Addiction

Dictionary definition of word psychotherapy | up close
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What is Psychotherapy

What is Psychotherapy?

Psychotherapy, also known as Talk Therapy, is the treatment of disorders using psychological techniques rather than medical intervention. The general intention of psychotherapy is the promotion of communication to aid in recovery from a variety of ailments. PT is used to improve conditions of emotional stress, anxiety, and substance abuse. By communicating with trained psychotherapy professionals, the patient can work towards a solution to their problems, usually by learning how to modify their thinking and behavior. The wide variety of approaches used in PT means it can prove successful for those of any age, gender, and personality type.

 

Types of Psychotherapy

Cognitive Behavioral Therapy, often referred to as just CBT, falls under the category of a psychotherapy. The psychotherapist’s aim with CBT is to aid the patient in altering their own behavior and thought. Commonly used for anxiety and depression, Cognitive Behavioral Therapy is a type of talk therapy where the therapist focuses on specific solutions to the patient’s problems. The Purpose of CBT is to get the patient thinking and acting more appropriately for their situation.

 

Psychodynamic/Relational

Psychodynamic Therapy is sometimes known as Relational Therapy and involves in-depth psychoanalysis conducted by a specifically trained psychotherapist. This unique technique in psychotherapy attempts to help both the therapist and the patient understand where their problems are coming from. Be it from emotional distress or deeply rooted fears or behaviors, the goal of the therapist is to develop the establish and enrich the patient’s self-awareness. Psychodynamic Therapy hopes to connect previous experiences to current behaviors.

 

Somatic Experiencing

Somatic Experiencing is a psychotherapy approach concerned directly with body awareness. Its principal intent is to heal trauma that is often the result from what has become known as post-traumatic stress disorder (PTSD). The focus of the treatment is on the patient’s somatic sensations; their perceived body sensations. The theory behind SE is that negative symptoms of trauma, like shame, anxiety, and embarrassment occur because we do not fully process the trauma. During treatment, the therapist will introduce minute amounts of stressful trauma and make observations on the patient’s response. From this, the Somatic Experiencing therapist can begin developing with the patient, strategies to regulate their stress responses.SE is one of the more recently developed psychotherapy treatments and has been successful for a variety of stress disorders.

 

EMDR

It’s a long one! EMDR stands for Eye Movement Desensitization and Reprocessing Therapy. What could that possibly entail? This psychotherapy approach has been very well researched and has consistently shown to produce positive results with respect to trauma recovery. During the treatment, the therapist will dig into the patient’s history to determine the root-cause of the trauma. The patient will then be trained in a few stress reduction techniques to be used during the therapy sessions. Visualization of the trauma, identification of self-negativity, and emotional responses and body sensations are all key aspects of the treatment. The actual EMDR techniques are a bit difficult to envision but include eye movements, taps, and tones. The inclusion of these stimuli is what has shown in research to bring success to the therapy.

TRM

The goal of this psychotherapy approach is for the patient to be able to manage their nervous system by controlling the sensations they experience with respect to their traumas. Our bodies have automatic responses to perceived threats; think fight, flight, and freeze. Trauma Resiliency Model uses several approaches to help the patient understand their natural responses to trauma and stress. Titration, tracking, and pendulation are some of the technique you’ll come across if you choose to undergo this psychotherapy. The uniqueness of TRM is that the body’s innate responses provide the foundation to work from. In other words, the patient already has everything needed to be successful in this approach to psychotherapy.

Motivational Interviewing

Motivational Interviewing is a fairly straightforward psychotherapy approach that works on facilitating and engaging intrinsic motivation within the client by focusing counseling session more on specific goals rather than self-expression from the patient. In MI the aim of the therapist is to influence the patient directly in hopes of accomplishing specific goals geared towards improving the patient’s state of mind and behavior. The presence of ambivalence is commonly very high in those suffering from addictions and trauma. The focused and direct approach of motivational interviewing sessions is designed to help the patient omit conflicting and contradictory feelings and thoughts which impede progress and eventual success in psychotherapy.

