Hypervigilant

Merriam Webster Dictionary defines hyper-vigilance as, “the state of being highly or abnormally alert to potential danger or threat”. This is not to be confused with paranoia, “mental illness characterized by systematized delusions of persecution or grandeur usually without hallucinations”.

Normally hyper-vigilance is a term used when discussing PTSD or someone in a dangerous field of work; however, this term can also be used to describe those of us who experience anxiety disorders. On any typical day I am hyperaware of my surroundings and potential dangers that could be at play. My mind automatically thinks of the worst possible things that “could” happen, however highly unlikely. On a “good” day, I can allow those thoughts to flutter on by and shake them off as if they are just like any other thought. On my hard days, however, it’s not quite as easy.

My hard days often include: racing thoughts, constant “what ifs”, tense muscles, exhaustion, feeling “on edge”, irritability, and headaches. Most days are fairly “good” now, thanks to social support, medications, and therapy. Throw in a global pandemic, however, and my hard days have become my new normal again.

No matter how much I try to relax, turn off the news, or unwind, I constantly feel on edge these days. My shoulders creep up towards my ears, tensed. My stomach is always in knots, and I often sigh deeply just to get enough air, as I realize that I have been holding my breath. It feels as though I’m just waiting. Waiting for symptoms of the virus to HIT me out of nowhere, never knowing when it will strike. I am hypervigilant. Are you?

Hypervigilance isn’t always like you see on the movies. Sure, it can appear as constantly flinching at loud noises and acting out in irritability; however, I want you to know that a lot of the time, the battle of hypervigilance is within, unnoticeable to those around us and maybe even unrecognized by the person themselves.

My battle with hyper-vigilance is within. It’s a constant battle between fearing the worst, and feeling guilt and shame for not having enough faith. It’s not typically an outward struggle (unless illness is involved and then suddenly I’m washing my hands to the point of sores, wiping everything down with alcohol, and having a panic attack nearly every time I leave my house). It’s something that most people don’t notice. This is why it is so important that we check in on our friends during this unprecedented time. Even if our friends may not have a diagnosed mental illness like anxiety or depression, ALL of us are feeling the uncertainty and sometimes even the hyper-vigilance going on in the world right now.

Clinical Psychologist Karen Cassiday stated in an article by the Chicago Tribune, “The thing that makes the coronavirus difficult for people with anxiety is the level of uncertainty,” she said. “We know that when there’s uncertainty, then people with anxiety disorders try and narrow down the field of uncertainty to assume the worst-case scenario.” I would add to that and say that we are not merely trying to “narrow down the field of uncertainty” but we want answers. We want reassurance. We want to know the facts to know that we will be okay.

Moukaddam and Shah state, “Although the effects of the coronavirus on mental health have not been systematically studied, it is anticipated that COVID-19 will have rippling effects, especially based on current public reactions.” We are already seeing the effects of social distancing on those we love. Staying home, sometimes alone, is bound to lead to loneliness in most people. What we fail to recognize is the effects that this pandemic is having and will continue to have on individuals for years to come in regards to anxiety.

If you think about it, most of the world is experiencing hyper-vigilance right now. Please be intentional about reaching out to those you love. Be intentional about sharing how you are feeling about this pandemic. Be intentional about caring for yourself. Be intentional about putting your faith in God. Be intentional about having fun. If you do those things, the hyper-vigilance may not completely disappear, but it will help to know that you are not alone in this.

As a person of faith, I know that anything can happen any second of any day. I know that life could end instantly. I know that no human has any control over anything in this world, yet, my mind constantly fights for any sense of control. And that’s exactly what it is… a fight. A fight between faith in a God who loves me and is trustworthy, and my selfish, fearful, perfectionistic human nature.

I’ve had several people tell me throughout my life, but especially recently to “trust God and give it over to Him because He’s in control.” I know they mean well, but they aren’t telling me something that I don’t already know. I know that God is the only one in control. I know that I can trust him. I know that He is good. It’s not a matter of lack of faith or belief in those things, at least I don’t think it is. I appreciate the reminder, and sometimes it is helpful to be reminded of those truths, but it’s not a cure-all for my struggle, no matter how much I want it to be. God can and does bring me peace in the sense that: I know that He is with me, He will never leave my side, I am loved by Him, and no matter what happens, He’s got this. But that doesn’t always calm my racing thoughts, tense body, and emotions. Sometimes those truths do calm my mind and body, but most times they don’t.

