Understanding the Question

A lot of people ask this question long before anyone else knows they are concerned: do I have a drinking problem? Often, the reason it feels difficult to answer is because drinking issues do not always look dramatic from the outside. You do not have to drink every day, lose your job, or experience a major crisis for alcohol to be affecting your life in unhealthy ways.

When Alcohol Starts Interfering With Life

A drinking problem can exist anytime alcohol starts interfering with your health, relationships, responsibilities, emotions, or sense of control. For some people, that looks like drinking more often than they planned. For others, it means needing alcohol to relax, cope with stress, fall asleep, socialize, or get through difficult emotions. Sometimes the concern is not how often you drink, but what happens when you do.

Common Signs of a Drinking Problem

You may want to look more closely at your relationship with alcohol if you often drink more than you intended, feel guilty afterward, hide how much you drink, make promises to cut back but struggle to follow through, or notice that alcohol is affecting your mood, sleep, or relationships. Other signs can include blackouts, risky decisions while drinking, increased tolerance, cravings, irritability when not drinking, or using alcohol to manage anxiety, sadness, loneliness, or trauma.

Why Alcohol Problems Are Not Always Obvious

One of the biggest myths about alcohol problems is that they are obvious. In reality, many people appear high-functioning while privately feeling stuck, ashamed, or worried. They may still be succeeding at work or taking care of their families, but alcohol is quietly becoming their main coping tool. That pattern deserves attention.

Honest Questions to Ask Yourself

It can also help to ask a few honest questions. Do I feel uneasy when I try not to drink? Do I rely on alcohol to unwind? Has anyone close to me expressed concern? Have I changed my routines, social life, or habits because of drinking? Am I minimizing something I already know is affecting me?

When Uncertainty Is Worth Listening To

If you are unsure, that uncertainty itself may be worth listening to. Most people do not repeatedly wonder whether they have a drinking problem unless something feels off. Curiosity can be a sign of insight, not overreaction.

Alcohol Use, Substance Use, and Mental Health

Alcohol concerns also overlap with broader substance use patterns and mental health struggles. If you want a wider understanding of how professionals define unhealthy use, read What Qualifies as Substance Abuse? If you are beginning to think about support options, What Is an Intensive Outpatient Program (IOP)? and What Is Partial Hospitalization (PHP)? explain how structured treatment can help people address alcohol use while also working on the emotional challenges underneath it.

You Do Not Need a Label to Get Help

You do not need to label yourself before getting help. You do not need to wait for things to get worse. And you do not need to compare your drinking to someone else’s to justify concern. If alcohol is making life harder, affecting your peace of mind, or leaving you feeling less like yourself, it is okay to take that seriously.

Taking the First Honest Step

Recognizing a possible drinking problem is not a failure. It is often the first honest step toward feeling better, regaining control, and building healthier ways to cope.

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Many people ask this question quietly and privately before they ever reach out for help: what actually qualifies as substance abuse? It is an important question, and the answer is not always as simple as how much someone uses or how often.

In general, substance abuse refers to the harmful or risky use of alcohol or drugs in a way that affects a person’s health, relationships, responsibilities, or safety. A person does not have to “hit rock bottom” for substance use to become a serious concern. In fact, many people continue to work, parent, go to school, or meet obligations while still struggling with a growing problem.

Substance Abuse Is Defined by Impact

Substance abuse may involve alcohol, prescription medications, marijuana, opioids, stimulants, or other substances. What matters most is the impact.

Is use creating problems at home, at work, in relationships, or emotionally? Is it becoming harder to stop, cut back, or cope without it? Is someone using to numb stress, anxiety, depression, trauma, or emotional pain?

These are often more telling signs than quantity alone.

Common Warning Signs of Substance Abuse

Some common warning signs include:

• using more than intended
• needing more of a substance to feel the same effect
• spending a lot of time thinking about or recovering from use
• hiding use from others
• neglecting responsibilities
• taking risks while under the influence
• continuing to use even when it is causing harm
• experiencing cravings or withdrawal symptoms
• trying to stop or cut back without success

These signs do not always look the same from person to person. For some, the problem may appear gradually. For others, it may become obvious after a crisis, conflict, or health concern.

Substance Use Exists on a Spectrum

It is also important to understand that substance abuse and substance use disorder exist on a spectrum. Not everyone has the same severity, but early patterns still matter.

The sooner someone recognizes a problem, the easier it can be to get support before consequences become more serious.

The Connection Between Mental Health and Substance Use

Mental health often plays a major role in substance use. Many people use substances to cope with anxiety, depression, trauma, grief, or overwhelming stress.

This does not mean they are weak. It means they may be trying to manage pain in a way that is ultimately making things harder. When mental health and substance use occur together, integrated treatment can be especially important.

When to Explore Treatment Options

If alcohol is the main concern, you may also want to read Do I Have a Drinking Problem?, which explores common signs people often overlook.

If you are exploring treatment options, What Is an Intensive Outpatient Program (IOP)? and What Is Partial Hospitalization (PHP)? explain two levels of structured support that can help people recover while building healthier coping strategies.

When to Seek Professional Support

A diagnosis should always come from a qualified professional, but you do not need a formal diagnosis to start paying attention.

If substance use is affecting your relationships, your mood, your ability to function, or your sense of control, it deserves compassion and honest evaluation.

Help Can Start Before Things Get Worse

Substance abuse is not defined by shame, stereotypes, or how your struggle compares to someone else’s. It is defined by impact.

When use begins to interfere with well-being, it is worth taking seriously. Help is available, and recovery does not begin when things get worse. It begins the moment you are willing to ask whether something needs to change.

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Understanding Partial Hospitalization

When someone needs more support than weekly therapy or even an Intensive Outpatient Program can provide, a Partial Hospitalization Program, or PHP, may be the right next step. Despite the name, PHP does not mean staying overnight in a hospital. Instead, it is a structured, full-day treatment program that offers intensive care during the day while allowing clients to return home in the evening.

Who Is PHP Designed For?

PHP is designed for people who need significant support for mental health or substance use concerns but do not require 24-hour inpatient hospitalization. It can be especially helpful for individuals who are stepping down from inpatient care, coming out of a crisis period, or struggling with symptoms that are interfering with daily functioning.

What Happens in a PHP?

In a PHP, treatment is more intensive than IOP. Clients typically attend programming five days a week for several hours each day. During that time, they may participate in group therapy, individual therapy, psychiatric support, medication management, skills training, psychoeducation, and care coordination. The goal is to provide stabilization, structure, and clinical momentum while helping clients begin transitioning back into everyday life.

