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  • 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.

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Last Updated: 08/30/2022

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"I don't seem to feel anything." What is alexithymia and should it be treated - Knife

Friends of Alexei Sviridov call him a cold person. He rationalizes everything and wants to find an explanation for everything. In 30 years, he has never had a romantic relationship for more than six months. And his friendships are based more on rituals and practical mutual assistance than on empathy.

“I don't know what I feel when I like someone. I understand that a person suits me when I see that he has a sense of humor, intelligence, hobbies similar to me (anime, podcasts, computer games, boxing or art cinema) and he knows how to tell stories cool, ”says Alexey.

New partners often appear in his bed, which he finds in tinder.

With most of them, sex is ordinary, “like cottage cheese, which you don’t really want to eat every morning.”

But sometimes Aleksey meets mistresses "awesome, like a dessert that you can't get enough of." But he quickly gets fed up with them, after which he goes in search of new ones.

The guy does not think that he has any psychological problems, and only interaction with others makes him think that something is wrong with him. When someone jokes, he smiles and says that he is funny. When someone cries, he can hug. But at the same time, Alexei does not feel how his mood changes depending on the situation. In fact, he knows how to select masks with different emotions that match the context.

32-year-old Vera also memorized emotional responses appropriate for different situations.

“I often express feelings that I don't have because it's important for people to see feedback. I try to show friendliness, empathy, joy and sadness, but I do it based on the knowledge about it, ”she explains.

Like Alexei Sviridov, the girl does not like any illogical things - for example, excessive emotionality in work processes. At the same time, Vera cannot describe what she feels if her colleagues react too violently: “I believe that“ annoying ”and“ angry ”are the right words.”

Before her marriage, her personal life did not work out: her partners did not have enough response from her:

“I heard in my address that I cannot support. And once I was told that I did not express myself softly or politely enough. True, then the situation concerned a person who did not bother me, and I did not find it necessary to portray some kind of emotion, but people often call directness rudeness.

State of zero

Once Vera participated in a psychological study of women. Based on its results, the interviewer suggested that she might have alexithymia - reduced ability to feel, recognize and express emotions. Later, the psychologist confirmed this guess with the help of special tests.

Alexithymia is not a psychiatric diagnosis, but a condition that may accompany Asperger's syndrome, depression, PTSD, schizophrenia and other mental disorders or exist separately. Many do not even realize that they have this feature and do not turn to a specialist, so it is difficult to determine how many people experience such difficulties. Despite this, British researcher Rebecca Brewer believes that every tenth person is alexithymic.

Psychiatrist Kirill Sychev says that he often encountered alexithymia in his patients. “But, as a rule, they came to me with other complaints, and alexithymia was perceived more as a character trait, they simply did not imagine that it could be different,” he clarifies.

Vera describes her alexithymism as an ideal balance, that is, a state of zero without pluses and minuses. And Alexey compares alexithymics with asexuals.

“Some people have a sexual sphere of life, it is important and interesting for them. Others do not have sexual desire, but they do not feel bad about it. It’s the same with me, only with emotions.”

Others may consider such people "crackers" because they cannot show with the help of words, gestures and facial expressions what they feel. But in fact, only some of them do not experience emotions at all. Kirill Sychev recalls that in his practice he has never met completely insensitive alexithymics: "A complete lack of empathy is already closer to personality disorders."

Most people with alexithymic traits are still able to feel, only they are not aware of their emotions or their shades. For them, the phrase is typical: "I feel something, but I don't understand what."

Aleksey, for example, can accurately identify fear when he rises to a considerable height. And at the same time, he doesn’t know what it means to worry about extra pounds or whether his boss will tell him off at the meeting.

Something incomprehensible in the chest

Let's be honest: for many of us it is difficult to catch some experiences, such as mild irritation. But most people will not confuse this feeling with joy or sorrow. An alexithymic may well do this or interpret the irritation as a physical sensation.

Most likely, you will perceive "butterflies in the stomach" as excitement, and a person with alexithymia may consider that this is a simple hunger. The “lump in the throat”, which we feel when we are very upset, for him will be something really stuck in the throat.

Strong experiences that alexithymics feel in the body can frustrate and frighten them. For example, horror or falling in love, which are accompanied by a rapid pulse and sweating, can be read by them as a physical discomfort that needs to be quickly eliminated.

“I remember looking into the eyes of a girl I had been dating for a couple of months and I felt something strange in my chest, like something was shaking there. I understood that she was beautiful and we had good sex, in which we experimented freely. But I didn’t like the state that appeared next to her at that moment, so I told her a little later that I wanted to leave. She was shocked because she thought I was confessing my love to her. But what is love? Maybe it was her?" Alexei argues.