Please know that if someone you love is really struggling with the way things are going right now in the world, just be a listening ear. Acknowledge their fears, talk through them, and if they are believers, pray WITH them, remind them of God’s love and goodness without dismissing their inner turmoil. Chances are if they are a devout follower of Jesus Christ, like myself, and struggle with their mental health, they KNOW God is in control, but they need love, gentleness and to know they are not alone or going “crazy”. Let’s stay home, wash our hands and be there for each other in ways we never knew we needed to be.

Thank you for reading my rambles.

If you or someone you know is struggling, please reach out. The resources below would be glad to help you through this.

NAMI HelpLine, please call 800-950-NAMI (6264), Monday through Friday from 10 a.m. to 6 p.m., ET, or send an email to info@nami.org.

National Suicide Prevention Lifeline – For youth and adults
(800) 273-TALK (8255)

http://www.remedlylive.com

Resources Used
https://www.psychiatrictimes.com/psychiatrists-beware-impact-coronavirus-pandemics-mental-health

https://www.chicagotribune.com/coronavirus/ct-coronavirus-ocd-anxiety-20200309-sxwxvepaevh73ec4w3cdtzgopa-story.html



Pandemic and Mental Illness

Pandemic.

Just the word ignites panic, fear, and doubts. For someone who struggles with mental illness or even chronic illness, that word also brings havoc to mental health.

As someone who struggles with anxiety disorders and even diagnosed subclinical OCD, I ask that you PLEASE be patient with us. Whether you are concerned about the virus or you are one who thinks it’s all a hoax, the threat can be very real in our minds. Not only that but whether we want to or not, our minds may constantly be racing with thoughts pertaining to the pandemic. Sure, limiting exposure to media is helpful to a degree but there is still evidence of the pandemic everywhere you go.

I have noticed myself developing obsessive behaviors and thought patterns surrounding the pandemic. I read article after article, watch video after video, and can’t help but do mental checklists constantly to ensure that I am healthy and safe. I struggle with medical/health anxiety as it is, and THIS has made it flare up even worse. I constantly want to check my temperature to make sure that I’m in a safe range, and I’m becoming scared to leave my house. These are things we SHOULD be concerned about given the current state of things, but when it becomes obsessive and the only thing your mind can think about, it’s damaging.

I’ve already been over cautious and scared of the coronavirus, but when you see that every single store is completely out of essentials, it only makes the anxiety worse. So please stop hoarding things if you don’t actually need them. I’m one of those people that likes to be prepared for any situation, I’m what some may call an over-packer. To see all of these items completely wiped out can be terrifying. My mind then races with all of the “what if” scenarios, and it can become debilitating if I let it.

So to all of my fellow people out there struggling with their mental health in this crisis, here are the ways I’m trying to get through it that might be of help for you too.

  1. Pray.
    1. Whether you are a follower of Christ or not, praying to your higher power can bring so much peace. To know that I don’t have control over anything is scary, but to know that God is in control eases my mind and body. My spiritual walk is a rollercoaster, some days are better than others, but knowing that I am still loved by God brings comfort and ease of mind.
  2. Rest.
    1. Rest has been exceptionally challenging for me in the past 2 months as I have not been sleeping well. Rest is CRUCIAL for not only your physical health but your mental health too. When I don’t get enough good rest, my anxiety and depression are two-fold. Do your best to get enough sleep.
  3. Get outside.
    1. I’ve discovered in the past 6 months that getting outside and taking a walk, helps me tremendously. It helps me to clear my head, focus in prayer, and get the excess adrenaline out of my system. Not to mention the fresh air and sunshine (when the sun is out), is super uplifting.
  4. Keep a Normal Routine.
    1. If there is anything I learned in my 2 months off of work for IOP, it’s that keeping a normal daily routine is very important. If you’re off work or school for an extended period, like I am now, keeping a normal routine will be vital to keeping your sanity. Get up at a decent time, shower, get dressed, get ready for the day even if you’ll be at home with nowhere to go. Just doing those simple tasks, can make the world of difference to how you feel physically and mentally. Of course, it’s important to take some days here and there to stay in your pajamas and watch movies, but if you can keep some structure to your days, it will help tremendously with your mental health.
  5. Reach Out.
    1. I hate that the media is throwing around the term “isolation”. We are so fortunate to live in a time where the people we love are just a text message or video chat away, no matter the distance. Social distancing is important and crucial to keep the virus from spreading, yes, but that doesn’t mean we can’t still have valuable connections with those we care about. Text, call, dm, or video chat the people you care about and talk about something unrelated to the pandemic at hand. Yes, expressing our concerns and fears with others is important for our mental health, but don’t let the conversations be solely about that topic.
  6. Have Some Fun.
    1. If I’m going to be distanced socially from others, and I’m having to stay home out of work for four weeks, I’m going to have to get creative and make things fun. Don’t let boredom overcome you, as I often allow it to overcome me. I plan to take some time to read, watch movies and tv shows, write, and play way more hours of The Sims 4 than I care to admit. Allow yourself space to have some fun. Watch a funny show or movie, play a video game or board game, read that book that’s been on your shelf for years, learn a new talent. There are so many possibilities and I’m excited about all of them.

