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Ativan Addiction: What it is, Signs and Treatment Options

Ativan, also known by its generic name lorazepam, is a commonly prescribed medication used to treat anxiety disorders and insomnia. However, misuse or prolonged use of this medication can result in a serious condition known as Ativan addiction. Ativan addiction is characterized by a strong psychological and physical dependence on the drug, often leading to destructive behaviors and severe negative consequences.

Recognizing the signs of Ativan addiction is crucial in order to seek timely intervention and prevent further harm. This article aims to provide an overview of what Ativan addiction is, its signs, and available treatment options to help individuals struggling with this condition regain control of their lives.

What is Ativan?

Ativan, known as lorazepam, is a benzodiazepine medication for anxiety disorders, seizures, and insomnia. By acting on the central nervous system, Ativan produces a calming effect. This medication works by enhancing the effects of gamma-aminobutyric acid (GABA), a natural brain chemical that reduces excessive brain activity and promotes relaxation.

Ativan can be taken orally in tablet form or as an injectable solution. It is important to follow the prescribed dosage instructions a healthcare professional provides. The recommended dosage may vary depending on age, medical condition, and response to treatment. Not exceeding the prescribed dosage or using Ativan longer than recommended is crucial to prevent potential side effects and dependency.

Some common Ativan side effects include drowsiness, dizziness, and impaired coordination. These effects may be more pronounced in elderly individuals. It is advised to avoid driving or operating heavy machinery while taking Ativan. Headache, nausea, and memory problems are also possible side effects. If any of these side effects worsen or persist, it is important to consult a healthcare professional.

It is crucial to be aware of potential interactions with other drugs when taking Ativan. Combining it with alcohol or another central nervous system (CNS), depressants can increase sedative effects and cause harm. You must inform your healthcare provider of all current medications to avoid potential interactions.

It is important to note that Ativan has the potential to lead to dependence and abuse. Misusing or using it for an extended period can result in physical and psychological dependence. When discontinuing Ativan, it is recommended to follow the advice of a healthcare professional to avoid withdrawal symptoms such as seizures, tremors, and anxiety.

What Are the Common Uses of Ativan?

Ativan, known as lorazepam, is a benzodiazepine medication used to treat various conditions. Its common uses include:

  1. Anxiety disorders: Ativan treats generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. It reduces anxiety symptoms by enhancing brain activity.
  2. Insomnia: Ativan is a short-term solution for insomnia related to anxiety or stress. But it should not be used long-term to avoid dependence and withdrawal symptoms.
  3. Seizures: Ativan effectively manages epileptic seizures and status epilepticus, a life-threatening condition. It calms the brain and stops abnormal electrical activity.
  4. Alcohol withdrawal: Ativan is used during alcohol detoxification to reduce withdrawal symptoms like tremors, agitation, and hallucinations. It stabilizes the individual and prevents complications.
  5. Nausea and vomiting: Ativan is an antiemetic to relieve nausea and vomiting caused by chemotherapy or radiation therapy. It acts on the brain’s vomiting center and reduces the urge to vomit.
  6. Sedation before medical procedures: Ativan is given to induce relaxation and sedation. It alleviates anxiety and promotes a calm state of mind.
  7. Muscle spasms: Ativan effectively relieves muscle spasms and reduces muscle tension, especially in acute cases caused by injury or conditions like multiple sclerosis.

It is important to follow a healthcare professional’s prescription when using Ativan. It should not be taken without supervision or for prolonged periods due to the risk of dependence, tolerance, and withdrawal symptoms. Always follow the dosage instructions and consult a healthcare provider if any concerns arise.

Understanding Ativan Addiction

Addiction to Ativan, a prescription medication for anxiety disorders, can have serious consequences. It is important to understand Ativan addiction to address this issue effectively and clearly.

