Not Just an Addiction Problem

Ever wondered why addictions -- to drugs, alcohol, the Internet, shopping, etc -- are so hard to kick? Why expensive drug treatment programs so frequently fail to deliver their promised results?

The answer lies in the fact that addictions are but people's desperate way of coping with their deeper psychological problems, most often depression and anxiety but may include schizophrenia and other forms of psychosis as well. When substance abuse professionals focus on the person's dysfunctional behavior and ignore the underlying pain (even worse, downplay the pain by believing that the depression will go away once this person is off drugs), the chances of relapsing are extremely high.

It's time we pay serious attention to the use of substances for self-medicating reasons. I'm not denying the presence of substance-induced psychological problems. But contrary to what established institutions such as AA say, addiction is NOT a disease but a failed solution to overcoming a disease.

clipped from www.washingtonpost.com Experts Challenged by Mental Illness Mixed With Addiction In the often separate worlds of mental health therapists and substance abuse counselors, professionals began realizing in the mid-1980s that large percentages of the people they were seeing -- sometimes 50 percent or more -- suffered from both mental illness and addiction to alcohol or drugs. And treating just one affliction wasn't helping. Hence the term "co-occurring disorders," or "dual diagnosis." The federal government estimates that about 7 million U.S. adults suffer from co-occurring disorders and that more than 90 percent of those people are not getting the right treatment. Anderson said, "The mix of substance abuse and mental health problems really does complicate things." Those with co-occurring disorders, she said, "end up being marginalized in society. Because they have mental illness, they can't handle alcohol or drugs. They get criminalized. They can't get housing, they can't get jobs. What's left for them?"

Do Drug Rehab Clinics Work?

One of the few TV programs I watch is "Intervention." Each episode features a person with an addiction, usually to a drug such as meth, heroin, or alcohol. In a typical, formulaic reality-TV fashion, you follow this person in his/her day-to-day living. The show climaxes when the family arranges an intervention to try to get the person to pack up right away and check into a treatment facility.

(By the way, don't you agree reality TV is totally junk yet curiously addictive at the same time? Hmm, I'm addicted to watching others being addicted. Such a paradox of life.)

I'm always astounded by the sheer beauty and luxury of these treatment centers in Intervention. Quite inevitably they're in sunny places such as Florida or California, sometimes by the beach, always spa-like. They look like the perfect place to spend my honeymoon.

In real life it costs tens of thousands of dollars to check into one of these places for a month. And no one knows for sure whether these treatment programs work because these clinics are rather secretive about their success rates. Post-treatment or aftercare services are scarce; follow-ups with their patients 3, 6, or 12 months on are practically non-existent. But anecdotal evidence suggest that patients don't stay sober for long after discharge.

In the words of Thomas McClellan, chief executive of the nonprofit Treatment Research Insititute in Philadelphia (which I quote from the New York Times, Dec 23, 2008), "You go to Shady Acres for 30 days . . . And then you're discharged and everyone's crying and hugging and feeling proud -- and you're supposed to be cured. It doesn't really matter if you're a movie star going to some resort by the sea or a homeless person. The system [of drug rehab] doesn't work well for what for many people is a chronic, recurring problem."

Imagine spending a month at a rehab center in a picturesque setting. You make new friends, you have wonderfully supportive staff, you have a daily routine that comprises physical exercise, counseling, endless walks on the beach. You may even cultivate a passion for gardening. Then you say goodbye to this fairy-tale setting and return to real life that is your family, your community. Your teenager is still giving you an "f-you" attitude (or, if you're the teenager, your parents are still driving you crazy), you're still stuck in a dead end job, and every social gathering you go to has no lack of booze to take you right back to where you were a month ago.

You get the idea. You really can't expect addicts to break their habit without changing (a) their environment and (b) their response to the stressors in their environment. Most drug rehab programs would have you believe that addiction is a disease. Yes, we know about the hereditary factors that predispose some people to addiction, and that prolonged drug use can have profound impact on the brain chemistry and structure. I also agree that detox is often a necessary first step to recovery. So I'm not arguing against the biological and physiological dimensions of substance abuse and addiction.

