Acute Stress Disorder vs. PTSD

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Stress.
Photo courtesy of Pixabay.com

What is the difference between stress, Acute Stress Disorder, and PTSD?

Stress is a normal human reaction to something that threatens us or challenges our ability to cope. When challenged our bodies respond. Even good things we have looked forward to, like new jobs, marriages or the birth of a child, can cause stress. Negative events, loss of a job, divorce, sickness or the death of someone we love can be even more stressful. Stress is a normal part of life unless it gets out of control.

Acute stress disorder is when something stresses us out and this stress results in impairment of our ability to function. It goes far beyond just being stressed out and needing time to recuperate.

Acute Stress Disorder is a diagnosable mental illness, though much of it goes untreated and unnoticed and like adjustments problems or a mild depressive episode may go away by its self, untreated. If it becomes severe enough it needs treatment before the symptoms get out of hand. The symptoms of Acute Stress Disorder must last for at least two days and must happen during the thirty days after the stressful event. Once the episode lasts more than 30 days we reclassify it as PTSD. PTSD may also intensify and produce symptoms that are in excess of those seen in Acute Stress Disorder.

Acute Stress Disorder.

Acute Stress Disorder is not just being stressed out or needing time off from work, it is far more debilitating than those symptoms.

Here are the things that need to happen for the stress to be Acute Stress Disorder. This is in my words, not the official DSM language.

Warning: This description is not meant as a diagnose-your-self project. If you think you recognize yourself, a family member or friend in these descriptions you really should see a professional.

1. You experience or see something that makes you afraid you or someone close to you like a friend or family member will be killed or seriously injured. This could be an actual event or someone who threatened you and you believed them. As a result of this harm or risk of harm, you become intensely fearful, helpless, or horror-struck. Note this is pretty bad stuff, not just being chewed out by your boss or the risk of being fired. Those milder things are stressful and might result in an adjustment disorder if they affect you enough, but those non-life-threatening things don’t get called Acute Stress Disorder or PTSD.

2. You get lots of DISSOCIATIVE symptoms – 3 or more. Dissociative symptoms, those are bad.  Here is the list:

A. Numbing or not feeling emotions

B. You don’t feel like things are real – called derealization

C. You can’t be sure you are you – called depersonalization

D. You get dissociative amnesia – can’t remember big chunks of what happened.

3. You keep reliving this experience, like that episode of Star Trek where every day they got up and it all happened again. Your life turns into a rerun.

4. You would go a mile out of your way to avoid places or people like that again.

5. You are on edge, jumpy and the least little thing sets you off again.

6.  You get so upset you can’t go to work, avoid friends and are afraid to talk about this let alone ask for help.

7. This experience and all its terror lasts 2 days to 30 days.

8. By the way, if you did bad drugs and imagined this or there is something medically wrong with you – forget all the above and get to a doctor right away.

So what makes it PTSD?

If you have the above and it goes on over thirty days we change the name to PTSD. But then the longer this goes on the more the symptoms. This is one reason we are thinking that if we could get to people who have been injured and treat them right away we just might keep this Acute Stress Disorder from turning into PTSD. That means treating some people who could get better on their own without treatment in order to prevent others getting PTSD, but given the long-term debilitating results of PTSD, a little extra treatment might be worth it.

Not sure what you think, but I believe that if we could provide appropriate services to all those returning GI’s from the Middle East we could prevent a lot of long-term suffering.

Those guys are worth the effort right? For the accountants out there, prevention saves a lot of money on long-term treatment also.

As Acute Stress Disorder goes past the 30-day mark lots of more severe symptoms develop, nightmares, extreme efforts to avoid anything that might remind them of the trauma and lots of drug and alcohol abuse. PTSD and alcoholism are best friends.

There is disagreement right now about the best way to treat PTSD. I will write more in future posts on PTSD, stress and some available treatments and new approaches that sound really interesting.

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder (PTSD)

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

How are PTSD, PTG, and Resilience related?

Is some sort of personal growth possible as a result of living through a traumatic experience? Recently researchers have begun to study the concept of Posttraumatic Growth (PTG.) There has always been a body of literature about how some difficulty might spur changes in a person and lead to a new way of seeing life. But could something that was so severe a stressor as to be traumatic really lead to positive growth? And if that change might happen, why? What characteristics of the person, the treatment they received or their support system might transform Posttraumatic Stress into Posttraumatic Growth?