  • Ativan misuse: Ativan is a benzodiazepine that enhances the effects of gamma-aminobutyric acid (GABA), producing a calming effect. However, using higher doses or taking them longer than prescribed can lead to addiction.
  • Signs and symptoms: Recognizing the signs of Ativan addiction is crucial. These may include increased tolerance, withdrawal symptoms, cravings, social isolation, neglecting responsibilities, and doctor shopping or seeking multiple prescriptions.
  • Risk factors: Understanding the risk factors can assist in prevention and early intervention. Factors such as personal or family history of substance abuse, mental health disorders, and a history of addiction increase the likelihood of developing an addiction to Ativan.
  • Health consequences: Ativan addiction can have severe health implications. Prolonged use increases the risk of respiratory depression, overdose, and death. Long-term use may also result in memory problems, cognitive impairments, and decreased mental functioning.
  • Withdrawal and treatment: Stopping Ativan abruptly can cause withdrawal symptoms, ranging from anxiety and restlessness to seizures and hallucinations. Seeking professional help is crucial to manage withdrawal and safely initiate a comprehensive treatment plan.
  • Treatment options: Ativan addiction involves medical detoxification, therapy, and support groups. Cognitive-behavioral therapy (CBT) effectively addresses the causes of addiction and develops coping mechanisms to prevent relapse.
  • Support systems: Individuals struggling with Ativan addiction require strong support systems. Family support, counseling, and participation in groups like Narcotics Anonymous can provide encouragement and guidance.
  • Prevention: Preventing Ativan addiction starts with responsible prescribing practices and patient education. Doctors should carefully evaluate patients before prescribing Ativan and monitor their usage. Patients should be educated about the risks associated with Ativan and the importance of taking it as prescribed.

Understanding Ativan addiction is crucial. By recognizing the signs, risk factors, and treatment options, we can promote early intervention and support individuals on the path to recovery.

What Are the Signs and Symptoms of Ativan Addiction?

The signs and symptoms of Ativan addiction can vary. It is important to recognize these signs early on to seek help for the addiction.

  1. Increased drowsiness: Ativan is a sedative drug, so one sign of addiction is excessive drowsiness. Individuals may appear excessively tired or have difficulty staying awake.
  2. Changes in behavior: Someone addicted to Ativan may exhibit sudden behavioral changes, such as increased irritability, mood swings, or aggression. They may also become withdrawn or secretive.
  3. Neglecting responsibilities: As the addiction progresses, individuals may neglect important responsibilities at work, school, or home. They may have trouble focusing or completing tasks.
  4. Loss of interest in activities: People addicted to Ativan often lose interest in activities they once enjoyed. Hobbies, socializing, and personal relationships may take a backseat.
  5. Withdrawal symptoms: When someone addicted to Ativan attempts to reduce their use, they may experience withdrawal symptoms such as anxiety, restlessness, irritability, or insomnia.
  6. Doctor shopping: Individuals may engage in “doctor shopping,” visiting multiple doctors or clinics to obtain prescriptions for Ativan.
  7. Increased tolerance: With continued use, individuals may develop a tolerance to Ativan, requiring higher doses to achieve the same effects.
  8. Physical symptoms: Ativan addiction can manifest as blurred vision, slurred speech, impaired coordination, and muscle weakness.

Experiencing one or a few of these signs does not automatically mean someone is addicted to Ativan. Seek professional help if you or someone you know consistently displays several of these signs. Reach out to healthcare professionals or addiction specialists for guidance and support.

What Are the Risk Factors for Ativan Addiction?

People at a higher risk of developing an addiction to Ativan are individuals with a personal or family history of substance abuse. Additionally, people with a history of mental health disorders like anxiety or depression are more prone to developing an addiction to Ativan. Those who have previously struggled with substance abuse may also be more susceptible to developing an addiction to Ativan.

Furthermore, individuals who have experienced traumatic events are more at risk of developing substance abuse issues, including addiction to Ativan. Moreover, people surrounded by individuals who engage in substance abuse or have an enabling attitude toward drug use have a higher likelihood of developing an addiction to Ativan.

It is important to note that misusing Ativan by taking higher doses than prescribed or using it for longer durations than recommended increases the risk of addiction.

Finally, certain demographic factors such as age and gender can influence the risk of developing an addiction to Ativan. People with chronic pain or other physical health conditions may be prescribed Ativan for symptom management. However, extended use can potentially lead to dependence and addiction.

How Is Ativan Addiction Diagnosed?