Mental Health and Substance Use Support

PHP can be beneficial for people experiencing depression, anxiety, trauma, emotional dysregulation, grief, relapse risk, or co-occurring mental health and substance use issues. It can also help those who feel unsafe or overwhelmed with standard outpatient care but are medically stable enough to live at home.

Why Structure Matters in PHP

One of the most important features of PHP is the level of consistency it offers. When symptoms feel intense, healing often requires more than a once-a-week conversation. PHP creates a therapeutic routine that helps reduce isolation, build coping skills, and provide close clinical monitoring. That kind of structure can be especially valuable when someone is vulnerable to setbacks, hospitalization, or relapse.

PHP vs. IOP: What Is the Difference?

Many people wonder about the difference between PHP and IOP. The simplest answer is intensity and time commitment. PHP is usually a full-day program with more frequent support, while IOP typically meets a few times a week for shorter sessions. Both are valuable, but they serve different needs at different stages of recovery.

If you are comparing these options, read What Is an Intensive Outpatient Program (IOP)? for a closer look at how IOP works.

PHP as Part of a Larger Care Plan

PHP can also serve as part of a larger continuum of care. Someone may begin in PHP for stabilization, then step down to IOP as they gain strength and confidence. This gradual transition can make recovery feel more sustainable and less overwhelming.

When Substance Use Is Part of the Concern

If your concerns involve alcohol or drug use, PHP may also be part of treatment when substance use is affecting safety, stability, or mental health. To understand how clinicians think about these concerns, visit What Qualifies as Substance Abuse? If alcohol is the main concern, Do I Have a Drinking Problem? can help you think through common warning signs.

Taking the Next Step Toward Stability

Seeking a higher level of care can feel intimidating, but it is often a sign of insight, not failure. PHP offers a bridge between crisis and stability. For people who need meaningful support without overnight hospitalization, it can be a powerful place to begin rebuilding health, hope, and daily life.

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Finding the Right Level of Care

When someone is struggling with mental health symptoms or substance use, it can be hard to know what level of care is right. Weekly therapy may not feel like enough, but inpatient treatment may not be necessary. In many cases, an Intensive Outpatient Program, or IOP, offers the right balance of structure, flexibility, and support.

How an Intensive Outpatient Program Works

An Intensive Outpatient Program is a higher level of care than traditional outpatient therapy, but it does not require an overnight stay. Clients attend treatment several times a week for multiple hours per session, then return home afterward. This allows people to receive consistent clinical care while continuing to manage work, school, family, or other daily responsibilities.

Who Can Benefit From IOP?

IOP is often recommended for people who need more support than weekly counseling can provide. It can help individuals dealing with anxiety, depression, trauma, grief, mood changes, relapse risk, or substance use concerns. It may also be a strong next step after inpatient treatment, detox, residential care, or a more intensive program like Partial Hospitalization.

What Happens in IOP?

So, what happens in IOP? While every program is different, IOP typically includes a combination of group therapy, individual support, psychoeducation, coping skills training, relapse prevention, and treatment planning. Clients learn practical tools they can use in real life, not just in a therapy room. That might include strategies for managing triggers, improving communication, regulating emotions, and building healthier routines.

Practicing Recovery in Everyday Life

One of the biggest benefits of IOP is that it helps people practice recovery in the context of everyday life. Because clients go home after treatment, they can begin applying what they learn right away. Then they come back to process challenges, celebrate progress, and strengthen new skills with clinical support.

Mental Health, Substance Use, or Both

For some people, IOP focuses primarily on mental health. For others, it centers on substance use recovery. In many cases, treatment addresses both at the same time. This matters because mental health and substance use often overlap. Someone may be drinking to cope with anxiety, or using substances while also experiencing depression, trauma, or emotional distress. Treating both together can lead to better long-term outcomes.

The Value of Group Support

IOP is also helpful because it offers community. Many people feel isolated when they are struggling. Group-based care reminds clients they are not alone. It creates space for support, accountability, and connection in a safe, professionally guided setting.

Is IOP the Right Fit?

If you are wondering whether IOP is the right fit, the answer depends on your symptoms, your safety, your support system, and how much structure you need right now. Some people begin in IOP. Others step down into IOP after completing a more intensive program.

To better understand that next level of care, read What Is Partial Hospitalization (PHP)? If your concerns are more related to alcohol or drug use, What Qualifies as Substance Abuse? and Do I Have a Drinking Problem? may help you recognize when it is time to seek support.

Taking the First Step Toward Support

Reaching out for help does not mean something is wrong with you. It means you are paying attention to what you need. For many people, IOP is where healing becomes more manageable, more consistent, and more possible.

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At River’s Bend, we have provided evidence-based outpatient behavioral healthcare since 1995. We understand that people do not walk in with simple labels or easy answers. Many arrive feeling exhausted, overwhelmed, or unsure whether their substance use is serious enough to need help. A substance abuse evaluation helps answer the most important questions: What is happening? What is contributing to it? What treatment will help most right now?

What Is a Substance Abuse Evaluation?

A substance abuse evaluation is a structured clinical assessment that helps identify how substance use is affecting a person’s life. It gives both the individual and the clinical team a clearer understanding of what is going on and what type of treatment may be most effective.

A substance abuse evaluation typically includes:

• substance use history, including what substances are being used, how often, how much, and for how long
• patterns and triggers, such as stress, sleep issues, relationships, trauma, work, or social settings
• safety and risk factors, including withdrawal risk, relapse risk, and overdose risk
• physical and mental health concerns, including anxiety, depression, trauma symptoms, or mood changes
• current supports and stressors, such as family, work, housing, school, or legal and financial concerns
• readiness for change, along with personal goals, fears, and hopes

A substance abuse evaluation is not a test you pass or fail. It is a clinical conversation that helps turn personal experience into an actionable treatment plan.

Why a Substance Abuse Evaluation Matters

A substance abuse evaluation matters because it helps identify the underlying issues connected to substance use. It gives clinicians a full picture instead of focusing on one symptom or one behavior alone.

Without a proper addiction assessment, people may receive treatment that does not fully address their needs. Some may need more structure than weekly therapy can provide. Others may need support for both substance use and mental health symptoms at the same time. A strong clinical evaluation helps make sure care is appropriate, personalized, and effective.

Why Evaluations Matter for Co-Occurring Disorders

One of the most important reasons to schedule a substance abuse evaluation is to identify co-occurring disorders. A person may be living with both a substance use disorder and a mental health condition such as anxiety, depression, trauma, PTSD, bipolar symptoms, or ADHD.

