Addiction & Mental Health

Therapy during a pandemic: A family-focused approach to teletherapy

Tue, 31 Mar 2020 22:47:27 GMT

Sheltering in place has thrown a monkey wrench into American family life. While schools are doing what they can to provide distance learning, parents have been thrust into the role of home educators and 24-hour caregivers. Meanwhile, working parents are juggling new work-at-home demands and technologies. Teenagers seeking independence are stuck at home, pining for their friends. Nearly all of us are uncertain. What will this pandemic mean for us and our families? Has anyone we know been infected? Will they be? How will the pandemic affect the security of our family and those we love?

Mental health problems are among the most common that Americans face . In times of stress and change, they often get worst. Anxiety can become more obsessive or panicky. Depression can feel more hopeless. Desperate for some relief, we will sometimes turn to unhealthy coping strategies such as drinking, overeating, isolating, or overworking. Closeness within our household can increase conflict and misunderstanding. Separation from family members can contribute to worry and isolation. Now more than ever it is important to take care of ourselves: physically, mentally, and emotionally.

Providing a safe, quiet, and comforting space has always been a strength of office-based therapy. But technology has advanced significantly. Today, video sessions feel much more like office visits than they used to. Joining a trusted therapist for a break from the crush of life can provide a healthy and much needed refuge from life's demands. Saving time on the commute to and from the therapist’s office can actually reduce stress and make therapy more practical.

With teletherapy, it is easy for family members to join a session from multiple locations and to feel like they are together in the same room. T his feature of teletherapy can help us to address estrangement, isolation, and family conflict in ways that used to be out of reach.

When family members join a session from the same household, we encourage them to go to separate rooms and use separate devices. That way each person’s face and voice is clear and no one is left poking their head in from the edges of a device. This "facetime" can help focus each family members' attention on the work they are doing together.

Teletherapy platforms provide a virtual waiting room so that a therapist can see clients arrive and make sure their virtual office is empty before letting another client or family inside. This feature increases client confidentiality by eliminating waiting room interactions.

Many studies support the effectiveness and feasibility of teletherapy for a variety of mental health problems. If you or someone you know is struggling with a mental health or relationship problem, it may seem like an unlikely time to start therapy. But in fact, therapy has never been easier.

Some problems that can be addressed by teletherapy include:

Anxiety and/or depression
Divorce
Substance Use
Living with chronic illness
Interpersonal conflict
LGBTQ support
Life cycle changes
Death of a loved one
Behavioral problems
Becoming a caregiver

A Family Therapy approach can help:

Promote understanding
Improve communication
Identify patterns in family functioning
Improve ability to work together to alter conditions that contribute to unwanted behaviors
Provide a safe space to discuss difficult topics

You can read more about me here. Set up an appointment by leaving a message at (314) 222-5873 or by emailing acacia@claytonprograms.com.

Legalizing Recreational Marijuana: What You Need To Know

Tue, 26 Mar 2019 17:26:53 GMT

It’s been a little over six years since marijuana became legal in the United States, yet scientists today are still unearthing data on both the mental and physical effects of this drug.

With the number of states pushing toward legalization expected to grow this year, it’s important to understand how legalizing recreational marijuana could affect the public and possibly even our health.

The State of Legalization

Marijuana legalization initiatives swept the U.S. last year, with a majority of states now permitting legal use in some form.

Despite marijuana remaining illegal at the federal level as a Schedule I substance, states have continued to push forward with legalization over the last decade, making recreational marijuana now legal in 10 states and medical marijuana legal in 33.

Starting in November of 2012, Colorado and Washington became the first two states to legalize marijuana for adult use. Two years later Alaska, Oregon and Washington, D.C. followed suit. By 2016, voters in four additional states – California, Massachusetts, Maine and Nevada – also approved measures legalizing marijuana. Then in January 2018, Vermont became the first state to legalize marijuana through a state legislature—with more to come in the near future.

As for 2019, Forbes notes that the number of states that allow the use of marijuana is expected to rise—largely due to the number of pro-legalization candidates that won at the midterm ballot boxes last November.

Though not all political leaders, U.S. government officials, health care providers and medical organizations share these same views on marijuana use, public support for legalization is at a record high. Reflecting a steady increase over the past decade, a new Pew Research Center survey shows that six in 10 Americans (62 percent) say the use of marijuana should be legalized, which is double what it was in 2000 (31 percent).

As legalization begets more legalization and less stigmatization, many scientists continue their push to uncover just how this substance can affect our health. Although many consider it to be a ‘real-time’ experiment, there are several concerns to take into consideration.

Recreational Marijuana: The Consequences

Marijuana is the most commonly used illegal drug in the United States. Over the last several years, it has become legally available for recreational use to roughly a quarter of Americans. While there are arguments in favor of the substance for medical purposes , marijuana use may have a wide range of health effects on the body and brain.

Addiction

Some medical experts note that, contrary to popular belief, marijuana can be addictive. Specifically, the CDC notes that one in 10 marijuana users will become addicted; for people who begin using before the age of 18, that number rises to one in six. While it is possible for some people to occasionally use marijuana without developing problems , there are some additional effects some users may not be aware of.

Lung health

How marijuana affects our lung health is determined by how it’s consumed. In many cases, marijuana is smoked, which can harm lung tissues and cause scarring and damage to small blood vessels.

With more than 500 chemicals, marijuana comes from the dried flowers of cannabis plants, and its smoke contains many of the same toxins, irritants, and carcinogens as tobacco smoke. As a result, smoking marijuana can also lead to a greater risk of bronchitis, cough and phlegm production.

Brain health

In terms of cognitive effects, marijuana use directly affects the brain — specifically the parts of the brain responsible for memory, learning, attention, decision making, coordination, emotions and reaction time.

While short-term effects for heavy marijuana users can include problems with attention, memory, and learning, which can affect relationships and mood, there is a possibility of these extending into long term effects.

In an episode of Eye on Health , Richard Grucza, PhD., professor of psychiatry at Washington University in St. Louis, explains that marijuana use can impair working memory during use but also weeks and months afterward. As a basic mental skill involved in most everyday tasks, working memory is crucial for students and young adults whose brains rely on this function to learn and retain information in the future, says Grucza.

That being said, it’s important to note that some more recent studies have begun to cast doubt on these claims, suggesting that the relationship between adolescent cannabis use and cognitive decline in adulthood might not be as straightforward as previously thought.

Conclusion

Though the federal ban on marijuana makes it harder to study its effects on humans, scientists aren’t sitting idle in their efforts to uncover how marijuana affects us. In the meantime, as the number of states legalizing marijuana continues to grow, the current evidence to suggest its consequences to our health should be taken seriously—especially with our younger generation.

Clayton Behavioral provides intensive outpatient addiction programs ranging from six weeks to six months. We also offer safe medical detoxification, psychiatric assessment and treatment, psychotherapy for anxiety, depression, and other co-occurring mental health problems and continued care and support groups to facilitate long-term recovery.

If you think you or someone you know may be affected by alcoholism or drug addiction, please contact us for a confidential individual or family consultation at 314-222-5830. You can also visit our website or send us an email for more information.

How To Combat Substance Use: Sober Living on Campus

Tue, 26 Mar 2019 16:50:16 GMT

Let’s face it—the college lifestyle doesn’t exactly support abstinence from drinking and drugs. For many, college means enduring long hours of study, worrying about grades, making new friends and, yes, even partying. However, for some college students, college presents a variety of other challenges.

For those who have completed a drug or alcohol rehab program, or have entered recovery, it can be difficult to return to college life which is encompassed by relapse triggers. But, whether they are entering the semester in recovery or struggling with symptoms of addiction, it’s important for students to know that maintaining sobriety is possible.

While collegiate recovery programs (CRPs) vary from small student-run communities to large university-sponsored programs, their goal of sober living on campus is the same: to help students stay sober while also succeeding in school.

Here’s what you need to know about college students’ attitudes toward substance use in college and how collegiate recovery programs can help.

College and Substance Use

At colleges and universities across the United States, substance use is a real and ever-present problem. Free from parental supervision, students tend to turn to substances to cope with feelings of separation anxiety, academic pressures and, most of all, heightened peer pressure.

