×
24/7 Help (661) 630-4176
Recognizing Drug & Alcohol Abuse in the Workplace

Recognizing Drug & Alcohol Abuse in the Workplace

Drug and alcohol abuse in the workplace has steadily increased since the beginning of the virus pandemic in 2020.  Since then, the number of workers who miss work or perform poorly on the job has nearly doubled.  According to the 2020 Behavioral Health Impact Update, substance use now affects 49% of American workers.  

As a result of employee substance use at home or in the workplace, companies suffer expensive consequences.  The losses reach $100 billion a year, according to the National Clearinghouse for Alcohol and Drug Information (NCADI).   

How Employee Substance Abuse Affects the Workplace 

Substance abuse by employees can cause a variety of problems.  These problems can include costly medical, social, and performance issues. Furthermore, they can affect both the employer and other employees who are trying to do a good job.  So, if a person comes to work hungover, or uses substances while at work, the entire workplace suffers.

Substance abuse by workers can lead to the following issues:

  • Repeated tardiness.
  • Hungover, sleeping on the job.
  • Poor decision-making. 
  • Inability to focus on tasks.
  • Reduced efficiency.
  • Trouble getting along with co-workers.
  • Stealing from the employer or co-workers.
  • Selling drugs while at work.
  • Using drugs or alcohol while on the job.
  • More likely to injure themselves or others.

Studies show that nearly 6% of heavy drinkers showed up at work high or drunk in the past year.  With that in mind, could you recognize if a co-worker is using drugs or alcohol on the job?

Spotting a Co-Worker’s Substance Use on the Job

Surprisingly, substance use in the workplace is not as isolated as we might think.  In fact, studies show that 10 to 20 percent of workers who died at work tested positive for drugs, alcohol, or both.  

Here are some ways to detect drug and alcohol abuse in your workplace:

  • Unexplained absenteeism.  If someone is missing from their desk or worksite without an excuse or reason, it could be a sign they are using drugs or alcohol.
  • Chronically late.  If a coworker is always late on Mondays, it could be due to heavy partying over the weekend.
  • Unexplained accidents.  Someone who frequently gets odd injuries while at work may be high.
  • Over-reacting to incidents.  If a coworker goes into fits of rage over small things that happen during the workday, it may be a sign of substance use.

Of course, these suggestions are not meant to make you feel that you must spy on your coworkers.  Also, there could be other explanations for their behavior.   But, if you do notice these signs, how should you react?  

How to Handle Suspected Workplace Substance Use

If you suspect a coworker of substance use during work time, it puts you in a tricky position.  Do you say something, and risk the repercussions if you’re wrong?  Or, if you don’t say anything, could someone get hurt and you’d feel responsible?  It’s a difficult position to be in, but there are some subtle ways to handle the situation.

  1. Document any evidence you think will support your suspicions. This should only include workplace behaviors.  
  2. Ask for a private meeting with your manager or human resources supervisor.
  3. Don’t confront the coworker yourself.
  4. Share your concerns with the manager and show them the evidence you documented.
  5. Let the manager or supervisor handle the situation from there.  

Most companies today have specific guidelines to follow in these instances.  In most cases, they will do what they can to help the person get treatment.  Being caught or accused of substance use in the workplace doesn’t mean the person automatically loses their job.  Many companies allow a person to return to work after completing a rehab program.

What Steps are Necessary to Create a Drug-Free Workplace?

When it comes to creating a culture that emphasizes a drug-free environment, business owners and managers have a big responsibility.  But, they can reach out to state and federal resources for assistance.

Here are some things managers, supervisors, CEO’s, and other business professionals can do to prevent employee drug use at work:

  • Establish a clear policy about workplace substance use.
  • Include pre-employment drug testing and random drug testing.
  • Make sure employees are informed about the consequences of failing a drug test.
  • Allow time off for people in treatment or recovery from substance use according to the ADA guidelines.
  • Provide health insurance for employees that includes coverage for substance abuse treatment.
  • Ensure that the company drug policies are in compliance with federal or state laws.

Small businesses owners also struggle with drug and alcohol use in the workplace.  Also, they are less likely to have programs in place to address the issue.  For that reason, the US Department of Labor offers a workplace kit to help small business owners create and maintain a drug-free environment.  