 

Group Therapy

This is one of the more well-known types of psychotherapy. Most often involving 6-12 patients and a single therapist, group therapy is a very open strategy that can integrate other psychotherapy techniques like cognitive behavioral therapy and motivational interviewing, in a group format. In this approach, the group itself is the key strategy. Group therapy leverages the group setting as an instrument for change by relying on the dynamics of interpersonal relationships. In groups, patients can lean on each other for support while learning from one another’s strengths and skillsets. For this reason, group therapy is one of the more command preferred psychotherapy approaches.

 

Interpersonal

Interpersonal psychotherapy is as the name implies, personal. Differing from group therapy as a one on one approach, IPT is highly structured and follows a strict timeframe usually of 12-16 weeks. Originally developed to treat depression, this psychotherapy approach is now utilized to treat many more types of issues, including substance abuse. There are 2 principal techniques in IPT, attachment theory, and interpersonal theory. The ultimate goal of interpersonal psychotherapy is to develop the patient’s communication abilities and therefore improve their ability to enter and maintain relationships with others.

What to Expect

 

There is no general expectation one could have for psychotherapy. The variety of approaches means the patient won’t know what to expect until they speak with a professional. Also varying is the length of treatment. Again, until the patient meets with a psychotherapy provider it is hard to say exactly how frequently and for how long they will receive treatment. When deciding to contact a PT provider it is key to keep in mind that these types of treatments for addiction have a long-standing record of success. Discuss your goals and define key indicators of successful psychotherapy with your provider.

 

Who Can Benefit

 

So, who can benefit from psychotherapy? In a nutshell, everyone. While psychotherapy comes in many different approaches and strategies there is more or less something for everyone. The benefits of PT to those suffering from addiction are well documented and widely utilized. However, it should be noted that a patient undergoing psychotherapy for addition can frequently make improvements in other aspects of life including mood, anxiety, and personality disorders.

 

How to Find a Provider

 

Google, of course! When searching for a provider in your area consider all the traits you would for most services. A local, well-established psychotherapy provider will have a better understanding of the local community and the common issues with substance abuse and addiction in that area. Ensure your providers is certified with reviews and has long-standing experience with your specific needs.

 

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The Secret Agreement To Treatment

What to expect in this episode

 

  1. It’s hard to give up your freedoms
  2. You need to trust others before you can trust yourself again
  3. Recognize what capital F freedom is

 

The whole crazy interesting dynamics of treatment

 

You know, treatment’s nothing like the marketing on the website, you go on the website and there’s a picture of two people sitting by a swimming pool and it’s like, “Oh, a romantic, safe place, where all of your needs will be taken care of, with a chef!” Maybe there are Treatment Programs like that, but they’re not very effective.

 

Treatment has a whole crazy interesting dynamic that’s not good to market on your web site, which is part therapy, part jail. What do we mean when we say that? Well, people come into treatment because, you know, they don’t trust themselves.

 

Basically, they’ve been engaging in a behavior that’s harming themselves, they’ve made multiple commitments to stop themselves from harming themselves and they’ve continually betrayed themselves and don’t trust themselves anymore.

 

So, then they come into treatment and you do your Intake, you have your conversation, you come to see if they’re appropriate, and then you shake hands and you say, “Okay, you’re coming in here”.

 

But, underneath that handshake — there’s a secret deal. What’s the deal? The deal is the client comes in and says, “I don’t trust myself, so I’m going to give you some of my freedom, because I can’t make my own healthy choices and I’m going to let you make decisions for me, okay?” and now, it’s like any easy deal, if you’re a decent person like I am.

 

“You’re like great. I’ll take a little bit of your freedom for a short period of time until you can begin to trust yourself and then you know, onward and upward”.

 

But, the secret part of that is, “I’m going to give you my freedom because I need you to take it, because I don’t trust myself, but in three weeks, I’m going to be fighting tooth and nail for my freedom back, even though I still don’t trust myself”.

 

Giving up your “freedoms”

 

This is the interesting dynamic of treatment — where people are willingly giving up some of their so-called freedoms to be able to walk to Starbucks when they want or make a phone call when they want, because they don’t trust themselves, but they’re so addicted to those so-called freedoms the non-capital F for freedoms, lower cast freedoms, that they fight you tooth and nail later.