However, this substance use among college students and young adults is hardly a new trend. Starting in the 1970s, rates of alcohol consumption and binge drinking have remained somewhat constant. As a result, college students have always represented a large portion of the population abusing drugs and alcohol on a regular basis.

The Substance Abuse and Mental Health Services Administration reports that 1.2 million college students drink alcohol.

63 percent of 18-22-year-old college students self-report drinking alcohol within the past month
41 percent have been intoxicated
A third of all college students have engaged in binge drinking within the past 2 weeks

It makes sense that alcohol makes up the majority of substance-related problems on college campuses because drinking is often considered socially acceptable for college students. However, recognizing when it becomes a problem can be difficult.

According to the Addiction Center , approximately:

31 percent of U.S. college students report symptoms of alcohol abuse.
80 percent of U.S. college students have abused alcohol.
110,000 students between the ages of 18-24 are arrested every year for an alcohol-related violation, such as public drunkenness or driving under the influence.

However, substance use on college campuses isn’t solely alcohol related. According to Dual Diagnosis , substances commonly used by students in college also include:

Marijuana
Over-the-counter drugs
Cocaine
Heroin
Ecstasy

Similarly, not all drug abuse among college students involves illicit substances, either. Where coffee may have been the original pick-me-up for studying, amphetamines such as Adderall, Ritalin and Vyvanse have increasingly become a staple on college campuses.

Though these drugs may be prescribed for people coping with symptoms of ADHD, many non-prescribed college students tend to abuse these stimulants to enhance their studying ability to meet all of their academic requirements.

Coined “the study drug,” many college students believe amphetamines such as Adderall to be harmless. However, the short-term effects include elevated blood pressure, disrupted heart rhythm, weight loss, irritability, insomnia and headaches. As for long-term use, the effects can mimic those of regular cocaine use, including paranoia, depression, anxiety, cardiovascular problems and stroke.

While most students learn to navigate the college circuit without lasting damage, those who arrive at school already struggling with substance abuse may find easy access to drugs and alcohol a major concern.

Sober Living on Campus

Just a decade ago, most college students with substance abuse problems had little help besides student health services and local Alcoholics Anonymous chapters. However, collegiate recovery programs are helping to change that.

With approximately 21 percent of college students meeting the criteria for a Substance Use Disorder, Collegiate Recovery Programs (CRPs) strive to offer services and support that avoid some of the substance abuse pitfalls that are everywhere on college campuses. As a campus-based, “recovery-friendly” space and supportive social community CRPs aim to enhance academic opportunities while offering support for continued recovery and emotional growth.

Components of sober housing include:

Academic Services – Students receive help and support through the transition process from a drug treatment program back to school, while academic tutors provide help and support throughout the student’s college career.
Recovery Program – Offers students continued support for finding sober entertainment, dealing with peer pressure and how to handle social situations through workshops and group.
Crisis Management – Offers help and support for mental health or medical issues that arise. Having someone that can refer to medical professionals that have an understanding of addiction is an added benefit.
Relapse Prevention – Sober environments give 24/7 support for maintaining abstinence from their substance of choice.

Though addiction experts note that collegiate recovery programs are not a source of treatment, they are designed to support students who have acknowledged their substance use but are looking to stay sober and stay in school.

The Future of Sober Living

As a positive consequence of national attention on the ongoing opioid epidemic , colleges and universities are looking at ways to curtail student substance use—and sober living is a step in the right direction.

According to the Association of Recovery in Higher Education , a nonprofit that promotes collegiate recovery programs, 95 percent of students who have access to these programs don’t relapse. Compare that with the general population who relapses at up to a 60 percent rate, CRPs could be considered one of the best ways to serve students in recovery.

Fentanyl: The Deadliest Drug In America

Tue, 26 Mar 2019 16:42:21 GMT

In 2016, a powerful drug known as fentanyl was the culprit in the death of music legend Prince—which, as a result, has largely contributed to the next wave of America's opioid crisis.

While fentanyl has claimed the lives of a number of other musical artists in the last decade, the risks of this substance stretch far beyond the music industry, making fentanyl the most dangerous drug in a generation.

According to the latest report from the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, the rate of drug overdoses involving the synthetic opioid skyrocketed by about 113 percent each year from 2013 through 2016. Surpassing heroin as the leading cause of overdose deaths, fentanyl the deadliest drug in America according to the CDC .

In the midst of a national emergency surrounding this epidemic, it’s become increasingly important for people to understand how fentanyl works as well as the danger it brings.

What Is Fentanyl?

The United States is in the middle of a fentanyl public health crisis. And, today, there is more fentanyl available than at any other time since the drug was first created in 1959.

According to the National Institute on Drug Abuse (NIDA) , fentanyl is a synthetic opioid that is 50 times more potent than heroin and 100 times more potent than morphine. However, because of its effectiveness in medicinal uses, it is classified as a Schedule II controlled substance by the DEA .

Legally prescribed via injection, patch, lozenges or lollipop, the FDA approves this powerful painkiller for:

Use before surgery as an adjunct to anesthesia, and in some cases, during postoperative recovery.
Treating chronic or acute pain in opioid-tolerant individuals, or those individuals who have become tolerant of their narcotics and need a stronger analgesic.
Managing advanced cancer pain.

Though typically prescribed to patients for severe pain or injury, fentanyl is often sought out for illicit purposes due to its powerful pain-relieving and relaxing effects. For example, the drug is sometimes mixed with heroin or cocaine to heighten their effects. Unfortunately, by heightening its effects, the inherent dangers of fentanyl also increase.

The Dangers of Fentanyl

While some people knowingly seek out fentanyl for its increased high, fentanyl use often occurs unknowingly, as it is often disguised as heroin. In recent years, drug dealers have also increasingly been mixing oxycodone or Xanax with fentanyl, deceiving drug users who are unaware that they have purchased the laced substance.

However, this deception is part of the reason some have said that the Opioid Crisis is now a Fentanyl Crisis.

How does fentanyl work?

Fentanyl is a synthetic opioid so potent that a miniscule amount equal to just several grains of salt can cause a fatal overdose. According to the Georgia Bureau of Investigation , there is even one strain of fentanyl (furanyl fentanyl) that is so potent you could die from simply touching it.

Fentanyl (and other opioids) bind to receptors in parts of the brain that control pain and emotions, increasing dopamine levels and emitting a state of euphoria. However, some of these opioid receptors that fentanyl binds to also help control breathing—causing high doses to stop someone breathing altogether.

According to Lewis Nelson , M.D., medical toxicologist and emergency physician at NYU's School of Medicine:

“The only thing killing you is respiratory depression. If I took a few times the therapeutic dose of an opioid, my breathing would slow, and I might die in several hours–it’s a slow spiral toward death. If you took 10 times the dose, you'd likely die, and if you took 100 times, you'd die immediately." Fentanyl is just a more rapid version of the same kind of death, from respiratory depression.”

Though there’s no difference in the way in which fentanyl works on the brain, the danger lies in how quickly it binds. For example, when drugs such as morphine circulate in the blood, it takes a while for it to cross the blood-brain barrier whereas others such as heroin cross much more rapidly. Due to fentanyl’s much higher potency than the other opioids, it takes a much smaller amount of the drug to have the same effect.

Specifically, according to a New Hampshire State Police Forensic Laboratory , a lethal dose of heroin is equivalent to about 30 milligrams whereas a 3-milligram dose of fentanyl is enough to kill an average-sized adult male. “Heroin and fentanyl look identical, and with drugs purchased on the street, you don’t know what you’re taking,” says Tim Pifer, the director of the New Hampshire State Police Forensic Laboratory. “You’re injecting yourself with a loaded gun.”

Together, the relatively uncontrolled street fentanyl and the potency of even small traces of fentanyl, the most dangerous aspect of this substance lies in how it’s dosed and sold.

Conclusion

The American Society of Addiction Medicine notes that nearly a quarter of people who use heroin will suffer from opioid addiction. Due to the rising numbers of overdoses from fentanyl (and other opioids), the CDC recommends that law enforcement officers and first responders increase the amount of naloxone they have on hand.