When diagnosing Ativan addiction, healthcare professionals rely on physical and psychological assessments to determine how Ativan addiction is diagnosed. Here are the key factors considered in the diagnosis process:

  1. Medical history: Doctors review the patient’s medical history, including any known history of Ativan use or previous substance abuse, to understand their health and addiction risk factors when diagnosing Ativan addiction.
  2. Physical examination: A physical examination checks for signs of Ativan addiction or complications. This includes assessing vital signs like blood pressure and heart rate. Additionally, healthcare professionals may conduct blood or urine tests to detect Ativan or its metabolites and aid in diagnosing Ativan addiction.
  3. Psychological assessment: When diagnosing Ativan addiction, healthcare professionals assess the individual’s mental and emotional well-being. They look for symptoms of anxiety, depression, or other mental health disorders that may co-occur with Ativan addiction.
  4. Diagnostic criteria: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria to diagnose substance use disorders, including Ativan addiction. Healthcare professionals evaluate if the patient meets these criteria, including specific behavioral patterns and impairment in important areas of functioning.
  5. Patient interviews: Open communication between the patient and healthcare provider is crucial in diagnosing Ativan addiction. The patient’s input about their Ativan use, patterns, and difficulties aids in accurately diagnosing Ativan addiction.
  6. Collaboration with specialists: In complex cases, doctors may collaborate with addiction specialists or mental health professionals to ensure an accurate diagnosis of Ativan addiction. These specialists provide additional expertise in assessing and treating Ativan addiction.

It’s important to note that diagnosing Ativan addiction requires professional expertise, and self-diagnosis should be avoided. If you suspect Ativan addiction, seek help from a qualified healthcare professional for an accurate diagnosis and appropriate treatment.

The Side Effects of Ativan

Discover the world of Ativan and its impact on our well-being as we explore the intriguing side effects of this medication. From the common to the most serious, we’ll unveil the potential consequences that can arise from its usage. Brace yourself to uncover the multifaceted nature of Ativan’s side effects, diving into the peculiarities that can arise in our ongoing quest for optimum health. This exploration will shed light on this widely prescribed medication’s expected and unexpected effects.

Common Side Effects

The common side effects of Ativan (lorazepam) include:

  • Drowsiness: Many patients feel drowsy after taking Ativan. This can impair their ability to operate machinery or drive. It is important to avoid activities that require alertness until the medication’s effects are known.
  • Dizziness: Ativan can cause dizziness, especially when standing up. It is advisable to rise slowly to minimize the risk of falling.
  • Weakness: Some individuals may feel weak or lack energy while taking Ativan. It is important to engage in comfortable activities and listen to your body.
  • Confusion: Ativan can cause confusion or difficulty concentrating, especially in elderly patients or those taking higher doses.
  • Memory problems: Some individuals may experience memory impairment while taking Ativan. It is important to discuss any concerns with your healthcare provider.
  • Blurred vision: Ativan can temporarily affect vision, making it difficult to see clearly. Avoid tasks that require precise vision until the side effect subsides.
  • Nausea: Ativan can cause an upset stomach or feelings of nausea. Taking the medication with food may help alleviate this side effect.
  • Headache: Some individuals may develop headaches while taking Ativan. If the headache persists or worsens, consult your healthcare provider.
  • Changes in appetite: Ativan can alter appetite, leading to an increase or decrease in food cravings. Maintain a balanced diet and discuss any concerning changes with your healthcare provider.
  • Mood changes: Ativan may affect mood, leading to feelings of euphoria, irritability, or sadness. If significant mood changes are noticed, discussing them with a healthcare provider is important.

While these common side effects are well-known and experienced by some patients, it is important to note that not everyone will experience them. Consult with your healthcare provider if you have any concerns about the side effects of Ativan. They can guide managing the side effects or adjusting your medication if necessary.

In the early days of psychiatric medication, the side effects of drugs like Ativan were poorly understood. Patients often experienced significant sedation and memory impairment. However, as medical knowledge advanced, healthcare providers become more adept at managing and minimizing these common side effects. Today, healthcare providers thoroughly evaluate patients before prescribing Ativan to determine the appropriate dosage and monitor for potential adverse effects. Constant research and advancements in psychiatry continue to improve our understanding and management of the common side effects associated with Ativan.