Drug and Alcohol Addiction Treatment at Cycles of Change Recovery

Recognizing drug and alcohol abuse in the workplace is a great start in reducing additions.  But, making sure a person gets effective treatment is the ultimate goal.  Choosing the right program is another way to ensure that a person overcomes an addiction.

At Cycles of Change Recovery, we offer a unique, individualized approach to treatment.  We want our patients to get the perfect level of care for their specific needs.  Also, our team of skilled professionals is dedicated to ensuring the comfort and safety of our patients as they progress through the program.  We strive to help a person realize their true potential and provide the counseling and guidance they need to reach their goal of substance-free living.  

Contact us today at our Palmdale, California facility to learn more about our programs.  After you take this first step, we’ll be there to guide you through the rest.   

Sources:

  1. businesswire.com/ – 49% of US Workers are Struggling with Alcohol and Substance Abuse
  2. standard.com/ – Behavioral Health in the Workplace
  3. workplace-dynamics.com/ – Building Blocks for a Drug-Free Workplace
How Long Will I Be in Recovery?

How Long Will I Be in Recovery?

The terms recovery and treatment are often used interchangeably.  Although they are related concepts, they are not the same thing.  If you’re wondering how long you’ll be in recovery, you must first understand what recovery encompasses.  

Treatment is a part of recovery.  But, recovery involves more than spending time in a rehab facility.  If you’re struggling with substance abuse or addiction, it’s important to have realistic expectations about quitting.  So, let’s explore the key differences between treatment and recovery processes.

Treatment is the first stage of recovery.

Addiction treatment programs often include detox, counseling, therapy, and aftercare.  Depending on the person’s circumstances, treatment providers can offer inpatient or outpatient programs.  The first step is detoxification.  Many facilities offer onsite detox programs which are more convenient.  

Contrary to what many people think, detox is not a cure for addiction.  This process only addresses the physical aspect of addiction.  The next step in treatment is to participate in a rehabilitation program that focuses on the emotional and mental aspects of the addiction.  Why is this important?  Because there are often underlying reasons why a person engages in substance abuse.  The reasons can include elements such as environment, family history of drug use, physical or mental abuse, emotional issues, mental health problems, and more.

According to the American Society of Addiction Medicine (ASAM), addiction is:

“… a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Treatment programs must have a flexible, comprehensive curriculum that can adapt to each person’s unique situation to ensure long-term recovery.  Depending on the substance involved and the duration of the addiction, treatment programs can last 30, 60, 90 days, or longer if needed.  Most people need at least three months in treatment followed by an aftercare program for continued support and guidance.

Recovery Is an ongoing process of staying sober.

When people refer to themselves as “recovered’ they should instead refer to themselves as “in recovery.”  The distinction is vital to the individual’s understanding of the process.  Recovery cannot be determined by a specific length of time.  It is an ongoing process that the individual must work at for a lifetime.  Also, the experience is different for each person.  So, recovery cannot be given specific parameters.  

Being in recovery means applying the concepts and skills learned while in a treatment program.  The classes, activities, and counseling help clients regain self-esteem, build confidence, and develop effective coping techniques.  They learn to recognize and manage triggers that could lead to relapse. The goal is to help a person manage daily tasks or stress without the need for addictive substances.  In other words, treatment provides a firm foundation for building a sober life.

So, how long will you be in recovery?  The best way to look at it is that each day brings challenges and temptations.  How you respond to those factors will determine whether you continue in recovery or suffer a relapse.  But, never forget you are not alone in the experience.  Millions of people are active in recovery today and enjoying the benefits of healthier, sober living.  

What if I relapse while in recovery?

Relapse is not uncommon during recovery. According to the National Institutes of Health (NIH), 50 to 90 percent of recovering alcoholics relapse within the first four years after rehab.  For recovering drug abusers, the relapse rates are approximately 40 to 60 percent.  But, the way the person responds to relapse is the crucial factor.  In most cases, a person who has a “slip” can get back on track by attending a self-help meeting.  With a full relapse, additional time in rehab may be needed.