But seeing addiction as a disease keeps us focused on treating the individual person, neglecting the ecology (such as family dynamics) that maintains the disease or the person's psyche that prevents him/her from using adaptive coping skills. An important skill to learn, for example, is emotional regulation. A person without this capacity is likely to want to escape from them whenever they threaten to overpower this person. In the quest to escape one's emotional pain, if the spa-like comfort house by the beach is not within reach, the bottle (or syringe) would once again look immensely promising.

The Pain of Avoidance

In a comment to my previous post, a reader of this blog recently shared that she tried to avoid stress as much as possible to alleviate her physical (and perhaps emotional) pain.

I bet that's what most of us do. It's instinctual, isn't it? We stay away from things we don't like. That's perfectly fine with tangible things -- objects, persons, places, a third slice of that sinfully decadent chocolate fudge cake-- that we can physically remove ourselves from. This often doesn't happen so easily with non-tangible things such as memories of the past and anticipation of the future. That's right, we can't avoid our thoughts and feelings.

Classic Psychology 101 exercise: for the next 30 seconds, think of anything but a white bear.

Chances are, you couldn't think of anything else but the white bear. One strategy to "succeed" in this exercise is to substitute the thought of the white bear with, say, that of a pink elephant. In real life, however, substitutions are not always healthy and adaptive. Just look that how many people you know who abuse drugs and alcohol to avoid dealing with their pain or grief. Or those who immerse themselves in work to avoid having to deal with the emptiness they would otherwise feel in their lives.

The fact is, the more we try to avoid a thought or feeling, the more we inadvertently become slaves to it, giving it more power while we continue to run and hide from it in fear.

But why do we run in the first place? We willingly bear with the pain of a vaccination shot because we know it'll benefit us. The thought, "It's good for me" is a judgment that leads to our decision to stay still in the doctor's chair and let him prick our arm with the needle. It also helps to know that no matter how much it hurts in the moment, the pain will go away.

With psychological distress, it's hard to imagine how it can be good for us, let alone know when it'll end. It seems the only option is to keep it at bay for as long as we can. But let's back up to the point we start to think, "This is bad." If we're able to look at an event or an emotion without judgment or attaching a value to it, what would happen?

Suppose you lose sleep tonight. Does it help to have the thought that you have an important meeting first thing in the morning and you should get some sleep? Suppose you feel depressed because you lost your job. Do you feel better or worse when you start thinking, "But I still have my house, I'm better off than most people, I shouldn't feel depressed"?

The problem with avoidance is that it adds to the very pain we're trying to overcome. Instead of wishing for the pain to go away, you may want to practicing mindfulness. This helps you relate to your pain in a different way, so you don't feel powerless against it.

Notice the frustration, sadness, or other negative feelings and thoughts as they come up as if you're watching a movie. Your mind is the silver screen on which fleeting images are projected.

Notice that these are thoughts and feelings inside of you, not reality itself.

Notice without judgment. Let go of the should's and must's.

Notice the urge to want to push these unpleasant feelings away, but just let it be. You don't have to act on this urge.

Notice that you're drifting in and out of your thoughts and feelings, and tell yourself it's okay.

Notice that you're probably beating yourself up because you're "not doing a good job" meditating or noticing, then let your "good job" judgment go.

Be curious and compassionate as you stay present with your thoughts and feelings.

Smell the Roses (or Coffee)!

Who hasn't taken a trip down memory lane with a mere whiff of a familiar scent? Whether it's the woodsy smell of some old furniture that reminds you of your wonderful time in grade school, or a particular cologne that fills you with the bittersweet memories of an old lover, scents have a powerful way of stopping us in our tracks and at times filling us up with rather intense emotions--good or bad.

Yes, it's not just the information that we recall with a scent, but more importantly the emotions that go along with the memory.

According to the following article, scents go straight to the limbic system in the brain, the very place our emotions are triggered. Is it any wonder why aromatherapy is so effective in calming nerves and revitalizing one's energy? Of course, it helps that when we smell something pleasant, we take in slower, deeper breaths--often the very action that soothes us and clears our mind.

