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When You Need Help, Make Us Your.....1st Alternative  
   Isaac Yohanas MA, LCADC, LCPC

Links for Further Research

Department of Health and Mental Hygiene

National Institute on Alcohol Abuse and Alcoholism

Recovery Solutions Magazine

Baltimore Alcoholics Anonymous

Narcotics Anonymous

Mental Health

mental health



Research has shown that most individuals with alcohol/drug problems typically have underlying mental health issues (called co-occurring disorders or dually diagnosed problems).  At 1st Alternative, each client is initially evaluated not only for substance-related problems but also assessed for mental health concerns/problems.  Our staff is state-licensed in not only the substance abuse field but also in the mental health field.


Mental Health Services

     At 1st Alternative Counseling, we offer counseling in the areas of depression, stress and anxiety reduction, interpersonal conflicts/problems and techniques on how to more appropriately manage an individual’s feelings of anger, resentment and hostility.  The latter is done through an Anger Management course.  All of the other mental health services are facilitated as they emerge and are handled on an individual basis.  In addition, we offer a Smoking Cessation course, which is certified by the American Cancer Society.  This course is geared towards helping the client change their thinking, examine why they started smoking and what other influences were present which exacerbated their need to smoke.  As time progresses, they are able to keep up their abstinence with continued support and intervention, albeit less frequent basis.  Only after a comprehensive interview with the satisfaction of the therapist, are the clients actually discharged from the program. 


Nicotine Addiction

If you have tried to quit smoking, you know how hard it can be. It is hard because nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine.

Quitting is hard. Usually people make two or three tries, even more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts.

Quitting takes hard work and a lot of effort, but you can quit smoking.


Recognizing Your Addiction


Every smoker is addicted to a slightly different combination of “stimulants” in cigarettes and the act of smoking. A stimulant is the addictive property in a cigarette that keeps you craving for more, even though you know you shouldn’t.

You must find out what you like about smoking. Write that reason down. By writing it down, you will understand it.


Why Do You Smoke?


Is smoking a “positive” experience for you? If so, then you have conditioned your mind and body, through prolonged exposure to smoking, to get positive feelings when you smoke.

Non-smokers don't experience the roller-coaster ride of the highs and lows. Instead, they maintain a much higher level of well-being. They don't need a cigarette to relax – they have learned to relax naturally.


The Effects of Nicotine


Nicotine affects almost every system in the body. When you take a puff, your heart beats faster, your pulse quickens, your veins constrict, your blood pressure increases. Your adrenal glands pump out adrenaline that increases your heart rate, relaxes many of your smooth muscles, and raises your metabolic rate.  Even the electrical activity in your brain changes.

These are powerful biological effects. Indeed, nicotine is a very powerful drug. In fact, it is one of the most toxic of all drugs, comparable to cyanide. Take enough nicotine and it can kill you. But the amount of nicotine in a single cigarette is only 8 to 9 milligrams on average.

The amount of nicotine that smokers inhale from each cigarette is even smaller. Most popular brands of cigarettes deliver less than 1.5 milligrams per cigarette. This amount may be somewhat higher or lower for each smoker, depending on how deeply you puff and how many puffs you take from each cigarette.

But nicotine is so potent that even this small dose causes significant changes in the functioning of numerous organs and systems in your body.. When people first take up smoking, these physiological changes seem extremely unpleasant. Beginning smokers usually experience nausea, dizziness, headache, stomach upset, coughing and other uncomfortable symptoms. But people who continue to smoke soon develop a tolerance to these symptoms, until they become unnoticeable.

Tolerance is a term used to describe an important feature of addiction. Tolerance has developed when, after the repeated administration of a drug (in this case, nicotine) produces a decreased effect. As well, tolerance has developed when increasingly larger doses must be administered to obtain the effects observed with the original dose.

What does this mean for the smoker? The small dose of nicotine delivered by several puffs on a cigarette may make people feel ill the first few times they try smoking. But after they’ve been smoking for a week or so (repeated “self-administration” of nicotine), several puffs and even an entire cigarette no longer have that effect. Now they’ll feel ill only if they smoke several cigarettes one after another (a larger dose).

Psychologically, tolerance to the unpleasant effects of nicotine allows the smoker to focus on nicotine’s pleasurable physiological effects. Many smokers don’t realize that nicotine’s effects on the heart, the nervous system, and the endrocine system are significant contributors to the relaxation, alertness, stress relief, and other good feelings they experience.

