Tag Archives: Addiction

Biochemistry and Addiction

If someone suffers from anxiety, depression, or addiction they could have a biochemical imbalance. A biochemical imbalance is not the sole factor in addiction, but it can play a large part. There are many factors to understanding something as complex as addiction, and biochemistry is only a part of that. With that being said, understanding a person’s biochemistry can provide significant insights into their history and current health. It can also help to determine what treatment will be most helpful for each patient. Additionally, biochemical imbalances can manifest as issues that are more than just mental health issues. Our testing will take a comprehensive look at how biochemical issues might be affecting each patient. At Reflections, we want to completely understand each patient to be able to thoroughly treat and overcome their addiction. Our efforts to look at each person’s biochemical makeup is a part of that process.

Someone might be struggling with addiction and they do in fact have a biochemical imbalance. Their first step does not have to be prescription drugs to try to supplement what their body is lacking. That is not to say that prescription drugs have no value or do not help people, but that there are other solutions. These solutions can work separately from prescription drugs or in tandem as needed. Often when someone is struggling with a biochemical imbalance, they turn to substance abuse hoping to fix the problem. We want to completely understand how it is affecting each patient, whether mentally or physically. At Reflections, our hope is to find long-term solutions which will be essential in preventing relapse.

Heavy Metal Imbalances

Heavy metals are a natural component of the earth’s crust and there are a number of ways that our bodies can absorb them. At certain quantities, the heavy metals become toxic in a way that begins to significantly impact our health. There are many different ways someone can be exposed to heavy metals and some of the most recognizable may be lead, mercury, and arsenic. These are metals that are recognizably dangerous, however not all heavy metals are necessarily bad. Some heavy metals provide essential nutrients, but at certain levels they can become a problem. For example, zinc is a heavy metal that plays an important part in many biological processes “…including growth and development, lipid metabolism, brain and immune function.” (NIH)* Zinc also has a number of positive aspects, but too much can lead to symptoms like nausea, vomiting, loss of appetite and lower copper levels over time.

Copper is another essential heavy metal, but again it needs to be balanced. At Reflections, Dr. Lisa Parsons, our Medical Director, looks closely to see if any patients are suffering from a copper/zinc imbalance. For anyone living in the Southwest, where we have a lot of copper and zinc, this can become even more of an issue. Per Dr. Parsons, someone might have a genetic difficulty maintaining a proper balance and they will have too much copper. This becomes an issue with too much free copper, which depletes the dopamine pathway and raises up the norepinephrine. With a lack of dopamine, someone would feel low, have a hard time getting up, they would not look forward to anything, and would feel a lack of joy or motivation. With too much norepinephrine, someone might feel all over the place, tense, anxious, and they might have a hard time focusing.

Testing and Treatment

There are numerous heavy metals that go beyond just copper and zinc. Those are just a few good examples of heavy metals that are needed, but need to be kept in balance. At Reflections, we are want to understand these imbalances because they can clearly have a significant impact on our lives. People will often turn to substance abuse to try to cope with symptoms that are manifested through the imbalance. From a New York Times article, Daniel Goleman wrote, “…addiction becomes a kind of self-medication in which drugs correct the chemical imbalance and bring a sort of relief.”* While a heavy metal imbalance might not be the sole reason for addiction, it can play a significant part. If we can test to identify imbalances and correct them, we can work to help each patient feel better. Addiction is a complicated issue and it takes hard work to understand each step.

The Path to Addiction

With biochemical testing, we hope to understand and treat as many of the steps or causes that we can identify. We want to find out how someone can go from use or experimentation to dependence and then to addiction. Some of the many factors include social and economic environments, personal choices, and genetics.

From the 2017 National Survey on Drug Use and Health (NSDUH), the data showed 140.6 million Americans aged 12 or older were current alcohol users. Within that, 66.6 million were binge drinkers in the past month and 16.7 were heavy drinkers within the last month.* At the time of the study, in 2017, 30.5 million people aged 12 or older used an illicit drug in the last 30 days.* As alcohol is widely used and socially accepted, it can be hard to recognize when it becomes a problem. While most illicit drugs are not widely accepted, it can still be difficult to recognize when it becomes abuse and addiction.