Psychologists Beata Herbert, Olga Pollatos, and Cornelia Herbert found that the better we sense bodily changes, the better we understand our emotions. And with alexithymia, on the contrary, it is difficult for a person to focus on the internal processes of the body - Oxford professor Geoffrey Bird came to this conclusion.

For the first time, alexithymia began to be studied in connection with the body. Psychiatry professor Peter Sifneos, who coined the term in the 1970s, researched the personality traits of patients in psychosomatic clinics. Some patients could not clearly articulate their emotional state and convey bodily sensations in words. Their postures and movements were tense, their facial expressions were poor, and the actions of these people resembled robots. But what was primary - manifestations in the body or alexithymia, then could not be determined.

The Russian-Soviet psychiatrist Pyotr Gannushkin wrote in his book "Clinic of Psychopathies: Their Statics, Dynamics, Systematics" that it is alexithymia that can be a factor predisposing to obesity in combination with depression.

For an alexithymic person, food is a regulator of internal tension. A person "jams" stress, among other things, because he ignored and did not speak out his feelings for a long time.

The same applies to alcohol abuse. According to the Polish sociologist Marek Zelkowski and his colleagues, 48% of male patients with alcohol dependence had alexithymia. And the American scientist Leonard Handelsman found that the level of alexithymia among alcoholics is higher than among people without addiction.

Moreover, alexithymia is believed to be associated with coronary heart disease, diabetes mellitus, bronchial asthma, gastric and duodenal ulcers, Crohn's disease, malignant neoplasms, and chronic pain.

“My emotional peculiarity is strongly connected with psychosomatics. Stressful situations strongly affect the body, and I quickly get tired of communicating with people, ”says Vera, who was recently diagnosed with abdominal pain.

This is pain in the abdominal cavity, the causes of which may be psychogenic. Gastroenterologist Emilia Yakovenko explains why chronic pain in the abdominal cavity is closely associated with depression - the point is insufficient synthesis of serotonin. Therefore, antidepressants work well with both depression and abdominal pain.

Boring, non-empathetic robots

Alexithymics find it difficult not only to identify sensations in their bodies, but also to understand other people's experiences. Studies by Professor Jeff Bird have shown that such people distinguish between a smile and a frowning person in a photo. However, some do not have the slightest idea what these facial expressions mean.

Aleksey recognizes the joy and sadness of his friends, but cannot truly empathize with them, as he does not experience such emotions.

“Someone suffers after a breakup, someone is worried about the lack of money. I can tell them: "It must be hard for you now" or "I'm happy for you." But in reality, I have no idea what it all means. I don't have such problems. That is, I also had partings and difficulties with finances, but I didn’t care. I didn’t kill myself, but prescribed a plan of action or told myself that there was nothing to worry about, ”the guy explains.

Vera also has no sympathy:

“I try to evaluate the person and the situation. There are those for whom it is enough to hear "Everything will be fine." There are people who are only pissed off by such words. Then I try to express understanding, to say something positive, to wish something, to share advice.”

In addition, due to her peculiarity, Vera finds it easier to survive difficult situations.

Problems with empathy are not the only things alexithymics have to put up with. Candidate of Biological Sciences Anna Iskusnykh writes that they also have a reduced ability to imagine and be creative, and their thinking is concrete and mechanistic. Jason Thompson, author of The Emotionally Dumb: A Review of Alexithymia, describes their communication style as coherent and logical, but "without poetic overtones."

It may seem that alexithymics are boring and will discuss excels and plans for tomorrow with you. But this is not so. Alexey is a rather erudite man. He can talk about DNA and RNA in such a way that you will immediately understand the essence, even if someone erased all your knowledge of biology. Or retell in detail the biography of serial killer Ted Bundy so vividly that you will dream of all the horrors of his bloody crimes. Besides, he jokes a lot. But if you think it's not comme il faut to trump other people's stand-up jokes, you won't like his humor.

But Alexey's profession seems to confirm the description of Anna Iskusnykh: he works as a financial analyst in a large IT company. There is not a lot of creativity in profit reports, but Sviridov is sure that finding cause-and-effect relationships is real creativity.

This love of reporting, as well as psychological stability and resilience where others fall into stress and panic, makes him a valuable employee.

Vera, on the contrary, is a very creative person. She is an artist, draws comics and illustrations for fairy tales:

“Alexithymia is not a disease with a strict set of symptoms. I have no problem with fantasy. On the contrary, imaginative thinking sometimes helps me describe a feeling that I cannot identify and name in one word.

What is the reason?

There are three theories about why some people don't "get along" with their emotions.