While action must be taken extremely quickly in the event of a fentanyl overdose to prevent fatality, there are preventative measures such as accepting addiction treatment that could be life-saving amidst this epidemic. Since neither heroin or fentanyl should ever be stopped cold turkey, treatment programs can help implement a withdrawal medication to slowly taper off of the drug and minimize withdrawal symptoms.

How We Can Help

Clayton Behavioral provides intensive outpatient addiction programs ranging from six weeks to six months. We also offer safe medical detoxification, psychiatric assessment and treatment, psychotherapy for anxiety, depression and other co-occurring mental health problems and continued care and support groups to facilitate long-term recovery.

Monitoring The Future 2018 Survey Results: What You Need To Know

Thu, 07 Feb 2019 20:47:52 GMT

The results are in and the message is pretty clear: youth e-cigarette use has reached epidemic levels.

Released once every year, the Monitoring The Future (MTF) survey measures drug and alcohol use and related attitudes among adolescent students nationwide. This year, 44,482 students from 392 public and private schools participated in the latest Monitoring the Future survey—and the results are causing quite a stir.

From drugs and alcohol to the latest vaping craze, here’s what you need to know about the 2018 Monitoring The Future survey results.

Most teen drug use is down

Before we dive in, let’s start with some good news. According to the 2018 results , teen smoking is still at the lowest point since Monitoring the Future’s annual survey began 44 years ago. With only 3.6 percent in 2018, the number of daily high-school smokers is down from more than 22 percent a couple decades ago.

As for other substances, the numbers are also down. For example, despite the ongoing opioid epidemic , less than 1 percent of high school seniors use heroin. Additionally, the percentage of senior prescription opioid use dropped to 3.4 percent from the 4.2 percent a year earlier. Consider the decline in binge drinking and the use of other drugs like cocaine and MDMA at historically low levels, parents everywhere should be breathing a sigh of relief, right?

Unfortunately, not quite. Although teens are saying ‘no’ to these harmful substances, there’s yet another trend that has top health officials looking at a problem ‘that needs immediate attention.’

Teens turn towards vaping

Increases in teen vaping from 2017 to 2018 was the largest single year increase in the use of a single monitored substance ever recorded since the survey began 44 years ago.

Following the Centers for Disease Control and Prevention’s report in October , MTF is now the second major survey to confirm that e-cigarette use among teenagers is soaring, showing an increase from 11 percent in 2017 to 21 percent in 2018.

Although these numbers are worrisome, they aren’t all that surprising considering Food and Drug Administration Commissioner Scott Gottlieb declared youth vaping an ‘epidemic ’ back in November of 2018.

Since then, there have been numerous attempts to thwart underage sales from manufacturers like Juul —the e-cigarette company that originally developed its product to act as an alternative for adult smokers but quickly became popular to a younger demographic .

Robin Koval, CEO of the Truth Initiative (a nonprofit tobacco-control organization), tells USA TODAY that, in addition to the industry being largely unregulated, kids have been able to get their hands on e-cigarettes in ways that are a lot easier to use than your typical cigarette.

“Once you are addicted to nicotine, you are addicted to nicotine. It’s very concerning to have made all this progress (against smoking) and to be sitting on a ticking time bomb of what kids are at risk for in the future," says Koval.

With the percentage of high school seniors using e-cigs now up 91 percent from last year, the MTF results are just the latest to prove that use of these nicotine-filled products continue to pose a problem to the health of today’s younger generation.

Is your teen vaping, using drugs or alcohol or engaging in other behaviors that concern you? It can be difficult to set limits with a teen, but the parent-teen relationship is crucial for preventing serious substance and behavioral problems. Call us to schedule a consultation at 314-222-5830, visit our website or send us an email for more information.

Why Have Opioid Overdoses Drastically Decreased in Dayton, Ohio?

Thu, 07 Feb 2019 20:25:38 GMT

The decline in opioid overdose deaths in the Midwestern city of Dayton, Ohio caught the attention of The New York Times last November. The publication ran an article discussing how the city pulled it off in the midst of the nation’s opioid epidemic, which the current presidential administration has deemed a public health emergency.

Dayton once had one of the highest rates of overdose deaths in the country. The Dayton/Montgomery County Public Health Department reported a total of 566 opioid overdose deaths in 2017. By the end of 2018, that number was cut in half , as the Public Health Department reported 294 opioid overdose deaths from the past year.

What could have accounted for such a drastic change? There are a few ways Dayton has treated the issue differently than the rest of the country. This has been primarily done through tandem efforts between the city’s public health department, law enforcement and policymakers to address the problem with programming and resources to help addicts.

Public Health Initiatives and Medicaid Expansion in Ohio

While Dayton has adopted an approach that utilizes several strategies to treat and prevent opioid addiction, one of the most obvious explanations for the decrease in opioid overdoses is the state’s decision to expand Medicaid.

The expansion drastically lowered financial barriers to treatment for lower-income residents, providing them with free or highly-reduced addiction and mental health services. According to a report by state auditor Dave Yost , Ohio has invested heavily in treatment for persons with addiction, giving many people access to medical care they wouldn’t otherwise receive.

Dayton has also devoted resources to public health initiatives like the GROW program (Getting Recovery Options Working), which is comprised of a team of social workers, EMT’s and police officers who follow up with patients who have been revived with Narcan. They also help connect them to treatment programs, 12-step recovery meetings and mental health services.

The city also has a robust Syringe Services Program , which allows persons who use drugs intravenously to switch out used needles for clean ones. It also provides free HIV and Hepatitis-C testing, pregnancy testing, wound care, and more. While dissidents presume this kind of programming encourages drug abuse, research shows that needle exchanges can save lives.

Findings from a five-year study published by the American Journal of Public Health in October 2018, discovered that “increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths.”

Increasing the Availability of Narcan

Many public health efforts across the country have also resolved to create fast and easy public access to the drug naloxone , or Narcan, a drug that can be administered via nasal spray or injection to reverse the effects of an opioid overdose if performed quickly enough. Dayton has taken it a step further.

The Ohio Department of Health partnered with Project DAWN (Deaths Avoided With Naloxone) and distributed 3,303 naloxone kits in 2017, as well as 248 refills. Dayton Police Department Chief Richard Biehl also authorized officers to carry Narcan, which decreased the number of fatal opioid overdoses in the region.

While the opioid crisis is far from over, Dayton is an example of what future solutions could look like nationwide. It starts with a collaborative effort across law enforcement, public health programs and policy to ensure a fully-effective approach to handling addiction.

How We Can Help

Can Mindfulness Meditation Help Persons With Opioid Addiction?

Thu, 07 Feb 2019 20:13:19 GMT

Many people with addiction around the world have used 12-step recovery programs to achieve and support long-term sobriety. While recovery literature often deals directly with the notion of connecting with a “Higher Power,” the eleventh step also directly addresses the concept of meditation as vital to maintaining recovery.

Positive Effects of Meditation, Supported by Neuroscience

The emotional, mental, physical and psychological benefits of meditation have been substantiated by many studies that have examined its positive effects on the brain. A study published in Nature Reviews Neuroscience in 2015 utilized neuroimaging technology to examine the mechanisms underlying these positive effects.

Called “The Neuroscience of Mindfulness Meditation,” the scientists wrote:

“Research over the past two decades broadly supports the claim that mindfulness meditation - practiced widely for the reduction of stress and promotion of health - exerts beneficial effects on physical and mental health, and cognitive performance.”

It then goes on to detail the role of neuroimaging, which allows scientists to actually see how meditation impacts different areas of the brain.

Decreasing Opioid Cravings in Patients with Chronic Pain

Another study by University of Utah professor, Eric Garland, Ph.D., shows how these positive benefits can be implemented to interrupt the cravings of opioid cravings. Garland spearheaded the development of a program called Mindfulness-Oriented Recovery Enhancement (MORE) , which studied patients who used opioids to treat chronic pain.