Many of the more obvious factors in addiction, may be the social, economic, and familial components. They are all important to identify and understand. However, it can be essential to look for the things that others might not. That is something that we firmly believe in at Reflections. We want to consider the aspects listed above, of course, but we also want to look at what might be overlooked. If we look at genetic testing, biochemical imbalances, and nutrition we can better know how to help each patient.

Moving Forward

Each factor that we can understand and work on will add up to a more complete treatment. Nobody can guarantee that every single issue will be fixed. However, at Reflections we do take care to work on all of the possible causes as we are able. The more we can help and the more tools we can give our patients they better off they will be. With a holistic approach, we look at the entire patient and hope each patient will feel better overall. If someone is feeling better physically that should translate to improved mental health and an improved outlook on life. If you or a loved one needs help, contact us today.

*Resources:
Decreased Zinc and Increased Copper in Individuals with Anxiety – NIH
Scientists Pinpoint Brain Irregularities In Drug Addicts – NY Times
2017 NSDUH Annual National Report SAMHSA

Genetic Testing & Addiction

How Genetic History Impacts Addiction

The science behind genetic testing used as a method to understand addiction may be relatively new. Still, it is making a significant impact. It is not a perfect fix when it comes to resolving or preventing addiction, but it helps in understanding addiction and treatment. If medical professionals fully understand their patient’s history and makeup, they are better equipped to help them. At Reflections, we firmly believe in fully understanding and treating each patient. When we work with genetic testing, we are not going to get a magic book with all of the answers. However, we will better understand each patient. This will help the patient in their recovery and they will have a better chance at maintaining sobriety.

When someone is already suffering from addiction, our goal is to understand their history and how they got there. Is there anything in their history and genetic make-up that made them susceptible to addiction? In a study published by the National Institute of Health (NIH), they noted, “Addictions are moderately to highly heritable.”* This does not mean that every person with addiction in their heritage will suffer from addiction. The risks are higher but there a lot of factors. The possibility of addiction can greatly depend on the availability of an addictive agent, exposure to the addictive agent, and their choice to take it (NIH)*. Nonetheless, the reality is that there can be a greater risk and this is important to keep in mind. Identifying genes that make a person susceptible to addiction make it easier to then identify tools to help prevent relapse.

Genetic testing is only one piece of a very complex puzzle in resolving the problem of addiction.

-Robert Parkinson, U.S. News

Understanding Addiction with Genetic Testing

At Reflections Recovery Center, Lisa Parsons is the Medical Director. Dr. Parsons is particularly interested in understanding every aspect of the patient’s physical makeup to fully help them. It helps to look at the DNA of patients to understand if they are carrying any vulnerability in their genetics. If so, did something occur in their life that turned that vulnerability on? Someone that is prone to stress and anxiety might be fine until something traumatic happens. Part of their genetics that drive the stress and anxiety can be what then makes them susceptible to substance abuse. The testing our team does, including Dr. Parsons, looks at these factors and check for imbalances. Once an imbalance is identified, we can begin treatment to regain a proper balance again. As with any treatment, nothing is a perfect or a total fix on its own. Nonetheless, regaining balance in any area is hugely important and helpful.

DNA Methylation

One of the genetic structures we look at is DNA methylation. Methylation is a chemical reaction that occurs in every cell and tissue in our bodies.* It is, understandably, an incredibly important part of our health. As methylation is a process that involves DNA, understanding it and our genetic history is so important. Within the brain, there are reuptake proteins which act like vacuum cleaners. They live between brain cells that take away neurotransmitters to create balance. Balance is incredibly important for health in every aspect and especially so when it comes to methylation.

When someone is undermethylated, with too many reuptake proteins, they may feel chronically depressed, tense, and anxious. Some people may feel suicidal or a lack of care for their own life or safety. With too few reuptake proteins (overmethylation) someone might feel fidgety, tense, have a hard time relaxing, or have a hard time sleeping. With either imbalance, this can leave someone susceptible to addiction as they try to cope with these symptoms.  Methylation is a process that significantly impacts our health and lives more than most of us realize.

There are, of course, many other aspects of genetic testing to look at. This is just a brief example of what we will look at to thoroughly help each patient.

