputation may be threatened if word gets out. 

Telling your friends or coworkers is totally up to you. The big problem, however, is that at local substance abuse centers it’s common to run into people you know, even in large urban areas. Traveling to an out of state drug rehab makes it much easier to protect your privacy and focus on recovery.

Get A Fresh Start at First Step Behavioral Health in Florida 

Traveling to an out of state drug rehab might be one of the best things you’ll ever do for yourself. Located in beautiful Pompano Beach, South Florida, our substance abuse and dual diagnosis specialists can help you explore your addiction treatment options. Give us a call today at 855-425-4846 or contact us here for more information

South Florida beach

Florida: An Affordable Alternative to Drug Rehab Centers in California

Are you looking into alcohol and drug  rehab centers in California? Before you commit to a California substance abuse treatment facility, take a moment to consider Florida for rehab instead. Florida is a perfect alternative to the west coast; similar weather, beautiful beaches, and quality treatment — at a more affordable price. 

The Cost of Drug Rehab in California

The cost of living in California is high, and the often outrageous price tag for drug rehab centers in California is a huge stumbling block for many people. Southern California is especially well known for its luxury treatment centers that roll out the red carpet for Hollywood celebrities, star athletes, or titans of the business world. California has the highest number of posh treatment centers in the country, many of which are located in trendy SoCal cities like Malibu, Laguna Beach, andHollywood Hills. 

Unfortunately, unless  you’re a person with money, power, and influence, the high price and exclusivity of many Southern California drug rehab centers may be out of reach. This severely lowers the available options for those looking to get into treatment quickly. In contrast, Florida has a large number  of treatment centers, and many rehabs in the sunshine state specifically focus on providing high-quality treatment at a price that won’t make you gasp.

Are Florida Treatment Centers as Good as Southern California Drug Rehab Centers?

The quality of substance abuse treatment isn’t always connected to the cost. Many Southern California drug rehab centers are notoriously expensive, not because the treatment is better, but because they offer a resort or spa-type experience. For instance, higher-priced rehabs offer an array of amenities such as personal chefs, private suites, gourmet dining rooms, horseback riding, or tennis. It isn’t unusual for a California substance abuse treatment facility to freely advertise its roster of celebrity clients.

All the perks are nice, but an expensive treatment center won’t get you on the path to recovery any faster than a moderately priced drug addiction treatment. Drug addiction treatment in California may be out of your price range, but if you’re committed to your recovery, a reasonably priced rehab in South Florida may offer precisely what you need. 

You Won’t Be Giving Up Sunshine and Beautiful Beaches

People love Southern California for the warm, sunny days, spectacular vistas, and sandy beaches, but if you’re looking for the best weather, Florida’s tropical climate is hard to beat. You may need to pack a sweater or light jacket during the winter, but be ready for plenty of balmy days all year round.

California vs. Florida for Drug Rehab: Questions to Ask No Matter Where You Go

How can you tell which rehabs are good, and which are substandard? The best way to do this is to ask a lot of questions. Whether you decide to travel to Florida, or attend a California substance abuse treatment facility, here is a list of several factors that you should consider when you’re choosing a rehab for yourself or a loved one.

Vetting Substance Abuse Treatment Centers

Staff at a quality rehab is knowledgeable, compassionate, and willing to freely share information. If they are unwilling to answer all of your questions, even if you make multiple phone calls, it’s probably not the right place for you. 

  • Find out if the treatment methods evidence-based, which means they have been carefully tested and backed by solid scientific research. Be careful about treatment providers that make lofty promises or offer miracle cures. Similarly, beware of gifts or other inducements, which may indicate some shady business is going on.
  • What types of drug detox programs does the treatment center offer? Will you be carefully monitored during withdrawal? Is a physician on staff? If the center doesn’t provide medical detox, can they refer you to a detox clinic or hospital if necessary? 
  • Does the rehab offer dual diagnosis treatment? This is an essential factor if you need help with conditions such as depression, bipolar disorder, or PTSD in addition to substance abuse. Staff at a dual diagnosis center should be educated, experienced, and able to help you with both issues together, not separately. 
  • Does the center offer medically-based treatment (MAT)? Medically based treatment, which involves traditional therapy in addition to certain prescribed medications, has proven to be effective for many people. 
  • Will your treatment be carefully planned with your needs and goals in mind? Beware of cookie-cutter treatment plans. Recovery isn’t a one-size-fits-all situation, and what works for one person may not work for you.
  • Does the center offer complementary or alternative therapies that are important to you, such as outdoor therapy, yoga, massage therapy, mindfulness meditation, or fitness? 
  • Ask if treatment length is flexible if your needs change. Research over the last few decades has proven that longer stays in rehab, often lasting at least 90 days or even longer, offers a higher chance of long-term recovery. The standard length of 29 days isn’t enough for many people.
  • Inquire about the price of treatment in Florida, then compare it to the cost of drug rehab in California and ask what insurance companies they each accept. If you aren’t insured, ask about payment plans or financial assistance programs. Be sure to let them know if you live out of the local area, as some insurance companies won’t cover treatment centers that are “out of network.”
  • Find out what types of programs are available; for instance, does the center offer gender-specific treatment or co-ed programs? If a 12-Step, spiritually-based program or family therapy is important to you, don’t hesitate to ask about them. Programs may also be geared toward specific populations such as adolescents or LGBT individuals. 
  • Will the treatment center guide you through the creation of an aftercare or relapse prevention plan? Some centers offer counseling sessions after completion of treatment, or they will contact you via phone if you live outside the area. Others have regular alumni events.
  • Ask about living conditions. While they don’t need to be fancy, the environment should be clean and comfortable. Many Florida treatment centers offer virtual tours on their websites, but an actual visit, if possible, is the best way to determine if conditions are suitable. 
  • What does a typical schedule look like? Will you have time for socializing with other clients? How about opportunities for solitude and quiet reflection? Does the center offer enjoyable group activities?