When substance use and mental health are treated separately, recovery can become more difficult. Many people try to stop using substances, only to find that the anxiety, panic, shame, or trauma underneath feels impossible to manage without support. A substance abuse evaluation helps identify these overlapping concerns early, so treatment can address the whole person.

At River’s Bend, our care model supports dual-diagnosis treatment because recovery often requires both mental health care and substance use treatment working together.

What to Expect During a Substance Abuse Evaluation at River’s Bend

At River’s Bend, we approach every substance abuse evaluation with clinical expertise and compassion. Many people come in carrying fear of judgment, fear of change, or fear of being misunderstood. Our goal is to create a space where honesty feels safe and helpful.

During your evaluation, you can expect:

• respect and confidentiality
• a clinician who listens for both symptoms and strengths
• a practical focus on next steps rather than shame or blame
• clear recommendations based on your unique situation

If you are a family member encouraging someone to come in, it may help to know that the goal is not to pressure them. The goal is to help them feel supported enough to begin.

How a Substance Abuse Evaluation Helps Determine the Right Level of Care

A substance abuse evaluation does more than confirm a diagnosis. It helps determine the right level of care and the right next step in treatment.

River’s Bend offers evidence-based, dual-diagnosis treatment through:

• Mental Health and Substance Use Disorder IOPs
• Partial Hospitalization Program (PHP)
• Individual Therapy
• Group Therapy
• Family Therapy

Some people need structured treatment several times each week while still managing work, school, or family responsibilities. Others need a higher level of clinical support to stabilize symptoms and reduce relapse risk. A substance abuse evaluation helps match each person to the care that fits their needs.

You can also explore our related services, including Intensive Outpatient Programs (IOP) and Partial Hospitalization Program (PHP), to learn more about treatment options.

Breaking Down Barriers to Recovery

A major benefit of a substance abuse evaluation is that it helps turn vague distress into something understandable and treatable. Many people describe their experience in ways like these:

“I do not know why I keep doing this.”
“I cannot shut my brain off.”
“I am fine until I am not.”
“I have tried to stop, but I always end up back here.”

These experiences often point to deeper issues such as trauma, chronic stress, grief, mood instability, relationship patterns, or sleep disruption. A substance abuse evaluation helps uncover these drivers so treatment can focus on what is truly maintaining the cycle.

If Gambling Is Part of the Picture

For some people, online gambling can become part of the same pattern of coping, avoidance, or emotional distress that contributes to substance use. When stress, anxiety, or addiction are already present, gambling may quietly become another harmful behavior.

You may also want to read these related resources:

• Signs of Gambling Addiction and What Michigan Residents Need to Know
• Why Addiction Treatment Might Fail Without Mental Health Support

These topics are especially important when co-occurring disorders are part of the clinical picture.

The Value of a Clear Starting Point

Recovery rarely begins with one perfect decision. More often, it begins with one clear and courageous step. A substance abuse evaluation can be that step because it replaces confusion with guidance.

When you or a loved one understands what is happening and why, it becomes easier to make choices based on evidence, support, and a real treatment plan. That clarity can make a meaningful difference in the recovery process.

At River’s Bend, our approach emphasizes coordinated care, clinical transparency, and respect for the therapeutic relationships you may already have. If you are a provider, we partner with you. If you are a client, we meet you where you are and help you move forward.

Schedule a Substance Abuse Evaluation

If you are worried about substance use, whether it is your own or someone you love, you do not have to wait for things to get worse. Early support can help prevent deeper harm and create a more stable path toward recovery.

Schedule a confidential substance abuse evaluation today and take the first step toward understanding what support is needed.

You can also visit our Get Started page to connect with River’s Bend and begin the process.

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Gambling-related harm is showing up more often in behavioral healthcare settings, sometimes clearly labeled, but more often disguised as anxiety, insomnia, depression, relationship rupture, financial crisis, or relapse risk. For Michigan providers, the clinical landscape has shifted quickly because gambling is no longer limited to casinos or occasional events. It can be 24/7, mobile, private, and aggressively normalized.

Why this is a Michigan “right now” issue

Michigan’s regulated online gaming and sports betting went live January 22, 2021, accelerating access and convenience statewide.

Since then, Michigan has reported continued growth:

• 2024: MGCB reported $2.4B in combined iGaming + internet sports betting adjusted gross receipts (AGR), and $2.9B total gross receipts for iGaming + sports betting.¹
  
• 2025: MGCB reported $3.3B in combined iGaming + internet sports betting AGR.
  

These figures don’t diagnose harm, but they do illustrate scale, exposure, and normalization. As availability expands, providers can expect more clients whose gambling behavior intersects with mood symptoms, substance use, and family stress.²

Michigan has also increased the visibility of help-seeking pathways by adopting 1-800-GAMBLER as the statewide problem gambling helpline (with operators required to display it in responsible gaming messages).³

National context for comparison (why Michigan isn’t alone)

The National Council on Problem Gambling notes that problem gambling exists on a spectrum, and estimates that ~2 million U.S. adults meet criteria for severe gambling problems in a given year, with ~4–6 million more experiencing problems due to gambling behavior.⁴

That national baseline matters for Michigan providers because online access and high-volume marketing have created a climate where gambling is increasingly “ambient”—and where screening can’t be limited to specialty addiction settings.

How gambling disorder presents clinically

Many clients will not lead with “I have a gambling problem.” Common presenting concerns include:

Mental health and functioning

• Anxiety, panic symptoms, irritability, sleep disruption
• Depressive symptoms and shame spirals (often after losses)
• Emotional numbing and dissociation-like “zoning out” during play/betting
• Suicidality risk can rise with escalating financial and interpersonal consequences (treat as high-acuity when present) 

Social and relational

• Relationship conflict, secrecy, erosion of trust
• Social withdrawal and loss of previously rewarding activities
• Increased anger or defensiveness when gambling is questioned

Financial/legal/occupational

• Unexplained debt, late payments, missing funds, borrowing, cash advances
• Workplace impairment: distraction, absenteeism, performance decline
• Legal concerns (theft, fraud, disputes, or high-risk borrowing)⁵

Youth and young adult signals (Michigan-relevant)

MGCB has specifically highlighted the prevalence of sports wagering behaviors among 18–22-year-olds, referencing NCAA survey findings and noting campus-level pervasiveness. It also lists warning signs in teens/young adults such as skipping class to gamble, lying, borrowing/stealing, and gambling linked to loneliness or depression.