Treating Addiction with Genetic Testing

Not everyone suffering from addiction carries the same genes indicating addiction. Likewise, not everyone with vulnerable genetics will suffer from addiction. For those that are vulnerable or carry “addiction genes”, understanding their genetic makeup will help. Genetic testing allows us to determine if a patient is suffering from any number of disorders. We can see what in their genetic makeup may have made them vulnerable to addiction in the first place. It can also help to determine what is the best course of action for treatment. The more precisely we can understand genetics, the better we can tailor treatment to each individual.

In an article for U.S. News, Robert Parkinson writes, “Genetic testing is only one piece of a very complex puzzle in resolving the problem of addiction.”* This is incredibly important for any person, or loved one, dealing with addiction to know. Genetic testing is not going to provide a clear map for curing addiction and ensure there is never a relapse. What it will do is provide clarity and direction in some aspects. Addiction may be a complex puzzle and genetic testing may only be one part of that puzzle, but each piece is still vital. We want each patient to maintain sobriety, not just become sober for a short amount of time. If we are going to meet this goal, then we have to look at everything we can to help them.

*Resources:
NIH – Genes and Addictions
Revolution Health – What is Methylation and Why Should You Care?
U.S. News – Genetic Testing for Addiction

Dual Diagnosis & Co-occurring Disorders

The National Alliance on Mental Illness (NAMI) defines Dual Diagnosis as, “…when someone experiences a mental illness and a substance use disorder simultaneously. Either disorder-substance use or mental illness-can develop first.”* Dual Diagnosis Treatment Centers may not be the easiest to find, but they are incredibly important. Clients need doctors that can properly address both psychiatric disorders and substance use disorders.

Co-Occurring Disorders in Men

Addiction and mental illness can clearly create a vicious cycle. To properly address it there needs to be a clear diagnosis of addiction and mental illnesses. Not every person struggling with addiction will face a mental illness and their path will be a little different, though no less thorough. The people that do face addiction and mental illness though will need specialized care to properly address both issues. In a 2017 study from the Substance Abuse and Mental Health Services Administration (SAMHSA), it was reported that 8.5 million adults, or 3.4 percent of adults (18 or older) had co-occurring disorders in the prior year.*

Moreover, when it comes to seeking treatment, men rarely seek treatment for any disorder. If they seek treatment for addiction, they are less likely to seek treatment for mental illness due to shame and social stigma (NIH).* At Reflections, we are a men’s only rehab which we believe allows us to thoroughly treat the men we help. We work to be proactive in identifying and treating any mental illness with which our clients may be struggling. Our aim is for all of the men we treat to feel comfortable and to know that there is no shame in seeking help.

A Comprehensive Recovery

For recovery to be comprehensive, it is important to treat a patient as a whole person. This means thoroughly going over their physical and mental health. We also will look at their history up to the point where they have entered rehab. Addiction is a complicated disease and treatment should be varied to thoroughly address all of the underlying causes. With dual diagnosis, the aim is to address the mental illness and drug addiction as separate but co-occurring disorders. The best plan for treatment is to integrate different forms of therapy. This will allow each issue to be addressed individually, but coordinated to adequately tie everything together. Treating only the mental health problems or only the addiction will not allow for a full recovery.

Our goal is to accurately and thoroughly understand each patient and how to best help them.

Behavioral Therapy to address Dual Diagnosis

At Reflections Recovery Center, clients will go through complete intake assessment within a few days of arriving. This will allow us to do physical and mental health evaluations. We will review medical history as well as family’s health history, if possible, to look for any patterns and to gain a thorough understanding of the patient. Each client with have a variety of therapies that they can engage in to best help their recovery.

Among the different types of therapy that we engage in, clients can participate in Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). CBT works to help clients adjust their thoughts and attitude, leading to improved emotional stability. DBT is similar and helps clients learn to regulate emotions, tolerate pain in stressful situations, and maintain healthy relationships with other people. CBT and DBT both greatly help someone who is dealing with a dual diagnosis. Reflections also has a number of other relevant and beneficial therapies that our clients have the opportunity to engage in.

Nutrition and Biochemical Deficiencies

A physical evaluation will be essential to understanding what state the patient’s body is in. It is important to understand what nutrition the client is lacking or if they have any physical disorders. Nutrition plays a significant part in addiction. With regard to nutrition, part of what we are especially interested in is your cholesterol and vitamin D. Sleep is essential for any person and is absolutely necessary when in recovery. Cholesterol helps the brain to function and that can help manage feelings of impulsivity. When your brain is functioning better, sleep should be easier to get back to normal. Furthermore, lack of vitamin D can potentially lead to bone demineralization, myopathy and immune system problems. These in turn can lead to other symptoms like pain and fatigue, which begin to disrupt your sleep.