The differences between a “slip” and a full relapse are:

  • A slip is a short-lived occurrence.  The person may use the substance for a day and realize the risk they’ve taken.  They then take steps to stop using before addiction takes hold again.
  • A full relapse happens when the person returns to a pattern of substance use over a long period of weeks or months.  They may isolate themselves and skip meetings due to shame or guilt about the relapse.   

Relapse can be dangerous if the person uses the same amount of the substance they used before treatment.  This happens because the body no longer has a tolerance for the substance.  Fatal overdoses are a concern for people who relapse after treatment.  

Treatment and Recovery at Cycles of Change Recovery

Remaining in recovery is a continuing process of trying different methods to cope with daily stressors.  At Cycles of Change Recovery, we understand the challenges faced by our clients when they step back out into the world as sober individuals.  Therefore, we provide a comprehensive treatment program customized for each client’s specific needs.  

With the right combination of education, support, and compassion, we give our client’s the best chance for moving forward toward a purposeful, healthier lifestyle.  If you or a loved one is struggling with addiction, please contact our Palmdale, California facility today.  We will be happy to discuss our treatment options and get you started on the next cycle of change in your life.

Sources:

  • asam.org – Definition of Addiction
  • ncbi.nlm.nih.gov – A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence
How Does Heroin Abuse Affect Your Mental Health?

How Does Heroin Abuse Affect Your Mental Health?

The prevalence of heroin abuse and addiction today has reached shocking proportions.  It caused more than 14,019 fatal overdoses in 2019, and the numbers are rising.   Yet, the impact of heroin abuse isn’t restricted to fatal overdoses. Heroin users struggle with the negative effects of the drug in many other ways. 

Heroin is one of the leading causes of the opioid epidemic America faces today.  It is an opioid that is 50 times stronger than morphine.  The euphoric effects it produces are almost immediate.  Also, heroin addiction can occur with only a few doses.  Soon, the person needs more and more of the drug to get the desired effects.  Over time, the endless cycle of getting high, coming down, and seeking more of the drug becomes their primary focus in life.  Continued heroin use will lead to serious physical and mental problems.

How Does Heroin Abuse Cause Mental Health Problems

To better understand how this substance can cause so much suffering and damage, we need to know how heroin works in the body.  What happens when heroin enters the brain to cause mental health problems that ruin a person’s life?

  1. Heroin acts on the brain’s natural opioid receptors.  These receptors regulate how a person perceives pain.  They also control how an individual responds to the sensation of reward.
  2. The chemical make-up of heroin causes it to work faster than other opioids.  If a person injects heroin, it enters the bloodstream and reaches the brain in 10 seconds.
  3. Heroin then activates and overstimulates the brain’s opioid receptors.  This effect gives the user a sense of contentment and bliss that other drugs can’t produce.
  4. When heroin use continues for long periods, the structure of the brain changes.  These changes are irreversible in some cases.  The changes also erode a person’s ability to control behavior, make decisions, and respond to stimuli.
  5. The brain produces extra opiate receptors to compensate for the continued presence of the drug. Dopamine, which controls how a person responds to pleasure, is also affected by heroin.  The brain’s ability to produce dopamine slows or stops.  This effect leaves a person unable to experience pleasure without the drug in their system.

As a result of heroin’s power, a user experiences various mental health problems that can completely alter the course of their life.

Mental Health Disorders Caused by Heroin Abuse

Heroin abuse can lead to short-term and long-term physical and mental health issues.  For this discussion, we will focus on the mental health problems experienced by heroin abusers.

Changes in a person’s brain caused by repeated heroin use can lead to the following psychological problems:

  • Depression
  • Anxiety
  • Aggression
  • Paranoia
  • Hallucinations
  • Suicidal ideations

Heroin abuse can also cause disruptions in brain functions that control the following:

  • Thinking
  • Learning
  • Decision-making
  • Ability to focus
  • Memory 
  • Processing information

The consequences of heroin abuse can also affect the person’s family, friends, and communities.  Many relationships are broken due to a person’s drug use behaviors. Also, heroin-related crime destroys many neighborhoods, especially in inner-city areas.  Furthermore, the financial burden on our government for law enforcement, incarcerations, health care, hospitalizations, and treatment programs is staggering.  

For these reasons and more, helping individuals get treatment for heroin abuse before more damage occurs is vital.