Serious Side Effects

Ativan is a prescription medication used to treat anxiety disorders and seizures. There are serious side effects of taking Ativan. Here are some important things to know:

  1. Respiratory depression: One of the serious side effects of Ativan is respiratory depression. This happens when the medication slows down or suppresses breathing. It is more likely to occur in individuals taking higher doses of Ativan or those with pre-existing respiratory conditions. Respiratory depression can be life-threatening and requires immediate medical attention.
  2. Severe allergic reactions: Another serious side effect of Ativan is severe allergic reactions. These reactions can manifest as swelling of the face, tongue, or throat, difficulty breathing, or a rash. If you experience these symptoms after taking Ativan, seek medical help immediately.
  3. Abuse and addiction: Ativan can be abused and lead to addiction, particularly in individuals with a history of substance abuse or addiction. Take Ativan as prescribed, and be cautious of any changes in behavior or cravings for the medication. Misusing Ativan can result in dependence and withdrawal symptoms when discontinuing its use.
  4. Cognitive impairments: Ativan can cause cognitive impairments, particularly in older adults. This includes confusion, memory problems, and difficulty concentrating. Monitor these changes and discuss them with your healthcare provider, as dosage adjustments or alternative treatment options may be necessary.
  5. Sedation and drowsiness: Ativan can cause sedation and drowsiness, especially when starting the medication or increasing the dosage. This can affect your ability to drive or operate machinery safely. Avoid activities that require alertness until you know how Ativan affects you.
  6. Interactions with other medications: Ativan can interact with other medications, particularly those that depress the central nervous system. This increases the risk of respiratory depression and other serious side effects. Always inform your healthcare provider about your medications to prevent potential interactions.

The Dangers of Ativan Abuse

Ativan abuse presents significant dangers. Misusing this medication can result in serious repercussions. The hazards associated with Ativan abuse encompass:

  1. Physical dependence: Consistently misusing Ativan can lead to physical dependence, manifesting through withdrawal symptoms like tremors, seizures, and heightened anxiety.
  2. Increased tolerance: Prolonged abuse of Ativan may cause the body to develop a tolerance to the drug, increasing the chances of overdose and other adverse effects.
  3. Impaired cognitive function: Ativan abuse significantly affects cognitive function, resulting in memory issues, difficulty concentrating, and impaired judgment.
  4. Respiratory depression: Ativan is a central nervous system depressant that slows down brain activity. Combining excessive doses with other depressants like alcohol can lead to dangerously low breathing rates or even respiratory failure.
  5. Interactions with other substances: Combining Ativan with alcohol, opioids, or sedatives can have fatal consequences, leading to severe respiratory depression or death.
  6. Psychiatric complications: Long-term abuse of Ativan can worsen pre-existing mental health conditions or give rise to new ones, increasing the risk of depression, mood swings, and suicidal thoughts.
  7. Social and occupational impairment: Ativan abuse can impact relationships, work performance, and overall functioning, impairing motor skills, coordination, and judgment.

To avoid the dangers associated with Ativan abuse, it is crucial to adhere to the medication only as prescribed by a healthcare professional. If you or someone you know is grappling with Ativan abuse, seek assistance from a healthcare provider or addiction specialist to ensure a safe detoxification process and successful recovery.

Treatment Options for Ativan Addiction

When it comes to addressing Ativan addiction, there are various treatment options available. In this section, we’ll explore the different approaches that can aid in overcoming this addiction. From medication-assisted treatment and therapy to support groups and detoxification, we’ll uncover the various paths individuals can take on their journey toward recovery. Let’s dive into the specific methods and techniques that have proven effective in helping individuals overcome Ativan addiction and regain control of their lives.

Medication-Assisted Treatment

Medication-Assisted Treatment (MAT) helps individuals recover from Ativan addiction. Important facts about MAT include:

  1. Medication-Assisted Treatment (MAT) combines medications with therapy and counseling to address Ativan addiction. It is a comprehensive and evidence-based approach.
  2. MAT for Ativan addiction usually involves long-acting benzodiazepines like diazepam or clonazepam. These medications manage withdrawal symptoms and reduce cravings.
  3. Medication-Assisted Treatment (MAT) is supervised by healthcare professionals who ensure proper dosage and monitor for side effects or complications.
  4. MAT should always accompany therapy and counseling, such as cognitive-behavioral therapy (CBT) or motivational interviewing. These behavioral therapies address psychological aspects and help individuals develop coping skills.
  5. Support groups like Narcotics Anonymous are integral to MAT. They provide a supportive environment for sharing experiences, receiving encouragement, and building a sober support network.
  6. Detoxification and rehabilitation may be necessary before starting MAT. Detoxification helps individuals safely withdraw from Ativan, while rehabilitation focuses on the underlying causes of addiction and strategies for long-term recovery.
  7. MAT significantly improves treatment outcomes for Ativan addiction. It reduces relapse risk, improves treatment retention, and enhances overall well-being.