Addiction deprives the body of nutrients and your body will let you know that it is struggling. When our doctors know how the patient’s body is deprived, this allows us to begin the process of healing. When your physical and mental health are in a better place, you will have gained important tools in your fight against relapse. We will of course look into much more than cholesterol and vitamin D. Those are just a few examples of how important seemingly small parts of our health can greatly impact our lives. When you are working to treat an entire person, you need to look at the details that are often overlooked.

Dual Diagnosis Treatment Centers

The truth is, a dual diagnosis is not something that is easy to treat. However, a dedicated medical professional works to find the root causes of the disorders and properly treat them. If you or a loved one is possibly dealing with a co-occurring disorder, then you need an experienced and licensed dual diagnosis treatment center. We have a qualified medical team that can treat psychological issues and substance use disorders. Our goal is to accurately and thoroughly understand each patient and how to best help them. We aim to help each patient develop the skills and knowledge to maintain sobriety wherever they go. Contact us today to find out more!

*Resources:
Dual Diagnosis – NAMI
National Survey on Drug Use and Health – SAMHSA
Men with Co-Occurring Disorders – NIH

Skill-Building Activities for Mental Health and Addiction

“Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.” Substance Abuse and Mental Health Services Administration

Steps to Recovery

Recovery takes time, a community, and will involve many different steps for each person. In recovery, a setback may be inevitable. However, a setback is not a reason for recovery to be abandoned. Everyone struggles with something in their own way and will face obstacles and setbacks. One of the best courses of action you can take is to accumulate various tools and means of support. Addiction is complex and thus your recovery will also be complex. This does not mean it is impossible, but simply that it is a process that will take serious effort.

The thought of addressing mental health issues, particularly when in recovery, may not be the most appealing. In fact, it may feel like an exhausting task. However, it is possible to engage without using all of your energy. With recovery, there are different forms of therapy that will be needed. Among them, Adventure Therapy is a way to participate in therapy while staying active. Understandably, it is not always going to be possible to engage in more strenuous physical exercise. Sometimes you just need something that is calming and simple. The good thing is there are a lot of options for low-impact activities. They will do a lot to improve your mental health and help you in your sobriety.

Low-Impact Activities to Improve Mental Health

A sense of purpose is incredibly important for any person and especially so when you are in recovery. When you have a routine and engage in physical exercise or social activities, that is a part of establishing your identity. There are low-impact activities like gardening and volunteering that allow you to be active without extending too much energy. They may even help you find a sense of self-worth.

With gardening and volunteering, you can take care of where you live and the community around you. When you give back to others, you should do so without expecting anything in return. Nonetheless, it will in turn enrich your life and you may find great improvements to your mental health. While gardening and volunteering can differ, both will develop the communities that are immensely important in recovery.

With gardening, you can work with a wide variety of plants that are visually pleasing as well as plants that can provide food. As you nourish the plants, it is rewarding to see the results of your labor. It is also fulfilling to know you are helping to create and maintain life. When you volunteer, you may be able to gain leadership and team-building skills. These skills will be essential in work and day-to-day life.

Practicing Mindfulness

Activities like yoga, meditation, cooking, and walking are all easy-going ways to relax, ease stress, and reduce symptoms of mental illness. They won’t be an instant fix, but they can be a component of the working parts that comprise your recovery. Yoga, in particular, has been shown to be helpful for stress and pain management. A Harvard Mental Health Letter cites a study by the University of Utah, which showed that people who practiced yoga had better stress regulation and in turn better pain management.*

There are many different ways to practice meditation, with no one way being correct. Often, people who practice meditation want to focus on their breath and focus on the present moment. The idea is to create a state of calm and peace, which will allow for internal reflection. From an article published by the US National Library of Medicine, author Michael McGee MD, wrote, “Several studies have also suggested that meditation can be helpful for the treatment of anxiety, addiction, aggression, suicidality, and depression.”*

Often, we can be our worst enemy when we constantly over-think our problems. This feeds a negative mindset from which it is hard to recover. Meditation and yoga are great ways to calm a racing mind. Adventure Therapy can be totally calm like yoga and meditation or high-impact like team sports and white-water rafting. Whatever you choose, it should help you to stop dwelling on the negative aspects of life that keep you down.