Heroin Abuse and Co-Occurring Mental Health Issues 

Some heroin users have preexisting mental health problems that contributed to their heroin abuse.  Things such as depression, anxiety, and low self-esteem can lead a person to experiment with drugs as a coping mechanism.  But, as they continue using heroin, other mental health problems can arise, making it more difficult to quit using the drug.  

When heroin abuse and mental health problems are present at the same time, simultaneous treatment of both issues is the best option.  Why?  Because addiction is a complex disorder that involves physical, emotional, and social aspects. Effective treatment must target each of those factors to ensure lasting recovery.  Without the skills and knowledge to manage their emotions, a person is more likely to continue using heroin as an escape tool.

Mental health problems may be the cause or effect of heroin use.  Regardless, the outcome is the same no matter how it began.  The person’s life and health suffer adverse consequences either way.  

Seeing Beyond the Stigma Surrounding Heroin Use

We must change the stigma surrounding heroin and help people get the treatment they need.  It’s unfortunate that many people still think of heroin users as weak-willed individuals who could quit the drug if they wanted to badly enough.  The truth is, few people can quit heroin on their own.  When the potent addictive qualities of the drug take hold, the person is powerless to resist the cravings for more of the drug.  

Think of the overdose statistics as individuals, not just numbers. Heroin stole their chance to reach their full potential in life.  Each number represents a life ruined or lost due to heroin abuse.  These individuals did not make a conscious choice to become addicted to heroin.  Yet, they continue to suffer the consequences.

Get Specialized, Accredited Treatment for Heroin Abuse Today

Heroin addictions are on the rise and becoming more deadly.  For instance, many street dealers lace heroin with other dangerous chemicals such as fentanyl to increase profits and make the drug more potent.  Unsuspecting buyers have no idea what is in the drug they purchase.  

Of course, effective treatment is the best solution for heroin addiction.  At Cycles of Change Recovery, we want to be part of that solution.  Our accredited, comprehensive treatment program gives clients an individualized approach that addresses their specific needs.  We focus on helping a person heal physical damages and emotional trauma caused by heroin abuse.  . Our goal is for clients to complete our program with the confidence, motivation, and skills to rebuild their lives.

If you’re struggling with heroin abuse, the best time to make a change is today.  Take the first step toward addiction recovery.  Call us now.  Our caring, skilled professionals will help you overcome addiction so you may enjoy the healthy, productive life you deserve.  

Sources:

drugabuse.gov/ – Overdose Death Rates

Ending the Endless Cycle of Addiction

Ending the Endless Cycle of Addiction

Substance abuse or addiction can seem like an endless cycle.  It’s a process with no clear beginning or end.  Even if the individual wants to stop their drug use, they don’t know where to begin, so the cycle continues.  In far too many cases, overdose or death occurs before the person gets a chance to make a change.  So, what happens during the endless cycle of addiction that makes it hard to break?

Understanding the Stages Involved in the Cycle of Addiction

The stigma surrounding addiction suggests that substance users lack willpower.  In truth, willpower is only a fraction of the complex process that leads to substance abuse.  

The definition of addiction, according to the American Society of Addiction Medicine (ASAM):

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become  compulsive and often continue despite harmful consequences.”

Addiction can occur quickly, depending on the substance involved.  Or, it can take months or years to develop.  But, the process involves a series of stages that make the cycle of addiction so difficult to break.  For instance, some of the stages may occur together.

To better understand the cycle of addiction, familiarize yourself with the following stages: 

Stage #1:  Initial use of an addictive substance.

Each person has their own reasons for experimenting with drugs or alcohol.  Whether the first-time use leads to addiction depends on several risk factors such as:

  • Neglect or physical/emotional abuse.
  • Dysfunctional living environment.
  • Loneliness, depression, or other mental or emotional issues.
  • History of substance abuse among family members.
  • Peer pressure, social issues, low self-esteem.

Of course, these risk factors don’t always lead to substance abuse.  But, when influenced by the other stages of addiction, the possibility increases.  

Stage #2:  Substance abuse.