It is important to note that MAT is not a standalone solution. It should be part of a comprehensive treatment plan addressing addiction’s physical, psychological, and social aspects.

Fact: Studies show that MAT increases the likelihood of successful recovery from Ativan addiction by 50% or more compared to other approaches.

Therapy and Counseling

Therapy and counseling, including individual therapy, group therapy, family therapy, and psychoeducation, are essential for treating Ativan addiction. They offer support and tools for individuals seeking long-term recovery.

  • Individual therapy: In this form of therapy, a therapist works one-on-one with individuals struggling with Ativan addiction. It allows them to delve into the causes of their addiction, develop coping strategies, and transform destructive behaviors. Cognitive-behavioral therapy (CBT) is frequently employed to identify and modify addiction-related negative thoughts and behaviors.
  • Group therapy: Group therapy provides a supportive environment for individuals experiencing similar challenges. It enables them to share their struggles, learn from others, and receive feedback and encouragement. Group therapy also enhances social skills, communication, and support networks.
  • Family therapy: This therapy involves the individual’s family in the treatment process. Its goal is to improve family dynamics, enhance communication, and educate loved ones about addiction and recovery. Through family therapy, relationships are healed, and the support system for the recovering individual is strengthened.
  • Psychoeducation: Psychoeducation offers information on Ativan addiction, its effects, and the recovery process. It empowers individuals to grasp their addiction and make informed decisions regarding treatment and ongoing recovery.

The effectiveness of therapy and counseling can vary depending on individual circumstances, addiction severity, and co-occurring mental health disorders. A personalized treatment plan tailored to individual needs is crucial for successful recovery.

Support Groups and Peer Support

Support Groups and Peer Support play a crucial role in the recovery process for individuals struggling with Ativan addiction. These groups provide community, understanding, and encouragement to help individuals overcome addiction. Here are some reasons why support groups and peer support are beneficial:

  1. Emotional Support: Support groups offer a safe space for individuals to share their experiences, emotions, and challenges related to Ativan addiction. Peers who have gone through similar struggles can provide empathy, validate feelings, and offer encouragement.
  2. Accountability: Being part of a support group provides accountability as members can hold each other responsible for their actions and decisions. This fosters responsibility and motivation to stay on track with recovery goals.
  3. Shared Strategies: Support groups and peer support allow individuals to learn from each other’s experiences and gain insights into effective strategies for managing cravings, triggers, and relapse prevention. Members often share helpful coping mechanisms and techniques.
  4. Non-Judgmental Environment: Support groups create a non-judgmental environment where individuals can openly discuss their struggles and challenges without fear of criticism or stigma. This acceptance and understanding can reduce shame and promote self-acceptance.
  5. Peer Mentorship: Support groups often have individuals who have successfully overcome Ativan addiction and can serve as mentors to provide guidance and inspiration. Having someone who has walked a similar path and achieved recovery can be a beacon of hope for others.

Detoxification and Rehabilitation

Detoxification and rehabilitation are crucial in overcoming Ativan addiction. Medical professionals closely monitor individuals during detoxification to ensure safety and minimize withdrawal symptoms. The length of detoxification varies depending on the severity of addiction. However, detoxification alone is not enough for long-term recovery. It should be followed by comprehensive rehabilitation.

Rehabilitation focuses on addressing the psychological and behavioral aspects of addiction. Cognitive-behavioral therapy (CBT) is commonly used to identify and change unhealthy thinking and behavior patterns. Individual therapy sessions provide a safe space to explore the underlying causes of addiction and develop coping strategies for triggers and cravings.

Support groups and peer support are also vital components of rehabilitation. These groups offer emotional support and encouragement. Being part of a supportive community can reduce feelings of isolation and enhance motivation for recovery.

Medication-assisted treatment (MAT) may also be beneficial. MAT involves using medications, such as benzodiazepine antagonists or opioid replacement therapy, to manage cravings and alleviate withdrawal symptoms. Medical professionals prescribe and monitor these medications for safe and effective treatment.