Those are just some of the things I plan to implement in my time off of work during this crazy pandemic, and I hope it can be helpful for others out there who are struggling with their mental health during this time too.

If you are someone who is blessed to be in a good place mentally right now, then please make sure to reach out to those you know who may be struggling. Sometimes when our mental health is suffering, we do isolate. Reach out to us. Offer encouragement, support, and a listening ear. But most importantly, have patience. Our fears, thoughts and even behaviors may seem irrational and over the top, to you, but to us they are very real. Have compassion and patience. But also know how and when to give us a good dose of reality too. It’s a scary world we live in, especially now. We all need each other.

If you have any other ideas for making this time off of work even better, or you just want to share how you are dealing with this pandemic, feel free to share them with me! Stay safe and healthy! Thank you for reading my rambles.

iocdf.org/covid19

Stuck.

I’ve had a few people ask me as to why I haven’t made any recent blog posts. In three words, I’ve felt stuck.

I have been dealing with some personal and health/sleep struggles. In all honesty, I’ve felt stuck in almost every area of my life, feeling as though I have no idea where to go next. To say that it’s been frustrating would be an understatement. So with that being said, I have been taking a break from writing/publishing blog posts.

In all honesty, I’ve been so exhausted that I can barely make it through the day, let alone use my brain to think about what to write. Don’t get me wrong, I love writing. Writing is my main creative outlet. Writing is the way in which I am able to make sense of everything bustling around in my head. So… I won’t be gone for long. For the time being, I need to press pause and take a break. I am working hard to be able to find adequate rest. I now have some sense of direction in how I will go about that (praise God!), some answers that most certainly will help, and I have hope that I will return to writing in the very near future. So for now… I say, I will see you soon!

Thank you for reading my rambles.

Walking On Water

I’m not going to lie, life has been challenging for me recently. Especially in the past few weeks I have noticed a major shift in myself. December of 2019, I was feeling confident. I was confident in my faith and where it was heading. I was confident in my jobs. I was confident in my health and caring for myself. Overall I felt confident in life. I was keeping my focus on Jesus and the work He was doing.

As January rolled around, however, life began to pick up pace. I ended up getting caught up in my schedule and specific struggles that God was bringing to my attention. I got hyper-focused on the struggles and lost my focus on Jesus. Satan began attacking me and doubts, fears, depression and anxieties crept in… well, flooded in. I lost all confidence in myself, my health, my work, and my faith. I began to neglect my health. I stopped reading God’s word and praying for other people as much as I had been. In reality, I stopped caring. I just wanted to escape.

It’s no surprise that when my chronic illness hit me full force, my body got wiped out. Not only that, I put myself through so much anxiety and stress from focusing on those specific struggles, that my body began to fall apart…again. My muscles were aching, weak and sore, my digestion was all out of sorts, and my energy was nonexistent. While some of those symptoms are from my chronic illness, I know they were intensified by the stress I put myself under.

While I was in the upswing of my energy returning, after taking several days off of work, the story of Jesus walking on the water came to my mind through a song I had been playing on repeat. Let’s take a look at it below in Matthew 14:

22 Immediately he made the disciples get into the boat and go before him to the other side, while he dismissed the crowds. 23 And after he had dismissed the crowds, he went up on the mountain by himself to pray. When evening came, he was there alone, 24 but the boat by this time was a long way[b] from the land,[c] beaten by the waves, for the wind was against them. 25 And in the fourth watch of the night[d] he came to them, walking on the sea. 26 But when the disciples saw him walking on the sea, they were terrified, and said, “It is a ghost!” and they cried out in fear. 27 But immediately Jesus spoke to them, saying, “Take heart; it is I. Do not be afraid.”