Theory No. 1 is biological. She considers primary alexithymia, the causes of which are in genes, defects or developmental features of the brain.

“There is scientific evidence that dysfunction of the anterior cingulate cortex and disorders in the right hemisphere can lead to alexithymia. The reason may also be a decrease in the corpus callosum: in this case, the emotional information that is formed in the right hemisphere is transmitted worse to the left, ”comments psychiatrist Kirill Sychev.

The experiments of the candidate of psychological sciences Irina Korosteleva and the psychophysiologist Vadim Rotenberg confirm that people do not recognize emotional experiences when they have impaired interaction between the left and right hemispheres. It turned out that patients who underwent surgery for transection at the level of the corpus callosum had a decreased ability to symbolize, fantasize, and they were less likely to dream.

Theory No. 2 is psychological. She associates alexithymia with trauma and views it as a defense mechanism. An important feature of this state is the lack of reflection, one of the mechanisms of self-regulation. For some reason, alexithymics have not developed a need for regulation. For example, if in childhood the parents decided everything for the child, as it was with Alexei.

Sviridov Sr. died of a heroin overdose when Lesha was one and a half years old. Fearing that her son might repeat the path of his father, his mother planned his life in advance: the best school at any cost, circles, sports clubs, university. Alexei was surrounded by care all the time, choking any sensual manifestations. He could not be angry with his mother for not allowing her to play with the boys in the yard. He was forbidden to talk about liking girls because "it distracted from his studies." His emotional range was very poor and, apparently, it has remained so to this day.

Theory No. 3 is sociological. She attributes alexithymia to social and cultural factors. Firstly, the specific educational approach in the family may be the reason.

An alexithymic personality can be formed if the parents devalued the child's feelings, punished them for showing them too violently, used psychological and physical violence, or simply did not pay attention to him.

Vera assumes that her mother and father are also alexithymic, because she notices behavior patterns similar to hers - which means that it was the family atmosphere (and genetics) that made her "that way." If the parent does not empathically respond to the baby's emotions, does not mirror them, calling surprise surprise, and anger - anger, the child does not learn to understand his experiences.

On the other hand, cultural characteristics can also squeeze out the emotional component. Perhaps for this reason, alexithymia is more common and more pronounced in men.

Psychologist Ronald Levant even hypothesized that "normative male alexithymia" is limited emotionality influenced by the traditional representation of masculinity. The more severe the gender socialization of the boy, the more alexithymic the adult male will become. If a boy was simply told that he shouldn't cry "because only girls do that," then in the future he may suppress the emotions that cause tears. And if a belt or something heavier came to him for crying, then later he may show dissociation.

What to do if "everything is complicated" with feelings

Psychoanalyst John Nemia proposed the concept "psychic production of emotions" . Every person has its deficiency to varying degrees, and not just alexithymics. It is difficult for some to express at least some experiences in words - while others, with the help of metaphors, will tell about the vivid feelings that they experienced while standing in front of the expressionist painting, but at the same time they will not be able to convey what they feel in relation to a particular person.

In the course of life, we all learn to say and show what we feel, including in the psychotherapist's office. The specialist helps to work out the affect, that is, to translate bodily experience into images and words. As a result, a person can express in words feelings, the existence of which he had not even suspected before. This may help him get rid of compulsive actions (such as overeating), which were his only way to suppress unconscious sensations.

« In working with alexithymics, cognitive-behavioral methods specially developed for them are usually used. They also use the psychodynamic approach and the mentalization method. All of them are aimed at teaching the brain to identify emotions,” comments Kirill Sychev.

Pumping the mental production of emotions is useful not only for people with alexithymia, but also for any person, because it affects intellectual growth, health and quality of life in general.

For starters, you can read Paul Ekman's book “The Psychology of Emotions. I know how you feel”, in which he talks about various emotions and their connection with physical sensations. You can work out the connection between the body and the senses by regularly focusing on what is happening in the body. Breathing practices and meditation are suitable for this. Try group therapy where you can see how other people talk about their emotions. And in order not to forget about what feelings are and to highlight them in yourself, hang a huge poster on the wall with a spectrum of all emotions.

"I don't feel anything": how to get yourself back

98 522

InterviewKnow yourselfAntistress

Psychologies: Overexertion, fatigue, anxiety... Why can't we cope with the pace of life?

Olga Armasova, trainer: Our "I" has three components: physical - body, mental - mind, emotional - feelings. Often in modern man there is no connection between these links. We grow and develop in an environment where we are taught to identify with a goal-oriented mind. Keeping in mind a large number of tasks, often associated with material, external values ​​- to earn, to succeed, to be in time for everything - we experience mental overload.