“Participants in Garland's study received eight weeks of instruction in applying mindfulness-oriented techniques to alleviate pain and craving while strengthening positive emotions and the sense of reward and meaning in life,” a description of the study reads.

Outcomes supported a quantifiable link between implementing mindfulness techniques and a decreased desire to turn to drugs. Garland’s findings were later published in the Journal of Consulting and Clinical Psychology.

Mindfulness Meditation for Relapse Prevention

Additional studies also point towards mindfulness meditation as a possible strategy to help persons with addiction remain sober once they’ve achieved a period of drug cessation.

A study called “Mindfulness Meditation for Substance Use Disorders: A Systematic Review” from 2010 found evidence that consistent mindfulness meditation by persons with addiction could be an effective component of relapse prevention, but additional research would be required to further confirm a positive correlation.

How We Can Help

How To Distinguish Recreational Substance Use From Addiction

Thu, 10 Jan 2019 16:29:53 GMT

For some, spending time with friends and family may include recreational alcohol or drug use. While recreational substance use comes with its own risks, it is clinically different from addiction, a disorder marked by persistent use despite negative consequences. When persons with addiction experience negative consequences, they often make short-term attempts to quit using substances. During these quit attempts, physical craving and mental obsession often wear away their resolve to remain abstinent. They begin to minimize the consequences and risks of use, and unless they have strategies to manage their cravings, they often relapse. Once a craving hijack's the brain of a persons with addiction they can think of little else besides using alcohol or drugs.

Learning about the science of addiction can help you understand if you or a loved one are experiencing a craving. Scientific research makes clear the distinction between a “want” to use substances, often in a social setting, and an addictive craving which results from chronic substance use.

Wanting Drugs vs. Drug Cravings

Ingesting alcohol or drugs activates the brain’s pleasure centers, causing it to release excessive amounts of the neurotransmitter dopamine. Dopamine release also correlates with other positive experiences that happen organically, like enjoying a meal, going shopping or having a short burst of excitement. However, drugs and alcohol overstimulate dopamine production, and over time the brain responds by producing less and less of it.

According to an article titled “How addiction hijacks the brain” from Harvard Health Publishing, “Addictive drugs, for example, can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably.” This is why “tolerance” occurs and a person suffering from addiction needs more of a substance to achieve the same effect.

Failing to satisfy a craving can often lead to mental obsession or physical withdrawal symptoms. Some symptoms of withdrawal are quite subtle such as anxiety, irritability, and depression. Other types of withdrawal can be more severe and include flu-like symptoms of nausea, vomiting, and muscle spasms. Responding to a craving with substance use relieves the negative symptoms of withdrawal and craving but continues the dangerous cycle of addiction, causing the persons with addiction a great deal of suffering and isolation as well as problems at home, in relationships, with health and on the job.

This cycle can be interrupted by timely medical and mental health care. Effective treatment

includes medical detoxification (if necessary) followed by individual, group, and family therapy to support patients in readjusting to life without substances, coping effectively with the stresses and challenges of their lives, and actively preventing relapse to substance use.

How We Can Help

Get Sober This Year By Building Your Sobriety Network

Thu, 10 Jan 2019 16:23:31 GMT

Treatment professionals make no bones about how challenging it can be for persons with addiction to get sober. That’s why, behind persons in recovery, you’ll often find a team of friends, family members, sponsors, peers and treatment professionals.

So, if you or a loved one would like to achieve sobriety, this could be your year! Start by building your support system from the ground up.

The Power Of Peers

Scores of research have shown the positive effects of social group therapy on persons in recovery, and count it as one of the most impactful factors that determine whether an individual can successfully maintain sobriety. A research-driven guide for counselors published by the Substance Abuse and Mental Health Services Administration (SAMHSA), a subset of the U.S. Department of Health and Human Services, found that “Group therapy is a powerful therapeutic tool for treating substance abuse, one that is as helpful as individual therapy, and sometimes more successful.”

The guide goes on to attribute the effectiveness of group therapy to our inherently social nature as humans, which can work as an antidote to the many difficult emotional components of addiction recovery that can send addicts back out: “Whether a person abuses substances or not, these problems often respond better to group treatment than to individual therapy,” it says. These may include depression and anxiety, shame, guilt, physical distress, confusion, withdrawal and more.

Other programs and strategies for achieving long-term sobriety, like 12-step programs, also heavily emphasize the importance of creating a reliable network of peers in recovery, including a sponsor and friends. These programs almost always recommend regular attendance at 12- step group meetings, where person sin addiction can share their experience, build their network and help others who are just beginning. Healthy persons in recovery can serve as friends and mentors to the newly sober, and often understand them in a way that others cannot. This social support can be the difference between long-term recovery and relapse.

Another paper, published in 2014 , examined the effects of addiction on families and social networks. It found that comprehensive therapy sessions with a patient's immediate family can help them understand when the patient may be headed towards relapse and how to intervene in a helpful way. Titled “Family and social aspects of substance abuse disorder and treatment,” it says, “Families can help their loved one in several ways: facilitate their involvement in treatment; attend sessions together to address the SUD and recovery needs; ...and help them stabilize from a relapse should one occur.”

How We Can Help

Note: If your loved one with addiction is not yet ready for treatment, Clayton Behavioral therapists can meet with you and other family members to provide support and help you develop strategies for motivating your loved one to get the help they need.

The Opioid Overdose Epidemic in the U.S.

Thu, 10 Jan 2019 16:16:46 GMT

Since the rise of the opioid epidemic in the United States, you probably know someone who has been affected by addiction—perhaps a close friend or family member, or you may even struggle with the disease yourself.

Either way, you’re not alone. The Opioid Epidemic in the U.S. has caused tremendous grief and suffering for many. According to the U.S Department of Health and Human Services (HHS), over 42,000 people in the U.S. died in 2016 due to an opioid overdose, a huge spike from preceding years. Forty percent of those 42,000 cases involved an opioid that was obtained through a prescription.

What has led to this dramatic increase in persons with opioid addiction and opioid-related deaths in recent years? And why is this potent drug so addictive?

Misinformation from Pharmaceutical Companies

In the 1990’s, pharmaceutical companies convinced doctors that opioids were not addictive and could be prescribed to patients for pain management with impunity. That led to doctors over-prescribing opioids, even for simple outpatient procedures. As r ates of patient misuse skyrocketed, it became clear that opioids are indeed highly addictive. Statistics also show that many heroin users transition into using the street drug after first obtaining opioids through a prescription for opioid pain medication such as hydrocodone or oxycodone.

Pharmaceutical companies like Purdue Pharma have come under fire for encouraging doctors to prescribe their drugs without adequately conveying their likelihood for misuse. The company manufactures pain medications like hydromorphone, oxycodone, fentanyl, codeine, and hydrocodone, and is also the maker of the well-known and highly used opioid OxyContin.The company engaged vigorous marketing campaigns that intentionally downplayed the long and short-term dangers of opioid misuse. According to a 2017 article in The New Yorker, in 2003 the U.S. Drug Enforcement Administration drew a direct link between OxyContin abuse and the company’s marketing efforts. As prescription opioids continued to become more available over the years, so did the rates of persons with addiction.

Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain, and, a ccording to the CDC , is 50 to 100 times more potent than morphine. However, unlike other pain medications, fentanyl is also manufactured in large quantities illegally: “most recent cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally made fentanyl. It is sold through illegal drug markets for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge—to increase its euphoric effects.”

The Effects of Opioids

Widespread availability of opioids through legal and nonlegal means has contributed to addiction rates. Many teenagers and underage users report heroin is easier to get than alcohol, which can hook them into the dangerous cycle of addiction at a frighteningly young age. Further, illegal drugs are completely unregulated and can be cut with a variety of harmful substances, with varying levels of purity.

When opioids are processed in the body and brain, the psychological effects include an intense feeling of euphoria as they cause the brain to quickly pump out an excess of the neurotransmitter dopamine. Once the effects wear off, persons with addiction often report immediately desiring more.

