Denial anger bargain depression acceptance


SAMHSA’s National Helpline | SAMHSA

Your browser is not supported

Switch to Chrome, Edge, Firefox or Safari

Main page content

  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

SAMHSA Behavioral Health Treatment Services Locator

Home

Welcome to the Behavioral Health Treatment Services Locator, a confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance use/addiction and/or mental health problems.

PLEASE NOTE: Your personal information and the search criteria you enter into the Locator is secure and anonymous. SAMHSA does not collect or maintain any information you provide.

Please enter a valid location.

please type your address

  • FindTreatment.

    gov

    Millions of Americans have a substance use disorder. Find a treatment facility near you.

  • 988 Suicide & Crisis Lifeline

    Call or text 988

    Free and confidential support for people in distress, 24/7.

  • National Helpline

    1-800-662-HELP (4357)

    Treatment referral and information, 24/7.

  • Disaster Distress Helpline

    1-800-985-5990

    Immediate crisis counseling related to disasters, 24/7.

  • Overview
  • Locator OverviewLocator Overview
  • Locator OverviewLocator Overview
  • Finding Treatment
  • Find Facilities for VeteransFind Facilities for Veterans
  • Find Facilities for VeteransFind Facilities for Veterans
  • Facility Directors
  • Register a New FacilityRegister a New Facility
  • Register a New FacilityRegister a New Facility
  • Other Locator Functionalities
  • Download Search ResultsDownload Search Results
  • Use Google MapsUse Google Maps
  • Print Search ResultsPrint Search Results
  • Use Google MapsUse Google Maps
  • Icon from Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers). Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers).
  • Icon from Find practitioners and treatment programs providing buprenorphine for opioid addiction (heroin or pain relievers). Find programs providing methadone for the treatment of opioid addiction (heroin or pain relievers).

The Locator is authorized by the 21st Century Cures Act (Public Law 114-255, Section 9006; 42 U.S.C. 290bb-36d). SAMHSA endeavors to keep the Locator current. All information in the Locator is updated annually from facility responses to SAMHSA’s National Substance Use and Mental Health Services Survey (N-SUMHSS). New facilities that have completed an abbreviated survey and met all the qualifications are added monthly. Updates to facility names, addresses, telephone numbers, and services are made weekly for facilities informing SAMHSA of changes. Facilities may request additions or changes to their information by sending an e-mail to [email protected], by calling the BHSIS Project Office at 1-833-888-1553 (Mon-Fri 8-6 ET), or by electronic form submission using the Locator online application form (intended for additions of new facilities).

Five stages of grief. The Rise and Fall of Kübler-Ross

  • Lucy Burns
  • BBC

Image copyright Getty Images

Denial. Anger. Finding a compromise. Despair. Adoption. Many people know the theory according to which grief, when receiving unbearable information for a person, goes through these steps. The scope of its application is wide: from hospices to boards of directors of companies.

A recent interview with a psychologist in English on the Internet proves that the perception of the current quarantine is subject to the same rules. But do we all experience the same?

When Swiss psychiatrist Elisabeth Kübler-Ross began working in American hospitals in 1958, she was struck by the lack of methods of psychological care for dying patients.

  • A method that can predict your death

"Everything was impersonal, the attention was paid exclusively to the technical side of things," she told the BBC at 1983 year. “Terminally ill patients were left to their own devices, no one talked to them.”

She started a workshop with Colorado State University medical students based on her conversations with cancer patients about what they thought and felt.

Author photo, LIFE/Getty Images

Photo caption,

Elisabeth Kübler-Ross talks to a woman with leukemia in Chicago, 1969. Seminar participants observe through a special mirror glass

Despite the misunderstanding and resistance of a number of colleagues, soon there was nowhere for an apple to fall at the Kübler-Ross seminars.

In 1969 she published a book, On Death and Dying, in which she quoted typical statements from her patients and then moved on to discuss how to help doomed people pass from life as free of fear and pain as possible.

Kübler-Ross described in detail the five emotional states that a person goes through after being diagnosed with a terminal diagnosis:

  • Denial: "No, that can't be true"
  • Anger: "Why me? Why? It's not fair!!!"
  • Bargaining: "There must be a way to save myself, or at least improve my situation! I'll think of something, I'll behave properly and do whatever is necessary!"
  • Depression: "There is no way out, everything is indifferent"
  • Acceptance: "Well, we must somehow live with this and prepare for the last journey"

difficult situation.

