Substance Abuse

Different substances affect the brain in different ways. People use substances because of these effects, which include increasing feelings of pleasure or decreasing feelings of distress. Using alcohol and/or other drugs does not in itself mean that a person has a substance abuse disorder.
Substance use disorders include any of the following:

• Abuse of alcohol or other drugs which leads to work, school, home, health, or legal problems
• Dependence on alcohol or other drugs (see to the right)

​Substance use disorders tend to begin in adolescence or early adulthood... 75% develop substance use disorder by age 27... many people use alcohol or other drugs as self-medication for anxiety and depression.

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Symptoms of substance dependence are:

• Tolerance for the substance (the person needs increased amounts over time or gets less effect with repeated use)
• Problems with withdrawal (the person experiences withdrawal symptoms or uses substance to relieve withdrawal symptoms)
• Use of larger amounts over longer periods than intended
• Problems in cutting down or controlling use
• A lot of time spent getting the substance, using it, or recovering from its effects
• The person gives up or reduces important social, occupational, or recreational activities because of substance use
• The person continues using the substance despite knowing that use has negative consequences

The Rapid Alcohol Problems Screen (RAPS4)

A "YES" ANSWER TO AT LEAST ONE OF THE FOUR QUESTIONS SUGGESTS THAT YOUR DRINKING IS HARMFUL TO YOUR HEALTH AND WELL-BEING AND MAY ADVERSELY AFFECT YOUR WORK AND THOSE AROUND YOU. IN THIS CASE, YOU SHOULD GET A FULL EVALUATION FROM A QUALIFIED PROFESSIONAL.

1. During the past year, have you had a feeling of guilt or remorse after drinking?
2. During the past year, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
3. During the past year, have you failed to do what was normally expected from you because of drinking?
4. Do you sometimes take a drink in the morning when you first get up?

Mental Health First Aid USA: 2009 Edition. Kitchener, et al. 2009. Anne Arundel County Mental Health Agency, Maryland.

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Substance Use Resources

American Addiction Centers

A confidential, toll-free call with a medical professional specifically for first responders.
​1 (888) 731-FIRE (3473)

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Alcohol Screening

A confidential website developed by the Boston University of Public Health to help identify problem behavior.

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Drug Screening

A parallel website to the Alcohol Screening website; a confidential website developed by the Boston University of Public Health to help identify problem behavior.

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Alcoholics Anonymous

Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. Membership is open to anyone who wants to do something about his or her drinking problem.

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Narcotics Anonymous

A group that provides help through group meetings of peers and offers an ongoing support network for addicts who wish to pursue and maintain a drug-free lifestyle. Narcotics Anonymous, is not meant to imply a focus on any particular drug; NA’s approach makes no distinction between drugs including alcohol. 

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IAFF Center of Excellence for Behavioral Health Treatment and Recovery

Opening in March of 2017, the "IAFF Center for Excellence" is built and developed by Advanced Recovery Systems, and will be located in Upper Marlboro, Maryland to offer treatment of successful recovery from post-traumatic stress and co-occurring addictions and help IAFF members return to the job as quickly as possible. The Center will offer: Detox, Intensive in-patient care, Residential care including medical monitoring, Outpatient care and services, and 12-step meetings. For more information use the website linked through the name or by calling 1 (855) 900-8437. 

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Florian Treatment Center

The Rosecrance Florian Program offers the best opportunity for lasting recovery by incorporating occupational factors into the treatment process. Daniel DeGryse, an active-duty Battalion Chief/EMT with more than 27 years of experience at the Chicago Fire Department and 30 years of experience in the field of addiction and mental health, directs the Rosecrance Florian Program. He developed the program in collaboration with Dr. Raymond Garcia, a board-certified psychiatrist and addictionologist who is trained and experienced in treating firefighters and paramedics for co-occurring disorders

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Stepstone Connect

Stepstone Connect is an organization based out of Utah connected to Dear Hollow.  Dear Hollow is geared around working with first responders and treating everything from post-traumatic stress to addictions.  Stepstone is a an alternative form of counseling, it is all done via video conferencing.  You don’t have to drive to an office and you don’t have to sit in a waiting room hoping to not be recognized.  You don’t have to figure out what day of the week you can go that fits in with your shift schedule and your family schedule.  You meet with a counselor on-line, they work around your shift work schedule, they can connect you with a specialist who just might happen to be in Florida but they are the best in the business with what you are dealing with. And they take insurance.

