Mr. David Ackerman, NY LCSW 038001

Those suffering with a substance abuse addiction are often unable to cease their behavior without some form of medical intervention. Studies have found that repeat use of certain drugs can figuratively rewire the brain, resulting in alterations to neural pathways associated with dopamine. This means that repeat drug users may become reliant on consuming the substance in order to function. For example, those with alcohol addiction ("alcoholism") become physically dependent on alcohol and may experience extreme withdrawal symptoms when avoiding alcohol entirely; in rare cases, medically unsupervised withdrawal can lead to death.

Behavioral addictions are similar to substance abuse addictions; however, people with behavioral addictions are addicted to a behavior or emotion associated with certain behaviors, as opposed to drugs. In addition to gambling, common behavioral addictions include food, video games, social media, shopping, and pornography addictions. When performing the activity, people experience euphoria (a rush of dopamine) that slowly lessens over time, meaning they build a tolerance and dependency on a behavior. For example, people who are addicted to shopping may need to purchase more items or spend more money to feel the same rush that once fueled their addiction.

Addictions can be assessed through a variety of means such as diagnostic screening, abuse assessment, or psychiatric evaluation. Treatment can help patients recover from their addictions and manage mental and physical health conditions related to their addiction. People with addictions may be treated in rehabilitative treatment facilities, hospitals, and other clinical settings.

Addiction treatment for substance abuse may include:

• Detoxification (withdrawal from an addictive substance)
• Pharmacotherapy (prescription medications), such as buprenorphine-naloxone (Suboxone), disulfiram, and naltrexone to ease withdrawal symptoms
• Overdose treatment, such as the administration of naloxone (also known as Narcan)

Addiction treatments for both substance abuse and behavioral addictions may include:

• Addiction therapy and psychiatric care, such as cognitive behavioral therapy (CBT)
• Prescription medicine for co-occurring psychiatric disorders
• Twelve-step programs and support groups, such as Alcoholics Anonymous (AA) or Food Addicts Anonymous (FA)

Addiction treatment has expanded to include care for patient substance abuse in non-clinical settings. A number of community programs now provide at-risk substance users a safe place or means to use drugs and mobile doctor's services for drug-associated illnesses and injuries. Behavioral addictions are also gaining increased attention as researchers and mental health professionals seek to better understand and treat them. For example, some researchers are assessing the connections between video game addiction and childhood risk factors. More and more, mental health experts are recognizing the importance of meeting people with addictions where they are at, using more advanced treatments. Addiction treatment is intended to care for people with addictions with compassion and respect.

These problems and others can make a job seem unbearable. For example, a demanding or detached supervisor can contribute to poor job satisfaction and work anxiety. Similarly, a lack of control in one's job, such as the inability to work on a project or make day-to-day decisions, can diminish one's workplace morale. Many workers in these situations find themselves dissatisfied and eager to leave their jobs or even to become fired. However, resignations and job losses can pose equally challenging career difficulties. Job loss or unemployment can trigger financial stress as well as feelings of isolation, depression, and diminished self-confidence. People experiencing job loss may feel dissatisfied with other job prospects or fear their career opportunities are limited.

For many, mental health therapy can improve negative emotions and behaviors arising from career difficulties and both those with jobs and those experiencing job loss may benefit from therapy. Therapists may listen to people's career difficulties and provide advice for navigating a number of work-related problems. Online counseling can be particularly helpful for career issues in the modern workplace in that direct access to a therapist throughout the day can help alleviate recurring pressure and anxiety arising from one's job. Many people find that therapy or counseling for career difficulties can improve their overall job performance and disposition. For example, therapists can guide people to develop and hone essential skills, such as building the self-confidence necessary to deliver a presentation or the sustained focus needed to complete a lengthy project. For those experiencing job loss or unemployment, therapy can help with feelings of isolation, depression, and diminished self-confidence. Therapists may encourage some to seek other job prospects and opportunities. Like some problems in other areas of life, difficulties in the workplace can be debilitating for some, and consultations with a therapist can help some overcome initial feelings of being overwhelmed.

Career counseling is another option for those with career challenges. Career counselors help people develop professional skills and gain the tools necessary to further their careers. A career counselor may help with job applications, coach practice job interviews, proofread resumes, and provide networking strategies to move someone towards his or her ideal career. Career counseling can also help people navigate work problems like lack of motivation, indecisiveness, and burnout, so that they might better enjoy their current position.

Some people decide to switch career paths in order to achieve happiness and fulfillment. Through personality and aptitude tests, therapists and career counselors can help people identify occupations or industries that are better suited to them. Therapists and counselors also take into account a person's intellectual and physical strengths, as well as what a person values in work, whether that be job security or opportunity for creativity and challenge. Therapists and career counselors may recommend people complete certification courses or educational degrees to shift towards their ideal careers.

Career difficulties are a widespread issue that nearly everyone who works has or will endure at some point in time. Many people find that mental health therapy or career counseling can greatly improve their career satisfaction and overall happiness.

Anorexia nervosa, frequently referred to as anorexia, is a disorder where people severely restrict the types and quantity of food they eat. Those with anorexia have an extreme fear of eating and gaining weight and may repeatedly weigh themselves or engage in harmful behaviors such as excessive exercise or starvation. Those with anorexia often find themselves preoccupied with food, but unable to consume a healthy amount of it. This results in symptoms such as abnormally low BMI, vitamin deficiency, fatigue, fainting, and amenorrhea (lack of menstruation in women). Anorexia may cause bluish discoloration of the hands, brittle and falling out hair, yellowish skin, and lanugo (fine, downy hair). Left untreated, anorexia can lead to organ failure, brain damage, and even death.

Bulimia nervosa, typically called bulimia, is a disorder where people binge (eat large quantities of food) and purge the food that they just consumed by vomiting, laxative abuse, fasting, or excessive exercise. This behavior is usually motivated by a feeling of powerlessness over eating and a fear of weight gain or desire for weight loss. Bulimia can occur in underweight, normal weight, and overweight people. Symptoms of bulimia include acid reflux, intestinal distress, dehydration from purging, amenorrhea, and dental erosion from vomiting. Some people with bulimia have swollen parotid glands (salivary glands near the cheeks) and red scars and marks on the backs of their knuckles. Electrolyte imbalance from bulimia can be particularly severe and may lead to heart attack or stroke.

Binge eating disorder (BED) is the most common eating disorder. People with BED feel that they are unable to control the amount of food they eat and may continue to binge after reaching a point of fullness. BED binges (consuming large amounts of food) are often accompanied by feelings of sadness, guilt, and shame. Symptoms of BED include obesity, acid reflux, weight gain, and dissatisfaction with one's body. People with BED tend to experience cycles of negative emotions and binges. Binges or BED episodes can be provoked by stress, boredom, restrictive dieting, depression, and other triggers.

Other common eating disorders include:

• Pica, eating things that are not food, such as paper, ice, or soil
• Avoidant/Restrictive Food Intake Disorder (ARFID), disinterest in eating and avoidance of food
• Other Specified Feeding or Eating Disorder (OSFED), abnormal eating that does not fall under any disorder

Many people with eating disorders do not consciously develop them, and have difficulty seeking treatment. For this reason, it's important to detect and treat eating disorders as early as possible. Treatment for eating disorders can vary from therapy visits to inpatient treatment, depending on the disorder and its severity. Treatment aims to not only restore physical health and correct negative behaviors, but to also promote psychological well-being and self-confidence.