Tolerance and Increased Risk of Overdose

Persons with addiction also quickly develop a tolerance, which requires them to ingest more to achieve the same psychological effect. Physical dependence also increases with repeated exposure to the drug, as withdrawal symptoms quickly emerge when an addict attempts to stop using. These include flu-like symptoms like nausea, vomiting, muscle spasms, anxiety, depression and more. It can also be dangerous if a person with addiction chooses to use again after a period of sobriety, as a previously-tolerated dose can be lethal. These risks increase greatly when opioids are combined with alcohol and other drugs.

How We Can Help

The Truth About "Winter Blues" And What You Can Do

Tue, 04 Dec 2018 20:53:30 GMT

The anticipation and excitement that surrounds the holidays can often be infectious—but even so, holiday cheer isn’t always a given.

In addition to less daylight and colder temperatures, the pressure and expectations associated with the holiday season can leave some feeling overwhelmed, stressed, lonely and even depressed.

While the winter blues are common—with many of us experiencing a mood shift in November and December—it’s extremely important to determine whether these feelings of low mood are temporary or if they are part of the more complex seasonal affective disorder (SAD).

What Is Seasonal Affective Disorder?

High expectations, financial woes, family troubles and other holiday stressors are enough to have an emotional impact on anyone—but for people prone to depression, the holidays can often heighten symptoms.

Seasonal depression, also known as seasonal affective disorder (SAD) or the “winter blues” is known as a type of recurrent major depressive disorder in which depression occurs during the same season each year. In most cases, SAD symptoms appear during late fall or early winter; however, it’s also possible to have the reverse pattern with symptoms appearing at the beginning of spring or summer.

Though many may be quick to dismiss feelings of sadness around the holidays, seasonal affective disorder is actually quite common and is a serious mental health problem. In fact, SAD is estimated to affect 10 million Americans, with another 10 to 20 percent showing more mild forms of the disorder.

Not everyone with SAD has the same symptoms, but if you think you may be affected by seasonal affective disorder, you may experience some of the common symptoms such as:

Sleep disturbance
Loss of interest in activities
Feelings of guilt
Loss of energy
Difficulty concentrating
Change in appetite
Sadness

While people prone to depression may feel these symptoms more severely, the good news is that there are some effective ways to help prevent stress and depression or curb the intensity of emotional tolls of the holiday season.

Tips for Coping with Holiday Stress and Depression

When feelings of stress and sadness are at their peak, it can be hard to stop and regroup. While it’s best to seek medical help for diagnosis, there are several things that can help stave off the holiday blues in the meantime.

1. Get Plenty of Rest

While depression often increases the desire to sleep, taking care of your body and retaining healthy habits is the best way to help your body feel better.

2. Know That It’s Okay to Feel Sad or Lonely

Experts say one of the biggest causes of holiday depression symptoms is unrealistic expectations. However, putting on a front for family or friends can make the stress or anxiety worse. Instead, know your limit and be willing to tell others you need a break or need to leave.

3. Spend Time with Friends and Family

For most, the holidays are associated with friends and family, and trying to work out how to share time between them can be a common reason for feeling stress or sadness. Getting out of the house and socializing with loved ones is one of the best ways to battle depression.

4. Know It’s Also Okay to Spend Time Alone

If the expectations around the holidays have you feeling down, spreading yourself out with too many holiday activities can often make things worse. Even a couple of minutes alone can be enough to separate yourself from distractions and allow you to regroup.

Further Treatment Options

Since seasonal depression has a predictable pattern of recurrence, it may help to look into some preventative treatment methods proven to help SAD such as light therapy and Cognitive Behavioral Therapy (CBT) .

The Center for Environmental Therapeutics (CET), a non-profit organization which provides educational materials about SAD also offers free self-assessment questionnaires that you can download.

In the end, it’s important to remember that it’s normal to have some days where you feel down—but if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, it could be time to take a deeper look at the cause and further treatment options.

If you think you or a loved one may be experiencing symptoms of seasonal affective disorder or are simply looking for more information, please contact us for a confidential individual or family consultation at 314-222-5830, visit our website or send us an email for more information.

The Science Behind What Makes Us Happy

Tue, 04 Dec 2018 19:35:46 GMT

In response to the elusive, age-old question of what brings about meaningful, lasting happiness, a number of responses may come to mind: wealth, a house in the Hamptons, eternal youth and beauty, the perfect partner, etc.

However, there is much quantitative research available that not only questions the link between happiness and external factors, but whether or not we’re even fully aware of what traits, behaviors and perceptions underlie happiness.

Let’s take a look.

How much do external factors matter?

Dr. Jennifer Aaker, general Atlantic professor of marketing at the Stanford Graduate School of Business, cited factors in a 2010 talk that were organized by traits commonly believed to result in happiness, including assets like earning power, physical attractiveness, level of education, intelligence, etc. The research, instead, identified factors like high self-esteem, consistent volunteering, a sense of humor, free time and even dancing as the strongest indicators of happiness.

These kinds of findings are also corroborated by researchers like Dr. Emiliana Simon-Thomas, science director of the Greater Good Science Center at the University of California, Berkeley. In an interview in the university publication Berkeley Wellness , Dr. Simon-Thomas identified a threshold over which additional earning power no longer correlates with increased levels of well-being and contentment.

“From the 1920s to the 1950s—an era of depression and world war—as household income rose there was an increase in people’s self-reported happiness. But then the line just tapered off. Studies show that money increases happiness when it takes people from a place where there are real threats—poverty—to a place that is reliably safe. After that, money doesn’t matter much,” she said.

What factors actually matter?

It’s a phenomenon many researchers attribute to what has been dubbed “ the hedonic treadmill, ” in which perceived levels of happiness adjust to match surrounding circumstances. This is why lottery winners, for example, often report a spike in happiness for a short time after collecting their winnings, and then return to their former levels of happiness once they’ve readjusted.

Dr. Simon-Thomas also noted the presence of positive biological responses that happen in the human brain when engaging factors correlated with happiness, such as the act of giving, volunteering and being of service to others.

“The mesolimbic dopamine system linked to addiction also makes people feel pleasure when they give to others. If you measure hormones and activity in the body and the brain when people are being helpful or cooperating, you can see that pleasure happens,” she said. “We’re hardwired to be generous with others.”

These observations point to a fascinating conclusion that calls a number of cultural and conceptual assumptions into question. They suggest that frantic attempts to pursue wealth, success and prominence can lose their meaning once achieved, and don’t have much of an impact on life satisfaction without the presence of more meaningful factors.

Thus, if you’re looking to fill your life with deeper levels of happiness, cultivate the inherent generosity that exists within you on a biological level and embrace the art of service.

Are there factors in your life that are preventing you from experiencing the highest levels of happiness possible? Call us to schedule a consultation at 314-222-5830, visit our website or send us an email for more information.

The Connection Between Mental Health Disorders and Substance Use

Tue, 04 Dec 2018 19:28:05 GMT

It should come as no surprise that there is a strong connection between mental illness and substance use. According to the National Bureau of Economic Research , people who have been diagnosed with a mental illness at some point in life consume 69 percent of the nation’s alcohol and 84 percent of the nation’s cocaine.

But, just what are the factors that connect mental health disorders and substance use, and how do they influence each other? Let’s take a look.

Mental Health Disorders and Substance Use

Compared with the general population, people addicted to drugs are roughly twice as likely to have mood and anxiety disorders, and vice versa, according to the National Institute on Drug Abuse (NIDA) . And, due to the fact that one problem will often influence the other, the Substance Abuse and Mental Health Services Administration reports that approximately 7.9 million adults in the U.S. live with co-occurring disorders.

According to reports published in the Journal of the American Medical Association :

Roughly 50 percent of individuals with severe mental disorders are affected by substance use.
37 percent of alcohol users and 53 percent of drug users also have at least one serious mental illness.
Of all people diagnosed as mentally ill, 29 percent misuse either alcohol or drugs.

Though depression is the most common disorder to occur with substance use, there are other mental health disorders that can affect substance use, as well. The types of mental health issues commonly seen in those with co-occurring disorders include:

Anxiety
Bipolar Disorder
Depression
Obsessive-Compulsive Disorder
Panic Disorder
Post-traumatic Stress Disorder (PTSD)
Schizophrenia

The reasons a person may struggle with both a mental health disorder and substance use are not few and far between—especially since the trigger can differ from one person to another. However, there are certain factors that have been found to trigger both a mental disorder and substance use.