 

And the process of holding somebody through that, holding somebody through until they come to a place of higher recognition, until they come to a place of recognizing what capital F freedom is, what real freedom is, freedom from their self, you know, freedom from the ego-self, freedom from my addiction, the freedom to say yes, the freedom to say no, right.

 

 

 

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Hitting Rock Bottom

 

What to expect in this episode

  1. Yeshaia’s Rock Bottom Moment
  2. Incarceration & Panic
  3. When the Darkness in Your Life is Exposed
  4. The Need for Something “Good”

 

Yeshaia tells the story of his own “intervention“. The day he went to jail and the weight of his life and his decisions came into sharp focus.

 

Finding Rock Bottom in Jail

 

I went to jail I remember I was in the county jail, and I had a panic attack – because I was so frightened and I was scared of the trouble I was in, and I was also really ashamed.

 

Because suddenly the darkness that I have been living in was really palpable to me and I couldn’t find anything in my life that felt good.

 

That was a bottom for me, yeah, it was, it was an eye-opener – Oh my god there’s nothing good and me and in my life! – and so as soon as I realized that I knew what I needed I needed good something good – you know – that really began the journey of recovery for me.

 

 

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Opening Up the Locked Heart of an Addict

 

What to expect in this episode

  1. The Paradox of Addiction
  2. Thread Between Unhappiness & Drug Abuse
  3. Help People Recover by Helping them Find Happiness
  4. The Day Yeshaia’s Heart Began to Open
  5. Cutting Through the Fear, Hopelessness
  6. Create Connection, Hope, & Opening the Heart

 

Addiction is Paradoxical

 

So, one of the things about addiction is, it’s paradoxical.  On the one hand, it’s very complicated, biological psychological phenomenon, on the other hand there are parts of it that are very simple, like, you’re never going to find a happy person who’s using tons of drugs.

 

you’re never going to find a happy person who’s using tons of drugs

 

We know there’s a relationship between being unhappy or demoralized or hopeless and the state of addiction, right.  So, we can gather from that, I gather from that, that one of the ways that we help people recover, is to help them find happiness or as I often talk about it, you know, opening the heart, because many people who are coming into addiction are really numb, they’ve really numbed out a lot of their feelings.

 

I know that because I was that, you know, since I was maybe 12 or 13 years old, I really stopped having the wide range of feelings that we have as human beings.  I want to share a story about one of the moments that my heart opened up. It’s a true story.

 

I have a daughter named Eden and she’s short, you know, short for her age.  My wife is also you know, relatively short. And I love basketball and so, you know, I want her to try the sport.  She was playing on a basketball team and the entire season I’m going to every game and she’s not making a single shot and she’s watching other people score and I’m you know, just kind of holding it in and feeling bad for her, that you know, she’s not succeeding in the way that she wants.

 

And the last game, there were all these parents around the basketball court and the ref, you know, it’s like five-year-old’s, so the ref is like holding people back, so the kids that never made a shot get a chance to make a shot.  And the ref is holding people back and my little five-year old daughter takes this basketball and she throws it up, you know, potty-shot style, and it pops in the hoop.

 

In that moment, like the moment that you heard the pop from the net, you know, the ball, my heart went, “Pop” and it was like it had been closed for years.  You know, even in sobriety. And I was like “Oh, my God what happened?” And I would just remember, I was like in this circle and I turned around and I put my hands over my face, because I was so surprised by what it felt like to feel love and feel your heart, and I began to cry, you know.

 

And I didn’t know what to do, other that to hide it, because I had never felt it before.  And so, you know, I relate that to sobriety and recovery, that we’ve got to be able to cut through a lot of our nomenclature, a lot of our fears, a lot of our hopelessness and we’ve got to be able to cut through a lot of that complexity and we’ve got have a lot of heart in the work.

