Quitting smoking is an empowering and life changing experience. Taking control of an addiction involves your complete commitment. As you move through this quitting process it’s important to recognize and reward your accomplishments. Doing this builds confidence and reinforces a positive attitude towards quitting.
You are more likely to remain smoke-free if you attach a positive response to saying ‘no’ to any thoughts of smoking a cigarette. Rewards for not smoking are best when they are experienced short term. If you pass on a strong urge to buy a pack of cigarettes, or reach a one month smoke-free goal, then reward yourself. Have lunch with a friend; go to a movie, etc. After awhile, you will associate these pleasurable moments with not smoking.
Many smokers say that they smoke because they enjoy it and when they quit they feel deprived and miss their cigarettes. Cigarettes were a reward for a job well done. Cigarettes were like a constant companion, there through thick and thin and could always be depended on to feel better. Smoking is often associated with a good time; some smokers say it makes a good time better. If you found smoking pleasurable then you will need to find other sources of enjoyment in your life. A good way to support your new nonsmoking life is to try introducing different activities or hobbies. Join that class you’ve always wanted to take, or start that exercise program. Choose something you find fun. Eventually activities that you linked to smoking will be enjoyable again as a non-smoker.
You probably found that smoking cigarettes reduced anxiety, increased concentration and quelled your appetite. Nicotine has a dramatic effect on the brain's reward system, conditioning you to want more of this drug that relaxes, energizes and improves mood. When the nicotine was taken away withdrawal symptoms occurred and the rewarding effects disappeared. Change your reward pathways away from nicotine by rewarding yourself regularly. Treat yourself with the money you saved not smoking. Get some pampering, a massage, pedicure or haircut. The rewards need not be costly. A walk on the beach, curling up with a good book, a scented candle and relaxing bath all help to relieve stress and manage cravings. Acknowledge the changes you’ve made in your new smoke-free life and continue to reward yourself for making it to this point!
Keep Going and KTQ!
No matter how busy you are this holiday season, be sure to keep your quit going strong! Around this time of year, some quitters may find themselves losing momentum. You may be second guessing your reasons for quitting, or feeling overwhelmed by a seemingly endless to-do list. Rest assured, life is not getting in the way of your quit; this is life! Moving forward as a nonsmoker means keeping the quit regardless of what is happening to you or around you.
Reaffirm your commitment to keep your quit going no matter what. Make sure your quit stays your number one priority. Reflect on why being a nonsmoker matters to you, how far you have come and what it took to get here. If you do have a craving or weak moment, address your feelings! What do you really want? Are you seeking comfort, reward, assistance, sleep, enjoyment, social interaction, or a break? Stress free living requires flexibility. There is nothing wrong with giving yourself permission to change plans or take a time out to relax. Celebrate the new habits you have worked so hard to put in place. You have made it this far, so that means you have a successful smoke-free daily routine in place. Acknowledge how awesome you are for quitting smoking. You did it - you actually did it this time! You are amazing, and so is your quit.
Reviewing your quit progress and celebrating your accomplishments ensures your continued success during stressful times. Staying motivated will help prevent relapse. Remember that at this very moment, you are Quit! Congratulations! Cherish your quit and commit to spending the holiday season as a nonsmoker this year. As a nonsmoker, you continue to gain:
- Healthier lungs
- A reduced risk of cancer
- Increased longevity
- More energy to enjoy life
- A healthier smile and fresh breath
- Better immunity to fight off colds and flu
- More money to spend on things you need or want
- More time to spend doing things that matter to you
- More time with the people you care about
- Freedom from guilt or pressure about smoking; you're finally free!
- Increased self confidence
- Fresh air around you, your home and your vehicle
- Prettier skin
- Improved mood
- Decreased stress
Those are a lot of gifts to appreciate. Keep giving yourself the best gift of all; a smoke-free life! Keep up the good work, keep going, and KTQ:)
Happy Holidays to you and yours,
CTTS-M Master Certified Tobacco Treatment Specialist
Friends don't let friends Quit alone:
In lieu of a written blog this week, I thought it would be nice to include a history of the Great American Smokeout, which has brought millions of smokers into smoke-free living. The story of how the Smokeout has shaped public perception throughout the years is a fascinating one, and many of us literally owe our lives and our health to the people who made it happen:
ACS Smokeout Story
Thanks to the American Cancer Society for this account.