So take your time when you wake up tomorrow and smell the rich, textured layers of your coffee. And let the world stand still for you for a minute.

clipped from www.care2.com according to psychologist Rachel Herz, a Brown University professor who studies the psychology of smell. “A person may have no emotional reaction to seeing a photo of a loved one who died, but that person may unexpectedly encounter the same smell particular to the loved one’s study–a combination of cigarettes and books, for instance–and feel like weeping.” She notes that “those who lose their sense of smell because of accident or illness also report a loss of emotional richness and, over time, a loss of emotional intensity toward life. Experiences are flatter, they report.” Margo Valentine Lazzara writes that scents “trigger memories because of their quick access to the limbic system in the brain. It is here that scents will evoke an emotional response, such as hunger or sexual appetite. They can help you recall long- and short-term memories. If a particular scent stirs up past or painful emotions and memories and causes you suffering, then you might want to avoid this specific scent.

Unexplained Pain? It Could Be Depression

Every now and then, when we experience shoulder tightness or backaches, we know it's stress related. But do you know that depression can similarly cause pain in our body?

According to a recent study reported in Science Daily, about 73% of pain and other bodily symptoms seen by doctors in general practice have no physiological causes. Symptoms that cannot be explained in medical terms or cannot be attributed to organic origins are known as somatoform symptoms. Contrary to popular belief, the patient is not imagining the physical sensations; indeed the pain is real and can cause clinically significant impairment in one's daily functioning.

In this study of 308 patients, the researchers found a significantly higher incidence of somatoform pain in patients who are depressed or have had depression in the past year, compared with patients without depression.

I'm reminded that in many cultures, depression can look very different from that as described by the Diagnostic and Statistical Manual (DSM-IV-TR). The DSM includes feelings of emptiness, worthlessness, excessive guilt, and thoughts of death amongst its criteria for major depression. The affective (feelings) and cognitive (thoughts) dimensions of depression may not play a prominent role in non-western cultures. For example, depression among the Chinese population often manifests in the forms of bodily aches, digestive difficulties, and obstruction of the flow of qi (energy) within the body.

If you're experiencing discomfort or pain in any part of your body for which your doctor is unable to determine any medical causes, do some research online or talk to a mental health professional to see if there could be underlying psychological issues.

It's All in the Head: Psychotherapy Changes Brain Activity

Medication or psychotherapy? Pharmaceutical companies would have us believe that depression and anxiety disorders cannot possibly be lifted if we don't address the underlying neurochemical imbalance with medication. Yet increasing evidence indicate that receiving counseling and therapy brings about similar changes in the brain that are associated with improved mood and functioning.

I'm really excited about findings like this. To be sure, I'm not advocating that we do away with medication altogether. Medication may indeed be necessary to treat psychotic symptoms or severe depression. But I am hopeful this and other studies will get us to think twice before we reach out for that bottle of Adderrall or Concerta for ourselves or our kids.

clipped from www.psychologytoday.com The Biology of Psychotherapy growing evidence from brain imaging research suggests that the form of therapy known as cognitive behavioral therapy, or CBT, produces changes in the brain similar to those produced by medications when they work. Cognitive behavioral therapy emphasizes the role our thoughts play in how we feel. Obsessive-compulsive disorder (OCD) is characterized by anxiety-laden intrusive thoughts and accompanying repetitive behaviors that are meant to reduce the anxiety. In a study that compared CBT to Prozac, researchers used a brain-scanning technique called positron emission tomography to measure the rate of glucose metabolism in the OCD brain after Prozac treatment alone and after therapy treatment alone. The results were essentially identical: both interventions decreased the rate of glucose metabolism to levels seen in healthy people without OCD, and the rate of the decrease seemed proportional to the degree of improvement in their OCD symptoms.

The Power of Negative Thinking?

An interesting article that reflects a basis premise of mindfulness and other modern therapeutic approaches: the more we fight the demon, the bigger it becomes. So let's just sit with it, instead of acting on the urge to confront, challenge, and change it.

clipped from www.time.com Yes, I Suck: Self-Help Through Negative Thinking A Million Little Pieces by James Frey (center) is displayed amongst other self-help, recovery books, at a Borders Book store."> A study just published in the journal Psychological Science says trying to get people to think more positively can actually have the opposite effect: it can simply highlight how unhappy they are. unfavorable thoughts about ourselves intrude very easily, especially among those of us with low self-esteem — so easily and so persistently that even when a positive alternative is presented, it just underlines how awful we believe we are. The paper provides support for newer forms of psychotherapy that urge people to accept their negative thoughts and feelings rather than try to reject and fight them. In the fighting, we not only often fail but can also make things worse. Mindfulness and meditation techniques, in contrast, can teach people to put their shortcomings into a larger, more realistic perspective. Call it the power of negative thinking.