Learn More About 1st Step South Florida Rehab Center

Choosing a treatment center is an important decision that only you can make. First Step Behavioral Health in South Florida is a top-rated treatment center with a variety of program options and mental health services.

If you’re looking for help for you or a loved one, give us a call at 855-425-4846 or contact us here for more information. We’ll take the time to answer your questions and provide you any information you need that will help you in your search.  

4 Types of Bipolar Disorder

The 4 Types of Bipolar Disorder: What Treatment Options are Available?

In the United States, approximately 4.4 percent of adults experience bipolar disorder at some point. Bipolar disorder is something many people struggle with. That’s why it’s crucial to draw attention to the issue and encourage those struggling to seek help. 

Bipolar is a disorder that can be explained by moods marked by highs and lows, or periods of mania and depression. Mental health professionals can classify the four types of bipolar disorders by examining the duration and intensity of these episodes.

The four basic types of bipolar disorder all vary in symptoms. They can be classified by significant changes in mood, energy, thinking, concentration, and behavior. These changes consist of manic episodes, which are periods of feeling euphoric, and depressive episodes, which are periods of feeling hopeless and sad. Hypomanic episodes are a milder form of manic episodes.

Understanding the different types of bipolar disorders can help you or a loved one seek help, sooner rather than later. Addressing mental health concerns, as well as substance abuse, helps return the power into the individual’s hands. Fortunately, there are wonderful treatment options available for those struggling with any type of bipolar disorder.

Different Types of Bipolar Disorder

The disorder types are each identified by the pattern of episodes of mania and depression. Each type of bipolar disorder is unique in its pattern of episodes and intensity. 

Bipolar I Disorder

Bipolar I disorder can be classified by manic episodes that last at least seven days. These manic episodes may also coincide with certain symptoms of psychosis. In some cases, the manic symptoms are severe enough to require immediate hospitalization to prevent harm to oneself or others. 

Depressive episodes generally last at least two weeks. These types of episodes also occur often. An individual may have manic episodes including some depressive symptoms or depressive episodes accompanied by some manic features.

Bipolar II Disorder

Mania is not a part of bipolar II disorder. Instead, bipolar II disorder can be classified by recurring episodes of major depression and hypomania, a milder form of mania. A diagnosis of bipolar II disorder requires experiencing at least one hypomanic episode and one major depressive episode in your lifetime.

Compared to bipolar I disorder, although one or more major depressive episodes may occur, it is not a requirement. Bipolar II disorder consists of one or more major depressive episodes. 

General symptoms that take place in a major depressive episode include:

  • Insomnia or hypersomnia
  • Unexplained or uncontrollable crying
  • Severe fatigue
  • Loss of interest in things the person typically enjoys
  • Recurring thoughts of death or suicide

Cyclothymic Disorder

Cyclothymia symptoms differentiate between emotional highs and lows. The highs of cyclothymia include signs of an uplifted mood (hypomanic symptoms). The lows consist of mild or moderate depressive symptoms.

Cyclothymia symptoms are similar to those of bipolar I or II disorder. However, they’re significantly less severe. If diagnosed with cyclothymia, you can typically function on a day-to-day basis, though not always well. Changes in mood and behavior can get in the way of your stability if you never see it coming or don’t feel like you can control it. 

Cyclothymic disorder generally develops in adolescence. Those diagnosed with this disorder can be seen as simply difficult or moody to others, thus left untreated. If this occurs, cyclothymia can increase your chances of developing bipolar disorder.

Bipolar Disorder – Due to another medical or substance abuse disorder

Bipolar disorder that does not follow a particular pattern (for example, recurring episodes of hypomania episodes without depressive symptoms, or very rapid swings between some symptoms of mania and some symptoms of depression) is called bipolar disorder Not Otherwise Specified (NOS).

Typically, NOS can be diagnosed when the individual alternates between depression and short episodes of hypomania (a milder form of mania). Oftentimes, the mood swings are rapid, occurring within days of each other.

Bipolar Disorder: Recognizing the Signs 

The different types of bipolar disorders can be recognized by a variety of symptoms. These symptoms range from person to person, as each case is different. However, there are certain similarities that most people can search for when recognizing bipolar disorder.

Mania and hypomania can be generally identified by the following features:

  • An individual that displays intense, elevated, or irritable signs of changes in mood that are persistent and last for at least one week. If the person’s euphoric mood is so severe that it calls for hospitalization, then help should be sought after immediately. 
  • Additional signs and symptoms must also occur. If you’re mainly showing increased levels of energy or an expansive mood, you must also depict three of the following symptoms in order to be diagnosed with bipolar disorder. If you’re primarily showing signs of an irritable mood, you must display at least four of the following symptoms:
    • Inflated self-esteem or grandiosity
    • Being markedly more talkative than normal
    • A significant decrease in sleep or the need for sleep
    • Racing thoughts (this is often assessed by rapid speech patterns)
    • Extreme distractibility
    • A significant increase in goal-directed behavior, such as work-related activities or cleaning the house, or in non-goal-directed behavior, such as pacing
    • A significant increase in behavior that could be potentially dangerous or damaging, such as engaging in multiple sexual relationships, shopping binges, excessive investing, etc.