KTQ, and Happy GASO,
Alan Q, CTTS-M
For many of us, the first reaction to any conflict was a cigarette or a dip. Tobacco seemed to level us off, cool us down, help us focus during or after an upsetting situation. We shouldn't be surprised if we find ourselves getting angry more often, or getting more angry often, after we quit tobacco. Some of us seemed to be in all kinds of disagreements for awhile after quitting, and have even been asked by significant others to please start smoking again!
We didn't quit smoking just to be angry and miserable, did we? And we certainly don't want emotional firestorms to jeopardize our quits. The good news is that we can manage confrontations without alienating everyone around us, or by turning to the numbing distraction of nicotine. We do this by managing ourselves in tense situations, following these three simple rules:
Rule #1: Remove Yourself From The Conflict (or, It's Ok To Walk Away)
You don't have to go to every fight you're invited to. Trying to resolve conflicts while emotionally super-charged is counter-productive; it's too easy to misread and escalate. Remind yourself that your quit is your #1 priority, and that arguments can be a relapse trigger. You don't have to exit gracefully, just get out of the argument by any means possible. Tell the other person that you're too fired up to continue right now, that it would be a good idea to take a break. Then leave the room, hang up the phone or log out, take a walk. The problem won't just go away, but you won't have worsened it by adding tobacco to the mix.
Rule #2: Get a Handle on Your Emotions (or, Don't Try to Control What You Can't)
Nobody and nothing has the power to make you smoke against your will, so take responsibility for your own feelings and choices. Deep breathing is a stress reliever (we used to do it when smoking, with smoke), so start by regaining control of your breath. Have a seat, and take five to ten deep breaths. Breathe in as much air as you can hold, count to five, and then push your breath out through tightly-pursed lips. If you use any kind of prayer or meditation tools, or affirmations like, Easy Does It, now is a good time to employ them.
When you're reasonably settled, log in or call a quit-buddy or trusted confidant and run the situation by them. Listen to yourself as you recount the story; we often tell ourselves exactly what we need to hear when we open ourselves up a little to someone else. The humor with which others respond to our crises is often a great anger deactivator. Our friends' similar experiences, or objective observations, can enlighten us, too.
Rule #3: Clean Your Side Of The Street (or, Do You Want To Be Right Or Be Happy?)
Sooner or later, you'll have to re-engage with the person or situation you were fighting. Nothing frees us more, or resolves conflicts more effectively, than first getting clear on our own part in them. Think over the beginning, middle, and end of the situation, asking yourself:
"Is any of this mine to own? What is my role in it? Is this really an issue important to me, or am I just blowing off steam? Is my anger appropriate to the situation?" We often use anger to cover our own culpability, no matter how small, or to re-direct the anger we feel over someone or something else. Sometimes we're just mad because we can't smoke!
Looking ahead toward a solution to the conflict, consider:
"What is the result I desire most here? Am I trying to punish, or just to be heard? Am I trying to control or change someone else's thinking or behavior? Is there any of my behavior or thinking that needs to change?"
Writing about your thoughts in a journal can help you calm down and see more clearly.
Finally, the most important questions of all:
"What is the best course of action to achieve my desired result? What's my next move, or 'next right thing' that needs to be done here? Do I owe an apology? Do I want to be right, or be happy?"
When you feel ready to move on, stand up and do a nice hard stretch, letting the internal tension release itself. You've done some important work, without an iota of nicotine in the mix.
There's no easy fix for post-quit anger. It just slowly dissipates. We develop new behavioral responses to life the same way we formed the old ones -- one day at a time, one situation at a time. And the best we know how to do is always a little ahead of the best we're able to do, so don't be too critical of your progress. Practice makes perfect, but it's progress, not perfection, that we should seek.
Alan Peters, CTTS-M
If you have ever relapsed, this blog is for you! A relapse is a red arrow pointing to your unmanaged personal trigger(s). You can avoid a relapse by learning how to navigate through the following high risk situations.
1. HANDLE STRESS LIKE A PRO
One of the strongest relapse triggers is stress. Stress is particularly dangerous for women, but men and women alike have lost solid quits during stressful times. Today is a great day to identify new, smoke-free coping tools to help you relax, step away, let go. By planning ahead now, you will be prepared before you end up in a difficult situation. This is your quit, so get involved! Brainstorm an answer or two for the following statements, and write them down:
- When I need to relax, I will __________.