Mutual Triggers

Most people with alcohol or substance use and mental health disorders experience them independently, but when people suffer from both, it’s known as a Dual Diagnosis.

Though Dual Diagnosis can be a combination of any mental disorder (anxiety, depression, bipolar disorder) and addiction (drugs, alcohol, sex, gambling), Dual Diagnoses most often occur with depressive disorders. In fact, Current Opinion in Psychiatry reports that one in three adults who struggle with alcohol or drug use also suffers from depression.

Together, these conditions share certain triggers. Possible connections between substance use and mental health disorders include:

The Brain

Similar areas of the brain are affected by both substance use and depression. Both addiction and mental health disorders affect the same molecules, chemicals and pathways in the brain—specifically, the areas that deal with stress responses. According to Mental Health Daily , dopamine levels may be lower in individuals who have depression, which may be why some turn to addictive substances such as cocaine, which stimulates an increase in dopamine activity.

Genetics

According to research published in Disease Markers , your DNA can affect the likelihood of developing a mental disorder or addiction. The NIDA also notes that genetic factors can make it more likely that one condition will appear as a result of the other.

Environment

It’s no surprise that environmental and developmental factors can also have an impact. From something as simple as a stressful job to anything that may have affected your brain’s development—such as early drug use. But, the opposite can also be true: Early mental health problems often increase the chances of later substance use.

Though there are many factors to weigh—from the combination of the specific mental health disorder to the drug of choice—there are many treatment options available that can handle both mental health disorders and substance use.

Finding Treatment

To be effective, treatment must address both conditions. There are many types of therapy that can be effective in treating both substance use and mental health disorders, but it’s important to find a treatment center that is equipped to handle both—specifically, places that specialize in co-occurring disorders .

In addition to medication, there are also many different types of therapy available for people dealing with both substance use and a mental health disorder. For example, Cognitive Behavioral Therapy (CBT) is an approach to treatment that understands problems that we face in life from the context of thoughts and behaviors. In short, CBT focuses on identifying, understanding and changing thinking and behavior patterns. Additionally, treatment options may also include therapy or support groups to lessen the chance of relapse.

At Clayton Behavioral, we use medical and counseling approaches supported by research to treat addiction and co-occurring disorders. Call us today for a free confidential consultation 314-222-5830 or visit our website for more information.

The Truth About How Alcohol Affects The Body

Thu, 15 Nov 2018 19:06:18 GMT

We are all confronted with the omnipresence of alcohol in our daily lives—whether it be at a party, wedding, happy hour, holiday get-together, etc. Subsequently, it’s not hard to misinterpret the effects of alcohol on the body as relatively mild. And that can be true—for light to moderate drinkers.

No Healthy Levels of Alcohol

According to the Dietary Guidelines for Americans prepared by the Office of Disease Prevention and Health Promotion in 2015, no more than one to two drinks per day should be consumed to minimize health risks. The guidelines define one drink as 12 ounces of beer with 5 percent alcohol content, 5 ounces of wine with 12 percent alcohol content or 1.5 ounces of spirits with 40 percent alcohol content.

However, research published this year indicates that there is no safe level of alcohol consumption for the body. The long- and short-term effects of excessive drinking can be detrimental to the body’s vital functions, and can be particularly heightened for underage drinkers, those with a medical condition or those who are taking specific medications.

Increased Dangers for Women

Alcohol can also be more dangerous for women , as it metabolizes differently in the female body and can cause problems quickly. Studies have shown that women who consume the same amount of alcohol as men will have a higher BAC percentage, as men tend to weigh more and have more muscle mass—which means women are more susceptible to harm from excessive drinking.

Gender aside, the effects of excessive alcohol consumption for all drinkers can lead to a variety of detrimental consequences. To simplify, the impact of alcohol consumption on the body can be divided into long-term and short-term effects. Both are dangerous, and possibly even fatal.

The Effects of Alcohol

According to the Foundation for a Drug-Free World , short-term effects of excessive alcohol consumption include slurred speech, disorientation, blacking out, passing out, difficulty breathing, vomiting, loss of consciousness, and even alcohol poisoning or alcohol overdose, which can be fatal if not treated immediately.

Long-term excessive drinking can also damage nearly every vital function and organ in the body. Researchers have developed causal links between alcohol consumption and cancer, cirrhosis of the liver, fatty liver, chronic pancreatitis, anemia, hepatitis, psychosis, depression and anxiety disorders, delusional hallucinations, and more. Several of these conditions can be fatal if drinking does not cease immediately. Whether you end up with one of these conditions or not, alcohol can substantially alter the following organs :

Brain

The brain is quickly affected by alcohol in the form of loss of coordination and memory. However, long-term effects can alter the brain’s structure and functionality. Communication pathways are impacted by damage to the cerebellum, cerebral cortex and limbic system, leading to decreased motor skills, memory function and emotional responses.

Heart

Initial effects of alcohol on the heart will change the delivery of oxygen to other organs. Continuous drinking can weaken the heart muscle and can lead to life-threatening conditions such as diabetes, heart disease, stroke, cardiomyopathy and even sudden cardiac death.

Liver

Since the liver is responsible for breaking down alcohol, high levels of consumption can modify the metabolic process and lead to a condition called fatty liver. Fatty liver, cirrhosis of the liver, and alcoholic hepatitis are all detrimental to the body and, without proper treatment, will lead to liver failure and death.

It’s also a myth that moderate consumption of alcohol results in a lowered risk of cancer, as touted by a number of research investigations into the possible health benefits of resveratrol, a natural phenol found in red wine—which has been documented by the National Cancer Institute .

In short, it is possible to avoid all of of these health risks by abstaining from binge drinking, drinking underage, drinking while taking medications and long-term excessive drinking.

If you think you or someone you know may be affected by alcoholism or another type of substance abuse, please contact us for a confidential individual or family consultation at 314-222-5830, visit our website or send us an email for more information.

Five Common Types of Feeling Sad

Thu, 15 Nov 2018 18:59:21 GMT

Generally characterized by feelings of overwhelming hopelessness and sadness, the condition of depression has many facets, and there’s no one-size-fits-all diagnosis. It’s important to understand the signs and symptoms to discover what the next steps to getting back to daily life will include.

According to statistics from the World Health Organization (WHO), over 350 million people suffer from depression worldwide, and that only about 50 percent of these individuals will ever receive treatment. This may be due to the fact that not everyone who is depressed will experience every warning sign. The range of symptoms people experience vary widely—as do the severity of the symptoms .

While there are many variations of depression, some common subtypes of depression include major, situational, persistent, atypical and seasonal. Read on and ask yourself: “Do any of these symptoms sound familiar?”

Major Depressive Disorder

When people use the term clinical depression, they are generally referring to the most common type of depression, also known as major depressive disorder (MDD). In fact, according to the National Institute of Mental Health (NIMH), about 7 percent of the adult population in the U.S. suffers from this mental health disorder.

While the primary symptom is an overwhelming depressed mood for more than two weeks, it can affect all aspects of the person’s life, including work, home life, relationships and friendships. Some may find it difficult to get motivated for day-to-day activities—but finding help can sometimes be an even bigger challenge.

In addition to a structural difference in the brain, major depressive disorder is a mood disorder that can be characterized by a number of key features:

Depressed mood
Lack of interest in activities normally enjoyed
Changes in weight
Changes in sleep
Fatigue
Feelings of worthlessness and guilt
Difficulty concentrating

If you have any of these symptoms for two weeks or longer, you may be suffering from major depressive disorder. When seeking treatment, MDD can often be treated with psychotherapy and antidepressant medication.

Adjustment Disorder

While this type of depression is often triggered by a by a stressful or life-changing event, situational depression is about three times more common than major depression—with about 10 percent of adults and up to 30 percent of adolescents experiencing this condition.

Though symptoms may clear up once the event has passed, it doesn’t mean they should be ignored. In fact, if symptoms go untreated, it can sometimes lead to major depression.