Zoellner & Maercker defined PTG as “the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma.” So far studies of PTG have been lacking and those that have taken place include mostly groups of people who are different from the clients we see in therapy who have PTSD. For example, many patients with PTSD also have co-occurring substance abuse disorders. Most studies of PTG have excluded clients with substance use disorders. We know from many individual reports that overcoming substance abuse especially in clients with PTSD can result in the client developing a new way of seeing the world and many in recovery report that they have grown as a result. Clients with suicidal thoughts have also been excluded from studies of PTG despite the recurrence of clients telling us that being hospitalized for a mental illness, especially with suicidal thoughts, can be a life-altering experience.

Hagenaars & van Minnen (Journal of Traumatic Stress, Vol. 23, No. 4, August 2010, pp. 504–508 (c 2010), conducted a study using Exposure Therapy. The therapy included steps beginning with low-intensity experiences such as “Patients were asked to close their eyes and talk about the traumatic event in the first person and in the present tense, recollecting as many sensory details as vividly as possible, i.e., as if the trauma was happening “here and now.” The intensity progressed to real-life situations. This procedure is similar to systematic desensitization procedures in use for specific phobias.

So what did they find? The more PTG the less PTSD and vice versa. Also, the more someone was “emotionally numb” the less likely they were to benefit from the treatment and the less likely they were to have PTG. They concluded that an inability to feel emotions is related to an inability to grow. So the ability to face problems leads to growth and the inability to face problems leads to staying stuck in the problem. Unfortunately, this leads us around in a circle to the place we started. Resilient people can grow as a result of trauma but trauma can make you less resilient especially repeated traumas.

Some clients who have been forced to relive traumatic events become re-traumatized. So sometimes the exposure techniques make you better but the same treatment can also make you sicker. How do you choose? Clients who share about trauma in a safe environment seem to get positive benefits; those who are cross-examined for details get worse. So, in the end, the value or damage of the technique depends on the relationship. This is one reason that group counseling is so appealing. People with similar traumas feel safer in talking about them in a group who has had a similar experience. Counselors who are seen as accepting help and rejecting professionals harm. It is in the case of PTSD as in other therapy – all about the relationship.

One further problem with the concept of PTG, how do we know it happens? Mostly we measure it by the client’s subjective report. They say they grew as a result of the trauma so that is evidence. But how did they grow? Did they take new actions or did they have a change of attitude? Maybe both? People who are spurred to action appear to grow more.

We also suspect that PTG is related to resilience. So do resilient people have more growth as a result of a traumatic event or do people who overcome a traumatic event become more resilient?

We know that PTG reduces PTSD symptoms and that the process of growth is related to resilience somehow. It is also clear that there is a lot more PTSD out there than we wanted to recognize. The challenge is making use of the things we learn in research and theory to help the clients who walk in the door in their journey from Posttraumatic Stress Disorder (PTSD) to Posttraumatic Growth (PTG.)

Do any of you have experiences with Posttraumatic Stress Disorder (PTSD) or Posttraumatic Growth (PTG) you would care to share?

This post was featured in “Best of Blog – May 2012

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

8 warning signs you have PTSD

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

8 warning signs you have PTSD.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

Could you have PTSD?

There is a whole lot more Posttraumatic Stress Disorder (PTSD) around than we would like to recognize. People struggle with the symptoms, sometimes for a lifetime. Often they think they are weak or crazy when in fact they have a recognized illness. PTSD is treatable if only those who have it would seek help.

There are three main causes of PTSD. One huge source of the illness is living through the horrors of war, either as a combatant or a civilian in a war zone. The recurring theme of so many young Americans sent off to wars in distant lands guarantee’s that we will be seeing an expanding number of PTSD cases for years to come.

Other large groups with PTSD are children who were abused and those who have been victims of domestic violence. There can be other sources of PTSD, such as witnessing a violent death or living through a natural disaster.

So what are the warning signs that you or someone you know has PTSD?

With PTSD you relive the horror day after day.

If the memory never goes away, you have recurrent thoughts about that time, that place, and it upsets you, these are all signs of PTSD. The key here is, are the thoughts intrusive? Some people especially young children get “stuck” they relive the events over and over, incorporating the things they have experienced into their play and their daily routines

The pain of PTSD follows you into your dreams.

We all have dreams; the mind tries to work out problems and save memories. Dreams in PTSD are different. The same dream recurs. It is as if you are living through the event all over again. People with PTSD can wake up screaming. If you are afraid to go to sleep for fear you will have that dream again or you don’t remember the last time you had a full night’s sleep you should be checked out for PTSD.

The feeling that the trauma is still happening is a sign of PTSD.

The trauma does not slip into the past. Every day you live through it again. This feeling of reliving the horror can be heightened by alcohol, some drugs or a new traumatic event.

If you avoid feelings, thoughts and can’t talk about the trauma it may be PTSD.