Clinical takeaway: If you work with college-age clients (and even younger adolescents exposed to gambling-adjacent content), screen routinely—especially when you see impulsivity, mood symptoms, and financial stress.

Similarities to substance use disorders—and what’s different

Similarities (treatment-relevant)

• Cravings/urges and preoccupation
• Loss of control (failed attempts to cut back/stop)
• Tolerance-like escalation (larger bets, higher-risk play)
• Continuation despite harm
• High co-occurrence with depression/anxiety, trauma, and substance use

Differences (why providers miss it)

• Concealability: no odor/intoxication markers; behavior can be hidden in “normal” phone use
• Money is both trigger and consequence: losses drive urgency to “repair” (chasing losses)
• Rapid reinforcement schedules: near-misses and intermittent wins can strengthen compulsive cycles
• Access without stopping cues: online environments remove natural “closing time” boundaries
• Stigma profile: clients may disclose debt, anxiety, or conflict long before naming gambling⁶

Practice implication: Make gambling screening as routine as alcohol/substance screening—particularly for clients presenting with financial strain, sleep disturbance, relationship conflict, relapse vulnerability, or impulsivity.

Screening and assessment: practical steps that reduce stigma and increase disclosure

1) Normalize with a “because we ask everyone” script

• “Because gambling is so accessible now, we ask everyone a couple quick questions about betting or gaming to make sure it’s not impacting stress, sleep, or finances.”

2) Use behavior-anchored questions

• “How often do you place bets or play online casino games in a typical week?”
• “Have you tried to cut back and found it harder than expected?”
• “Do you ever gamble to change your mood—stress relief, escape, numbness?”
• “Have losses created pressure to win it back?”
  

3) Screen when these flags appear

• Unexplained financial changes, new debt, secrecy
• Mood instability tied to wins/losses
• Co-occurring SUD, anxiety, depression, ADHD/impulsivity
• Youth/college population with sports culture exposure

4) Document clinically, not morally

Avoid moralized language (“irresponsible,” “bad choices”). Document functional impairment and risk:

• impaired control, preoccupation, time spent, continued behavior despite harm
• financial impacts, occupational impairment, relational harm
• safety risk assessment when indicated

Treatment planning: core elements to include

A comprehensive plan often integrates:

Motivational interviewing (MI)

• Ambivalence is common: “It helps my stress… but it’s wrecking my life.”
• Focus on values, discrepancy, and autonomy while building readiness.

CBT-informed work (distortions + behavior loops)

Target cognitive distortions and reinforcement cycles:

• gambler’s fallacy, “near miss” interpretations, chasing losses
• identifying triggers, high-risk contexts, and emotional antecedents
• urge-surfing, delay strategies, alternative coping behaviors

Relapse prevention and harm reduction guardrails

• Money safety planning (shared budgeting supports, limits, reduced access to credit)
• Trigger management (notifications/marketing cues, time-of-day routines)
• Family involvement when clinically appropriate (repair + accountability)

Co-occurring conditions: treat the full picture

Given frequent overlap, integrate care for:

• depression/anxiety/trauma-related symptoms
• substance use relapse risk and cross-addiction dynamics
• sleep and stress physiology (often major relapse drivers)

Where River’s Bend fits clinically (levels of care you can refer to)

River’s Bend provides structured outpatient care that can be a good fit for individuals experiencing gambling disorder, especially when symptoms are escalating, co-occurring, or impacting functioning:

• Intensive Outpatient Program (IOP): structured treatment while maintaining work/school/family responsibilities
  
• Group therapy: skill-building, accountability, reduced shame/isolation, peer-supported recovery behaviors
  
• Individual therapy: personalized treatment planning, underlying drivers (anxiety, depression, trauma, grief), and long-term recovery supports
  
• Dual diagnosis care: integrated approach when gambling co-occurs with mental health and/or substance use disorders

Referral tip: When you’re unsure about fit, refer for an assessment and describe the functional impact you’re seeing (sleep, mood, finances, relationships, work/school). That helps align the level of care quickly.

Michigan system considerations providers should keep on their radar

• Responsible gaming messaging and helpline visibility are now more standardized through Michigan’s adoption of 1-800-GAMBLER, including requirements for operators to display the number.
• Policy attention is active. For example, Michigan lawmakers introduced bills (SB 713/714) aimed at tightening rules around online gambling and sports betting advertisements, including limitations on misleading ads and targeting under 21.

Clinical takeaway: Marketing exposure and normalization are not just background noise—they can become triggers, especially for clients early in recovery.

Professional development opportunity: P4P Day Conference (April 17, 2026)

If you want Michigan-specific education, practical tools, and direct connection to statewide resources and provider collaboration:

Collaboration of Providers for Providers (P4P) Day Conference: Gambling Addiction
Friday, April 17, 2026 | 9:00 AM–2:30 PM
Henry Ford Health: Maplegrove Center (West Bloomfield, MI)
4.5 MCBAP & Social Work CEU credits
Cost: $25 (lunch provided) | Sponsor w/ exhibitor table: $200

References

1. CDC Gaming Reports. (2024, November 20). Michigan sets online casino revenue record in October with more than $220M — CDC Gaming. CDC Gaming. https://cdcgaming.com/brief/michigan-sets-online-casino-revenue-record-in-october-with-more-than-220m/   ↩︎
2. Barnes, G. M., Welte, J. W., Tidwell, M. O., & Hoffman, J. H. (2015). Gambling and substance use: co-occurrence among adults in a recent general population study in the United States. International Gambling Studies, 15(1), 55–71. https://doi.org/10.1080/14459795.2014.990396 ↩︎
3. Keith, L. (2024, February 8). Michigan Gaming Control Board adopts 1-800-GAMBLER as statewide problem gambling helpline. Michigan Gaming Control Board. https://www.michigan.gov/mgcb/news/2024/02/08/mi-adopts-1800gambler  ↩︎
4. National Council on Problem Gambling. (n.d.). PROBLEM GAMBLING. https://www.ncpgambling.org/wp-content/uploads/2025/01/PGAM-2025-Problem-Gambling-Fact-Sheet.pdf  ↩︎
5. Moreira, D., Azeredo, A., & Dias, P. (2023). Risk Factors for Gambling Disorder: A Systematic Review. Journal of Gambling Studies, 39(2), 483–511. https://doi.org/10.1007/s10899-023-10195-1  ↩︎
6. Substance Abuse and Mental Health Services Administration. (2021). Treatment for stimulant use disorders. In TREATMENT IMPROVEMENT PROTOCOL. https://store.samhsa.gov/sites/default/files/pep21-02-01-004.pdf  ↩︎

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Gambling has changed, fast. In Michigan and across the country, betting no longer requires a trip to a casino or a race track. It can happen anytime, anywhere, from a phone. For many people, gambling stays what it was meant to be: entertainment. But for others, easy access and constant online availability can quietly tip into something heavier: gambling disorder, sometimes called gambling addiction.¹

If you’re wondering whether gambling might be becoming a problem for you, or for someone you love, know there are many in Michigan dealing with the same real, treatable behavioral addiction, and support can make a meaningful difference.