28 And Peter answered him, “Lord, if it is you, command me to come to you on the water.” 29 He said, “Come.” So Peter got out of the boat and walked on the water and came to Jesus. 30 But when he saw the wind,[e] he was afraid, and beginning to sink he cried out, “Lord, save me.” 31 Jesus immediately reached out his hand and took hold of him, saying to him, “O you of little faith, why did you doubt?” 32 And when they got into the boat, the wind ceased. 33 And those in the boat worshiped him, saying, “Truly you are the Son of God.”

I resonate with Peter on so many levels. I too have felt the confidence of trusting in Jesus and stepping out in faith, as I was doing at the end of 2019 and early 2020. Like Peter, I focused on the storms around me and became fearful and anxious. I too lost sight of Jesus face, His glory, His power, and His love. I began to sink. And like Peter, when everything became too much for me to handle, when I was sinking in my health conditions, anxiety and depression, I cried out to Jesus. And He reached His hand out to me and blessed me with this story of Him and Peter.

I don’t think it’s any coincidence that this Bible story came to mind during this time in my life. I know the Holy Spirit was trying to tell me something here.

I see very clearly now what happens when I take my eyes off of Jesus. The second we take our eyes off of Jesus and our identity as a son or daughter of God, we begin to doubt. Fear and depression rolls in, we lose hope, and we sink. For me, personally, sinking comes in the form of uncontrollable anxiety, depression and physical pain. My mind and body literally fall apart when I lose sight of my savior for even a brief moment. For others it could be a bad attitude, snarky comments to those they love, falling back into addiction or making quick decisions. These things don’t creep in over time, they can flood in the second satan is able to get our eyes off of Jesus. It can happen just that quick.

The story of Peter above gives so much hope. I think it shows a wonderful picture of the love Jesus has for us. He didn’t yell at peter for doubting. He didn’t scold him, or punish him for losing sight of Him and sinking. It says, “Jesus immediately reached out his hand and took hold of him, saying to him, “O you of little faith, why did you doubt?” 32 And when they got into the boat, the wind ceased.” Jesus immediately reaches his hand out to peter and holds him. Yeah, He says “O you of little faith, why did you doubt?” But He doesn’t yell at Peter, He simply poses a question to get Peter thinking. What a beautiful picture of how He rescues us when we are sinking.

I don’t know about you, but I tend to beat myself up when I lose sight of Jesus and end up going through these painful, difficult periods. I often feel as though I should be punished or am being punished for losing sight of Him. But that’s not what Jesus wants for us. He wants to grab us, hold us, and calm the storm going on around or in us. What an amazing God I serve, that when I mess up, when I leave Him, or stop pursuing Him, He doesn’t give up on me, rather He reaches out to me. I take so much comfort in that mental picture of Jesus reaching out His hand to me and holding me as I am sinking in the struggles of this broken world.

I won’t lie, I’m still struggling and working on getting better physically and mentally after this rough patch. It will take time to fully bounce back so I still appreciate your prayers. I know the consequences of losing sight of Jesus, and I don’t want that to happen again. Will I mess up again? yes. I’m human. But what a comfort to know that God loves me enough to reach out to me and He wants to calm the storms even when I rebel or allow satan to take over my mind.

I hope this gives you some sort of peace and comfort, as it has to me. When I feel my anxiety boiling up, or my body is drained and exhausted down to the bone, I can imagine Jesus reaching His hand out to me and holding me through it all. I hope that you can too when you go through a rough patch or difficult season. Jesus isn’t leaving you to drown, He’s right there reaching out His hand to hold you.

The song that spurred the Spirit to remind me of this story is called “Safe” by neon Feather.

Thank you for reading my rambles.

Intensive Outpatient Program (I.O.P.) Part 2: What led me to I.O.P?

I am honored and humbled to say that I had the privilege to be a part of a mental health I.O.P. group for eight weeks. During those eight weeks, I was also off of work. It was some of the hardest, but best weeks of my life. If you haven’t read my previous blog post, part one titled, What is IOP? You can read it here.

What Led Me To I.O.P.

This post is going to be a bit vulnerable. Please bear with me.