Many returning veterans have never been able to talk about the things they experienced. When they do talk, it is usually only with other military veterans who have had similar experiences. Many with PTSD are never able to talk about their trauma outside a peer group.

Avoiding anything that reminds you of the trauma is a symptom of PTSD.

Holiday celebrations, people who wear particular cultural styles of clothing, smells and ethnic foods, all of these can trigger a recurrence of symptoms. These recurrences are not just memories but reliving both the facts and the feelings of the first event. People with PTSD may panic and be unable to be around particular things that remind them of the traumatic incident.

Blackouts and memory gaps are common in people with PTSD.

People with PTSD may be horrifically frightened of things that remind them of the trauma but unable to recall large parts of the incident. Frequently important facts are forgotten. They see small details with great accuracy but other important parts of the story are lost in the fog.

With PTSD you experience a loss of connection.

People with PTSD lose interest in people and things around them. They find it difficult to participate in activities with others. They may become detached or unable to feel. They don’t see themselves as having a future, no family, no career. They don’t expect to live long.

Lots of episodes of sudden excessive emotions may be PTSD.

If you have PTSD you may suddenly become angry. You may be extra anxious, jump at the smallest sound. You may have trouble concentrating, be irritable and unable to relax or sleep.

A precise diagnosis of PTSD should be made by a professional. There are other illnesses and problems that could resemble this condition. But if you experienced trauma you probably recognized yourself in this list.

For more information on Stress and PTSD see:

Posttraumatic Stress Disorder – PTSD and bouncing back from adversity

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why can’t we forget the painful past?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Why can’t we forget the painful past?
Photo courtesy of pixabay

Are there some things you just can’t get over?

Why is it so hard to forget the pain of the past and so hard to remember times when things go well? Your brain is hard at work here, reminding you of your mistakes, not letting you get over the past. Why can’t we forget?

It is as if the brain stores memories in two different ways. Pleasant experiences, our successes in life get filed in boxes somewhere in the back of the brain. They take work to find. Not so with the pain.

Pain is grooved into the brain, great deep gashes in our consciousness. That one argument, that one mistake, and your mind just won’t let you forget. The unhappiness just doesn’t want to let you go.

There are good reasons for the brain to store memories that way. By emphasizing pain, keeping it close to the surface where it can be easily found again, your brain is trying to protect you from making the same mistake again. We should learn from our mistakes. Learn from what happened but not be controlled by the past.

This also means that if you are under the influence of drugs or alcohol you may not remember the pain, your brain was anesthetized.

Say you eat a hot-fudge-sundae. You will probably eat a number of those or some similar treat, in your lifetime. Think back on the times you ate one. Can you remember which one was better? How did the tenth one taste? The eleventh?  Pleasure is stored in the brain in a general way.

Unfortunately, most of us store our successes in the same way. We can’t seem to remember anything positive about our lives. It takes work to find that happy life events file.

What if something bad happens? Say you are driving along the freeway that takes you to work. You have driven this way every day for years. Can’t remember which day was sunny and when was that day you saw the deer up on the hill as you drove by. But one day there is an accident, you see people hurt, maybe killed. Will you forget that day? Not likely.

Painful memories are stored in extra easy to find files. Sometimes they aren’t filed away at all. They lay there open. You see that accident over and over in your mind. Some small details you may never be able to forget even when you try.

Your mind may remind you of that one day and the crash so much the memories intrude on your sleep. Some people will become so fearful that they will no longer take that freeway. They may decide to avoid freeways altogether. They may only use surface streets. Some people give up driving altogether. These extreme reactions to trauma take on a life of their own. If the fear and efforts to avoid things that remind you of the event last a long time this may become Posttraumatic Stress Disorder.

If you were in a war zone, were abused or neglected as a child, this makes sense. Treatment for PTSD is available but it is not a one size fits all treatment. Some people need to talk it out, some people get worse when forced to talk about horrific experiences. This calls for professional help.

But if this constant negative thought is the result of your focusing only on the pain and forgetting the positive then there are many things you can do about it.

In marriages, we believe that the couple needs seven or more positive experiences for every negative one. The brain has trouble remembering the good times. For children we tell parents to “catch your child doing something right” you won’t spoil them and they need that much positive attention from you to offset the times you will need to tell them they did something wrong.

What if your parents didn’t tell you that you had ever done something right? How about those who are their own worst enemies and never give themselves a break? Being over hard on yourself is not likely to make you try harder. Constant criticism can cause people to give up and stop trying, even when the blame comes from within.

Give yourself a pat on the back for anything you do well. Keep a list in a journal of all the things in your life large or small you have done well. Say positive self-affirming things to yourself every day. Post those affirmations in places you will see.

