It crept up on me. I just feel/hope that if we didn't have it in our childhood, maybe its not permanent. What helped decrease your stammer? Substitution may work certainly but its hard for me. When I give a presentation on "treatment adherence", I have to say the word. When I narrate patient history to my senior, I have to say "constipation". When I don't have my pharmacology book, I have to ask around for "Katzun". "Prescription", medication names, there are a million more words that I have to say on a daily basis that can not be substituted.