A separate chapter of the book is devoted to each of the stages. In addition to the five main ones, the author identified intermediate states - the first shock, preliminary grief, hope - from 10 to 13 types in total.

Image copyright Getty Images

Elisabeth Kübler-Ross died in 2004. Her son, Ken Ross, says she never insisted that every person must go through these five stages in sequence.

"It was a flexible framework, not a panacea for dealing with grief. If people wanted to use other theories and models, the mother did not object. She wanted to start a discussion of the topic first," he says.

  • Last will: how did the photo of a dying American touch the world?
  • "You hear everything, Fernando." How was the evening in honor of the terminally ill football player

The book "On Death and Dying" became a bestseller, and Elisabeth Kübler-Ross was soon inundated with letters from patients and doctors from all over the world.

"The phone kept ringing, and the postman started visiting us twice a day," recalls Ken Ross.

The notorious five steps took on a life of their own. Following the doctors, patients and their relatives learned about them. They were mentioned by the characters of the series "Star Trek" and "Sesame Street". They were parodied in cartoons, they gave food for creativity to the mass of musicians and artists and gave rise to many successful memes.

Literally thousands of scientific papers have been written that have applied the theory of the five steps to a wide variety of people and situations, from athletes suffering career-incompatible injuries to Apple fans' worries about the release of the 5th iPhone.

Image copyright, Getty Images

Skip the Podcast and continue reading.

Podcast

What was that?

We quickly, simply and clearly explain what happened, why it's important and what's next.

episodes

The End of History Podcast

Kübler-Ross's legacy has found its way into corporate governance: Big companies from Boeing to IBM (including the BBC) have used her "change curve" to help employees at times of great business change.

And during the coronavirus pandemic, it applies, says psychologist David Kessler.

Kessler worked with Elisabeth Kübler-Ross and co-authored her latest book, Grief and How We Grieve. His interview with the Harvard Business Review at the start of the pandemic garnered a lot of attention online as people everywhere searched for solutions to their emotional problems.

"And here, first comes denial: the virus is not terrible, nothing will happen to me. Then anger: who dares to deprive me of my usual life and force me to stay at home?! Then an attempt to find a compromise: okay, if after two weeks of social distancing it gets better, then why not? Followed by sadness: no one knows when it will end. And, finally, acceptance: the world is now like this, you have to somehow live with it, "describes David Kessler.

"As you can see, strength comes with acceptance. It gives you control: I can wash my hands, I can keep a safe distance, I can work from home," he says.

"It's a roadmap," says George Bonanno, professor of clinical psychology and head of the Loss, Trauma, and Emotion Laboratory at Columbia University. "When people are in pain, they want to know: how long will it last? What will happen to me? something to grab on to. And the five-step model gives them that opportunity."

"This scheme is seductive," notes Charles Corr, social psychologist and author of Death and Dying, Life and Being. "It offers an easy solution: sort everyone, and it takes no more than the fingers of one hand to label each one." .

George Bonanno sees this as a possible harm.

"People who don't fit exactly into these stages - and I've seen the majority of them - may decide they're grieving the wrong way, so to speak," he explains.

According to him, over the years he has seen many cases when people themselves inspired that they must certainly experience this and that, or they were convinced of this by friends and relatives, but they did not feel it and decided, that they need a doctor.

Experimental evidence of the existence of the five stages of grief is not enough. The longest and most extensive bereavement interview was conducted in 2007.

According to him, the most common state at any time is acceptance, only a few go through the stage of denial, and the second most common emotion is longing.

However, according to David Kessler, while scientists debate the nuances and terms, people who experience grief continue to find meaning in the Kübler-Ross scheme.

"I meet people who tell me, 'I don't know what's wrong with me. Now I'm angry, and a minute later I'm sad. I must be crazy.” And I say, “It has names. These are called the stages of grief. ” The person says, “Oh, so there is a special stage called 'anger'? It's about me!" And feels more normal."

