For any of those that have actually checked back with the website on any regular basis, I apologize for the lack of contact. As some of you know I have relocated to another Alabama, and as anyone who has moved before, you will undoubtedly know that there is alot to do. Currently, I have yet to set up a practice, but progress is underway. During the course of the next few weeks I will be updating the website to reflect the change, and I hope to begin in the near future continuing with entries for the blog. Thanks for all your support in Nashville. Kindest Regards- DP
As a follow up to my last entry on post acute withdrawal, I figured a brief discussion about what to do with some of these symptoms might be relevant. Again some of the symptoms are: stress intolerance, mood numbness or fluctuations, sleep and other physical disturbances as well as concentration and memory problems. These symptoms are, surprisingly, at their worst at about six months of sobriety. So what can help?
Here are some suggestions:
4) Write: journaling or writing has repeatedly been found in research to have therapeutic qualities. Just getting thoughts and emotions out onto paper can have a powerful effect on quelling the chatter.
3) Vent: Talk about what is going on with anyone who will listen. The more educated they are about addiction, the better help they are going to be able to help. That is not to say that others may not be able to lend a sympathetic ear, but it is far better for someone to be able to say “Yes, I remember when that happened to me,” making one feel a little less alone and crazy. Regardless, talking to anyone about these issues is better than leaving it bottled up.
2) Reality test: If you are having frequent emotional flare ups, it can be good to bounce the emotions off someone else and ask for feedback. Example: I have just gotten into an argument with my significant other over money, and I call my friend to tell what has happened and say “— happened, is this really worth being this angry about?”
1) Balanced Living: Eating well, getting proper rest, reasonable work schedules, taking good care of general health, and well structured time. This sounds like a no brainer, but my experience has shown me that it is not. Many people first enter recovery living anything but a balanced life, so it follows that they are out of practice and must be intentional about this. Couple this with the fact that most recovering persons are in dire financial straits promoting the desire to work non-stop, and it spells a recipe for real problems. People who are recovering have bodies, and nervous systems especially, that have undergone damage that requires a period of healing. It makes sense that getting enough rest and proper nutrition would aid the process while the opposite would slow it. Being out of balance is a tell tale sign that a recovering person is headed for trouble as studies have linked unbalanced lifestyles repeatedly to relapse.
You can also see from this list why having proper social support is the number one predictor of whether people stay sober. It is common sense that being around people who still drink and use is risky for someone in recovery, but being isolated can also be just as dangerous. So if you are just getting started in recovery, there is no time like the present to get your positive support network started. Kindest Regards- David
Let me start by saying that if you are in recovery, and you assume that your doctor or psychiatrist understands the risks associated with prescribing medication for people in recovery…think again. There is only one medical school in the country at present that requires residency training in an addiction unit (University of Florida in case you were curious). I frequently run into people who are in early recovery from alcoholism or drug addiction that have been to visit a psychiatrist (or worse a primary care physician) who has made a diagnosis of attention deficit disorder, and has put that person at risk for relapse by prescribing them psychostimulant medication such as adderall or ritallin. A physician or psychiatrist who lacks training in addiction will fail to recognize the symptoms of Post Acute Withdrawal (a.k.a. secondary withdrawal) which will lead to the above mentioned misdiagnosis.
Most people familiar with addiction\alcoholism know what primary withdrawal looks like. Though it varies widely from drug to drug, they include things such as gastrointestinal disturbance, flu like symptoms, shaking etc. Following these issues subsiding within about 3-7 days depending on the drug, persons in recovery then will endure the symptoms of secondary withdrawal. Symptoms of secondary withdrawal or post acute withdrawal include: Problems with Memory, concentration difficulties, sleep problems, stress intolerance, mood fluctuations or numbness, and coordination problems. You can see now how this could be mistaken for an attention problem. The symptoms are the result of damage that occurs to the nervous system as a result of substance abuse, and thus take sustained clean time to heal.