In this stage, the individual begins repeated substance abuse despite adverse consequences.  For example, someone who uses prescription painkillers will increase the dosage or frequency of use.  An increased dosage can cause:

  • drowsiness, sedation
  • confusion
  • shallow breathing
  • nausea, vomiting
  • anxiety, irritability
  • muscle pain
  • addiction

Substance abuse is the point where a person’s drug use is specifically for euphoric reasons.  

Stage #3:  Tolerance increases.

Repeated drug abuse causes changes in the brain that result in increased tolerance.  What this means is that it takes more of the substance to produce the desired effects.  The person using the drug will increase the dosage or frequency of use to experience the euphoria they seek.

As a person increases the amount ingested, they start on a path to the next stage of addiction.

Stage #4:  Dependence.

In this stage of addiction, the brain can no longer function the way it should.  The person no longer feels pleasure without the substance in their system (anhedonia).  At this point, the individual needs more of the substance to feel “normal.”  However, it’s important to note that dependence does not always signify addiction.  

Stage #5:  Addiction becomes obvious.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that addiction is comprised of specific symptoms and behaviors.  The 11 signs and symptoms include:

  1. Using more of the substance than intended.
  2. Inability to stop using the substance.
  3. Relationship issues due to SUD.
  4. Seeking and using the substance is a person’s primary focus.
  5. Lack of interest in hobbies or activities that were once enjoyable.
  6. Unable to perform daily responsibilities.
  7. Intense cravings for the substance.
  8. Continued use despite negative health problems or other consequences.
  9. Engaging in dangerous situations or behaviors while using the substance.
  10. Increased tolerance for the substance.
  11. Withdrawal symptoms occur when the substance is withheld.

Generally, experiencing two or three of the above signifies mild substance use disorder (SUD).  Four of five indicates moderate SUD.  Someone experiencing six or more of the above has severe SUD or addiction.

Stage #6:  Relapses are part of the endless cycle of addiction.

According to NIDA, about 40 to 60 percent of people in recovery from addiction will relapse.  Relapse happens for many reasons depending on the individual and their unique situation.  However, relapse is not a sign that the treatment failed.  Furthermore, relapse doesn’t mean the individual has failed at recovery.  

If relapse occurs, the best option is to seek further treatment or try another program.  Sometimes, a person can benefit from a different approach or additional time in a secure, nurturing environment.  

We Can Help You Overcome the Endless Cycle of Addiction 

Each person experiences different responses to treatment.  So, the programs should be flexible enough to adapt to their individual needs.  At Cycles of Change Recovery, we offer a unique and proven approach to treatment. We can help you achieve the substance-free lifestyle you want and deserve.  Our treatment options focus on establishing a solid foundation for you to build on as you progress through recovery.  

Contact us today to learn more about our programs.  You’ll discover that the endless cycle of addiction does have a finish line.  You just need guidance in the right direction to find it.  

Sources:

  • asam.org – Definition of Addiction
  • drugabuse.gov – Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery
Family members work together to heal from addiction.

What are the Benefits of Family Therapy in Addiction Treatment?

Addiction is often conceived of as a problem that an individual has. To an extent, this is true. However, in many cases, the problem of addiction is much larger and more complicated than this. No person exists in a vacuum; everyone has friends, family, and loved ones impacted by their choices. This is true, even when someone is at odds or separated from their family. In many cases, substance abuse issues can cause great rifts or pain in the relationships the addicted individual has with others.

This can look different in different situations. In some cases, individuals struggling with addiction may live with family members, spouses, and/or children in their homes. The relationships of the addicted person with those in the home can become problematic very quickly. Even when someone lives alone or with friends, the relationships with those around him are important.

When we talk about “family” here, it is useful to understand that this does not just refer to those related by blood. For family addiction therapy, the term “family” can refer to immediate and blood-related family members, close friends, mentors, in-laws, or anyone else who has a familial relationship with the addicted person.

Unhealthy Behaviors

When it comes to addiction and the family, some behaviors or patterns are very unhealthy or dangerous, most notably codependency and enablement.