 

You know, and really recognize what we’re doing.  I’m not saying there aren’t other factors, there are tons of other factors, but somewhere in the core, it’s about connection, it’s about hope, it’s about opening each other’s heart, it’s about seeing each other, seeing myself and you, and you seeing yourself in me, and cultivating those moments.

 

Because when you have those moments, you don’t go back.  I’m not going to climb back into the shadows and the darkness.  I know that there’s love. I know that there’s light. I know that there’s care out there.

 

 

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Interventionit Leading drug abuse intervention
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How to Stage an Intervention

What is an Intervention

 

An intervention is often the very first step taken by loved ones in helping someone with addiction. Whether it be an alcohol intervention, or a drug abuse intervention, there is an organized, planned approach for success. The purpose of the intervention is to confront the addict in hopes of promoting acceptance of the addiction and to show comforting support for the rehabilitation process to come.

 

How to Stage an Intervention

 

Gather a team

This is the foundation of an intervention, the team. Family interventions are most common however friends and colleagues of the addict can also be present. The ideal size for an intervention team is typically between 3-5 people the addict has a close relationship with. 3-5 team members are large enough to show the addict that there is an obvious addiction, but small enough to not overwhelm them and allow for easy communication amongst the group.

 

Intervention professional

Selecting the right interventionist is key to a successful intervention. Make sure the professional you choose is certified, and they should hold some sort of counseling degree or license. Experience counts too! The number of interventions they’ve conducted and their approach to interventions is also highly important. Have they had much experience with family interventions?     

 

Planning an intervention

Interventions can be highly stressful for everyone involved and are crucial to beginning the drug rehabilitation process. It is, of course, most important to identify exactly what the issue is and the reasons why an intervention is needed. Given the dramatic and emotional nature of interventions, thought must be given in selecting your intervention team. Decide who the addict is closest to and with whom they have comfort and trust.

 

Rehearse

Not too many of us have interventions as commonplace in our lives. For this reason, rehearsing and practicing the intervention with your team, and your chosen interventional professional is a must. Go over the initial approach, discuss and prepare exactly how the intervention should go. Perhaps most importantly, prepare yourself and your intervention team for the likely refusal or resistance from the addict to participate.

 

Define consequences

Accepting that one has an addiction is a very difficult thing. There is a very good chance the addict will deny the issue, or refuse to participate in the intervention and planned follow up care. Situations like these are why the intervention team should have planned some consequences to the addict if they refuse help. The consequences, of course, are dependent on the situation but oftentimes a proposed consequence may be taking away a vehicle, denial of visitation rights to children, or loss of employment. Your interventionist will be able to discuss these with you.

 

Choose a location

Remember that when choosing your intervention team, you must consider how comfortable and trusting the addict will be with the team members. The same consideration should be taken when deciding on where to conduct the intervention. Family interventions are personal and can be very emotionally charged. For that reason, public venues should be avoided. Consider where the addict is likely to be comfortable. Make sure the venue is a commonly visited place by the addict but not somewhere that may have a negative association. Perhaps some dramatic events related to the addiction have occurred at the addict’s home; choose a more neutral location for the intervention.

 

Be prepared for anything

Anything can happen during an intervention. This is one major reason why a professional interventionist should be present. Consider the viewpoint from the addict. Will they be defensive, offended, confused? There is an added element of unpredictability when dealing with those suffering from drug or alcohol addictions. Give some thought to the addict’s personality, the type of addiction they suffer from, and recent behaviors. Consider the possible reactions during the intervention and use that when considering your team members. A professional interventionist will be well versed in a variety of possible scenarios.

 

 

What Happens After an Intervention?

 

Detox

Time is of the essence post-intervention. It is imperative that the intervention team be ready for the addict’s acceptance for help and have a follow-up plan in place. The team should have a treatment facility chosen and registered. There needs to be an immediate transfer of the addict to their treatment facility following acceptance of the intervention and agreement to therapy. Have necessary items ready to go for the addict so no distraction can occur with packing. Have what they need ready, and ensure them everything is planned.