Symptoms begin 7-14 days after initial sobriety, and here is the kicker…they peak at 3-6 months. Yes that’s right, they get worse as you stay sober longer, but the good news is they do subside within 6-24 months of continuous sobriety. It is uncanny to me how on cue the peak can be. I have frequently had the experience of working with someone who has been having a pretty smooth time in early recovery only to come in one day to tell me they think they are “going crazy” or some variation of that. When I ask how long they have been sober, it always amazes me how often they tell me a few days within the 90 day mark.
This common misunderstanding is just one issue that can present risk or confusion when working a physician who is ill prepared to deal with some one who has had an addiction. I have made it a personal mission of mine to make sure persons I work with in recovery have physicians that are sensitive to the needs of someone who has had an addiction. So if you have any doubts and would like the name of a trustworthy doctor, or you would like more info on post acute withdrawal, please don’t hesitate to ask. Kindly – David
No matter who you are, feeling the stress of having too much on your plate can have a significant effect on both your physical and mental well being. Often times people mistakenly believe that they are suffering from medical conditions when it is actually their bodies responding to high amounts of stress. The Journal of American Medicine estimates that 60-90 percent of visits to primary care physicians are conditions that are either caused or made worse by stress. Take the very common ailment of back pain; In three seperate studies chronic back pain was found to be unusually prevalent among person with trauma backgrounds or where people lived in war zones. In another study, job dissatisfaction predicts more reliably persons who will develop debilitating back pain more than the physical demands of that person’s job.
Some may scoff saying “Well, what about legitimate medical causes?” Approximately, two thirds of people who never suffered back pain have the same “abnormal” structures that are often blamed for back pain (Jensen, 1994). Also numerous studies exist showing that after “successful” mechanical repair of structures shown to be flawed, many continue to have pain. Finally, people who live in developing countries who do “back breaking labor” and use ergonomically primitive furniture and tools, have the lowest incidence of chronic back pain- not exactly what we would expect if spine damage where at fault.
Other medical issues that are thought to be stress related are high blood pressure, digestive problems (IBS, heartburn, or ulcers), and migraines. It is also worth noting that if you get sick frequently (colds, flu, etc), that stress may also play a role in this as well. If stress levels remain high, the proper functioning of the immume system is affected making persons more prone to infectious disease.
The link between stress and health is captured in a field called “stress physiology” and an excellent source for more information on this is a book called ‘Why Zebras Don’t Get Ulcers’ by Robert Sapolsky. If you suffer from any of the ailments listed above, and they do not respond to medical treatment or continue to resurface, it may be worth taking a look at your stress level and what changes you can make to support a more peaceful existence. In Wellness- David
As I mentioned in my last entry, I am a fan of diagnostic tools just because it gives a more objective view when looking at human behavior. Though there are some that would argue that “normal” behavior is all a matter of perspective, there are certainly aspects of the way that some interact with the world and others that cause them great difficulties. Using diagnostic tools therapuetically can provide a starting point to look at where thinking, feeling, or behaving start to deviate from healthy functioning. Positively, when completing assessment of any kind, it can often provide someone with optimism that what they are facing is really not as bad as they had assumed it was from their single perspective. Alternatively, it can start to define a vocabulary for the struggles a person is facing to facilitate awareness when these spots for growth arise is day to day life.
As I mentioned in a previous entry on codependency, there lacks a proper definition for what defines this popularized mental health word. While reading a book on this topic by Dr. Timmen Cermak, he gives a set of diagnostic criteria which may be helpful to illuminate the struggles that persons often face that are in unhealthy family systems:
Co-dependent Personality
A) Continued investment of self-esteem in the ability to control both oneself and others in the face of serious adverse consequences.
B) Assumption of the responsibility for meeting others’ needs to the exclusion of acknowledging one’s own.
C) Anxiety and boundary distortions around intimacy and seperation.