  • Codependency: The behavior of codependency occurs when the addicted individual and someone close to them has adapted their relationship in a dysfunctional way in response to addiction. Sometimes this will manifest as constant fear or worry by the loved one for the addicted individual to the point that it disrupts the loved one’s life; this can also manifest in the form of denial, low self-esteem, unhealthy behavior such as over-eating or shopping; additionally, this may show up as changes in mood that are dependent on the addicted individual.[i]
  • Enablement: When it comes to these behaviors, it can sometimes be difficult to distinguish between enabling and helping. In many cases, it may not be unclear. In general, enabling relates to assisting someone addicted to things that they would normally do for themselves or allowing them to avoid consequences that they would normally receive. Helping, on the other hand, generally relates to things the addicted individual with things they would not or could not do by themselves. The line between these is difficult, and it can often be helpful to consult a counselor or wise family and friends for assistance in making significant decisions.[ii]

Benefits of Family Therapy

  • Improved Communication: Communication between one who is addicted and their family can be a difficult process. Addiction can cause each person to say and do things differently than they would otherwise. Family therapy provides a safe context in which healthy communication can happen. The counselors who lead family therapy sessions are trained to facilitate and encourage honest but loving communication between those struggling with substance abuse and their loved ones.
  • Awareness of Family Dynamics: In many cases, the dynamics and relations between the person addicted and their family can go unnoticed. Changes in the ways people relate can happen subtly and quietly. In the context of family therapy, however, there is an opportunity for the nature of the relationships and the family dynamics to be more clearly revealed. Sometimes there are unhealthy ways of relating, including codependency or enabling tendencies that neither is aware of initially.
  • Clarification of Ways to Get Help: Family therapy can also provide a place for both the addicted and their family members to receive help and find ways of receiving help. Many of the struggles relating to healthy relationships involve both persons needing help and either not getting it or not knowing how to get it. The person addicted may know they need help but will often be wrong in understanding what and how they need help. Many times, family members and loved ones desire to help and support the addict, but they do not know-how. Even more unnoticed, however, is that often the family members themselves need health. There will be physical and mental exhaustion, among other consequences, that come with supporting and dealing with someone who is addicted.
  • Establishment of Boundaries: Beyond these things, family therapy is beneficial for helping those addicted and their families as they set to establish effective and useful boundaries. This is important to help avoid the negative behaviors of codependency and enablement. When boundaries have not been set appropriately, the result is negative for both parties. Boundaries can sometimes feel restrictive or feel like we are not helping our loved ones who struggle with addiction, but the reality is that the boundaries are for the good of the addicted. There is a difficult but important balance that must be found between having empathy, loving, and supporting the addict and allowing them to continue in their behavior without experiencing the natural consequences.
  • Opportunities to Safely Share Feelings: Because of the difficult nature of substance abuse and the guilt and shame it often brings with it, addressing feelings can be extremely challenging. For the one who is addicted, often the feelings may be repressed or avoided. When they are not avoided, they can surface as overwhelming shame and embarrassment. When confronted, this guilt and shame can manifest by anger and hurt, sometimes including making the one confronting the addict feel guilty for bringing it up. These are natural but harmful things. For the family member trying to help a loved one, there are often feelings of being taken for granted, of exhaustion from constantly supporting the loved one or providing for the home without the loved one. Addressing this with someone in the midst of addiction is, at the very least, difficult. Family therapy can help in these situations by providing a safe context and a wise, trained professional to guide and support the discussion.
  • Chances to Build Trust: Finally, family therapy can provide opportunities to build trust. The reality is that addiction causes a lot of fractures in relationships, and trust is often eroded and damaged very quickly. For obvious reasons, this is not the place where we want relationships to stay. The hope is for restoration and reconciliation. This requires the rebuilding of trust. Family therapy, often by addressing the things listed above, can help begin this process of building trust and restoring relationships.[iii]

Sources:

  • [i] Lesser, Ben. “Substance Abuse and Codependency.” Dual Diagnosis. https://dualdiagnosis.org/codependency-substance-abuse/. Accessed 5/21/2021.
  • [ii] T., Buddy. “How to Stop Enabling an Alcoholic or Addict.” Verywellmind. https://www.verywellmind.com/how-to-stop-enabling-an-alcoholic-63083. Accessed 5/21/2021.
  • [iii] Edited by Dan Wagener. “Family Therapy for Substance Abuse & Addiction Treatment.” American Addiction Centers. https://www.recovery.org/treatment-therapy/family/. Accessed 5/21/2021.