Depression in Different Types of Bipolar Disorders 

Experiencing periods of depression is a common symptom when diagnosing the different types of bipolar disorder. Depression is diagnosed when an individual displays at least 5 of 11 potential symptoms consistently over two weeks. 

These symptoms include:

  • Feeling sad for the majority of the day on a nearly daily basis
  • Displaying an inability to experience pleasure nearly every day
  • Sleeping excessively or not being able to sleep at all
  • Feeling guilty or worthless nearly every day
  • Problems with concentration, attention, remembering things, making decisions, etc.
  • Significant weight loss or gain in the absence of trying to intentionally lose or gain weight
  • Feeling extremely tired or fatigued nearly every day
  • Feeling restless and irritable almost every day
  • Moving as if in “slow-motion” most of the day nearly every day
  • Excessive thoughts about self-harm and/or suicide

Recognizing the signs of depression can help you decide to seek help sooner rather than later. Fortunately, there are many treatment options available that can alleviate these symptoms. Even more importantly, treatment teaches you the skills to work through these problems and guide you to a happier life.

Levels of Treatment for Different Types of Bipolar Disorder

When it comes to treatment at a rehab facility, there are varying levels of care offered. These levels of care each incorporate their own set of key components to help the patient recover. Our addiction and mental health specialists can help you determine where your needs are best addressed. These types of treatment include:

  • Outpatient treatmentOutpatient rehab is ideal for those who wish to reside in their communities but still treat their bipolar disorder. Patients will have the opportunity to create a schedule that best suits their unique needs. For example, you may have a child or you may need to attend night school classes. We can make it work to fit your circumstances.

The main advantage of outpatient care is convenience. Inpatient care may require too much commitment or a lack of flexibility. If that’s the case, don’t worry. You can still get the help you need.

  • Inpatient treatment – Inpatient treatment in a hospital or long-term care facility may be necessary when your mood is particularly unstable or if you are experiencing psychotic or suicidal thoughts or behaviors. This type of residential treatment will require patients to live at the treatment facility. Inpatient programs usually take 28 to 90 days to complete. 

Inpatient treatment is best for those struggling with severe bipolar disorder and/or coinciding substance abuse issues. Patients reside in a safe and secure environment.

  • Dual Diagnosis treatment – Did you know that about 56% of people with bipolar disorder also experience a drug or alcohol use disorder in their lifetime? Treatment that focuses on both substance use and bipolar symptoms is necessary for a lot of patients. Withdrawal symptoms of drugs or alcohol require immediate medical attention.

Dual diagnosis treatment addresses the addiction and disorder from the inside out. At 1st Step Behavioral Health, we believe in treating the person as a whole. Taking the time to understand the underlying roots behind a problem makes all the difference in finding a solution.

Components of Treatment for the Different Types of Bipolar Disorder

A treatment plan for any type of bipolar disorder must be comprehensive. Medical care and psychological care must be coinciding components. You may have a treatment team that includes a psychologist, a social worker, and a psychiatric nurse.

Bipolar disorder is a lifelong but treatable condition. Neglecting any part of the problem will only have the potential to cause more pain in the long run. Treatment is directed at managing and working through these symptoms. 

Depending on your needs, treatment may include:

  • Medications: Medications may be used to immediately balance moods. Our medical professional team will make sure to carefully assess you and monitor the use of medication throughout treatment.
  • Psychotherapy and psychoeducation: Also known as talk therapy or counseling, psychotherapy helps the individual learn and practice effective strategies for coping with the disorder, as well as managing symptoms. Cognitive-behavioral therapy can help an individual identify negative thinking patterns and the behaviors that follow. 

Family therapy can help family members learn to communicate calmly, in a productive manner. Thus, reducing overall stress in relationship systems. Psychotherapy can also provide valuable psychoeducation for problem-solving, developing self-care habits, and building resilience.

  • Substance abuse treatment: If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
  • Continued treatment: Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. Skipping maintenance treatment puts you at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression. Maintenance treatment is all about preventing relapse. 

The main treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also generally include education and support groups.

Seek Help Today

If you’re struggling with any type of bipolar disorder, don’t shy away from getting help. Many people are in the same boat. Whether it’s you or a loved one that needs treatment, we’re here to guide you throughout the process. Bipolar disorder requires effort to change, as well as a thorough evidence-based plan. 

That’s where we come in. Our mission is to help you live the life you deserve. We’ll help you get the treatment you need. Contact us here at 1st Step Behavioral Health for more information about available programs.

10 Types of Depression

10 Types of Depression: Which Best Fits Your Symptoms?

We all feel sad from time to time. It’s normal to feel down in the dumps after a rough patch in your life. These sad times are a crucial part of our lives that allow us to grow and appreciate the happy times that much more. 

However, depression is far more serious than just feeling sad. It’s a persistent feeling of dread, hopelessness, and sorrow that interferes with one’s ability to function normally. A depressive disorder is a mood disorder that affects how a person thinks, feels, and behaves.

Am I Suffering From Depression?

You may find yourself wondering – Do I have depression? If that’s the case, it’s crucial to understand the different types of depression. This way, you can receive some insight into what you’re going through. We do encourage getting diagnosed by a clinical professional to receive a more accurate diagnosis. 

Some types of depression may be caused by events in your life, and others by chemical changes in the brain. Regardless of what type of depression you have, please know that it does get better. With the right help and treatment, you can get to the root of the depression. 

Feel free to use this guide to get a better grasp of what type of depression you have, as well as educate yourself on the different symptoms.