D) Enmeshment (unhealthy closeness) in relationships with personality disordered, chemically dependent, other co-dependent, and impulse disordered individuals.
Three of more of the following:
A) Excessive reliance on denial (pretending a situation is not the way it is or doesn’t exist)
B) Constriction of emotions (with or without dramatic outbursts)
C) Depression
D) Hypervigilance (constantly watching over everything)
E) Compulsions (repeated behaviors)
F) Anxiety
G) Substance Abuse
H) Has been (or is) the victim of recurrent physical or sexual abuse
I) Stress-related medical illness (headaches, stomach problems, etc)
J) Has remained in a primary relationship with an active substance abuser for at least two years without seeking outside help.
I do not write about these concepts to aid pathologizing them (making these things seem like diseases), but rather to simply try to define common therapuetic struggles in order to find a jump off point from which to begin working. For many, some of the issues listed above seem routine until they begin to have more visible interference with their lives (e.g. excessive reliance on alcohol for stress relief, feeling constantly overwhelmed\stressed, or fights resulting in physical violence )for which they come in for therapy. If you identify with some of these patterns, know that you do not have to continue, and you can make changes that will support a healthier, more fulfilling way of life. Kind Regards- David
Frequently people use the term “compulsive gambler” when they refer to someone who has a gambling problem; Prior to much training in mental health, I myself did not really see anything wrong with the terminology. I received my first training in problem gambling from a women named Joanna Franklin, and she brought to our attention that this term, as frequently as it is used, is incorrect. Compulsions (such as those found in someone with obessesive compulsive disorder) are done because the person feels that have to in order to obtain relief. The is also referred to as “ego dystonic” or causes dissonance with the self. On the other hand, problem or patholgical gambling, is “ego syntonic” or causes pleasure for the self. The action of gambling is done because the person wants to instead of feeling they must.
I have already used the term “pathological” and “problem” to describe gambling, so you may be wondering what those terms mean. While “problem gambling” does not have a real accepted definition other than what I can only assume you might imagine such as…it is causing problems in life, pathological gambling does have well defined symptoms. Very generally, these symptoms include:
a) Gambling used to escape
b) Chasing loses
c) Lying about gambling
d) Preoccupation with gambling
e) Tolerance
f) Withdrawal
g) Loss of control
h) Illegal acts to support betting
i) Risks significant relationships
j) Uses others to bailout
Revised criteria indicate that any person exhibiting 5 of these 10 symptoms would warrant a diagnosis of pathological gambling. So if this is you, a phone call might be in order….well you are in luck. As gambling has become more pervasive in our society, so has help available including a dedicated help line: 1800-522-4700. If you are struggling with this destructive addiction, remember that there is assistance available. In wellness- DP
In my previous post, ANGER MANAGEMENT?, I discussed some of the mental and physical indicators of anger, but there is another aspect of the mental realm that I saved for a seperate post. These are EMOTIONAL indicators of anger. Frequently people come into therapy and talk about being angry, but what I usually notice when someone is talking is that they are also experiencing other emotions as well. In other words there are other emotions that are happening simultaneously to (and usually before) the emotion of anger, so it is essential to begin to identify some of these emotions to determine when anger may precipitate. You may now be wondering what some of these emotions are… well here is a short list:
sadness – frustration – abandonement- fear – guilt – shame – impatience – insecurity - disrespect – humiliation – rejection
So the next time butterflies of anger strike inside your chest or stomach, let your awareness travel up to your mind to determine what else is there. In wellness- David
I haven’t posted a screening tool in a while, so here is a new one. I am a big fan of screening and assessment tools because they really give an “honest” look at where someone’s alcohol (or drug use) stands. It is really easy to justify ones use when they are around others that drink and use like they do, but it becomes more difficult to see one’s use as so “average” or “normal” when it scores in the 98th percentile of a sizable research group. In a way, it provides a guidepost for clarity when there is difficulty seeing the reality of one’s use in their life.