We simply do not have enough resources, and we do not know where to look for them, how to replenish energy. As a result, the psyche cannot cope, the body signals problems, and there is no time left for inner life. And so we are in a state of internal disunity, disunity. It’s not for nothing that when we’re stressed, we feel like we’ve been taken to pieces. But we do not think at all about how to become whole again.

Why do we want to sleep when we are very tired? This is a defense mechanism of our psyche, a signal that everything is enough, there is no more strength, we need to urgently recover. And if we do not hear these body signals and do not take action, then exhaustion begins. It is expressed in irritability, apathy, depression, migraines, insomnia. Sooner or later, a breakdown will come, which will have serious or even irreversible consequences.

We want to appear strong and do not show our true emotional state to others, not even to ourselves

What does it mean to identify yourself with your mind?

A modern working woman is faced with the task of making a career, achieving success, earning a lot. She must look good, and therefore, take care of herself, since the conformity of her appearance to accepted standards affects her possibilities of self-realization. And if she has a family and children, she must take care of them, pay attention to them. All these tasks are lined up in a long queue in her head, require 100% concentration and take up all of her time.

If you try to turn her into a sensual side, ask her what she feels now, she will say: “I feel that I should do such and such”, or “I don’t feel anything.” She thinks that she is experiencing emotions, in fact, remaining at the level of the mind.

In the same way, it is often difficult for her to connect with the body side, to determine where and what she feels in the body, because she perceives the body only as an outer shell. Meanwhile, the body serves as an instrument with which we live and accumulate in ourselves those emotions that have been suppressed, repressed, not realized, which is reflected in the physical state. So the “I” of a modern woman is basically what is in her head.

But why do we lose contact with our feelings?

Parents, teachers, society as a whole transmit social norms to children, according to which the expression of feelings is not encouraged: you cannot cry, shout, laugh loudly. To fulfill the wishes of adults, we forbid ourselves to feel. We do not live, but we displace emotions, “package” and store them somewhere in the depths until a more serious stressful situation. Or until the complete depletion of resources, when suppressed emotions splash out and we express and live them in an acute form.

It is important for us what others think of us or what we think of ourselves, because often our strictest censor is ourselves. He constantly evaluates: here I can afford something, but here I can’t, I deserve this, but I don’t. We want to look good, to appear strong, and therefore we do not show our true emotional state to others, or even to ourselves. And as a result, we are increasingly disconnected from our sensual side.

"What do I feel?" is a question that will help you live your emotions in the present without pushing them out

How to avoid this?

Satisfy your most basic needs - security, peace, quiet, sleep. A great practice, for example, is to set aside at least half an hour a day to be alone with yourself. You can get up early for this or, conversely, retire in the evening when the children are sleeping. Being with yourself does not mean sitting on the Internet or on social networks. On the contrary, both gadgets and the TV should be turned off and left in silence. This is the time to look into yourself, to scan your state. If you are worried about something, listen to yourself, understand the situation and think about how to deal with it.

"What do I feel?" is a question that will help you live emotions in the present without crowding them out, thereby giving yourself the opportunity to be yourself. If, for example, I am angry with a colleague, then, after coming home from work, I can tell my relatives that I am upset and want to be alone. Admit to yourself: yes, I'm angry. When I acknowledge my emotion and connect with it right now, it can move into something else. In any transformation, the first step is awareness, the second is acceptance. Acceptance of oneself and what is happening around is the key to inner harmony.

How can this help us take control of ourselves and manage our lives?

We waste a lot of resources if we try to restrain our feelings, and this leads to tension. When we give ourselves the opportunity to live our feelings, we let go of this tension. These half an hour alone with ourselves are needed in order for us to move into the position of an observer and see from the outside what is happening to us.

Of course, it is not enough to be only an observer and do nothing at the same time. But after such practice, we will no longer be so dependent on a stressful situation. After all, when we see what we have to do, we do not worry in the now moment. We can relax because we have clarity: where we are, how we feel, what we want, and what we will do to realize our desires.

I can say from my own experience that such a daily practice is a good prevention of stress, it makes it possible to maintain internal balance.

We need to move from the normal state of brain activity to the one that corresponds to relaxation

Where else can we draw strength, replenish our resources?

There are a lot of effective practices. Meditation, for example, helps turn off the flow of thoughts. After all, our brain, like FM radio, “broadcasts” 24 hours a day. And in order to calm the mind, we need to move from the usual beta state of brain activity to the alpha or theta state, corresponding to relaxation and lack of control. It gives us emotional stability.

For us, direct contact with the earth is important as a source of life force, but a resident of a metropolis rarely walks on the earth - except that he runs from home to the subway or to the car.

Learn more