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Gambling Addiction

- Jeanne Segal, Ph.D., Melinda Smith, M.A., and Lawrence Robinson for FireStrong

Why We Gamble

A night out at the casino is all fun and games until you realize you lost $1,000 on the slot machines or blew it all at the blackjack table. However, just because you had a rough night and lost everything one time doesn’t mean you can’t win it back next weekend! Isn’t the whole point of gambling to take risks? With that being said gambling is easy to get addicted to because taking risks and betting is fun, and that slim chance of winning easy money is even better.

When Does Gambling Become a Problem?

Gambling is a type of impulse control issue meaning that even after numerous negative outcomes people cannot stop. Compulsive gamblers cannot control the impulse to gamble, even when they know it’s hurting themselves and their family. Even if the odds are against them, a person with a gambling problem gets sucked into the vicious cycle of betting and losing until they have nothing left. Behaviors like this can often cause someone to lose control in other parts of their life.
If you or a loved one is consistently going through one or more of the following indicators below, it might be best to seek further treatment.

• The need to gamble with increasing amounts of money in order to achieve the desired excitement.
• Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
• After losing money gambling, often returns another day to get even (“chasing” one’s losses).
• Lies to conceal the extent of involvement with gambling.
• Have jeopardized or lost a significant relationship, job, educational or career opportunity because of gambling.
• Relies on others to provide money to relieve desperate financial situations caused by gambling.
• Restless or irritable when attempting to cut down or stop gambling.
• Have made repeated unsuccessful efforts to control, cut back, or stop gambling.
• Are often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).

Someone can have a gambling problem, but not be completely out of control. Problem gambling occurs when any gambling disrupts your life. If you’re preoccupied with gambling, spending more time and money on it, or gambling despite serious consequences, you have a gambling problem.

​Myths and Facts about Problem Gambling

MYTH: You have to gamble everyday to be a problem gambler.
FACT: Gambling becomes a problem if it causes problems

MYTH: I can afford gambling so it’s not an issue.
FACT:  Problems caused by excessive gambling are not just financial. The lifestyle can cause issues with other relationships.
​
MYTH: Outside circumstances such as relationships and stressors cause a person to gamble
FACT: Problem gamblers can rationalize their behavior. Blaming others and situations are ways to avoid taking responsibility for their actions.

Signs and Symptoms of Gambling Addiction and Problem Gambling

Gambling addictions is sometimes referred to as the “hidden illness.” There are no obvious physical signs of gambling like there are with alcohol or drug addictions. Problem gamblers typically deny or minimize the problem and go to great lengths to hide it. People with gambling issues tend to be very sneaky and lie about where they have been and what they’ve been doing.

Do I Have a Gambling Problem?

Take a moment to answer a few of these questions:

• Do you feel the need to be secretive about your gambling?
• Do you have trouble controlling your gambling? (Once you’ve started you can’t stop?)
• Do you gamble even if you don’t have the money? (major red flag!!)
• Is your family and friends worried about your habit?

How to Recover From a Gambling Problem

While a night spent at the track or the casino can seem like a fun way to unwind and socialize there are healthier and less expensive ways to unwind and de-stress. Hobbies such as exercising, meditating, new hobbies, or binge watching 3 seasons of a TV show in one day are ways to relax after a stressful day at work. Even when gambling is not longer a part of your life, the painful and unpleasant feelings that may have prompted you to gamble in the past will still remain. It’s important to recognize feelings such as stress, depression, fear, anxiety, etc. and learn how to properly deal with those negative feelings.
Every gambler is unique and so needs a recovery program tailored specifically to him or her. What works for one gambler won’t necessarily work for you. The biggest step is realizing you have a problem with gambling. It takes tremendous strength and courage to own up to this, especially if you have lost a lot of money and strained or broken relationships along the way. Don’t despair, and don’t try to do it alone. Many others have been in your shoes and have been able to break the habit. 