So here is one for today: This was created by the World Health Organization- The questions pertain to alcohol use over the past 12 months. As you answer the questions, add up the numbers that are in perenthesis next to the answers.
The Alcohol Use Disorders Identification Test
1. How often do you have a drink containing alcohol?
(0) Never [Skip to Qs 9-10]
(1) Monthly or less
(2) 2 to 4 times a month
(3) 2 to 3 times a week
(4) 4 or more times a week
2. How many drinks containing alcohol do you have
on a typical day when you are drinking?
(0) 1 or 2
(1) 3 or 4
(2) 5 or 6
(3) 7, 8, or 9
(4) 10 or more
3. How often do you have six or more drinks on one
occasion?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
4. How often during the last year have you found
that you were not able to stop drinking once you
had started?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
5. How often during the last year have you failed to
do what was normally expected from you
because of drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
6. How often during the last year have you needed
a first drink in the morning to get yourself going
after a heavy drinking session?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
7. How often during the last year have you had a
feeling of guilt or remorse after drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
8. How often during the last year have you been
unable to remember what happened the night
before because you had been drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
9. Have you or someone else been injured as a result of your drinking?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year
10. Has a relative or friend or a doctor or another
health worker been concerned about your drinking
or suggested you cut down?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year
So, if you have a total score of more than eight, the makers of this screening tool indicate that you are in need of at least some contact with a professional. If you scored over 16, you should seriously consider seeing someone trained in treatment of alcohol abuse\dependence. Should you have any questions about this or anything else, please feel free to contact me. In wellness- David
One thing I find very interesting is how often I have people tell me that it was hard to schedule appointment due to the negative perception attached to getting counseling. It certainly is difficult to ask for help when needed in a culture where we are impressed with the notion from a young age that we must be fiercely independent and not rely on others (coincidently, a view point not shared by much of the rest of the world). The inherent difficulty is that many continue through their life carrying great pain which impedes ability to function and accomplish goals.
It is rather curious that there is a stigma around having a mental health issue despite the fact that a fairly sizable portion of the population deals with these types of problems. According to the mental health findings from the 2010 National Survey on Drug Use and Health, 41.5 million Americans (19.9%) were reported to have had mental illness in the last year. Though there may be difficulties with accessing services and other reasons people don’t get help, it is clear the views around getting help impede this as well. Only about 20 percent of those people who suffered from mental health problems sought services for their issue.
It is important to consider that most people come to counseling thinking that they are suffering alone, and that no one will understand their desire to get help, let alone what they are really going through. That being said, I like to put a spin on the statistics above to say that rather than seeing yourself in the minority by coming to counseling, your decision is shared in kind with millions of others. In Wellness- David
Feeling anxious a lot of the time? Well, consider yourself in good company. The National Institute of Mental Health’s study released in 2008 found about 30 percent of people in the U.S. will experience an issue with anxiety at some time in their life. It is important to remember that like many other concerns in the world of mental health anxiety functions on a spectrum. Anxiety is normal reaction to a stressful situations, and some anxiety is actually beneficial. Researchers Yerkes and Dobson are known for a bell curve which bears their name indicating that very low levels of anxiety actually associate with as poor of performance as very high levels. More importantly is that moderate levels of anxiety are associated with peak levels of performance, so in other words, not only is some anxiety desirable, it is necessary for peak performance.
With the benefits of anxiety being said, the point at which it becmes an problematic is when it begins to interfere with life. For instance, a person is so nervous when meeting for job interviews that they do not go or become physically sick leading to not able to acquire work. Or maybe excessive worry is causing problems in interpersonal relationships like arguments with family or significant others. Essentially, if anxiety (or any other mental health issue) is leading to problems with work, family, or experiencing life in general, then it may be worth trying therapy to develop some new coping skills. In wellness- David