Detoxification and rehabilitation are essential in breaking the cycle of Ativan addiction. However, success depends on the individual’s commitment and willingness to make positive changes in their life.

If you or someone you know is struggling with Ativan addiction, seeking professional help is crucial. Contact a healthcare provider or addiction specialist who can guide you through detoxification and rehabilitation. Remember, recovery is possible, and support is available for those who seek it.

Preventing Ativan Addiction

Preventing Ativan addiction is crucial for maintaining health and well-being. Here are steps to prevent Ativan addiction:

  1. Use non-medication options: Consider alternatives for managing anxiety and other conditions Ativan treats. This can include therapy, relaxation techniques, exercise, and lifestyle changes.
  2. Follow dosage instructions: If prescribed Ativan, carefully follow recommended dosage instructions. Never exceed the prescribed amount or use it for longer than necessary.
  3. Avoid recreational use: Do not use Ativan for recreational purposes or without a valid prescription. Misuse can lead to dependence and addiction.
  4. Monitor your use: Pay attention to how often you use Ativan and any cravings or compulsions to take it. If patterns raise concerns, discuss it with your healthcare provider.
  5. Communicate with your healthcare provider: Keep open communication regarding using Ativan. Discuss any concerns or questions you have.
  6. Be aware of risks: Educate yourself about Ativan’s potential risks and side effects. Understanding the risks helps inform your decisions and promotes responsible use.
  7. Store medication safely: Keep Ativan in a secure place to prevent misuse or access by others. Dispose of any unused medication properly.
  8. Avoid combining substances: Consult your healthcare provider before combining Ativan with alcohol or other drugs. The combination increases the risk of addiction and adverse effects.
  9. Seek help when needed: If struggling with Ativan addiction, seek professional help immediately. Addiction is treatable, and early intervention can make a difference.

Preventing Ativan addiction requires a proactive approach and responsible use. By following these steps and staying informed, you can minimize the risk of addiction and promote well-being. Remember, prevention is key to maintaining a healthy relationship with medication.

Can other medications also cause Addiction? 

Yes, let’s have a look at some: 

Can Ativan cause Addiction?

Yes, Ativan, also known as lorazepam, can cause addiction. Ativan is a benzodiazepine, a type of medication often prescribed for anxiety, insomnia, and seizures. It works by increasing the activity of a neurotransmitter in the brain, resulting in a calming effect. However, prolonged use or misuse of Ativan can lead to physical and psychological dependence. 

People may develop tolerance to the drug, requiring higher doses to achieve the desired effect. Signs of Ativan addiction include cravings, withdrawal symptoms, and difficulty controlling use. If you or someone you know is struggling with Ativan addiction, seek help from a medical professional. To learn more about Ativan addiction and treatment, read our article.

Can Oxazepam cause Addiction?

Yes, Oxazepam, also known as Serax, can cause addiction when taken for an extended period of time or in high doses. Oxazepam is a benzodiazepine, similar to Valium, and is often used to treat anxiety and insomnia. However, like other benzodiazepines, it can be highly addictive due to its ability to produce feelings of relaxation and euphoria. 

Over time, individuals may develop a tolerance to Oxazepam and require higher doses to achieve the desired effects, leading to physical and psychological dependence. In addition, abrupt discontinuation of Oxazepam can also lead to withdrawal symptoms, making it difficult to stop use without professional help. To learn more about Oxazepam addiction and treatment options, check out our article.

Get help for your Benzo Addiction

Finding help for your Benzo addiction can be challenging, but taking the first step is crucial. Our facility is here to support you through this difficult journey. By reaching out and seeking help, you are opening the door to a healthier, happier life. Let us guide you towards recovery.

Adam Siegel
Author
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Adam is the lead addiction therapist at Olympic Behavioral Health and has been in the field of addiction treatment since 2009. Adam earned his associate degree in Applied Science for Chemical Dependency Counseling from Hudson Valley Community College in Troy, NY, in 2009 and became a Certified Addiction Counselor in 2016. He is currently enrolled in the Bachelor of Social Work Program at Florida Atlantic University to obtain his MSW. Adam is also in long term sobriety which allows him to relate with patients on a deeper level.

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