For those who don’t know me or my journey with mental health, I want to give just a little backstory before jumping right into this year. I have I struggled with anxiety since as far back as I can remember, but we never knew that what I was experiencing was a diagnosable illness. I didn’t get treatment until I was a sophomore in high school, but didn’t officially get diagnosed until going into my sophomore year of college. The anxiety also brought its trusty sidekick, depression.

Before I began I.O.P I was in a very tough place mentally, physically, emotionally and even spiritually. 2019 has been a very challenging year. I ended 2018 feeling on top of the world. I thought things were going great, and thus I hoped and expected 2019 to be great too; However, I was in for quite the wake up call.

Towards the end of January 2019, while at work, I experienced one of the worst panic attacks of my life that landed me an ambulance ride to the ER. Many hours and tests later, I left the hospital with a diagnoses of palpitations due to panic attack. In other words, they couldn’t find a single thing wrong with me. I felt completely and utterly defeated. This incident began a long strand of panic attacks, obsessions and compulsions, and ultimately depression.

Despite my attempts to try to convince myself I was doing okay, I ended up completely breaking down by the time August rolled around. I spent six months of the year pushing myself, ignoring my mind and body, and desperately trying to convince myself and those around me that everything was okay.

By the end of summer, my body was beyond exhausted to the point that I now had physical health concerns. I would lay in bed and cry some mornings because I didn’t know how I was going to be able to make it through another day. Because of commitments, I continued to push through until I couldn’t push myself any longer.

I had pushed myself so much and for so long that my nerves and immune system were shot. I got sick with the typical back to school cold, but because my mind and body were so worn down, it wiped me out. Not only was my anxiety through the roof and I was sick with a cold, but I was in physical pain as well. This landed me back in the ER for the second time this year.

I was released again with nothing to show for the symptoms that I was experiencing. I found myself feeling defeated and frustrated all over again. This was ultimately my breaking point. By this time I had planned two weeks off of work after my commitments were done. One week for vacation, and another week to rest and focus on myself. Much to my surprise, God had other plans for me.

Just a little over a week before my vacation, everything caught up to me and I had an emotional breakdown. I was struggling with intrusive thoughts that would send me into downward spirals. I had so much anxiety, adrenaline, cortisol running through my body 24/7 that I couldn’t sleep, I could barely eat, and even just breathing was a struggle. I was exhausted down to my bones and I ended up feeling hopeless.

It was a different kind of hopeless than I had felt before. It was anxiety based as opposed to depression based. It was the fear of, “what if I am like this forever, there is no way I can keep going for years feeling like this”. I cried to God for healing, peace and rest, and to my surprise, He answered that prayer through I.O.P.

Upon having my emotional breakdown, I made an appointment to see my doctor. I told her I felt like I just needed a break, whether that be going on partial disability or something else. I just felt like I needed a break from work and life obligations. I was desperate for rest. Her suggestion was I.O.P.

She briefly explained that I.O.P was group therapy, 3 days a week for 3 hours a day. She explained that I would have to drive 45 minutes to get there from where I live. She also broke the news to me that this was the only option for taking an extended amount of time off of work. Terrified, I turned to my dad, who encouraged me to go for it, and I hesitantly agreed. Little did I know I would become apart of something that would change my life for the better.

I can’t wait to share with you the lessons I learned from I.O.P and my time away of rest. I’m eager to share them, as I know that this type of treatment could greatly help others. With little information out there about the benefits and experiences of I.O.P, it is my hope that by writing my experience I can help others who are desperately longing for more in their treatment. I also hope that by sharing my experiences, providers and mental health professionals can get a sense of what it is like from the client’s perspective. Of course nothing confidential will be shared, simply just my own experience and things I learned.

If you like my content, feel free to click the follow button to get notified when I make new posts! Thanks for taking time out of your day to hear my thoughts. If you’ve had any experience with an Intensive Outpatient Program, I’d love to hear about it! Feel free to leave a comment below! Thank you for reading my rambles.

As always, I am not a licensed therapist and these thoughts are all my own. If you are in crisis or feel hopeless, please call 911 or the suicide hotline at 1-800-273-8255.

Intensive Outpatient Program (I.O.P.) Part One: What is I.O.P?

Intensive Outpatient Programs or IOP’s are programs designed to help individuals who need more treatment than just individual counseling but less treatment than inpatient or partial hospitalization. IOP’s are typically designed to be in a group therapy format and often meet anywhere from 3-5 days a week, typically averaging 9 hours of treatment per week anywhere from 5 weeks to a year (Mee-Lee et al. 2001).