Major Depression (Clinical Depression)

Major depressive disorder, also known as unipolar or clinical depression, is identified by a persistent feeling of sadness or a lack of interest in external stimuli. If these feelings last longer than two weeks, then you may be suffering from clinical depression.

Symptoms will vary from person to person as everyone has their own set of unique circumstances. But, generally speaking, these are the universal symptoms of depression one can look out for:

  • Feelings of immense sadness, crying, emptiness, or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies, or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Fatigue and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation, or restlessness
  • Slowed thinking, speaking, or body gestures
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking and focusing
  • Difficulty making decisions 
  • Memory problems
  • Frequent or recurrent thoughts regarding death or suicide
  • Unexplained physical issues, such as back pain or headaches

Dysthymia (Persistent Depressive Disorder)

Persistent depressive disorder (PDD), also referred to as dysthymia, is a continuous long-term and chronic form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, have low self-esteem, and experience an overall feeling of inadequacy. These emotions can last for years and may significantly interfere with your relationships, schoolwork, career, and day-to-day functioning.

The symptoms of PDD are similar to those of clinical depression. However, the most important difference is that PDD is chronic, with symptoms occurring on most days for at least two years. These symptoms include:

  • Persistent feelings of sadness and hopelessness
  • Difficulty sleeping/Insomnia
  • Fatigued/Low energy
  • A change in appetite
  • Difficulty concentrating
  • Indecisiveness
  • A lack of interest in daily activities
  • Decreased productivity
  • Low self-esteem
  • A negative attitude
  • Avoidance of social activities

Manic Depression (Bipolar Disorder)

Bipolar disorder, sometimes referred to as manic depression, is a complex disorder that likely stems from a combination of genetic and non-genetic factors. Those with bipolar disorder experience mood episodes that involve clinical depression or mania (extreme elation and high energy). In between, there are periods of normal mood and energy where the person may seem like they are functioning normally.

The severity of mood episodes can range widely from very mild to extreme, and they can happen slowly or suddenly within a timeframe of days to weeks. There are different types of bipolar disorder as well. Below are the symptoms of manic and depressive episodes.

Symptoms of a manic episode include, but are not limited to:

  • A long period of feeling “high” — an overly elated, happy, and outgoing mood
  • Unrealistically believing you can do something
  • Engaging in impulsive, pleasurable, and high-risk behaviors (i.e. bad financial investments, sexual indiscretions, large shopping sprees)
  • Inflated self-esteem
  • Feelings of grandiosity
  • Easily agitated 
  • Increased goal-directed activities
  • Increased sex drive
  • Making grand and unattainable plans
  • Detached from reality — psychosis that may include delusions or hallucinations

Symptoms of a depressive episode include, but are not limited to:

  • Feeling sad, tearful, hopeless, or empty for most of the day daily
  • No enjoyment or interest in regular daily activities
  • Weight fluctuations — including large weight loss or weight gain
  • Sleep problems — oversleeping or other sleep issues, such as insomnia
  • Restlessness or slowed behaviors
  • Suicidal thoughts, planning, or attempts
  • Psychosis — being disconnected from reality; delusions or hallucinations
  • Loss of interest in activities you once enjoyed
  • Anxiety
  • Uncontrollable crying

Postpartum Depression (Peripartum Depression)

Peripartum depression refers to depression occurring during pregnancy or after childbirth. Did you know that an estimated one in seven women experiences peripartum depression? Women that give birth and struggle with sadness, anxiety or worry for many weeks or more may have postpartum depression (PPD). 

A woman may experience PPD for a variety of different reasons. These reasons may include the physical changes resulting from pregnancy: 

  • Restlessness about parenthood
  • Hormonal changes
  • Previous mental health problems 
  • Lack of support
  • Difficult pregnancy or delivery
  • Changes to the sleep pattern.

Recognizing the symptoms of PPD can help you determine when you need help. These signs and symptoms may include:

  • Sluggishness, fatigue
  • Feeling sad, hopeless, helpless, or worthless
  • Difficulty sleeping/sleeping too much
  • Changes in appetite
  • Difficulty concentrating/confusion
  • Crying for “without reason”
  • Lack of interest in the new baby, not feeling bonded to the baby, or feeling very worried about the baby
  • Feelings of being a bad parent
  • Fear of injuring the baby or oneself
  • A loss of interest or enjoyment in life

Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression related to the change of season. If you’re suffering from SAD, you may notice symptoms beginning and ending at about the same time each year. In either case, symptoms of depression, such as hopelessness and fatigue, start as moderate and grow in severity as the weeks go on. 

Those who experience SAD in the fall and winter may experience symptoms of:

  • Oversleeping
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
  • Tiredness or low energy

Those who experience SAD in the spring and summer may experience symptoms of:

  • Trouble sleeping (insomnia)
  • Poor appetite
  • Weight loss
  • Agitation or anxiety

Psychotic Depression

According to the National Alliance on Mental Illness, approximately 20% of individuals with depression have episodes so intense that they develop psychotic symptoms. Psychotic depression is a type of depression that occurs when a severe depressive illness includes some form of psychosis. 

The psychosis could involve hallucinations (such as hearing a voice telling you that you are no good or worthless), delusions (intense feelings of worthlessness, failure, or having sinned) or another interference with reality. Aside from the general symptoms of depression, psychotic depression may also include signs of:

  • Growing agitation and restlessness
  • Anxiety and panic attacks
  • Escalating complaints of pain or ill health
  • Further intellectual impairment
  • Bouts of physical immobility or unresponsiveness
  • Irritability and hostile responses
  • Paranoia, feelings of persecution
  • Odd and illogical speech or actions

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder, or PMDD, is a cyclic, hormone-based mood disorder, it’s commonly considered a severe and disabling type of premenstrual syndrome (PMS). According to a study in the American Journal of Psychiatry, only around 5% of women are diagnosed with PMDD.