If you can’t remember a time you succeeded, when it is really hard to give yourself credit, ask yourself what would your best friend say? Don’t discount the praise you get. Accept the compliments and praise without discounting it.

While you may never be able to forget the pain of the past completely, focusing on the positive in the present and future will shrink those old memories.

This post was featured in “Best of Blog – May 2012

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

February 2012 – Best of Blog Recap

Counselorssoapbox.com

Here it is – The Best of Blog Recap for February 2012 –

Thanks, some more to all of you that read this blog. This has been the most read month ever for the counselorssoapbox blog. Hope some of the things I have written have been helpful and thought provoking. Feel free to comment and especially pass along the link to anyone you think might want to read this effort.

This month there were a few days with no post but when we reached the month end there were more posts than I had originally planned. We will see what the next month holds.

Here are the top read blog posts of the last month.

1. Do drugs cause mental illness?

2. How does therapy help people?

3. How many mental illnesses are there?

4. How much should you tell a therapist?

The all-time top read posts were:

1. How does therapy help people?

2. Post-Traumatic Stress Disorder – PTSD and bouncing back from adversity

3. Do drugs cause mental illness?

4. Treatment for teens risky Behavior

Over time lots of you have viewed the home page and “about the author” page also.

Thanks to all my readers new and old.

Next month we will explore some other topics and see what we come up with.

Till next time, David Miller, LMFT, NCC

Post Traumatic Stress Disorder – PTSD, and bouncing back from adversity

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

We have been hearing a lot more about PTSD these days.

Returning military are experiencing this problem in larger numbers than in the past. The military is not the only place we see PTSD. Children who have been abused, battered women and men, and people who have lived through traumas like hurricanes and tornadoes are also experiencing PTSD. The counseling profession, as well as society in general, is looking for solutions to this problem.

Recently at a convention for therapists and counselors, PTSD and the need to improve treatment was a major topic. I listened to the big name people; the ones who have written books and given lectures, as they talked about how we should treat the disorder. Two of the biggest names on therapy did not agree on the best treatment. If they disagree, what is the person with PTSD to think? This made me start searching for answers.

Why do some people get PTSD and others do not experience it. In combat, let’s say ten men are in the same incident some get PTSD and some do not, why? Stix in a Scientific American Article reported that of people who were traumatized by a single traumatic event, 90 % recovered from the trauma without therapy. So some people have concluded that PTSD is not a normal response to trauma. Maybe some form of resiliency is more common than PTSD. Maybe we have been doing it backward by studying the few who get PTSD instead of the many who bounce back from adversity.

We know from another study that kids who grow up in dysfunctional homes are more likely to suffer from PTSD, depression, and anxiety. From 50% to 67% of exposed kids develop some mental health issue but the other one-third to one-half does not. Kids from this sort of background have repeated trauma and they have less social support. I wanted to know why some got PTSD and others did not.

There is a lot of research going on right now into the area of resilience. Some people seem to not develop PTSD when exposed to trauma. Others bounce back quickly. A few have lifelong problems. We need to know why these variations and how do we improve the ability to bounce back from adversity. A quick check of one journal database disclosed over 1400 articles about resiliency. I haven’t read them all yet but I will try to tell you the things I learn as I read them.

One thing seems clear from the articles I have read so far, and I am always comparing the research I read to what my clients tell me. Resilience, that ability to bounce back from adversity, is not something we are born with. Resilience can be learned and it can vary from situation to situation.

The subject is of such importance that I think there needs to be a book or books on how people can increase their resilience. So my plan at this stage is to share with you the things I learn and to add your comments and suggestions to what I find. In the process there just might be a book that needs writing. I will keep you posted on my efforts to write that book.

There are lots of writings on recovery, particularly from substance abuse or dependence, what it means to recover and be recovered. We are concluding that many people have both substance abuse disorders and mental health issues. It would be important to know how recovery is like resilience and how it is different, assuming these two terms do not describe the same thing.

One more thing I need to tell you about at this time. Some people experience a traumatic event and it changes their lives forever in a positive way. We call this Post Traumatic Growth (PTG). This intrigued me. Why and how is it that some people use a traumatic experience to transform their lives and grow into a stronger better person? We talk a lot about the way PTSD damages people but not much about the way in which it might inspire them. So I have been reading everything I can find on PTG. But I am also listening with new ears to the stories people tell about their life-changing experiences.

There is more to come on this subject so I hope you stay tuned for my postings and a possible book on Posttraumatic Stress Disorder (PTSD), Posttraumatic Growth (PTG) and the whole issue of how resilience is created and how you or someone you know can learn to bounce back from adversity.

For more information on Stress and PTSD see:

8 warning signs you have PTSD

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder

Acute Stress Disorder vs. PTSD 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.