Therapy By Design in Carlsbad's Poinsettia district has operated on Avenida Encinas since 1987 under Michele La Porte Downey, who holds concurrent RN, LMFT, and Master Addiction Counselor credentials — a triple-license combination rare among North County behavioral health practitioners. The addiction and mood disorder specialty treats families affected by substance use through individual psychotherapy, couples work, and weekly Advanced Recovery Group Psychotherapy sessions that layer communication skills training over 12-step integration, with medication components filled through dispensaries such as Carlsbad Village Pharmacy on Grand Avenue. A Recovery Life Coaching school founded in 2011 in Hollywood and Carlsbad trains and deploys certified recovery coaches who extend the therapeutic reach beyond the clinical hour. Service on the San Diego Board of the Society of Addiction Professionals anchors the practice in regional clinical governance rather than isolated private-practice methodology. DUI-related and court-referred cases involve coordination with North County legal practitioners including HHJ Trial Attorneys for clients navigating concurrent legal and treatment obligations. Dual-diagnosis treatment plans for co-occurring addiction and mood disorders deploy motivational interviewing alongside family systems restructuring, calibrated to each household's specific substance-use dynamics and relational patterns.