This is by far the biggest issue in your life so you need to do everything you can to improve the situation. You will need to be super proactive. [Find a therapist](http://www.westutter.org/who-we-help/find-speech-therapist/) [Join a local chapter if you can find one](http://www.westutter.org/find-nsa-meeting-near/) Third and maybe most importantly (unless you find a great SLP), is to go to the NSA conference next year. You missed it this year, but next year it's in Chicago around July. The first time I went I got more from those 4 days than what everything I've been doing the last few years. It set me on the path to taking back control of my life. I can't really tell you what to do because you need a trained professional who can see and evalutate you consistently, but I think you already know switching out words is bad. It's engraining a bad behavior that believe it or not, you don't need to do for any reason. It's a behavior you learned once when you were young and kept using it because it sometimes work to let you escape. You will eventually need to stop that. My advice is to not do it in the easiest situations (because you won't be able to stop it in difficult or probably even medium situations). You can only eliminate behaviors like that if you baby step it with a capital B. seriousy....small steps. And you'll still fail at times and fall and regress, but the next time you get back to it progress will be faster and you'll improve. Anyway, my advice is check out those first two links, do whatever you can to try and find something, and lastly but importantly, try to be kinder to yourself. I know full well how awful it is and I still have my real sad moments due to stuttering, but they're much fewer and further between. And after finding a good therapist and listening to her therapy (which I believed in), im still fairly severe but I can now talk to anyone and I dont even really think about it anymore. I never substitute words and I almost always speak when I have something to say. You can get there too. You can do it. Be kind. Get after it.