Symptoms of situational depression may include:

Feeling nervous
Having body symptoms such as headaches, stomach aches, or heart palpitations
Missing work, school, or social activities
Changes in sleeping or eating habits
Feeling tired
Abusing alcohol or drugs

Also known as an adjustment disorder , a diagnosis is often made when depression occurs within three months of a stressful event. With treatment, the goal is to help find ways to cope with stress and get back to daily life. From counseling with a mental health professional to support groups and family therapy, situational depression is a disorder that can and should be treated.

Persistent Depressive Disorder

Persistent depressive disorder, once commonly referred to as dysthymia , is a less severe type of depression that affects about 2 percent of the population—but is a very real disorder and can be difficult to understand and manage alone.

Because of their reduced intensity, symptoms can be confusing when compared to major depression, but can still be treated. Some of these symptoms include:

Persistent low mood
Sadness
Trouble concentrating
Fatigue
Changes in sleep habits and appetite

Although brain function and emotional processing are thought to play a role, this depression type usually responds better to talk therapy than to medications. However, some studies suggest that combining medication with talk therapy may lead to the greatest improvement.

Atypical Depression

Despite its name, atypical depression is not unusual. In fact, it’s one of the more common types of depression, and some doctors even believe it goes underdiagnosed. While a study published in the Archives of General Psychiatry found that oversleeping and overeating are the two most important symptoms in diagnosis, other signs include:

Excessive eating or weight gain
Excessive sleep
Fatigue, weakness and feeling "weighed down"
Intense sensitivity to rejection
Strong reactive moods
Relationship problems

Atypical depression tends to have an earlier onset than other types of depression and begins as early as the teenage years. Although selective serotonin reuptake inhibitors (SSRIs) and other newer medications are often the first choice for depression treatment due to a lesser likelihood of side effects, patients with atypical depression tend to respond better to monoamine oxidase inhibitors (MAOIs). However, you should consult your doctor to determine the best option for you.

Seasonal Affective Disorder

Also known as seasonal depression or SAD, seasonal affective disorder occurs during the winter months when there is less natural sunlight. Believed to be triggered by a disturbance in the body’s normal circadian rhythm, people with SAD may experience depression, sleepiness and weight gain in the winter months.

A popular treatment for SAD , known as heliotherapy or light therapy , consists of special lamps that use high-power, broad-spectrum bulbs to mimic the effects of natural sunlight. However, this treatment should never be used without consulting a medical professional. Similarly, medication has also been found to be effective in treating SAD, and can even be used in addition to light therapy.

If you think you or someone you know may be affected by depression or depression associated with substance abuse, please contact us for a confidential individual or family consultation at 314-222-5830, visit our website or send us an email for more information.

Drinking In Moderation: Safe or Deadly?

Thu, 15 Nov 2018 18:47:33 GMT

It’s likely that no one will argue that throwing back one drink after another is bad for your health. But, when it comes to “moderate” drinking—things become a little less black and white.

Despite the fact that there is research to suggest people who drink alcohol such as beer, wine, spirits, etc. have lower rates of heart disease than those who drink heavily (or not at all)—the evidence is still ambiguous.

So, while the research on alcohol consumption may seem like a collection of mixed messages, the key to determining the actual health effects is first to define what drinking in “moderation” entails.

Times Are Changing

Most of us don’t really think twice about a drink or two after a long day at work.

But, should we?

The alcohol industry has long embraced that alcohol in moderation is not only less harmful but could actually be healthy for you. This notion first garnered attention in the early 1990s when 60 Minutes reported on what is called the “French Paradox”—the idea that, despite all the saturated fats in their diet, the French have lower rates of heart disease which were correlated to the compounds in red wine . In decades since, however, the narrative has shifted.

In April of 2018, a meta-study published in the Lancet brought together data from 83 studies in 19 countries, which focused on nearly 600,000 current drinkers to determine what level of drinking presents a risk.

A stark contrast to previous studies, their results suggested that the levels of alcohol previously thought to be relatively harmless are actually linked with an earlier death. In fact, they concluded that drinking more than 100 grams of alcohol—about seven standard glasses of wine or beer —per week was associated with an increased risk of death for all causes.

With this in mind, the study also found that the risk of death increased the more a person drank. Using a mathematical model, they estimated that people who consumed between seven and 14 drinks per week had a lower life expectancy of about six months by age 40; people who drank between 14 and 24 drinks per week had one to two years shaved off their lives; and people who imbibed more than 24 drinks a week had a lower life expectancy of four to five years.

Why Every Sip Matters

According to the founders of AA, attempts at moderation provide the best litmus test for alcoholism. In their view, drinkers that are able to cut back without abstaining are not alcoholics because they haven’t become powerless over alcohol.

However, moderate drinking is a more ambiguous principle. New research on alcohol and mortality combined with an increased awareness about the rise of alcohol-related deaths in the U.S., is causing researchers to re-evaluate the risks of even moderate levels of alcohol consumption.

For example, more than its impact on judgment and social interactions, alcohol also disrupts sleep and can react negatively with certain medications such as acetaminophen, antidepressants, anticonvulsants, painkillers and sedatives.

In the end, given the complexity of alcohol and its effects on different people, blanket recommendations for alcohol consumption aren’t an option. However, there are resources to help you moderate your drinking , along with hands-on options such as treatment programs , therapy and counseling.

The Scary Side Effects Of Screen Addiction

Fri, 26 Oct 2018 19:44:56 GMT

Twenty-four hours. That’s the amount of time it takes for your heart to beat 104,000 times, your body to take 23,000 breaths, and according to data from USC Annenberg , it’s also how much time the average American spends in front of a screen each week.

Since 2000, time spent online every week by the average American has risen from 9.4 hours to around 24. Whether it’s your phone, computer screen, Kindle, tablet or any other digital device born from technological advancements, the effects of screen addiction don’t discriminate by age. As a result, recent studies have suggested these device-related activities have become less of a pastime and more of a troubling habit.

So, is screen addiction a consequence of being a human in the digital age, or is it something far more serious?

The Effects Of Screen Addiction

Though many people may scoff at the notion that they’re ‘addicted’ to their screens, the risks associated with too much screen time are worth taking pause—for parent or child, addicted or not.

We know that too much screen time can affect sleep habits , but research suggests that it can also impact our social skills, emotional development and even restructure our brain . So, let’s take a look at the full scope of these possible side effects.

Screen Addiction and Adults

Though concerns often seem to focus more on children, a recent report from the Pew Research Center suggests that parents are just as compromised by screens as their kids.

While you would be hard pressed to find a job that didn’t include at least some activity on a computer, too much time in front of screens each day can cause side effects such as headaches or migraines, sensitivity to light, sore neck and dry eyes caused by blinking 60 percent less.

According to Psychology Today , another one of the fundamental consequences that a large amount of screen time has on adults is a restructuring of the matter that makes up your brain. Specifically, atrophy in the gray area (where processing occurs) and compromised white matter translate into the loss of communication within various areas of the brain, such as the cognitive and emotional brain centers.

According to addiction expert Dr. Nicholas Kardaras , for adults who aren’t full-on addicted, he recommends tech-free dinners, no-tech periods throughout the day and keeping your phone away from your nightstand. You can also increase your non-screen activities like sports, recreation, and face-to-face time with friends and loved ones.

Screen Addiction and Children

For kids these days, most of whom have grown up alongside the rise of the digital age, drawing the line between addiction and normal activities can be almost impossible—especially with screen-based technologies becoming ubiquitous in schools. Combine that with social media, mobile devices and gaming, and it makes sense why a recent survey found that children spend an average of 1,314 hours in front of screens each year. So, with all these activities seeming fairly standard it’s easy to wonder, “What’s the harm?”

Unfortunately, the answer is children’s bodies and brains. According to the American Optometric Association (ADA), children are increasingly learning how to use technology before they can talk, walk or read - risking serious consequences to the development of young eyes. Additionally, research has found that screen time is also directly linked to poorer connectivity in areas associated with language and cognitive control.