When I was given the opportunity to be apart of an Intensive Outpatient Program, I had absolutely no idea what to expect. I was told the logistics of it: when we would meet, what time, and where, but I had no clue what it actually entailed. The only experience I had with group therapy prior to treatment, was my mock group counseling class in college, and that was not a great time. Even having studied counseling in college, I had never heard of IOP before. I was terrified upon making the decision to join one, and that led me to do some research.

While doing my research to help me understand what it was that I would be walking into, I was surprised by the lack of information out there. I mostly just found information from treatment centers, addictions/recovery centers, and healthcare websites. For the life of me, I could not find any information from someone who had actually been apart of one. I longed to hear that IOP helped someone and wanted to learn what I had to look forward to. I found none of that. That is why I have decided to share my own personal experiences.

Going into IOP I felt defeated, ashamed and just beaten down. I felt like my pride had been shattered by having to take that step to join IOP. I felt ashamed that my mental health had gotten to a point that I needed more treatment. I was scared that I was unfixable. But Intensive Outpatient Program has forever changed my life for the better. It was one of the hardest decisions I have ever had to make, but has been one of the best. I have made lasting relationships with people from all walks of life, and I no longer feel stuck.

I went into IOP hoping that it would help me get better, but I still had nagging thoughts in the back of my head that it wouldn’t. Like I said, I had no idea what to expect walking into my first day of IOP. I thought it would just be everyone sitting in a circle talking about their problems, and maybe some intensive outpatient programs are that way, but I’m glad mine was not. IOP was so much more than that.

IOP is about working together as a group to retrain your brain. It’s about experiences and doing activities together to bring you closer and to create movement within you. It’s about vulnerability in a group setting, acceptance, forgiveness, shame, and so much more. IOP is about community and being apart of something bigger than yourself to help you understand that you are not alone. IOP is about experiencing your emotions and your pain and learning how to move past it. IOP is so much more than just sitting in a circle, sharing about your issues, or doing worksheets. It’s about experiences.

The activities and experiences in IOP are there to help clients and are highly encouraged by the therapist to participate; however, it is ultimately the client’s decision whether or not they join in. It takes courage to be vulnerable in a group setting, to share their heart, and to participate in many of the activities. But ultimately whether or not a client experiences growth by the end of IOP depends upon their participation and willingness to jump in. It is not a cure-all, but it is a great tool to help promote growth and movement when a client feels stuck.

Obviously this is all from my own personal experience and every Intensive Outpatient Program or group is different. I want to share my experiences so that those who are about to attend an IOP can get a glimpse into what to expect. It was also brought to my attention during this journey that many therapists and medical providers don’t know what IOP is either, and thus aren’t able to offer these programs as a treatment option. It is my hope that by sharing my experience and being vulnerable, more people will be able to receive the care that they need or want. As I mentioned before, I studied counseling and I had never heard of IOP. So many people could really benefit from this type of help, if it was just talked about more.

Being vulnerable online is not easy for me, it’s scary. But if sharing my story can help just ONE person out there, then it is worth it. I have been SO blessed to have the support that I have had. I have seen God’s hand in every aspect of my journey, especially in relation to IOP. God has been there in every detail, from the therapist leading the group, to the members in the group, to every activity we have done, He has been there. I am so grateful. God loves us, and He created us to experience emotions, and I firmly believe that He too wants mental health to be a priority in each of our lives. If IOP is the way He wants to do that, then let Him.

I’m going to be sharing even more of myself and my journey through IOP in the coming days, weeks or months. If you’re interested in that content, feel free to follow this blog. If you have any questions or you have your own experiences with IOP I’d love to hear them in the comments below! Thank you for reading my rambles.

As always, I am not a licensed therapist and these thoughts/opinions are all my own. If you are in crisis or feel hopeless, please call 911 or the suicide hotline at 1-800-273-8255.

References
Mee-Lee, D.; Shulman, G.D.; Callahan, J.F.; Fishman, M.; Gastfriend, D.; Hartman, R.; and Hunsicker, R.J., eds. Patient Placement Criteria for the Treatment of Substance-Related Disorders: Second Edition-Revised (PPC-2R). Chevy Chase, MD: American Society of Addiction Medicine, 2001.