Image copyright, Getty Images

"People need catchy statements. If Kübler-Ross hadn't called it stages and stated that there are exactly five of them, then she probably would have been closer to the truth. But then she would not have attracted to attention," says Charles Corr.

He believes that talking about the five stages distracts from the main scientific legacy of Elisabeth Kübler-Ross.

"She wanted to take on the topic of death and dying in the broadest sense: how to help terminally ill people come to terms with their diagnosis, how to help those who care for them, support these patients and cope with their own emotions, how to help everyone live a full life, realizing that we are not eternal,” says Charles Corr.

"The terminally ill can teach us everything: not only how to die, but also how to live," said Elisabeth Kübler-Ross at 1983 year.

During the 1970s and 1980s, she traveled the world, giving lectures and giving workshops to thousands of people. She was a passionate supporter of the hospice idea pioneered by British nurse Cecily Saunders.

Kübler-Ross has established hospices in many countries, the first in the Netherlands in 1999. Time magazine named her one of the 100 most important thinkers of the 20th century.

Professor Kübler-Ross' scientific reputation was shaken after she became fascinated with theories about the afterlife and began to experiment with mediums.

One of them, a certain Jay Barham, practiced non-standard religious-erotic therapy, in particular, he persuaded women to have sex, assuring that he was possessed by a person close to them from the afterlife. In 1979, because of this, a loud scandal arose.

In the late 1980s, she tried to set up a hospice for children with AIDS in rural Virginia, but faced strong local opposition to the idea.

In 1995, her house caught fire under suspicious circumstances. The next day Kübler-Ross had her first stroke.

She spent the last nine years of her life with her son in Arizona, moving around in a wheelchair.

In her last interview with the famous TV presenter Oprah Winfrey, she said that at the thought of her own death she feels only anger.

"The public wanted the famed expert on death and dying to be some kind of angelic personality and quickly get to the stage of acceptance," says Ken Ross. "But we all deal with grief and loss as best we can."

The theory of the five stages of grief is not widely taught in medical schools these days. It is more popular at corporate trainings under the name "Curve of Change".

Since then, there have been many theories about how to deal with your grief.

David Kessler, with the consent of Kübler-Ross's family, added a sixth stage to the five: the understanding that everything that is done makes sense.

"Understanding can come in a million different ways. Let's say I've become a better person after losing a loved one. Maybe my loved one passed away in a different way than it should have happened, and I can try to make the world a better place to this has not happened to others," says David Kessler.

Charles Corr recommends the "double process model". It was developed by Dutch researchers Margaret Stroebe and Nenk Schut and suggests that a person in grief is simultaneously experiencing a loss and preparing himself for new things and life challenges.

George Bonanno talks about four trajectories of grief. Some people have great stamina and do not fall into depression, or it is weakly expressed in them, others remain morally broken for many years, others recover relatively close, but then a second wave of grief rolls over them, and finally, the fourth becomes stronger from the loss.

Over time, one way or another, the vast majority of people get better.

But Professor Bonanno admits that his approach is less clear-cut than the five-stage theory.

"I can say to a person: 'Time heals.' But that doesn't sound so convincing," he says.

Grief is difficult to control and hard to endure. The thought that there is some kind of road map that suggests a way out is comforting, even if it is an illusion.

Elisabeth Kübler-Ross, in her latest book, Grief and How We Grieve, wrote that she did not expect to sort out the tangled human emotions.

Everyone experiences grief in their own way, even if some patterns can sometimes be deduced. Everyone goes their own way.

Denial - anger - bargaining - depression - acceptance. Edition 66.RU in five stages of mental quarantine — news about health in Yekaterinburg

Marina Shuleva, PR director:

— I walk through the stages like in a large amusement park, each time bypassing denial. Apparently, there is still too much queue for this attraction. Most of all, of course, I like the carousel « Acceptance" . But the ticket for it is too expensive, and the ride is too short.

Therefore, the subconscious mind is increasingly dragging me to the attraction " Depression" . It is somewhat similar to the “Engine from Romashkovo” in the TsPKiO: a rusty little train, painted with bright colors, creaking, slowly drags in a circle to the same song, from which after 10 minutes it starts to feel sick. Cheap. Angrily. Seasick. And getting off on the go is difficult.