Why this conversation matters in Michigan right now

Michigan’s regulated online gaming and sports betting went live on January 22, 2021, which significantly increased 24/7 access across the state.

When something is available 24/7, heavily promoted, and always within reach, it can show up in the moments people feel most vulnerable—late at night, after conflict, after a triggering day at work, or when anxiety spikes. In those moments, gambling can start to function like emotional relief: a quick distraction, a temporary rush, a way to numb or escape.

From a clinical perspective, this matters because coping tools can turn into coping traps. What begins as “something to take the edge off” can gradually become a pattern that feels harder to control—especially when someone is already running low on support, stability, or healthy ways to regulate emotions.²

This isn’t shared to judge gambling. It’s shared to reflect how normalized and accessible online gambling has become, and why some people may need support navigating it. That’s also why Michigan has increased public awareness around problem gambling resources like 1-800-GAMBLER—not because most people are in crisis, but because enough people are, and help should be easy to find the moment someone realizes they need it.

What is gambling addiction?

Gambling addiction (clinically, “gambling disorder”) is not about how much money someone wins or loses on a single day. It’s about loss of control and continuing to gamble even when it causes harm—financially, emotionally, socially, or professionally.

Clinically, gambling disorder is considered a behavioral addiction because it can activate the brain’s reward and craving systems in ways that resemble substance addictions. Research has linked gambling to the same reward circuitry that responds to natural rewards like sex and to drugs like cocaine, which helps explain why urges can feel so intense, and why stopping can be so hard even when someone truly wants to.³

A common pattern looks like this:
stress or strong emotion → gambling as escape or excitement
→ temporary relief or “rush”
→ losses, shame, conflict, or debt
→ more stress → more gambling to “fix it” (often called chasing losses)

That cycle can create real consequences quickly—sometimes before anyone else even realizes there’s a problem. And the broader impact is real: nationally, problem gambling is associated with significant social costs (healthcare strain, job loss, legal and financial consequences), which is one reason it’s increasingly treated as a public health issue.⁴

Who is most affected right now?

While anyone can develop a gambling problem, recent consumer and industry reporting shows much of the growth in online betting activity is being driven by Gen Z and Millennials (roughly ages 18–43)—especially in digital-first formats like mobile sportsbooks and online casinos. ⁵Clinically, we also see risk rise when people have more unstructured time (late nights, isolation, time off work, or long stretches on a phone) and are using gambling to shift mood or escape stress.

How gaming can blur the lines

For teens and young adults especially, the pathway into gambling can feel subtle because some gaming features mimic gambling mechanics, especially systems based on randomized rewards (like loot boxes). Multiple studies have found links between loot box engagement and increased gambling-related risk, suggesting these “chance + reward” loops can normalize the chase for the next win.⁶

Signs of gambling addiction

Gambling problems can be hard to spot. There’s no smell on someone’s breath. No obvious paraphernalia. Many people become skilled at hiding it, until consequences pile up.

Emotional and behavioral signs

• Thinking about gambling a lot (planning bets, replaying outcomes, checking odds)
• Feeling restless, irritable, or “off” when not gambling
• Gambling to escape stress, anxiety, loneliness, sadness, or numbness
• Lying, minimizing, or becoming defensive when asked about gambling
• Mood swings—especially after wins or losses
• Pulling away from people, hobbies, or responsibilities

Financial signs

• Unexplained missing money or frequent transfers
• New debt (credit cards, payday loans, borrowing from friends/family)
• Selling items, taking cash advances, or repeated overdrafts
• Bills going unpaid despite “normal” income

Work, school, and relationship signs

• Missing work or school, decreased performance, or increased conflict
• Repeated promises to stop or cut back, but not being able to
• Gambling even after major consequences (relationship rupture, job risk, legal/financial fallout)
• Increased secrecy with phone use (especially late night), deleting apps, or hiding statements

A note for parents and caregivers

Online spaces can make gambling-adjacent content feel normal for teens and young adults (odds talk, betting influencers, “picks,” simulated gambling, etc.). Even when someone isn’t legally gambling, the culture around gambling can increase curiosity and risk. 

Call out: If you notice secretive money behavior, sudden debt, intense mood changes around games, or a pattern of late-night “locked-in” phone use, it’s worth addressing early and supportively. Contact our team for help

How gambling addiction is similar to other addictions

Even though gambling doesn’t involve a substance, it can look and feel similar to alcohol or drug addiction:

• Cravings/urges that feel hard to resist
• Tolerance, where bigger risks are needed for the same excitement
• Failed attempts to cut back
• Continuing despite harm (relationships, health, work, finances)
• Shame and secrecy, which keep people stuck
  

And like other addictions, gambling concerns often overlap with co-occurring disorders:

• anxiety and depression
• trauma histories
• substance use concerns
• ADHD/impulsivity (especially in younger people)

How gambling addiction can be different

Gambling disorder also has a few features that make it uniquely easy to miss, and sometimes fast to escalate:

It’s easier to conceal. Someone can gamble from a phone in bed, in the bathroom, at work, or while sitting next to family.

Money is both the trigger and the consequence. Losses can create urgency (“I have to win it back”), which fuels a painful loop.

The “near miss” effect is powerful. Almost winning can feel like proof that a win is “due,” even when it’s not.

Online access removes natural stopping points. With 24/7 availability, there isn’t always a closing time or a built-in pause.

What to do if you’re worried

You don’t have to wait for a crisis to ask for help. Early support can prevent deeper harm.

1) Name what you’re seeing—gently

Try:

• “I’m not here to judge. I’m worried because I see how stressed this is making you.”
• “I miss you. I feel like gambling is taking up more space in your life.”

2) Focus on impact, not morality

Instead of “Why can’t you just stop?” try:

• “What happens to your mood after you gamble?”
• “How is this affecting sleep, money, or relationships?”
  