The core symptoms of this type of depression are anxiety and a depressed mood. Although, behavioral and physical symptoms may also occur. The symptoms of PMDD generally show up the week before the start of a period and last until a few days after it begins. 

The signs of PMDD may include:

  • Mood swings
  • Depression or feelings of hopelessness
  • Intense anger and conflict with other people
  • Tension, anxiety, and irritability
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Fatigue
  • Change in appetite
  • Feeling out of control
  • Sleep problems
  • Cramps and bloating
  • Breast tenderness
  • Headaches
  • Joint or muscle pain
  • Hot flashes

Atypical Depression

Atypical depression is a subtype of major depression or dysthymic disorder that involves several specific symptoms. Atypical depression is similar to clinical depression, but with atypical features. This means that your depressed mood can brighten in response to positive events. 

These specific symptoms include:

  • Increased appetite or weight gain
  • Sleepiness or excessive sleep
  • Marked fatigue or weakness
  • Moods that are strongly dependent on environmental circumstances
  • Feeling extremely sensitive to rejection

Situational Depression (Reactive Depression/Adjustment Disorder)

Situational depression is also referred to as reactive depression or adjustment disorder. It is a short-term, stress-related type of depression. Situational depression can occur after a traumatic event or a series of changes in one’s life. Examples of events or changes that may onset situational depression can include (but not limited to) divorce, job loss, loss of a friend, getting very sick, and relationship issues or changes. 

Situational depression stems from a person’s inability to accept the change that has occurred. The majority of people who experience situational depression begin to have symptoms within about 90 days following the event.

Symptoms of situational depression may include:

  • Feelings of low mood and sadness
  • Tearfulness; frequent bouts of crying
  • Hopelessness
  • Poor concentration
  • Lack of motivation
  • Loss of pleasure
  • Withdrawing from normal activities
  • Loneliness or social isolation
  • Thoughts of suicide

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a type of depression that has been discovered fairly recently. In 2013, it appeared for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DMDD is a psychiatric condition that’s typically only diagnosed in children. 

The key symptoms of DMDD are identified as:

  • Temper tantrums – these tantrums are not considered normal for a child’s age
  • Severe temper tantrums – yelling, screaming, or behavioral outbursts (physical aggression toward people or things)
  • Outbursts – occur approximately three or more times a week
  • Irritability and angry mood between tantrums – disturbances in mood for the majority of the day, nearly every day
  • Tantrums occur in multiple settings – symptoms are present in at least two settings, such as at home, in school, or with peers.

In addition to the above symptoms, diagnosis generally requires that:

  • The disturbance in mood has been occurring most of the time for a year.
  • The child is between 6 to 17 years of age.
  • The symptoms were present before the age of 10.
  • Tantrums aren’t due to another condition, like autism spectrum disorder, a developmental disability, or the effects of substance abuse.

Seek Help For Any Type of Depression Today

If you’re struggling with any type of depression, don’t shy away from getting help. We understand that depression can be an overwhelming challenge to go through. You or a loved one may feel lost and hopeless about a better future.

But we’re here to tell you that it gets better. But you must take that first step. Progress requires effort. Our rehab programs offer many different forms of treatment from therapy to support groups. With the right treatment plan, you can set forth towards a better life.

Our mission is to help you live the life you deserve. We’ll help you get the treatment you need. Call us here 1st Step Behavioral Health for more information about available programs.


Is it Self-Doubt or Depression? Reasons it Might Be a Mental Illness

It’s important to understand the difference between self-doubt and depression. Recognizing what you’re going through enables you to find healthy solutions and work through toxic behaviors. 

We all experience feelings of sadness from time to time. We may get down in the dumps or have days when we look in the mirror and say, “I’m not too fond of you today”…It happens! Self-doubt is a normal emotion to feel and you should never feel ashamed of not feeling your best sometimes.

However, depression is something that should be taken much more seriously. Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that an individual feels regularly. Feeling deep sadness or dead for an extended amount of time may mean that you have depression.

You’re Not Going to Experience Self-Doubt or Depression Forever

Before we get into the differentiation between self-doubt and depression, I’d like to drive home a point. The pain you’re feeling now has the potential to not only make you a better person but to ultimately catapult you into a much happier life. It’s not always easy to understand how that’s going to happen in the moment. Sometimes it feels pretty impossible that you’ll ever feel better or truly happy.

As someone that’s experienced depression, I’m here to tell you it doesn’t have to last forever. Emotions are like waves – they flow in and out. You are not your emotions. You may feel them, but that doesn’t mean you have to let them define you.

One of the most valuable lessons I’ve learned from experiencing depression is that it was a hidden blessing in my life. Depression allowed me to develop a deep sense of empathy towards others. Depression has shown me how strong I truly am by overcoming feelings of hopelessness and self-doubt. Depression has allowed me to work through my problems and redefine happiness.

With the right lifestyle changes and treatment, you become acutely aware of yourself. You also become more aware of your surroundings and life. Experiencing depression sets you up to come to realizations and break-throughs other people may never understand. 

For example, I learned that awareness in the present moment is a powerful tool. Taking the time to focus on your five senses and appreciate the environment around you. The past is long gone and the future is can be defined by each present moment building upon the next. 

So appreciate the present. Look around you and just take a moment to breathe. After doing this enough times, you get a certain feeling of comfort. 