Cooking and Walking as Therapy

Cooking and walking are two activities that can do a lot to help your physical and mental health. With walking, you can get much needed exercise without too much of a strain. When you are walking outdoors, you may find that you are able to find time for reflection and it may help relieve some stress. Cooking is an activity that requires you to learn and focus on the tasks at hand. You may end up learning a lot about nutrition which obviously affects your physical health, but also affects your mental health in ways you may not even realize.

In an article for Psychology Today, Linda Wasmer Andrews writes that culinary therapy is growing at clinics and therapists offices, and is being used to treat a number of conditions including, “…depression, anxiety, eating disorders, ADHD, and addiction.”* What you eat can greatly affect your mental health, but the act of cooking itself can be immensely helpful.  As you cook, you gain new knowledge and also you can practice mindfulness as you focus on each step. Mindfulness may appear to be simple, but it something that when you practice it, it yields extraordinary benefits. Among the benefits, it will help reduce the time you spend worrying which feeds into mental illness.

Mental Health and Recovery

While the activities listed above are calm and low intensity, they can still be adventurous and you can learn. Sometimes just learning new facts and skills can be an exciting experience. Any type of Adventure Therapy should help you develop life-skills, interpersonal relationships, and even enable you to learn more about yourself. As the types of Adventure Therapy vary, the benefits will also vary from activity to activity. You can try a wide variety and figure out what is best for you. Whatever you choose, hopefully you are able to challenge yourself and find experiences that will be so fulfilling you will only want to move forward on this new path.

Addiction and mental health issues are not always going to feed in to one another. However, they can end up forming a vicious cycle when left untreated. Even if you are fortunate to never face serious mental illness problems, it will still be beneficial to you to work on your mental health. When you are in a better place mentally, you are better equipped to fight addiction. Mental health and addiction are both complex issues and not something you can solve by yourself. Engaging in these light activities with the support of your community will be important steps in your recovery.

*Resources:
Harvard- Yoga for anxiety and depression
US National Library of Medicine – Meditation and Psychiatry
Newsweek – 1 in 5 suffer from a mental illness
Psychology Today – Kitchen Therapy

The Link Between Hunger Hormones, Substance Abuse and Addiction


When you start continually using a substance such as alcohol, opioids or cocaine, your body not only builds up a tolerance, but it eventually starts to develop cravings for that substance. This isn’t all too dissimilar to cravings you will have for certain kinds of food.

When one’s hunger hormones are out of whack, the person is at risk of overeating and eventually obesity. Researchers have begun studying this phenomenon as it relates to drug and alcohol use. And in limited trials to this point, they have found quite positive results.

This article will break down the likely connection between hunger hormones and substance cravings, and then we will get into the latest advancements and what they could mean for treating addiction in the near future.

How Hunger Hormones May Be Related to Substance Use 

As we learn more about overeating and obesity, the more important it is to focus on how hunger hormones (aka gut hormones) work. And as scientists study these hormones more and more, they are finding an increasingly stronger connection to the continued use of alcohol or drugs.

“Hormones from the gut act in the brain to modulate dopamine signaling, which controls decisions to seek out rewards,” said Dr. Mitchell Roitman, University of Illinois-Chicago neuroscientist, in a Society for the Study of Ingestive Behavior article.

It’s no secret that drugs and alcohol have a direct effect on the brain’s dopamine production. Dopamine is a chemical in the brain sent by neurons to other nerve cells. In most cases, drug and alcohol use temporarily speeds up the production of dopamine. It tempts people into repeating and reinforcing this perceived pleasurable activity.

Prolonged substance use changes the brain’s natural ability to produce dopamine, and the body physiologically wants more of the substance in order to feel “normal” again. There is a reward in the brain when substances are used to achieve a certain state, and after a while, that reward almost becomes expected, leaving the person on edge until it is met again.

So if gut hormones have an effect on dopamine, and drugs and alcohol do, too, it follows that the key to fighting substance abuse should be in figuring out how to regulate these hormones. We are starting to understand that gut hormones are responsible for our cravings for more than just food, but any substance we put into our bodies.