3) Add safety around money and triggers (temporary guardrails)

These steps aren’t about punishment—they’re about reducing harm while someone gets support:

• Reduce access to credit or betting funds (temporarily)
• Add a trusted support person to help with budgeting oversight
• Turn off gambling-related notifications and marketing triggers
• Create “pause points” (no-phone zones/times, especially at night)

4) Get support early

You do not have to “hit rock bottom” for treatment to help. Many people benefit from care that addresses the gambling behavior and the stress, anxiety, depression, or substance use concerns that may be connected to it. 

Treatment options and support at River’s Bend

At River’s Bend, we treat gambling addiction with the same compassion and clinical seriousness as any other addiction. Because gambling concerns often overlap with mental health symptoms and substance use, our care can be tailored to the whole person, not just the behavior.

IOP (Intensive Outpatient Program)

Our IOP provides structured support while allowing clients to maintain work, school, or family responsibilities. Treatment commonly includes:

• identifying triggers and interrupting the “chasing losses” cycle
• coping skills for urges, stress, and emotional overwhelm
• relapse prevention planning
• strengthening accountability and support systems

Group therapy

Gambling addiction often grows in isolation. Group therapy helps restore what shame takes away: connection. In a supportive, clinically guided setting, clients can:

• reduce shame and secrecy
• learn strategies from others working toward recovery
• build impulse-control and emotion regulation skills
• practice healthy communication and repair
  

Individual therapy

Individual sessions help clients explore what’s underneath the gambling, stress, anxiety, depression, trauma, grief, relationship distress—and build a plan that fits real life. This form of therapy supports:

• personalized goals and coping strategies
• addressing co-occurring mental health symptoms
• rebuilding trust and strengthening relationships
• long-term recovery planning

Dual diagnosis support

Gambling addiction frequently occurs alongside mental health and substance use disorders. Our dual diagnosis approach supports recovery across conditions—helping clients stabilize symptoms, reduce relapse risk, and improve overall functioning.

If you’re not sure what level of care you need, that’s okay. Our team can help you identify the best starting point based on what’s been happening, your support needs, and your goals.

References

1. Clark, L., Averbeck, B., Payer, D., Sescousse, G., Winstanley, C. A., & Xue, G. (2013). Pathological Choice: the Neuroscience of gambling and gambling addiction. Journal of Neuroscience, 33(45), 17617–17623. https://doi.org/10.1523/jneurosci.3231-13.2013  ↩︎
2. Wood, R. T. A., & Griffiths, M. D. (2006). A qualitative investigation of problem gambling as an escape‐based coping strategy. Psychology and Psychotherapy Theory Research and Practice, 80(1), 107–125. https://doi.org/10.1348/147608306×107881  ↩︎
3. Yau, Y. H. C., & Potenza, M. N. (2015). Gambling disorder and other behavioral addictions. Harvard Review of Psychiatry, 23(2), 134–146. https://doi.org/10.1097/hrp.0000000000000051  ↩︎
4. Latvala, T., Lintonen, T., & Konu, A. (2019). Public health effects of gambling – debate on a conceptual model. BMC Public Health, 19(1), 1077. https://doi.org/10.1186/s12889-019-7391-z  ↩︎
5. Guillou-Landreat, M., Gallopel-Morvan, K., Lever, D., Goff, D. L., & Reste, J. L. (2021). Gambling Marketing Strategies and the Internet: What do we know? A systematic review. Frontiers in Psychiatry, 12, 583817. https://doi.org/10.3389/fpsyt.2021.583817  ↩︎
6. Cox, C. M., Evans, S. A., Amarante, E. F., Beattie, R., & Catalfamo, J. (2022). The George Washington Law Review. The George Washington Law Review, 90(2). https://www.gwlr.org/wp-content/uploads/2022/04/90-Geo.-Wash.-L.-Rev.-Issue-2-Full.pdf  ↩︎

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Connecting Metro Detroit to Faster, More Collaborative Outpatient Care

In behavioral health, referrals aren’t just logistics, they’re a lifeline. When a client is ready for care, delays and uncertainty can cost momentum, safety, and hope. That’s why River’s Bend partners closely with professionals across Metro Detroit, offering clear pathways into evidence-based outpatient treatment and responsive communication that supports continuity of care.

At the center of those partnerships is Cheryl Narduzzi, B.S., Business Development Liaison. With more than 12 years of experience in behavioral health, Cheryl helps referral partners across Troy, West Bloomfield, Birmingham, Bloomfield Hills, Rochester, Rochester Hills, Auburn Hills, Royal Oak, Clawson, Berkley, Madison Heights, Sterling Heights, Novi, Farmington Hills, and throughout Oakland County and Macomb County connect people to the right level of care—quickly, compassionately, and with clarity.

Her role is simple in theory, powerful in practice: make it easier for professionals to help people get the support they need—without losing time, trust, or the therapeutic relationship already built.

Meet Cheryl Narduzzi, B.S., Business Development Liaison

Cheryl brings a blend of business expertise and mission-driven service to her work. She earned her Bachelor’s Degree in Business Administration from Central Michigan University and has a strong background in sales, marketing, customer service, and strategic growth—skills she uses every day to strengthen relationships and streamline access to care.

What distinguishes Cheryl most is how personally she takes the work. She’s deeply committed to helping individuals and families find support during some of life’s most vulnerable moments. As a community-facing liaison, she offers education and resources, answers questions, and helps referral sources feel confident that their clients will be treated with dignity, clinical excellence, and respect.

Outside of River’s Bend, Cheryl enjoys cooking, golfing, and spending time with her husband and two dogs.

Three Pillars of Cheryl’s Partnership Approach: Access, Communication, Trust

Like many River’s Bend leaders, Cheryl’s impact is built on values, not just responsibilities. Her work with referral partners across Southeast Michigan often centers on three key pillars:

1) Access: Fast, flexible pathways into outpatient care

When your client is ready, timing matters. River’s Bend offers virtual and in-person outpatient programs with daytime and evening options, helping reduce delays that can lead to worsening symptoms, relapse risk, or missed opportunities for engagement.

Cheryl helps partners understand which level of care fits best, including:

• Partial Hospitalization Program (PHP)
• Mental Health Intensive Outpatient Program (IOP)
• Substance Use Disorder IOP
• Adolescent IOP
• Early Recovery Groups

2) Communication: You’re not “handing off” care—you’re collaborating

One of the most common concerns referring providers share is:
“Once I refer someone, I don’t know what’s happening.”