- When I feel stress building up, I will __________.
- When I want a reward or comfort, I will __________.
- When I want to socialize or fill my time, I will _____________.
- When I need a break, I will __________________.
If smoking is the only thing you can think of for each item on the above list, that's only because it is only thing you've tried so far! By replacing cigarettes with things that actually do help you diminish stress, you will be able to avoid relapse and keep your quit going strong.
Rethink your stress = smoking connection! Did you know that smoking increases stress levels by causing anxiety, withdrawal and a craving for another cigarette? Smoking prevents you from doing the very things that ease stress, boost confidence, entertain you, and help you feel better. Give other things a chance to work - really work - to help you cope with day-to-day life effectively!
2. PREVENT BOREDOM
Avoid sitting in your usual chair, pondering, "What now?" Do something - anything - to occupy your mind! Boredom leads to bartering, slip justification, romancing the smoke, and the ultimate delusion of 'just one'. Fill your time with every activity, task, project and chore you can think of to keep you away from old habitual smoking patterns. Read, do sit ups, call a friend, take a walk, clean a drawer, do your nails, pay the bills, wash the car, clean a closet, bake something, write something, repeat a mantra, watch a movie, drink ice water, make a cup of tea, knit, surf the internet, clean the top of the refrigerator, take a class, follow an exercise video, brush the dog, talk to your kids, do laundry, stretch, deep breathe, make a meal - stay busy, busy, busy! This will prevent your mind from wandering off towards smoking thoughts. Even if a fleeting smoking thought does occur, you can redirect immediately to the task at hand. Also, be sure to find a personal mantra that is meaningful to you, and repeat it often:
- To inspire myself to keep going, I will repeat this mantra: _________.
3. DEAL WITH OTHER SMOKERS
At some point, you will have to venture out from your super busy, relaxing, controlled home environment into the real world. There may be cigarette ads on gas station windows, smokers gathered at entryways, or even a friend extending a pack toward you! This is where all of your home practice, redirecting smoking thoughts, repeated mantras, advance planning and new coping tools combine to lead you through temptation.
Avoid going on autopilot! Right up front let friends know you have quit, and thank them for their support. Repeat your quit motivations, repeat your mantra, and keep your hands full and busy. Hold a water bottle, hold your cellphone, hold your car keys, have mints or hard candies in your pockets, chew on a toothpick or straw - do all you can to replace the old habit of holding a cigarette. Last but not least, if the going ever gets too tough - leave! You can't relapse if you are driving away from a risky relapse situation while repeating your mantra.
As you work your way through your strongest triggers, you will gain all the confidence, new behaviors and coping tools needed to ensure permanent quit success! Plan ahead, follow your plan and KTQ :)
Vikki Q CTTS-M
Master Certified Tobacco Treatment Specialist
You don't have to Quit alone;
When you stop smoking, you may have no idea what else to do during those moments you used to smoke. The things you come up with may not really 'do the trick' at first. Finding new emotional coping tools and behaviors can be challenging. The newly-quit often feel lost. Rest assured, most every smoker goes through this during their quit! Allow yourself a month or so to get to the 'feeling better' part. To help you navigate the beginning phase of your quit process, give these 3 tips a try:
1. Get To Know Yourself
What interests you? Motivates you? Inspires you? What do you find relaxing, rewarding or fun? Identify new meaningful activities, effective emotional coping tools and daily routines that really appeal to You. This is your quit, so get involved!
2. Plan For Success
Planning ahead for your personal triggers will ensure you make it to the other side successfully! Identify your top 2 smoking triggers, and that is where you'll want to put your time, energy and focus during the next month. Make a plan. What are some things you can do instead of smoke whenever you encounter a trigger? Could you take a walk, call a friend, listen to music, write in your journal, repeat a mantra or wash the car? What has worked for you before? What else can you try? Where will you go to enjoy yourself that is smoke free & supports your quit? How will you handle anger, stress or boredom? Know your triggers and have a clear plan of action for each and every one of them.