You are not your depression. You are not your feelings of self-doubt. At 1st Step Behavioral Health, we would be honored to help show you your potential. 

Symptoms of Depression

As we navigate through these feelings of sadness, let’s start with the symptoms of depression. You may find yourself asking the question: “Is it normal self-doubt and sadness or is it depression?” 

Everyone is unique in what they experience, but these are generally the most common signs of depression:

  • Feelings of helplessness and consistent dread –  A negative perspective on life – nothing will change and there’s nothing you can do to feel better.
  • Loss of interest in daily activities –  You don’t care anymore about former hobbies, pastimes, social activities, or sex. It may seem like you’ve lost your ability to feel joy and pleasure.
  • Anger or irritability – You may find yourself feeling agitated or restless. Aggressive behavior may also begin to occur. The people around you, as well as your surroundings, easily get on your nerves. 
  • Loss of energy –  Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete. 
  • Self-loathing – Intense feelings of low self-esteem or shame. You’re a harsh critic towards yourself – you may spend a lot of time overanalyzing your perceived mistakes and decisions. 
  • Reckless actions –  You partake in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
  • Problems focusing –  Making decisions, concentrating or remembering things has become an issue.

So, What’s Self-Doubt and Sadness Then?

Although self-doubt and sadness go hand in hand with depression, they’re very normal emotions to experience on their own. Everyone feels self-doubt from time to time. It can even be healthy to critique yourself honestly, from a place of love. 

However, it’s the consistent dread and sadness that somebody depressed feels that makes the difference. If you find yourself feeling deeply unhappy and “out of it” regularly, then it may be time to seek help


Self-doubt can be described by not feeling good enough. You may find yourself doubting your capabilities and overanalyzing your every decision. An unhealthy self-doubt is the inability to see the good things about yourself. 

It’s hard to maintain motivation when you can’t appreciate the good in yourself. We may believe that we’ll never achieve our goals, that we don’t have talent, or are not worthy of our position or partner. Small failures give us a reason to partake in an unhealthy amount of self-loathing. Self-doubt paints a false picture in front of your eyes. 

Self-doubt is nothing but a monster your mind creates. You may feel self-doubt now and then that you’re able to overcome quite quickly. However, if your self-doubt follows you around every single day, then we urge you to give us a call today.

One of our caring specialists will help you determine if you’re experiencing normal feelings of self-doubt, or depression. You’re not alone in this struggle. 


Sadness is a normal human emotion that every single person will experience at stressful or challenging times. There are multiple reasons one may experience sadness. It can be because of the loss or absence of a loved one, divorce, loss of a job, financial issues, or problems at home. All these situations can leave you feeling glum. 

However, a person experiencing sadness generally finds relief from crying, venting, or talking out frustrations. Sadness tends to be triggered by an event, rather than something that shows up for no reason.

Sadness typically passes with time. If it does not pass, or if the person becomes unable to resume normal function, this could be a sign of depression. If sadness worsens or lasts longer than 2 weeks, outside help may be necessary. 

Are Feelings of Self-Doubt Getting in the Way? 3 Simple Ways You Can Alleviate These Feelings Today

Do you remember when I mentioned how feelings are like waves? Self-doubt is nothing but a temporary emotion that colors your reality in the moment. There is almost never a legitimate reason to be feeling self-doubt. 

We convince ourselves of truths that we allow to define our reality. However, these truths can be damaging at times if they’re negative. Self-doubt is a feeling you can work through. Keep reading to find out how you can start to feel more confident today.

  1. Invest in a journal.

Investing in a journal has many benefits and can quickly become your favorite habit. When it comes to self-doubt, it can help you to:

  • Keep a realistic record of your life. Keep track of positive things that arise in your day-to-day life. You can also write down your achievements to look back on when you’re experiencing self-doubt. 
  • Gain clarity. Writing down your negative thoughts or problems on paper can make a major difference. Once you see it written down, you’ll oftentimes realize the situation isn’t that scary. Making lists of pros and cons allows you to see your challenge in a clearer and more level-headed way. Also, it’s easier to come to solutions this way.

    2.  Get a positivity boost.

We live in an age where it’s so easy to access a wealth of resources on any topic. When it comes to self-doubt, there’s plenty of books, podcasts, and videos out there made to help you. Let someone else’s enthusiasm, motivation, and constructive optimism flow over to you.

Spend 20 minutes with an audiobook, a podcast or a book that helps lift feelings of self-doubt. 

Everyone has their preferences and you may have to do a little searching, but here are some of my personal favorites:

  • Super Brain: A book written by Deepak Chopra and Rudolph E. Tanzi.
  • Oprah’s Soulful Sunday Podcast – This is a little more on the spiritual side.
  • Joe Rogan’s advice in this motivational video (I listen to this every morning)

     3.  Sharpen your skills.

If you’re experiencing self-doubt before an important presentation or an event you’re attending, take the time to prepare! For example, read a book about public speaking that’ll give you more confidence. Feeling socially-anxious? Research ways to calm yourself down in the moment and work on implementing them.

Do You Have a Feeling Your Self-Doubt is Depression? – What Treatment at 1st Step Looks Like

If you’ve realized that your self-doubt has stemmed from depression, then we can help you today. Our treatment is tailored to each patient. We have a variety of programs ranging from inpatient rehabilitation to outpatient treatment. The type of care will be dependent upon the severity of your depression.

No matter which kind of rehab program you attend, the core of treatment will remain the same. We offer a wealth of resources such as one-on-one counseling, group therapy, holistic care, and much more. Each program will work with your schedule. Treatment may consist of a structured all-day program or it may mean evening visits to a therapist.