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Gambling Resources

Evergreen Council on Problem Gambling

A help and information resource for residents of Washington State on problem gambling. You may chat with them on their website, or call/text their free 24-hour help line: 1 (888) 547-6133

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Gamblers Anonymous

This a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from a gambling problem. The Washington Gamblers Anonymous phone line is: 1 (855) 2CALLGA

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National Council on Problem Gambling

A website whose purpose is to serve as the national advocate for programs and services to assist problem gamblers and their families

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Gambling FAQ

Informational website on gambling developed by Washington State DSHS

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Tobacco Addiction

Cigarettes
​Reasons to Quit

www.smokefree.gov

Smokeless Tobacco
Get the Facts

When a strong craving hits, it can be easy to lose sight of the benefits of quitting. You might lose your focus, but there is no good reason to smoke.
Remind yourself of the rewards of quitting to help yourself stay on track:

• 20 minutes: heart rate, blood pressure drop
• 12 hours: carbon monoxide in blood stream drops to normal
• 2 weeks–3 months: circulation, lung function improve; heart attack risk begins to drop
• 1–9 months: cough less, breathe easier
• 1 year: risk of coronary heart disease cut in half
• 2–5 years: risk of cancer of mouth, throat, esophagus, bladder cut in half; stroke risk is reduced to that of a nonsmoker
• 10 years: half as likely to die from lung cancer; risk of kidney or pancreatic cancer decreases
• 15 years: risk of coronary heart disease same as non-smoker’s risk

Immediate Rewards
There is no safe amount of cigarette smoke. When you smoke, the chemicals in tobacco reach your lungs quickly every time you inhale. Your blood carries the toxins to every organ in your body. But after you quit, your body begins to heal within 20 minutes of your last cigarette. The nicotine leaves your body within three days. As your body starts to repair itself, you may feel worse instead of better. Withdrawal can be difficult, but it’s a sign that your body is healing.
Long-Term Rewards
Quitting can help you add years to your life. Smokers who quit before age 40 reduce their chance of dying too early from smoking-related diseases by about 90 percent. Those who quit by age 45–54 reduce their chance of dying too early by about two-thirds. You can take control of your health by quitting and staying smokefree. Over time, you’ll greatly lower your risk of death from lung cancer and other diseases such as heart disease, stroke, chronic bronchitis, emphysema, and at least 13 other kinds of cancer.
When you quit, you’ll also protect your loved ones from dangerous secondhand smoke. You’ll set a good example and show your family that a life without cigarettes is possible.

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What is Smokeless Tobacco?
Smokeless tobacco is tobacco that’s not burned. It’s also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff.
Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up. There’s also “spitless” smokeless tobacco.
There are two main types:

• Chewing tobacco. This is available as loose leaves, plugs (bricks), or twists of rope. A piece of tobacco is placed between the cheek and lower lip, typically near the back of the mouth. It’s either chewed or held in place. Saliva is spit out or swallowed.
• Snuff. This can be finely cut or powdered tobacco. It may be sold in different scents and flavors. It’s packaged moist or dry—most American snuff is moist. It’s available loose or in small pouches similar to tea bags. People take a pinch or pouch of moist snuff and put it between the cheek and gums—or behind the lips. In the U.S., dip or dipping tobacco and snus are common forms of moist snuff.

Is it addictive?
Yes. Smokeless tobacco contains nicotine, which is addictive. People who use smokeless tobacco and people who smoke have similar levels of nicotine in their blood.
With smokeless tobacco, nicotine is absorbed through the mouth and gets into the blood. Then it goes to the brain.
Even after people take tobacco out of their mouths, nicotine is still being absorbed into their blood. Research shows that nicotine stays in the blood longer for people who use smokeless tobacco than for smokers.
Is it harmful?
Yes. Smokeless tobacco has high levels of chemicals and other substances that can cause cancer. People who use smokeless tobacco have a high risk of mouth and throat cancer.
People who use smokeless tobacco have more dental problems than people who smoke or people who don’t use tobacco products. The sugar in smokeless tobacco can cause decay and painful mouth sores. Dip and chew can cause people’s gums to pull away from their teeth. This leads to loose teeth. Smokeless tobacco can also cause leathery white patches that can turn into cancer. 

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FAQs for Helping Someone Quit

Quitting smoking is hard. Getting support from others can help smokers quit and stay smokefree. If you are a friend, family member, or health care professional, learn what you can do to support someone on their smokefree journey.
Someone who feels supported is more likely to quit smoking for good. That’s why friends, family members, and significant others can play a big part in helping a person become smokefree. 
It's Hard to Quit
Smoking cigarettes isn't a bad habit. It's a serious and complicated addiction. That makes quitting smoking one of the biggest challenges many smokers will ever face.
Deciding to quit doesn't mean thoughts of smoking go away at once. It takes time for cravings to fade, and it can take a person more than one try to successfully quit. Most people who quit don't do it on their own. They get a lot of help and support from friends, family, and significant others.
Know Your Relationship Style
The way you deal with smoking can have an effect on a person who is trying to quit. It helps to become aware of your relationship style. Your style affects their smoking, their quitting, their health, and yours. Ask yourself these questions:

• Do you mind that they smoke around you?
• Do you argue about smoking?
• Do you avoid talking about smoking?
• Has a health problem changed the way you deal with smoking?