River’s Bend is committed to being a true extension of your care. With appropriate consent, we prioritize ongoing communication, updates, and coordination, so referral partners stay connected to the treatment process rather than wondering from a distance.

3) Trust: Protecting the relationship you’ve built

Cheryl understands that referrals are rooted in trust, between you and your client, and between you and the provider you choose. River’s Bend honors that trust by prioritizing continuity of care whenever clinically appropriate, including returning clients to their original providers after completing a higher level of outpatient programming.

What Cheryl Supports Across Oakland County and Beyond

Cheryl works with a wide range of partners throughout Metro Detroit, including:

• clinical professionals (therapists, psychiatrists, group practices)
• schools and student support teams
• medical staff and hospital discharge planners
• managed care organizations
• EAP and labor representatives
• employers and HR teams
• ERs and crisis centers
• substance use and mental health providers
• law enforcement and court officials

Her goal is to make referrals feel less like a maze and more like a straightforward next step—especially when clients need structured care beyond weekly outpatient therapy.

Why Referral Partners Trust River’s Bend for Step-Down Support

River’s Bend has served the community since 1995, providing evidence-based outpatient care for mental health and substance use disorders, including co-occurring needs.

For discharge planners and crisis teams, step-down or up planning is one of the most critical moments in recovery. Without structured follow-up, people leaving inpatient treatment, detox, or emergency intervention can be at higher risk of relapse or rehospitalization. River’s Bend helps bridge that gap through customized step-down/up treatment planning, including PHP and IOP options designed to stabilize and sustain progress.

PHP at River’s Bend offers structured, weekday programming (Monday–Friday, 9:00am–3:30pm) for clients needing a more intensive level of support, while still returning home each day. IOP provides ongoing, structured therapy multiple times per week with flexible scheduling that supports real life—work, school, and family responsibilities.

Community Outreach That Makes Care Easier to Find

Cheryl is active at community events and professional touchpoints across the region, serving as a trusted liaison for professionals, and for anyone who simply needs direction or support.

If you’ve ever had a moment where you thought, “I’m not sure what to recommend next, but I know weekly therapy isn’t enough,” Cheryl is exactly who you can call. She’ll help you understand options, coordinate next steps, and connect your client to timely care.

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Since River’s Bend provides evidence-based outpatient behavioral health treatment for mental health and substance use disorders, and we’re closely tracking the regulatory reforms that could materially impact how behavioral health services are delivered, both in-person and via telehealth.

The three policy timelines to watch (and why they matter)

If you only take away three dates, make it these:

1) December 31, 2026: Federal telehealth rules for controlled-substance prescribing may change¹

If a care plan involves certain controlled medications (often managed through psychiatry), federal flexibilities allowing some prescribing via telehealth without an in-person exam are scheduled to sunset after 12/31/2026.

Why it matters for behavioral healthcare: this could affect how quickly some patients can begin or maintain certain medication regimens through telehealth—especially in areas facing provider shortages.

Callout: Want help planning around this?
If your organization, referral network, or care pathway includes psychiatric medication management, contact River’s Bend to discuss continuity-of-care planning, access strategy, and compliant care coordination.

2) December 31, 2027: Medicare telehealth flexibilities are scheduled through this date²

Current Medicare telehealth extensions run through 12/31/2027, with broader reversion changes beginning 1/1/2028.

Why it matters for Michigan behavioral health providers: while behavioral health telehealth is generally more protected than other medical telehealth, operational requirements increase in 2028 (more on that below). Leaders should treat late 2027 as the planning horizon for workflow redesign and compliance readiness.

3) 2026 Michigan legislative session: Telehealth payment parity (SB 772) is pending³

Michigan Senate Bill 772 (introduced 1/28/2026) would require insurers to cover telemedicine at the same rate as in-person services for the same care.

Why it matters for outpatient behavioral health in Michigan: if enacted, parity could reduce payer-by-payer rate variability and improve reimbursement predictability for services like therapy, substance use disorder treatment, and other outpatient behavioral healthcare delivered via telehealth.

Callout: If parity becomes law, it could also attract new market entrants—changing competition in Grand Rapids, West Michigan, and statewide.

Medicare telehealth in 2028: not a shutdown, but a new set of requirements

Behavioral health telehealth is relatively stable, yet still faces meaningful operational change

Starting in 2028, Medicare rules are expected to tighten for many non-behavioral telehealth services. Behavioral health is comparatively more stable, but Medicare’s behavioral telehealth requirements may add administrative steps that affect access if a provider isn’t prepared.

The “in-person visit” requirement is the biggest operational shift

The Medicare behavioral telehealth requirement for an in-person visit within six months of initiating telehealth (and periodic visits after that) is delayed until after 12/31/2027⁴, meaning it could take effect 1/1/2028 at the earliest.

In plain language for clients and families:
Telehealth can remain an excellent option, but some Medicare-covered patients may need occasional in-person visits to keep telehealth covered.

For industry leaders:
This becomes a workflow issue—tracking due dates, creating scheduling capacity, and preventing interrupted care.

How River’s Bend can help:
River’s Bend partners with clients, families, and professional referral sources to support care continuity, access to treatment, and strong clinical engagement, whether services are delivered virtually or in-person. Contact River’s Bend to learn more about outpatient program options and how we support treatment planning.

Audio-only (phone) sessions: still possible, but documentation matters more

Audio-only behavioral telehealth remains available through 12/31/2027⁵. Beginning in 2028, Medicare is expected to allow audio-only behavioral health visits at home when:

• the clinician is capable of video, and
• the patient can’t use video or does not consent to video

Why this matters in Michigan communities:
Audio-only visits can support access when broadband is limited, technology is unreliable, or privacy concerns make video difficult.

What’s changing isn’t necessarily access it’s compliance expectations. Providers who use audio-only as an access tool should standardize documentation to reflect the required rationale.

Callout: A small documentation improvement can reduce audit risk while protecting equitable access to behavioral healthcare.

Controlled-substance telehealth prescribing: planning for the 2026 shift

Federal DEA/HHS telemedicine flexibilities that allow certain controlled-substance prescribing via telehealth are extended through 12/31/2026.

Why leaders care:
If rules tighten, demand for in-person evaluation appointments could increase quickly, especially for psychiatry-related services.

What clients should know:
If your treatment includes medication, a provider may recommend an in-person appointment at certain points—not as a barrier, but because regulations may require it.