This combination of physiological and psychological effects provides so many positive reinforcements that smoking quickly becomes an established habit.

As the term tolerance implies, a smoker actually becomes accustomed to having a certain level of nicotine in his or her body. In fact, research studies have shown that (without realizing it) smokers regulate the number of cigarettes they smoke in order to maintain their own personally preferred level of nicotine. For example, smokers who are given a very high nicotine cigarette will puff less often than usual, so they don’t take in more nicotine than their preferred amount. Likewise, with a low nicotine cigarette, the smoker will take more puffs than usual, in order to get that preferred amount of nicotine.

When no cigarettes are smoked for a while (when someone is trying to quit), the smoker doesn’t get any nicotine. And it is the lack of nicotine that produces unpleasant physiological symptoms in the body. Medically, these symptoms are called “withdrawal effects.”

To relieve these withdrawal effects, many smokers must continue to take in their usual amount of nicotine. This is a sign of “physical dependence” on nicotine. Doctors define physical dependence as a change in the body’s functioning that is produced by repeated administration of a drug, such that continued doses of the drug are needed to prevent withdrawal symptoms.

But that’s not all. Smokers also become accustomed to the psychological effects of smoking. After the smoking habit is established, the smoker needs to smoke in to feel “normal.” In other words, the effects produced by nicotine, and the behaviors associated with smoking, become necessary to maintain the person’s optimal state of well-being. This condition is referred to as “psychological dependence.”

At the extreme, many smokers who run out of cigarettes or are unable to smoke, become totally preoccupied by thoughts of having a cigarette. This behavior is often referred to as “compulsive drug use.”


Is Smoking An Addiction?


Physiological and physical dependence, withdrawal, and compulsive drug use are the defining characteristics of “drug addiction.” Does this mean that smoking is an addiction? Certainly, the smoking habit meets many of the criteria needed to qualify as an addiction, including:

  1. A highly controlled or compulsive pattern of drug use. The experienced smoker has a lot of smoking patterns that (if broken) are disturbing.
  2. Psychoactive, or mood-altering effects involved in the pattern of drug taking.
  3. Drug functioning as a reinforcement to strengthen behavior and lead to further drug ingestion. It’s the nicotine that keeps people smoking.

Using these criteria, the U.S. Surgeon General’s Report (in 1988) on smoking made several major conclusions:

  • Cigarettes and other forms of tobacco are addicting.

  • Nicotine is the drug in tobacco that causes addiction.

  • The pharmacological and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.

All smokers show signs of physical and psychological dependence on nicotine. Their bodies crave nicotine, and they will smoke until their bodies have taken in a certain level of nicotine. Thus, addiction is more a matter of degree. Its not if you are addicted but how addicted you are. 


Some GREAT Reasons to Quit Smoking

Quitting smoking is one of the most important things you will ever do. Here’s why:

  • You will live longer and live better.
  • Quitting will lower your chances of having a heart attack,, stroke, or cancer.
  • If you are pregnant, quitting smoking will improve your chances of having a healthy baby.
  • The people you live with, especially your children, will be healthier.
  • You will have extra money to spend on things other than cigarettes.


Contact Isaac Today!!!





Conveniently located in Owings Mills at

10806 Reisterstown Rd Suite 3C






Mr. Yohanas is a very special person and a wonderful therapist. He is very patient and willing to listen. he is very knowledgeable about drugs, alcohol, anger issues, relapse traps, and DUI / DWI's. I learned so much from him and I am now on the road to maintaining my sobriety. Thanks so much.


Mr. Yohanas just made me feel so comfortable and I could discuss any topic with him. His knowledge of drugs, alcohol and issues relating to DWI / DUI's are amazing. I am so glad he was my counselor when I needed one. A very good professional.


I was very apprehensive about my latest DUI charge. When I spoke to Mr. Yohanas I could tell that he cared about my situation. He took the time to talk to me about the steps I needed to take and has been very helpful to me and has now involved my entire family as part of my overall treatment. I just want to thank you, Mr. Yohanas, for handling my situation with great professionalism and confidentiality.


Mr. Yohanas help me to recognize and deal with my underlying depression, which came up when I was seeing him for a DUI charge. He explained information to me and helped me along the way. Because of him I have been better able to cope with and learn about my problems. Thank you. 


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