Dima Shlykov, editor-in-chief:

Stuck in the stage of anger . I can't help myself. Infuriates. Everything. From the outside, it's probably not very noticeable. But the demons of malice and destruction rage in me. Sometimes they break out. I am very ashamed of myself afterwards. Sounds like some kind of hormonal imbalance. Or is it just the result of daily suppression of emotions. But now it will not work to not press them. Too much has accumulated.

I found myself really wanting to grab things and throw them at the wall. While I restrain myself and even try to direct my demons in a peaceful direction. I thought that I was not the only one, and together with the demons I figured out a cool (no) business idea in the elite segment. For a lot of money, based on the photographs of the customer in a conditionally empty room, we accurately reproduce the interior of his apartment. And then we launch him there for two hours and let him do whatever he wants: beat, tear, crush, break, kick and torment. I think it will be in demand. And the longer the quarantine, the higher the demand will be.

Sasha Morozova, journalist:

— A week ago I wrote to my sister that I have depression . It is in the context of the five stages of acceptance. A week later, acceptance seems to have begun. In any case, I'm glad that I still have a job that pays, and there is a fear of losing it. Hmm… judging by how gloomily I described it all, and by the fact that I enjoy my work, I still have depression.

Olya Koryukova, SMM guru:

- All I experience during self-isolation is relief . Seriously. As the comedian Idrak Mirzalizade rightly noted: “Finally, I am not the only one standing still.” No need to worry anymore about the fact that the passport is gathering dust on the shelf, and for a whole year I have not reached the pool. I legitimately waste my life

Dasha Nemchaninova, journalist:

— My entire regime of self-isolation consists of three stages — anger, depression and acceptance . And most often I am chatting throughout the day from state to state. Right now, I'm in the acceptance phase. It seems that she is used to what is happening around. Found some positives. I even like that the day follows the same schedule: get up at the same time, have breakfast, work, do exercises, go to the store, go to bed. Everything is clear and calm. But it is now.

Depression sets in from time to time, when you don't want anything at all. Such apathy that you have to force yourself to do something. And sometimes I feel angry: “Oh my God! Yes, how this coronavirus and quarantine shook me! Why can't I go and go where I want? How terrible it is to wear a mask in the store when your nose itches terribly!” At such moments, I just wait for everything inside me to calm down again and that very calm “acceptance” of the situation will come.

Lyosha Zemlyakov, journalist:
— I had no denial, much less anger. It was immediately acceptance of . Probably, this is the case when I treat what is happening philosophically. I won’t say that I feel eschatological delight, but I’m not 100% sure that I want the quarantine to end as soon as possible. A unique and very interesting situation (primarily in terms of people's behavior), despite all its horror. And, I am sure, we will remember and analyze it for a long time. You say I'm crazy? It seems not. Yes, it's definitely acceptance.

Kirill Zaytsev, journalist:
- This is definitely acceptance of . True, with the message: “Well, […] (a synonym is used for the word what, - approx. ed. ) to do.”

Polina Dikushina, SMM guru:

— I started with accepting . When it became clear that we were going remote and self-isolating, I took it absolutely calmly. I understood the inevitability and saw how it all works in other cities/countries. I prepared and tried to make the most of it for myself. I started cooking more, exercising at home more often and pretending that nothing had changed at all.

And then it dawned on me that all this is hard and scary, and most importantly - for a long time with us. And immediately flew into the stage " depression ", which is very close to me. Despair and horror, loss of interest in life - it's all about me now. Other stages were not even touched on a tangent. This is bad? Just awful. I don’t know how all this would have ended for me if work hadn’t taken up most of my life.

0084
— I go through these five stages every day. New day, new circle.

Denial is the morning, from the first alarm until the moment I sit down at my laptop. Anger is before noon, when plans are made for the day and it becomes clear how much pain and suffering there will be in this day. Bargaining is the shortest stage. It's a moment of tiny enlightenment and hope that things won't be so bad. The main part of the day is depression . And closer to 18:00, when it is already quite obvious that no work will end for a few more hours, the acceptance of comes.

Artem Ocheretin, editor of special projects:
- In order not to go through the second circle, I decided to bring comfort in the stage of " Acceptance" . Catch a few life hacks.