Need help thinking through access and continuity?
River’s Bend supports comprehensive outpatient treatment for mental health and substance use disorders and can help families and partners understand care options and continuity planning. 

Michigan telehealth payment parity (SB 772): why it could be a big deal for behavioral health

If Michigan SB 772 passes, it could:

• Improve reimbursement predictability for telehealth behavioral health services
• Reduce rate variation across insurers for the same service
• Encourage investment in virtual access and clinical capacity
• Potentially increase competition as more providers enter telehealth markets⁶

What this could mean for Southeast Michigan clients:
More predictable reimbursement can support broader availability of telehealth appointments, often translating to improved access, shorter waits, and stronger continuity of care.

Licensure compacts: one of the biggest “access levers” for the Great Lakes region

Most states require clinicians to be licensed where the patient is located during the visit. Interstate licensure compacts can help eligible clinicians work across state lines with fewer administrative barriers.

Where Michigan is already positioned well: PSYPACT for psychologists

Michigan is already part of PSYPACT, supporting interstate telepsychology (within compact rules). That can expand recruiting options and access, particularly valuable in areas with high demand.⁷

What’s next: Counseling and Social Work compacts

Compacts involving counselors and social workers are especially relevant to outpatient behavioral healthcare workforce capacity. If Michigan joins and operationalizes these compacts, the likely impacts include:

• Easier recruitment across the Midwest
• More cross-border telehealth options
• Increased competition from out-of-state providers serving Michigan patients

Why this matters for behavioral health leaders:
Compacts can expand access, but they also change the competitive landscape quickly.

Contact River’s Bend to learn more

Whether you’re an industry partner planning networks and step-down pathways, or a client/family exploring treatment options, River’s Bend can help you understand what’s changing and how to stay connected to care.

Contact River’s Bend to learn more about:

• outpatient behavioral health treatment in Michigan
• evidence-based mental health treatment
• substance use disorder treatment
• telehealth and in-person care options
• support for clients and families across West Michigan and beyond

References

1. Fourth temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications. (2025, December 31). Federal Register. https://www.federalregister.gov/documents/2025/12/31/2025-24123/fourth-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled  ↩︎
2. Telehealth FAQ. (2026). https://www.cms.gov/files/document/telehealth-faq-updated-02-04-2026.pdf  ↩︎
3. Senate Bill 772 of 2026 – Michigan Legislature. (n.d.). https://www.legislature.mi.gov/Bills/Bill?ObjectName=2026-SB-0772  ↩︎
4. Mshepard. (2026, February 5). Medicare Telehealth coverage extended through 2027. Center for Medicare Advocacy. https://medicareadvocacy.org/medicare-telehealth-coverage-extended-through-2027/  ↩︎
5. Telehealth. (n.d.). Medicare. https://www.medicare.gov/coverage/telehealth  ↩︎
6. MI – SB0772. (n.d.). BillTrack50. https://www.billtrack50.com/billdetail/1951161  ↩︎
7. Psychology Interjurisdictional Compact (PSYPACT). (2023). Psychology Interjurisdictional Compact (PSYPACT) Frequently Asked Questions (FAQs). In Psychology Interjurisdictional Compact (PSYPACT) Frequently Asked Questions (FAQs). https://www.michigan.gov/lara/-/media/Project/Websites/lara/bpl/Psychology/Licensing-Info-and-Forms/Psychology-Interjurisdictional-Compact-PSYPACT-Information.pdf  ↩︎

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From Intern to Clinical Director

At River’s Bend PC, healing isn’t just clinical, it’s deeply human. And few people embody that truth more than Amy Fresch, MA, LPC. As Clinical Director, Amy leads with a rare blend of therapeutic skill, personal wisdom, and unwavering compassion. Her journey from intern to clinical leader is more than a success story, it’s a blueprint for how lived experience can shape transformative care.

A Leader Who Understands Because She’s Lived It

Amy’s life has been shaped by the same challenges many of her clients face. Growing up in a family impacted by addiction and trauma, and standing alongside her husband in long-term recovery, Amy brings an unshakable empathy to every therapeutic space she enters.

Her message is clear: “You are not broken, you are becoming.”

This perspective informs everything she does:

• Building a trauma-informed culture across River’s Bend’s Troy and West Bloomfield clinics
• Supporting clients through mental health and substance use recovery with authentic, evidence-based care
• Training clinicians to lead with heart, listen deeply, and create space for all parts of the healing journey

Innovating Intensive Outpatient Therapy

One of Amy’s signature contributions is her development of River’s Bend’s 10-week, 30-lecture Mental Health IOP curriculum. Drawing on modalities like CBT, DBT, and motivational interviewing, she crafted a program that is both structured and soul-centered, offering real tools for recovery while meeting clients exactly where they are.

Her specialties include:

• Group therapy for clients in early recovery
• Co-occurring disorders (mental health + substance use)
• Curriculum development that turns theory into life-changing practice

Amy’s sessions are known for their depth. Clients often say, “She saw me when no one else did.” And that’s exactly her goal.

Calm in the Storm: When Clinical Skill Meets Human Presence

Amy is more than a curriculum builder, she’s a clinician who shows up in the hardest moments. In one virtual group, when a client disclosed a suicide attempt mid-session, Amy calmly de-escalated, contacted emergency services, and remained online with the client until help arrived. Later, she welcomed him back into care.

That moment didn’t define her, it affirmed her: Amy is the lifeline people need when everything feels like it’s falling apart.

Mentoring the Next Generation of Heart-Led Therapists

Today, Amy oversees and mentors River’s Bend’s growing team of clinicians. She teaches therapists to:

• Watch for the quiet ones
• Stay grounded in crisis
• Challenge imposter syndrome
• Lead with authenticity and empathy

She often shares her own journey of returning to school later in life, confronting the internal voice that said, “You’re not smart enough.” Her leadership reminds both clients and clinicians that healing isn’t linear, and it’s never too late to begin again.

Specializations

• Co-occurring disorder treatment (mental health + substance use)
• Group therapy facilitation for IOP
• Clinical curriculum development
• Trauma-informed crisis intervention
• Recovery support for individuals and families

Holding Hope in Every Session

Amy Fresch doesn’t just lead a clinical department, she leads a movement toward deeper, more personal mental health care. Whether guiding someone through relapse, coaching a therapist through burnout, or offering a message of hope to someone in early recovery, Amy brings her full self, present, honest, and hopeful.

Meet the River’s Bend Clinical Team
Troy & West Bloomfield | Virtual Care Available
Call Us: 248.585.3239

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