Understanding your relationship style can help you understand what both of you may have to change to better deal with their smoking and quitting. For example, you may need to:

• Recognize your friend or family member’s small successes when quitting. 
• Avoid criticizing them if they slip and have a cigarette.
• Decide it's time for you to quit smoking, too.

Start the Conversation
It can be hard to get someone to talk about quitting smoking. To get a conversation started, look for an opening. Respond positively when someone says: 

• "I'm thinking about quitting smoking."
• "My doctor told me that I should quit smoking."
• “I’m pregnant. I should probably quit smoking.”
• “My wife is pregnant. I should probably quit smoking for her.”
• "My kids are asking me about my cigarettes. I should probably quit smoking for them."

Let them know you think it's great they're considering quitting and that you're ready to help. If you're an ex-smoker, you can draw from your own experience of quitting. Let them know how much better you feel now that you're smokefree. You might say:

• "I'm so proud of you for trying to quit smoking. I'll help with whatever you need to make it happen."
• "Quitting smoking will be hard, but I know you can do it. Have you set a quit date?"
• "You're not in this alone. Even if it gets tough, I'll be here for you."
• "Quitting smoking is the best thing I ever did! Let me know if you need any tips."

Create an Opening
If someone doesn’t give you an opening, create one. Ask them whether they’ve thought about quitting. Or you could try a different approach. You might say:

• "I heard on the news that taxes on cigarettes might go up soon. Sounds expensive. What do you think?"
• "I saw a commercial last night that showed an ex-smoker who lost teeth from gum disease caused by smoking. I didn't know that could happen. Did you?"

Ask Questions
Asking open-ended questions can help you understand what a smoker who is quitting is going through. You might ask:

• "What made you want to start smoking?"
• "What things make you crave a cigarette?"
• "What made you decide to quit smoking?"
• "What things have been stressing you out lately?"
• "What could I do to help make quitting easier for you?"

Listen
Quitting smoking is about them—not you. Listen to what they have to say. If you ask a question, be quiet and give them time to answer. Resist the urge to insert your own comments.
Be There for the Long Haul
The challenges of quitting smoking don't end when a person puts down their last cigarette. Cravings can pop up weeks, or even months, later. It's not uncommon for ex-smokers to start smoking again within the first three months of quitting.
​Let your friend or family member know you're there for the long haul. Keep celebrating their smokefree anniversaries and offer distractions to help them deal with cravings. Your ongoing support could be all they need to make this quit attempt their last.

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Resources

Stay Away from Tobacco

Quitting tobacco is not easy, but it can be done. Whether you smoke cigarettes, use smokeless tobacco, or are trying to help a friend or loved one, you'll find the information you need at this page at cancer.org.

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SmokeFree.gov

Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.

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UCanQuit2.org

Quit Tobacco – UCanQuit2.org is an educational campaign for the U.S. military, sponsored by the U.S. Department of Defense. Launched in February of 2007, the mission of the campaign website is to help U.S. service members quit tobacco—for themselves and for the people they love.

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1-877-44U-QUIT

National Cancer Institute’s Smoking Quitline offers a wide range of services, including individualized counseling, printed information, referrals to other resources, and recorded messages. Smoking cessation counselors are available to answer smoking-related questions in English or Spanish, Monday through Friday, 8:00 a.m. to 8:00 p.m., Eastern time. 

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1–800–QUIT–NOW

Your state has a toll-free telephone quitline. Call to get one-on-one help with quitting, support and coping strategies, and referrals to resources and local cessation programs. The toll-free number routes callers to state-run quitlines, which provide free cessation assistance and resource information to all tobacco users in the United States. 

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What is Sexual Addiction?

Recovery.org

Sexaholics Anonymous as an organization defines sexual addiction as a relationship with sexual activity that leaves the individual in a state of guilt and dissatisfaction with life. Most individuals with sexual addictions are disconnected from their daily lives, families and peers as a direct result of their addiction. For example:

• They are often unable to have normally functioning relationships with their sexual partners due to the addiction.
• They tend to express an overall dissatisfaction with their lives.