3. Smoking Is Not An Option
If you do not smoke today, you will never smoke again! The new you does not reach for a cigarette, no matter what happens, no matter how you feel. Smoking is not an option, so always ask yourself, "What is an option?" "What can I do?". It is in that moment of choosing something else that you will find the very answers that work perfectly for you. You will also reinforce your identity as a nonsmoker, increase your self confidence and strengthen your quit resolve. N.O.P.E. - Not One Puff Ever!
It takes more than just not smoking to become a nonsmoker! It takes ongoing, daily effort and practice. Try these 3 tips so you can work your quit effectively, make healthy lifestyle changes and gain long term quit success!
Keep going and KTQ,
Vikki Q CTTS-M
Master Certified Tobacco Treatment Specialist
Remember; you can quit smoking for good, and QuitNet is here to help:
Quitting smoking isn't easy, and at times your motivation can begin to lose steam. To ensure success you will need to power up your desire to stay quit.
REASONS FOR QUITTING
One way to boost your motivation is to review all the reasons you wanted to quit in the first place. Are those reasons and motivating factors still important to you? If not, then reevaluate and come up with a new list of valid reasons to quit smoking. Keep in mind that the more reasons you find to motivate yourself in favor of quitting the more likely you are to stay quit.
Make your reasons personal and specific. For example, instead of saying 'To feel healthier' you might say 'So I don't feel out of breath when I play with my children.' Think about the personal costs of smoking for you and those you love. Being a good role model and protecting your family from second hand smoke may pull at your heart strings. Imagine yourself five or ten years down the road if you quit; picture that same time period continuing to smoke and what do you see? Think about the consequences of continued smoking. Where do you want to be? Perhaps you are upset with the control cigarettes have over your life and you want to be free of the addiction. You can't leave out the spiraling cost of cigarettes today, either. With the money saved by not smoking, you could take a trip or pay a bill.
BENEFITS OF QUITTING
Acknowledging the short and long term benefits you receive from quitting smoking, and reframing your thinking to focus on the positive aspects of quitting, will help get you out of a motivational slump. Smoking is detrimental to every organ in your body. Quitting smoking is the single best thing you can do to improve your overall health. Within minutes of your last cigarette your body begins to heal itself. In the first twenty minutes your blood pressure and heart rate decrease. There are other immediate benefits you become aware of right away, like fresher breath and clean smelling hair. The benefits of quitting get even better over time. Soon you may notice that your morning cough has disappeared, you can walk up the stairs and you are not out of breath, and the food you prepare smells and tastes good. Quitting helps improve self image and self esteem. You conquer an addiction, set a good example and take back control of your life. Your risks for smoking-related diseases decline and you get a chance to live a longer life. Focusing on the positive benefits of quitting will improve your motivation to move forward.
The more people you have cheering you on the better. This is especially helpful when you are going through a tough time and experiencing a lapse in motivation. Words of encouragement can spur you on and help you keep the focus on the positive. Involve yourself with others who are trying to quit smoking or have already quit. Most quitters have experienced dips in motivation; you can learn from them by listening to their stories. A great source of support can be found here on QuitNet, in the forums, clubs and chat. It's also important that you support yourself by recognizing your own quitting progress and the lifestyle changes you made to get to this point. Celebrate your quit milestones and reward yourself by buying something enjoyable with the money you have saved not smoking. Gathering support from others and acknowledging your quit success keeps you motivated and moving forward.
Keep Going and KTQ!
Quit With Us!
Quitting smoking is difficult, especially in the first few days. Physical and psychological withdrawals hit hard at this time and cravings and urges to smoke are strong. When a craving to smoke occurs, action needs to be taken. The choices are endless, but here are three of the best tried and true crave busters.
Drinking water is a great crave buster. Hand-to-mouth is a habit that's hard to break and water is a good choice for an oral substitute. Not only does water give you something to do with your hands, it’s also filling, reduces your appetite and has zero calories. Water is not a beverage that is usually associated with smoking, so it will unlikely trigger the same response as a cup of coffee or a beer. Staying well-hydrated is important in keeping your body healthy. Water removes the toxins from your body and helps with the healing process after quitting smoking. Reaching for that glass of water to quell a craving will help prevent constipation, which at times accompanies quitting smoking. If you don’t like the taste of water, try jazzing it up with a slice of lemon, lime, fresh fruit. When a craving to smoke hits, drink up and enjoy the benefits water offers.