Regardless of how lost you may feel, we assure you that it does get better. At the end of the tunnel is a bright light. We want to navigate you towards that light and show you what life should feel like.

Call Us Today

If you have a feeling your self-doubt is depression, don’t hesitate to give us a call today. With the right treatment program and support, recovery is possible. Depression doesn’t have to last forever. You can feel joy and happiness again. You just need the right tools at your disposal. 

We would be honored to help show you the potential that’s always been there. Call us at (866) 319-6126 or contact us here for more information about available programs.

Dual Diagnosis PTSD

The Correlation Between PTSD and Substance Abuse: How to Recognize When You Need Help

Post-traumatic stress disorder, or PTSD, affects people all over the world. Individuals of varying races, from diverse communities, and with different pasts and walks of life are currently facing the effects of PTSD in their lives.

PTSD is, unfortunately, a commonly seen disorder in our communities. People who have experienced traumatic and life-altering events in their lives are at risk of developing post-traumatic stress disorder.

Children who have been emotionally abused, women and men who have served in the military, people who have been physically or sexually assaulted, and many other individuals know all too well how trauma can impact daily life.

Sadly, many individuals who are dealing with the effects of trauma develop PTSD and, eventually, find themselves suffering from substance abuse and addiction.

PTSD and substance abuse often co-occur, changing the lives of those who are dealing with them.

Perhaps this is the case in your own life. Maybe you’ve been affected by post-traumatic stress disorder and have become dependent on drugs or alcohol. If so, just know that you aren’t alone. In fact, over 50% of those who are dealing with PTSD are also suffering from addiction.

You don’t need to face these issues alone. Through professional therapy and addiction treatment, you can overcome the effects of PTSD and substance abuse for good!

Maybe you’re a little unsure about whether or not you need to go to treatment. Many people find it difficult to recognize when it’s time to reach out for help. But, it’s good to learn more about what you’re experiencing and how it’s actually impacting your life. This will help you to make the best decision regarding treatment.

About PTSD and Substance Abuse

Needless to say, PTSD and substance use disorder are both very serious. People who suffer from either of these disorders often have trouble leading normal lives.

The symptoms of PTSD can cause life to become very challenging. Post-traumatic stress disorder is caused by many different elements. The causes vary from person to person.

But, regardless of the many people who struggle with the effects of this particular disorder have difficulty managing and controlling their emotions and feelings. It can be hard to live with the recurring memories of the past.

Post-traumatic stress disorder is characterized by things like flashbacks, nightmares, and vivid memories centered around the traumatic event(s) the person experienced. So, it can be difficult to thrive in the present when the mind is constantly struggling with thoughts of the past.

Substance abuse disorder, like PTSD, is often the result of many different factors. After people use drugs or alcohol excessively for a while, they may begin to abuse the substances. Eventually, this can lead to addiction.

Many times, people who drink or use drugs excessively do so in an attempt to cope with the negative effects of stress, physical pain, emotional disturbance, mental illness, and much more. Since the effects of drugs and alcohol wear off after a while, people continue to use them in order to escape from reality.

Sadly, this method of coping is extremely harmful and, in many cases, even deadly. So, it’s important to get professional treatment for dealing with substance abuse.

How are PTSD and Addiction Connected to Each Other?

So, how does a person end up dealing with both substance abuse and post-traumatic stress disorder? Well, there are several reasons why these two disorders frequently co-occur in people’s lives.

Often, individuals who are living with PTSD suffer from its effects on a regular basis. This disorder often impacts people’s day-to-day lives. It affects people’s ability to interact and connect with others. And it causes symptoms such as:

  • Isolation
  • Agitation
  • Irritability
  • Paranoia
  • Loneliness
  • Guilt or shame
  • Trouble focusing
  • Feelings of fear
  • Poor self-esteem
  • Sleep disturbances

People may take medication to help treat some of the symptoms of PTSD. But, sometimes, these symptoms can become extremely overwhelming. Unfortunately, many people struggle to deal with these effects in a healthy way. So, they turn to drug and alcohol use.

As a result, many individuals develop substance abuse and addiction problems. So, in addition to PTSD, they also begin dealing with the harmful effects of excessive substance use.

Do I Need to Get Professional Treatment?

As we mentioned earlier, it’s not always easy to recognize the need for professional treatment in your life. Many people have a difficult time realizing what’s happening in their lives when addiction or any other disorder is in the mix.

Some individuals struggle to understand the symptoms they’re experiencing. It can all be very challenging to work through. So, if you are currently a little uncertain about what’s going on in your life, be sure to be patient with yourself.

But, it’s also important to avoid trying to get through this alone. There is help for you through treatment and therapy. Whether you need to go through residential treatment for substance abuse or therapy to help you deal with the effects of post-traumatic stress disorder, you can find freedom!

1st Step Behavioral Health Can Provide Treatment for You!

Not only can treatment help people to overcome substance dependence and addiction, but it can also help individuals to deal with and work through co-occurring disorders, including PTSD.

When a person is suffering from multiple disorders, such as alcoholism and post-traumatic stress disorder, this is called “dual diagnosis”. If an individual has a dual diagnosis, it’s important to go through a professional treatment program that will deal with each of the disorders he or she is dealing with.

Here at 1st Step Behavioral Health, we work to help people find peace through freedom from addiction. But, we also understand that many of our clients are also dealing with other issues in their lives. Some of these other struggles may actually contribute to addiction. So, it’s important to also deal with those problems in addition to substance abuse.