If you feel that you or someone you know is struggling with sexual addiction, it is often difficult to overcome the stigma and fear that keep many from reaching out for help. Maybe you are afraid of judgment from family or peers, but sexual addiction is something you don't have to deal with alone.
Contact our 24/7 hotline at 1 (888) 319-2606 today to speak with one of our understanding and knowledgeable representatives about seeking treatment for your addiction. We are happy to provide you with information on joining a support group or on program to help you in the recovery process.

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Sexual Addiction Resources

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Heidi Monuteaux
heidi@befreecounseling.com
www.befreecounseling.com
(206) 304-3345

Heidi is a Licensed Mental Health Counselor (LMHC), Certified Sex Addiction Therapist (CSAT) and Attachment Focused EMDR therapist at BeFree Counseling in Bellevue and Renton. She works with children, teens, adults and couples who struggle with a wide variety of concerns. She specializes in treating women who are impacted by their partner's sexual compulsive behaviors and those who are experiencing negative consequences of their own compulsive sexual behaviors.  
Heidi has been working with families in some capacity for over 20 years as a coach, mentor, teacher and mental health counselor. She has extensive experience providing therapeutic services to children, adolescents, and families both within community health and school-based settings. She has experience working in an in-patient medical setting working with adults that have complex medical and behavioral issues. In addition, her father and grandfather were both first responders and she is passionate about helping individuals and families navigate the challenges of this work.
Heidi earned a Bachelor’s degree in Family Sciences from George Fox University and a Master of Arts in Counseling Psychology from Northwest University. Heidi is a Licensed Mental Health Counselor (LMHC), Certified Sex Addiction Therapist (CSAT) and Attachment Focused EMDR therapist at BeFree Counseling in Bellevue and Renton. She works with children, teens, adults and couples who struggle with a wide variety of concerns. She specializes in treating women who are impacted by their partner's sexual compulsive behaviors and those who are experiencing negative consequences of their own compulsive sexual behaviors.  

Heidi has been working with families in some capacity for over 20 years as a coach, mentor, teacher and mental health counselor. She has extensive experience providing therapeutic services to children, adolescents, and families both within community health and school-based settings. She has experience working in an in-patient medical setting working with adults that have complex medical and behavioral issues. In addition, her father and grandfather were both first responders and she is passionate about helping individuals and families navigate the challenges of this work.
Heidi earned a Bachelor’s degree in Family Sciences from George Fox University and a Master of Arts in Counseling Psychology from Northwest University.

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Justin Monuteaux, MA, MBA, LMHC, CSAT  
justin@befreecounseling.com
www.befreecounseling.com
(206) 304-7678

Justin is a Licensed Mental Health Counselor (LMHC) and Certified Sex Addiction Therapist (CSAT) Candidate at BeFree Counseling in Bellevue and Renton who specializes in working with couples, men and adolescent boys who have been impacted by compulsive sexual behaviors. In addition, he works with a wide variety of issues including:

• Infidelity
• Trauma
• Anger
• Anxiety
• Depression
• Alcohol & Drug use
• Premarital counseling
• Communication/Conflict Resolution in relationships
• Life Transitions
• Spiritual Concern

Justin has extensive experience working with first responders, couples and families as well as at-risk and incarcerated youth. His experience spans 20 years of work as a therapist, mentor and teacher. Justin married into a law enforcement family almost 20 years ago and is passionate about helping first responders deal with the unique challenges of the important work they do every day.

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Other Addictions

Addiction is a condition that results when a person ingests a substance (e.g., alcohol, cocaine, nicotine) or engages in an activity (e.g., gambling, sex, shopping) that can be pleasurable but the continued use/act of which becomes compulsive and interferes with ordinary life responsibilities, such as work, relationships, or health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.

However, most addictive behavior is not related to either physical tolerance or exposure to cues. People compulsively use drugs, gamble, or shop nearly always in reaction to being emotionally stressed, whether or not they have a physical addiction. Since these psychologically based addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn't what matters; it's the need to take action under certain kinds of stress. Treating this kind of addiction requires an understanding of how it works psychologically.

-Psychology Today, "Addiction", https://www.psychologytoday.com/basics/addiction

Some other types of addiction are:

• Food
  
• Computer/Video Games
  
• Working
  
• Exercising
  
• Shopping
  

If you or someone you know is struggling with an addiction, consider using one of the resources listed on the Health Care Resources page, under "Mental Health", or you may also contact a Peer Support Team Member, one of our Chaplains, Code 4 Northwest, or Safe Call Now.

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