Cravings to smoke often pop up when feeling stressed. Life stressors run the gamut, from issues with family, finance and health to the daily annoyances of traffic jams and waiting in grocery store lines. In the past, smoking may have been how you handled the stress in your life. Deep breathing is one of the best ways to manage cravings to smoke and stress. Now you can take a deep breath without inhaling the poisons in cigarette smoke. As you deep breathe, visualize yourself in a peaceful, soothing place where you can totally relax, escaping for a few moments. Repeating a personal slogan to yourself ‘Smoking is not an option’ while taking the deep breaths will reaffirm your decision to quit.
Take some time to practice deep breathing exercises. Begin deep breathing from the diaphragm, rather than the chest, by getting comfortable lying on the bed, floor or reclining in a chair. Begin by placing a hand on your stomach and breathing in slowly, through the nose while mentally counting to five. When you are inhaling picture the air going down into your stomach until it’s totally inhaled (you should feel your stomach rise up where your hand is placed). Now slowly exhale through your mouth for the count of five and picture the air emptying out of your stomach until it’s totally expelled (you should feel your hand on your stomach go down). Repeat this ten times during practice and you should feel stress and anxiety symptoms decrease. Taking a deep breath to get you through a craving will get you to the other side more relaxed.
Getting physical and moving helps distract from the cravings to smoke and reduces the intensity of the cravings. Quick and easy exercises that you can do in spurts when a craving appears work well. Knee bends, lunges, going up and down the stairs, or sitting in a chair alternately relaxing and tensing your muscles are exercise that can be done at home or work when time and space is limited. Even just getting up and walking around for a few minutes will help. Choose an activity you will enjoy, whether it be yoga, dancing, biking or swimming -- any activity that has you moving will do. Both high and low impact exercises increase your endorphin levels, which makes you feel good, more alert and energized. Physical activity helps reduce stress and tension. Not only does exercise help you deal with the physical and psychological cravings of nicotine addiction, but it’s also a major player in managing the weight gain associated with quitting smoking. Consult your doctor before starting an exercise program if you have a sedentary lifestyle or any medical problems. Daily exercise will improve your mood, lung function and stamina. Using exercise to handle your cravings to smoke will keep you fit and healthy.
Keep Going and KTQ!
Quit with us!
Last week we talked about the many benefits of drinking water. This week, we will look at how certain food choices may help you KTQ by reducing cravings.
Smokers usually smoke the minute they feel anything. That can make it difficult for the newly quit to even know what they are craving! It takes practice to identify thirst, hunger, fatigue or boredom. Chances are a tall, cool glass of water and the right snack can have a quitter feeling back on track in no time. Selecting foods that may help kill craves can also help prevent overeating and weight gain. Eating small amounts throughout the day can manage blood sugar levels, reduce cravings, increase energy, kick up metabolic rate and stabilize moods. Sounds like a good plan, doesn't it? Here are some great food choices:
• Fruit For sugar cravings, reach for fresh fruit. Eating fresh fruit is a good way to increase your fiber and water intake, and to fill up without filling out. Most fruits are alkalizing, which may help reduce nicotine cravings in the beginning of your quit. Blueberries, apples, cherries, watermelon, grapes, plums, and oranges are a few of the many fresh fruit options.
• Vegetables For hand-to-mouth snacking options, try fresh, sliced vegetables. Vegetables are high in vitamins, antioxidants, and fiber, and are low in calories. You can eat enough to get full without affecting your waistline. Most vegetables are alkalizing, which may help reduce nicotine cravings in the beginning of your quit. Try sliced bell peppers, zucchini, cucumber, celery and carrots. Or, mix up a salad with lettuce or spinach greens.
• Mint To reduce sugar or nicotine cravings, try strong mint flavors. Peppermint, spearmint, and menthol-flavored cough drops, gum, sugar free hard candies and breath mints may help kill a crave.
• Sour/Tart To reduce sugar or nicotine cravings, you can also try sour or tart flavors such as lemon, lime, lemon drops, dill pickles or stuffed olives.
• Spicy Try spicy foods like hot salsa, Tabasco sauce, red or green chilies, and jalapenos to kill cravings. A generous sprinkling of black pepper may help take the edge off of cravings, as well.
• Warm Eating a warm meal is often more filling than a cold one. Oatmeal is a good choice. Add some cinnamon, applesauce or raisins to increase fiber and crave fighting properties.