 

Extended care

Also known as Aftercare, extended care is the step following Detox. Here the addict may enter an inpatient care facility or an outpatient care center that allows the patient to return to some normal life activities. More information on Extended Care can be found at this link:

 

Sober living

A version of Extended Care where the addict can live in a designated housing community amongst other recovering addicts. This type of aftercare allows for a sense of normal life while still maintaining recovery strategies like group therapy, counseling, and structured behavior. This type of care may or may not suit all recovering addicts but should definitely be considered as a type of aftercare.

 

What if your Drug Intervention Fails?

 

What to do

Convincing an addict to seek treatment isn’t usually easy. Staging a successful intervention is tough and even if you do everything right there is a chance the addict may resist treatment. Don’t be discouraged if the first intervention attempt fails; plan, and try again. However, your post-intervention behavior is crucial to future success. Whatever ultimatums you made during the initial intervention should be maintained. This means you may have to move out of the house, cut off money supplies, or even make the addict leave the home. However difficult, you must stand firm on promises made during your intervention. Again, the most important thing you must do after a failed intervention is – try again.

 

What not to do

The things you shouldn’t do following a failed intervention fall in line with what you should do. Firstly, do not give up. It could very well take several tries before your attempt at intervention is successful. Secondly, do not make compromises. Remember the promises you made during the intervention; to leave, to file for divorce, to take away child visitation rights; this may be difficult but it is an absolute must for future success.

 

Why might your intervention fail?

Interventions are tough. They are tough to plan, tough to initiate, tough to go through, and tough to accomplish. Many will fail and if your intervention fails it is important to consider why. Perhaps the planning fell short. Maybe the flow of conversation wasn’t there or maybe the addict wasn’t comfortable with the group or location. Perhaps the intervention went in too many directions. Were there solid ultimatums given? Were those ultimatums committed to? Another reason interventions fail is because no clear solution to the addiction was presented. If too much focus is placed on the problem and not the solution, the intervention may stall. Focus on the solution!

 

 

 

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The Human Side of Treatment Behind the Opioid Epidemic: Ryan’s Story

I was working in residential treatment a few years back; one Friday night, a new resident, Ryan, approached me. He was a teenager, 5’6” with big, kind eyes, natural dark circles, and a face that turned red at every feeling or change in temperature. He asked, vulnerably, if he could speak with me. I took him to my office, we sat down and I asked, “What’s up?

 

I got out of Heroin detox two days ago. I’m 8 days sober. And I’m craving shooting heroin again.”

 

I could see that he was quite sincere and on the razors edge of going this way or that. I looked him in his eyes and asked him: “How are you going to use?” This question surprised him; I think he thought I was going to talk him out of it.

 

 

I’ll smoke it,” he said dryly.

“Do you have Heroin on you now?”

No,” he said.

I asked, “How will you get Heroin?”

“From my dealer” he responded, clearly getting impatient and annoyed.

I proceeded, “Do you have money?”

“Ten bucks” he answered.

I said “Give it to me,” and he did, and I put it in my pocket. “Do you have a cellphone?” I asked.

“No,” he was beginning to catch on to our game.

“How are you going to call him?” I pressed.

With some finality he said, “I’ll panhandle, get the money, I’ll call him from a payphone at the gas station, and get high.”

“So he will come drop it off and you’ll get high at the gas station?”

No.” Ryan said,  “my dealer doesn’t deliver, I’d have to take the bus to Inglewood and meet him.”

I continued, “After you meet him and get the dope where will you get high?”

“I’ll get some tinfoil and a straw from burger King and smoke it in the bathroom there.”

“And then what?” I asked accusingly.

“I’d be high,” he replied.

“And then what?” I asked.

“I’d go home,” he answered.

To your parents?” I asked.

“ No, they kicked me out. I’d come back here,” he admitted.

“To rehab?” I asked, “and then what?”

“I’d get sober,” he answered.

“You’d get sober? But you’re sober now!” I replied, too loud, revealing my inner judgement.

Yes but when I am High I really want to be sober,” he said.

Aha. “So let me get this right, in order for you to stay sober you have to get high?”