Which Hormones Play a Role in Cravings?

There are three main gut hormones in play when it comes to regulating cravings and how “full” someone is regarding food, liquids, substances and more. These hormones are:

  • Ghrelin: The primary hunger hormone that increases appetite and food intake while promoting fat storage. It also plays a role in insulin release, and it can act on regions of the brain known for reward processing. A recent study found that ghrelin can influence the reward value of alcohol intake similar to the way it increases the reward value of food.
  • GLP-1: A hormone that releases while eating to tell the brain when the person has eaten enough. GLP-1 originates in the small intestine, and it stimulates insulin secretion while inhibiting glucagen secretion. This lowers the blood sugar levels in the body.
  • Amylin: Another hormone that tells the brain when to stop eating, and it also mitigates glucagen secretion. Diabetic patients are deficient in this peptide hormone.

Medications that Focus on These Hormones

If GLP-1 and amylin tell the person when to stop eating or drinking, then focusing on these hormones appears to be the key to regulating cravings and preventing overconsumption.

“Medications affecting GLP-1 and amylin are already FDA approved for Type II diabetes and obesity. These drugs could be repurposed for treating drug craving and relapse,” said Dr. Heath Schmidt of the University of Pennsylvania’s Perelman Medical School.

And at the University of Rhode Island, a group of researchers from the school’s College of Pharmacy have begun studying how a ghrelin-inhibiting drug affects alcohol cravings. Their studies have worked under the theory that higher concentrations of ghrelin are associated with higher alcohol cravings and consumption.

Professor Fatemeh Akhlaghi said that his team has found positive results when using a drug to block ghrelin in order to stave off alcohol cravings. So far, they have tested this medication in rats, as well as 12 volunteer patients. Their study was published in May in the journal Molecular Psychiatry.

Granted, scientists need to do further research in order to make a rock-solid conclusion about treating substance cravings by inhibiting ghrelin. But, the early results show much promise, at least.

Types of Diabetes Drugs – and Their Drawbacks

When focusing on hunger hormones in order to reduce alcohol cravings, the goal would be to:

  • Mitigate ghrelin levels.
  • Increase GLP-1 and amylin production.

The University of Rhode Island team used a drug originally developed by Pfizer to treat obesity and diabetes in their study. Elsewhere, scientists are focusing on GLP-1 analogs and agonists. In total, all aforementioned drugs have to do with diabetes and obesity, but scientists are now looking at them as a potential solution to alcohol and drug cravings.

If you’re not familiar with GLP-1 agonists, also called incretin mimetics, some common names to know are (generic name followed by brand name in parentheses):

  • Dulaglutide (Trulicity)
  • Exenatide (Bydureon)
  • Exenatide (Byetta)
  • Liraglutide (Victoza)
  • Lixisenatide (Adlyxin)
  • Semaglutide (Ozempic)

An agonist means it boost the production of, in this case, GLP-1. The drugs listed here are for type 2 diabetes patients and injectable, but they aren’t insulin. Instead, they improve blood sugar control and make you feel “full” more quickly – and for a longer period of time. This helps prevent overeating and, by extension, promotes weight loss.

However, you have to be careful when using GLP-1 agonist drugs and watch for side effects such as:

  • Either diarrhea or constipation
  • Nausea and vomiting
  • Indigestion
  • Loss of appetite
  • Headaches
  • Heavy sweating

Managing Cravings in Rehabilitation and Recovery

Drug and alcohol addiction recovery programs typically place a major emphasis on managing cravings. This is often part of their relapse prevention education, in which clients learn about cravings and then practice a few strategies for keeping them in check. This is especially important as they graduate the program and return home to everyday life with no therapist or doctor to watch over them 24/7.

Cravings tend to last two to five years in most clients, although they can persist longer in some cases. They tend to lessen in intensity and frequency in time, but it’s important for people in recovery to know how to manage them and not let them draw them into relapse.

Although medications such as diabetes drugs may eventually become popular in order to help with substance cravings, they are not quite ready yet. In the meantime, learn some tried-and-true relapse prevention techniques, and find a rehab program that will teach these to you and give you sufficient time to practice these before you return home as a sober individual.

See Our Relapse Prevention Resource