• Hot Sipping hot tea is time consuming, and hot liquid may help satisfy cravings. Choose licorice, peppermint, lemon, cinnamon or other such flavored teas to help kill the crave. Green tea is high in antioxidants, and detox teas may offer added support for the newly quit.
• Crunchy The hand to mouth habit associated with smoking is hard to break. Eating crunchy foods like apples, almonds, seeds and raw vegetables can help to satisfy this trigger.
• Fat Foods that are high in healthy fats help you feel full longer and experience cravings less. Olive oil, coconut oil, nuts and avocados are some examples of healthy fats.
• Fiber Healthy foods that are high in fiber help you feel full longer and can counteract some of the constipation associated with quitting. Oatmeal, raisins, vegetables and legumes are some examples of high fiber foods.
To help yourself make good food choices, stock up ahead of time. Arrange your cabinets so the best food choices are front and center. Better yet, make a 'Quit Shelf' with all your go-to crave-killing foods and tape up a few motivational cards with images, mantras, or inspiring statements on them. You can even add your quit stats to your cards weekly. :) With preparation and commitment, you can make this quit your healthiest quit, your best quit - and your last quit!
Keep up the good work, keep going, and KTQ!
Vikki Q CTTS-M
Master Certified Tobacco Treatment Specialist
Quit with us!
Not enough can be said about the wonderful properties of water! Drinking water is healthy for your entire system, and helps you keep the quit! The human body is up to 70% water, and yet many people do not drink enough of it throughout the day. The American lifestyle itself can be dehydrating given our frequent consumption of caffeine, alcohol, cigarettes, sodas and high sodium meals. Mild dehydration can cause water retention, bloat, constipation and other symptoms including:
• Dry skin
• Lack of energy
• Dry mouth
Are you drinking enough water? Moderate to severe dehydration can be dangerous; even fatal. Drinking enough water can help your body in many ways. The ‘8 glasses per day’ conventional wisdom is not carved in stone (or substantiated by research) so how much water you need to drink per day varies. The more you sweat or exercise, the more water you need to replace. If you consume dehydrating foods and beverages, you will need to drink more. Fruits, vegetables, tea, soup and other diet choices contain water, so you can allow for some of the water content in your diet to count towards your overall daily water intake. Try aiming for 6 glasses a day to help get your water drinking habit moving forward. This can easily be accomplished by substituting a glass of water for every soda, sugar laden juice or junk food snack you would normally reach for. Water actually makes you want to drink more, so after a few days of drinking 6 glasses per day, you will actually feel thirsty. It is that easy!
Here are a few of the many benefits of drinking enough water per day:
• Helps you KTQ! Water is great for ‘hand to mouth’ triggers, reduces physical cravings, distracts from smoking urges and takes up empty time previous spent smoking.
• Helps clear toxins. Your kidneys use water to help break down, process and clear toxins from your system.
• Aids your digestive system. Your intestines use water to keep things moving smoothly! If you don’t drink enough water, your colon pulls water to maintain hydration and constipation is a likely result.
• Helps your blood and bones. Water is used by your body to make healthy new bone and muscle cells.
• Prevents puffiness. Water has a diuretic affect in your body. Inother words, drinking lots of water will increase the excretion of water from your body. Your body holds water to preserve it. If you drink enough water, you will not retain water (unless you have a medical condition).
• Helps your metabolism. Water contributes to weight loss by stimulating your metabolism, killing hunger pangs and filling you up.
• Helps your comfort level. Water is involved in balancing your body temperature.
• Saves your joints. Water lubricates your joints and may reduce pain.
• Gives your face a healthy glow. Water improves your skin through internal hydration.
• Saves You. Water may help prevent a heart attack! Drinking a glass of water before bed or a hot bath/shower may reduce your chance of a heart attack.
• Saves money. Water is cheaper than other beverages (or free).
• Improves your smile. Water has a slight alkalizing affect which helps reduce acidity and is good for your teeth and overall mouth health.
Drinking enough water is very good for all of you! You can add lemon, lime or a splash of juice to add flavor. Try ice, a straw and your favorite glass to make drinking water a pleasant part of your day. Next week we will talk about ways to kill your cravings with certain foods.
Drink up, and KTQ!
Vikki Q CTTS-M Master Certified Tobacco Treatment Specialist
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