 

 

Two days later, Ryan was on the street getting high. Ryan wanted to be sober. But he wanted to be high, also. By the eighth day in treatment and sober, he had run out of motivation to stay sober. Why did Ryan need to get high in order to stay sober? When he went into his memory he realized that when he was high, he found the motivation to get sober; the crisis of addiction created an energy, a desire in him to get well. Ryan was cutoff, he was stuck in his own thinking, and his thinking was cut off from the world. He was stuck in a narcissistic bubble of addiction. Ryan was rational, but his reasoning was driven by an unconscious craving to get high. He didn’t want to get high, that’s why he asked to talk to me, but it was almost as if once he engaged me he was sleep talking, unable to wake up and stay where it was safe and welcoming. Underneath the mechanics of Ryan’s thinking there was something else going on. Ryan was numb, and underneath his numbness was pain, fear and sadness.

 

I wonder if I had been able to break out of my role in that moment: warm and clever counselor and instead become loving and vulnerable with him, would the effect have been different? If I had held his hand, been there with him 2 or 3 hours or however long was necessary, listened to his pain, given him a hug, could I have broken through to a different part of him and changed his trajectory? As it was, I believe we were both stuck in our roles at the time, him the out-of-control addict in need of saving and me the young-smart-(slightly)-distant counselor. Ryan recovered from his condition; I am still working on mine.

 

Ryan ended up in treatment two weeks later and has been sober ever since. So it turns out he was right, he had to get high in order to get sober.[/vc_column_text]

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Is Addiction a Developmental Disorder? | Beyond the “Unbroken Brain”

In Maia Szlavavitz’s new book “The Unbroken Brain” Maia articulately lays out a subtle and nuanced idea: Addiction is a developmental disorder.

 

It is a beautiful (although not new) idea that bridges the gap between the brain disease model of addiction and the idea that addicts are selfish amoral people “model” of addiction. The idea that addiction is developmental in nature accounts for the vast majority of what we see in the addicted populations. Addiction as a developmental disorder posits that there is a correlation between addictive behavior and a stuck or disordered learning process. It also posits that the solution for addiction is growing, learning and changing. This is spot on and would seem obvious, except for some reason this view has not spread or been articulated well to the mainstream. It is important to note that this theory does not account for why some people who get stuck along the course of healthy development, also get stuck in a cycle of addiction, and others don’t, this remains a mystery.

The interesting question to ask about addiction as a developmental disorder is what type of developmental disorder is it?

 

In what areas are people stuck and or split? Is there a construct that can account for the diversity and totality of the stuck states we find in the addicted population? In fact, there is The Developmental Integrity Theory of Addiction. Dr. Charles Blakeney a Harvard psychologist (and proudly my father) and researcher hypothesized in 2002 that clients suffering from addiction were suffering from a state of dis-integration. The idea was that people with addiction had underlying developmental disturbances that kept them stuck in addictive cycles, put simply they weren’t whole. This dis-integration was due to certain parts of the self becoming stuck (not growing) in the course of development. When one part of the self is growing and another is not, it creates a split, a developmental disturbance that essentially if unaddressed manifests as stress, pain, anger, anxiety or cut-offness. The Developmental Integrity theory posits that people are medicating their splits with drugs, alcohol and other escapist behaviors. The theory goes beyond the Unbroken brain hypothesis and articulates specifically what types of developmental disorders lie underneath the addictive behaviors.

Integrity is when the parts of the self fit and flow, have a strength in character, and the potential for transformation. Underneath all addictive states is a dis-integration, a lack of fit flow, a lack of transformative potential. Dr. Blakeney engaged 700 people in the addicted population, and all 700 had the predicted dis-integration. It is important not to understate in a 10 yr. longitudinal study 100% of people who were tested coming into treatment had these predicted states of developmental spits or delays. The theory is quite revolutionary because for the first time there is a construct that accounts for the diversity we see in the addicted populations. It also gives treatment a whole new way to understand and treat addiction. The test can pinpoint clients underlying issues and prescribe the correct therapeutic approach.

Unbroken Brain has begun to popularize the idea that the causes of addiction are developmental, the question becomes, now that we are beginning to understand this, what are we going to do about it?[/vc_column_text]

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