Quotes of the Day

"Continuing to approach things in the same way is just more of the same of something that is not working, which is the exact definition of a problem."

-- Steve de Shazer

"Insanity is doing the same thing over and over again and expecting different results."

-- Albert Einstein

Do Something Different

Two parents saw a therapist because they didn't know what to do when their son threw temper tantrums. The therapist said, "The next time he throws a temper tantrum, instead of doing what you used to do to try to calm him down, I want each of you to do something different. I won't tell you want to do, it's up to you to decide." As you can imagine, the parents left the session uncertain if this was going to work (and whether they went to the right therapist!). But when Junior threw a temper tantrum the next day, Mom broke into a song and Dad gave him a dime. After some time, Junior stopped his tantrums altogether.

This story was told by Steve de Shazer, founder of the solution-focused approach. How did that happen?

We often get locked in negative cycles of communication (Junior's way of communication was through his temper tantrums) as tension escalates and power struggle ensues. Like actors in a play, we all follow a script that plays itself out over and over again as each participant's behavior becomes predictable. Typically, the script says, "Stop the other person from doing what he/she is doing." Or, "Try harder so they'll get your message." When we do something unpredictable and uncharacteristic of ourselves in such a situation, we throw the other person a curveball that invites a different response. In many situations, this breaks the negative exchange.

Remember when you were having a fight with your best friend, and one of you made a silly, irrelevant remark that made you both break into uncontrollable laughter? That's the power of the unpredictable response.

Bottomline: If it ain't working, do something different. It doesn't matter as much what you do, as the fact that you're changing up something.

Plants Help Your Kids Cope with Stress

clipped from www.psychologytoday.com The Healing Power of Nature A bit of green may calm a child's frayed nerves. Rural children who have access to nature seem better equipped to handle stress than kids in a room without a view. What's more, children who are the most vulnerable to stress benefit the most from adding greenery to their lives. Nancy Wells, an environmental psychologist at Cornell University, assessed access to nature in the households of 337 children in grades three through five. She noted the number of houseplants, the amount of greenery seen from windows, and if the yard had grass, dirt or concrete. Wells and her team also interviewed children and their parents to rate the kids' stress levels and also gave a standardized stress test. Even when controlling for income and socioeconomic status, the more green a child saw, the better he or she seemed to cope with adversity. And in a previous study, Wells found that children who were surrounded by nature have longer attention spans.

Therapy - Luxury or a Necessity?

We're halfway through 2009. Despite the occasional break of uplifting news--some hint of recovery in the housing market, stabilization of oil prices, the slow but certain withdrawal of our troops from Iraq--the mood is still sombre overall on the economic front.

While the debate over health care reform is still going on, everyday thousands of people across the country are losing their jobs--and their health insurance. You may know of someone, a friend of a friend perhaps, who is now struggling to keep up with the mortgage after having been pink-slipped a few months ago, and is only one illness away from bankruptcy.

Even those fortunate enough to keep their jobs are not spared from the mental agony of wondering, "Will I be next?" That is, if they have a moment to pause between the multitude of tasks they now have to cover with their company's downsizing.

The irony of it all? At a time when the population's mental health is on the decline, when marriages are crumbling due to financial stress, when family cohesiveness is giving way to distress, tension, and chaos, people are putting off seeking therapy because they can't afford it.

You know what eventually happens when you keep ignoring an aching tooth. You woundn't wait till your car goes up in smoke before you take it to a mechanic for a routine check-up. So why would you put your mental health on the line?

To be sure, psychotherapy, like other services in the healthcare industry, can be costly. But there are ways to get the services you need--in times of need. Many therapists (including myself) offer a sliding scale fee for clients who can't afford their full fee. Others offer variations of individual psychotherapy, such as group counseling, at a lower fee. Most therapists are also flexible in their scheduling: if paying $100 per week to see your therapist is not within your ability, negotiate to have bi-weekly sessions or shorter sessions.

Many good directories exists that allow you to check out the therapists practicing in your area. The good news is that you don't have to register or pay a fee to use these databases. Feel free to shop around on directories such as psychologytoday.com and goodtherapy.org. Or find out if your local church or synagogue offers free therapy services.

I believe that therapy should not be entitled to the rich. Everyone should have access to therapy when they need it.