Through our dual diagnosis treatment program, we work to help our clients overcome substance abuse and addiction as well as co-occurring disorders. So, if you or someone you care about is suffering from addiction and PTSD, just reach out to us here at 1st Step Behavioral Health.

Call us today to learn more about our services and how we can help you or your loved one: (866) 319-6126


dual diagnosis

You Just Received a Dual Diagnosis. Now What?

Approximately 15% of the world’s population is afflicted by either a mental health condition, a substance use disorder, or both.

If that isn’t startling enough, it’s generally accepted that the numbers are underreported. When it comes to having both a mental health condition and a substance use disorder, the problem is more complicated.

Dual diagnosis describes co-curring mental health and substance use disorders. A new insight for the fields of mental health and recovery, these can be difficult to understand.

But there are solutions. Part of that is knowing what you’re dealing with, and the second part is to understand your options. Keep reading to find out all that and more.

What Is a Dual Diagnosis?

Dual diagnosis is also known as co-curring disorders, comorbidity, and comorbid disorders. But the most commonly used term for describing a patient that has both a substance use disorder and a separate mental health condition is a dual diagnosis.

In a dual diagnosis patient, either the substance use disorder or mental illness can develop first. It’s very common for someone with a mental illness to turn to a substance as a form of self-medicating. Often, they find relief for their mental health symptoms in the substance they use.

But a dual diagnosis isn’t always associated with the use of a substance. People with mental health disorders might also turn to things like gambling, food, sex, exercising, and even shopping as a way to cope with their condition.

Common Mental Health Conditions of Dual Diagnosis

Dual diagnosis isn’t as rare as one might think. In fact, 7.9 million Americans are classified as having a dual diagnosis.

Some mental health conditions are more common than others in dual diagnosis patients. The more common mental health condition associated with dual diagnosis are:

  • Depression. Substances can mask symptoms such as hopelessness, loneliness, sadness, and suicidal thoughts.
  • Bipolar disorder. One of the most common disorders associated with alcohol abuse, bipolar patients use substances differently depending on their cycle. It’s especially dangerous during a manic phase which already makes a patient prone to reckless and careless behavior.
  • Obsessive-compulsive disorder (OCD). Substances are appealing to OCD patients because it distracts them from the sometimes debilitating symptoms of their disease.
  • Anxiety. Substances may help anxiety sufferers by allowing them to relax and place their focus on something other than what’s causing their anxiety.

Among the general population in the US, depression affects 300 million people, anxiety as many as 40 million, and bipolar disorder nearly 6 million. With this kind of prevalence in the American population, it’s important to know the symptoms of a dual diagnosis. 

Symptoms of Dual Diagnosis

Diagnosing a co-curring disorder requires professional medical intervention. But recognizing the symptoms can help you get help for yourself or your loved one sooner.

The symptoms of a substance use disorder include:

  • social isolation from friends and family
  • engaging in risky behavior
  • sudden and unexplained changes in behavior
  • loss of control over using substances
  • a craving to use substances
  • developing tolerance and experiencing physical withdrawal when the substance isn’t taken in the same amounts
  • needing a substance to function 
  • using a substance despite the negative and harmful consequences

But because a dual diagnosis suggests the presence of a mental health condition, you should know how to spot those symptoms as well. They include:

  • confused thinking
  • problems with focus and upholding responsibilities
  • extreme changes in mood and/or behavior
  • isolation from friends and family
  • suicidal thoughts

Patients with a dual diagnosis, especially one that involves bipolar disorder or depression, have a high likelihood of developing suicidal thoughts and ideation. This is why getting immediate help upon discovery of the problem is so important.

How Is Dual Diagnosis Treated?

Dual diagnosis requires special treatment. Unfortunately, many traditional rehab facilities aren’t equipped to properly care for a dual diagnosis patient. But a treatment center that specializes in dual diagnosis treatment will have the resources needed to adequately care for you or your loved one.

Because the conditions and substances involved vary greatly between one patient and another, there’s no one-size-fits-all treatment for dual diagnosis. But there is a general process that most patients will benefit from knowing more about. Keep reading to learn more about what you can expect. 


If the substance use disorder has to do with a drug instead of something like sex or gambling, the patient will have to detox from the substance. This is a process that can last as long as 7 days, and in many cases, requires 24/7 monitoring by trained medical staff. This allows the patient to safely and effectively get the substance out of their system so they can begin the real work of recovery.


Too many treatment facilities focus on substance use disorder and not the underlying mental health condition. That’s why facilities specializing in dual diagnosis perform an initial assessment that evaluates both aspects.

A trained mental health professional will work with the patient to evaluate and understand their mental health. They can then offer a personalized program that addresses both substance use and mental illness.


While medications aren’t typically used after the detoxification part of drug rehab, they’re often used in dual diagnosis situations. This is because many of the mental illnesses involved in dual diagnosis require medication to stabilize the disease and begin recovery with clarity and balance. 

Therapy and Counseling

Therapy provides coping skills and the tools needed to better deal with the symptoms of mental illness. Armed with more understanding of their illness and better ways to deal with it, they’re less likely to turn to substances to alleviate their symptoms. 

But therapy is also an important part of recovering from substance use. It gives a patient insight into their self-destructive behavior and helps change their thought patterns.  

Getting Help With a Dual Diagnosis

Dual diagnosis requires a lot more than traditional rehab can give. Because the symptoms of the mental health condition are often worsened by the substance use disorder, recovery takes a lot of time, patience, and understanding. But with the right treatment program, you or your loved one can begin leading a normal life.

If you or someone you know is struggling with a dual diagnosis, they need professional help. Contact us today to learn more about how we can be the help you need.