As for the brain, recent brain imaging research shows screen technologies and cocaine affect the brain’s frontal cortex in the same way. These effects are especially true with the side effects of gaming.

Since the 1950s, gaming has grown into a multi-billion dollar industry—and it comes as no surprise why. Research on video games shows dopamine (present in reward processing and addiction) is released during gaming and that craving or urges for gaming produces brain changes that are similar to drug cravings.

With games like Fortnite and Minecraft steadily engaging children and young adults, it seems as if there are even more opportunities for addiction. In fact, in June of this year, the World Health Organization (WHO) recognized “gaming addiction” as more than just a health risk, but a mental health disorder.

Unfortunately, screen addiction has even more consequences. Dr. Nicholas Kardaras , author of Glow Kids: How Screen Addiction Is Hijacking Our Kids, claims, “I’ve worked with hundreds of heroin addicts and crystal meth addicts, and what I can say is that it’s easier to treat a heroin addict than a true screen addict.”

Although he says the evidence is clear, he also suggests we’re not ready to face the facts.

"We have, as a society, gone all-in on tech, so we don't want some buzzkilling truth sayers telling us that the emperor has no clothes and that the devices that we've all so fallen in love with can be a problem" — especially for kids and their developing brains, he adds.

So...with that in mind, who’s ready to turn off those devices and tune out for a bit?

_______________________________________________________________________

If you or a loved one is struggling with substance-related problems, please contact us for a confidential individual or family consultation at 314-222-5830, visit our website or send us an email for more information.

The Rise of Teen Marijuana Use

Fri, 26 Oct 2018 19:37:26 GMT

As one of the most commonly used recreational drugs in the U.S., marijuana on university campuses is often perceived by students as one of the more benign aspects of the college social experience.

However, a recent study completed by researchers at the University of Michigan uncovered a troubling trend: in 2016, the rate of college students who reported using marijuana was the highest it had been in the past 30 years, and the data confirmed the trend continued into 2017.

The study found that 38 percent of college students surveyed confirmed they’d used marijuana at least once in the past year, and 21 percent confirmed using it in the past month. These numbers still stand as the highest confirmed rates of marijuana use by college students since 1987. The startling rise begs interpretation of the data.

So, what factors account for such a swift, dramatic rise?

Motivators Behind Marijuana’s Popularity

An article in the University of Michigan’s news source elaborates on a possible explanation that the original study explored, showing how researchers found quantitative evidence indicating that marijuana is not generally perceived as dangerous. Only 30 percent of students questioned in 2016 reported regular marijuana use as remarkably harmful, one of the lowest levels reported in the past 30 years.

Additional explanations that could account for the increase include strict laws in the U.S. around the purchase and consumption of alcohol, which makes marijuana easier to obtain for students under the age of 21. Drinking and drug use on college campuses is also relatively commonplace and widely accepted, exacerbated further by the high-pressure environment that comes with the importance placed on academic achievement. With the variety of possible contributors, it’s important to consider college students’ motives behind resorting to drug use, which can be a predictor of future problems.

For example, one study suggests young people may also use marijuana to feel good, ease boredom, relieve tension or frustration, seek deeper insights, escape problems, or to manipulate the effects of other drugs.

In this study, researchers examined the participants again when they reached age 35. The results showed that students who had reported experimentation as the primary motivator for trying marijuana had lesser instances of substance abuse and problems later on. Subjects who reported using marijuana as a means to relax or cope with a larger problem were positively correlated with greater instances of developing addictions and additional problems later in life.

Why Marijuana Use Trends Matter

While the studies show definitive proof of this increase in marijuana use, another question arises: how damaging can marijuana use really be for a teen’s growth and development?

A study from the Social Science Journal assessed the relationship between current college students who report using alcohol and marijuana. The anonymous online survey was conducted at a medium-sized university and found that students who reported higher levels of alcohol and marijuana use also reported lower GPAs on average, leading researchers to suggest there is likely a correlative relationship between students who partake in recreational marijuana use and don’t perform well academically.

Multiple research reports have also confirmed concerning effects of marijuana on the developing brain. The scientific community hypothesizes that the development of the human brain, particularly the part that governs rational thinking and decision-making, often hasn’t reached full maturation until the mid-20’s, or even early 30’s.

As a result, this could provide a possible explanation for why students who decide against marijuana use in college generally perform better academically than their peers, as it can cause short-term memory loss and inhibit brain processes required for studying and retaining large quantities of information.

If you think you or someone you know may be dealing with substance abuse problems, call us to schedule a consultation at 314-222-5830, visit our website or send us an email for more information.

The Dangers and Effects of College Binge Drinking

Fri, 26 Oct 2018 19:18:02 GMT

If you’re a parent of a teenager who’s preparing for college, talking with your child about the dangers of binge drinking can be just as uncomfortable as the dreaded “birds and the bees” talk.

However, it’s a vital conversation to have.

According to the National Institute on Alcohol Abuse and Alcoholism, research gathered by the 2015 National Survey on Drug Use and Health report estimated around 696,000 U.S. college students between the ages of 18 and 24 reported having been assaulted by another student who had been drinking. Another 97,000 disclosed having been victims of assault or date rape where alcohol was a factor, and an estimated 1,825 died from unintentional injuries or car crashes in which alcohol was a factor.

As quantitative evidence shows the indisputable negative impacts that binge drinking can have on students’ lives, it’s important to understand the risks and know what you can do to help.

The Effects of Binge Drinking

The consequences of college binging are undoubtedly harmful. However, it’s also a common part of university life that many high school students will be navigating for the first time without the stability of parental supervision. As binge drinking is an inevitable issue young adults are likely be confronted with, arming your child with facts and information is critical to helping keep them safe.

Excessive drinking in a short period of time relative to height, weight and muscle mass, can lead to alcohol asphyxiation (when a victim chokes on their own vomit) or cause breathing to slow and stop entirely, according to an article from Medical News Today . An article from the Child Mind Institute reports that students often decide against calling for help when binge drinking has been a factor to avoid getting into trouble, hoping that the victim will sleep it off and pull through on their own. However, students who have passed out from binge drinking are often at the highest risk for slowed breathing and asphyxiation, which must be treated with proper medical attention.

How You Can Help

Fortunately, these consequences don’t need to be fatal if students know the signs of alcohol poisoning and how to handle them. Make your child aware that if he or she is in the presence of someone who has been binge drinking and is unresponsive, loses consciousness, suffers from excessive vomiting, disorientation or passes out—calling 911 or a trusted adult could ultimately save that person’s life and avoid irreversible consequences.

It’s also important to remember that talking openly with your child about binge drinking does not mean you condone it. Instead, by maintaining a safe, open line of communication, you’re empowering your child with the tools they’ll need to make potentially life-saving decisions in moments of crisis.

Do you suspect your teenager is engaging in binge drinking? It can be difficult to set limits with a teen, but the parent-teen relationship is crucial for preventing serious substance and behavioral problems. Call us to schedule a consultation at 314-222-5830, visit our website or send us an email for more information.

Juul: Harmful or Helpful?

Tue, 02 Oct 2018 18:08:31 GMT

So, what is Juul?

By now, most people have probably heard about the latest smoking craze that’s causing a stir. Considering Juul Labs’ latest product is going up in smoke , the question of just what exactly Juul is has returned in a different context: Is it, in fact, a new and promising way to kick the smoking habit? Or is it a gateway to get millions of new, young customers addicted to nicotine?

According to David Peyton, it’s both.

“If you've never smoked, and you try Juul for a few days, this is a recipe for addiction. You could make someone addicted who's never been a smoker—or, for someone who is addicted to nicotine, this could be a way to get off of cigarettes,” says Peyton, a chemistry professor at Portland State University who tested 11 different e-cig liquids .

While the San Francisco-based e-cigarette company’s website makes the claim that, “They do not want kids using their products,” the term “Juul” has become such a pervasive trend in schools that it’s quickly made the switch from buzzword to a verb among students. In fact, some students have even admitted that they just can’t stop , spreading worry like wildfire across school administrations and parents everywhere.

Thanks to the company’s patented JuulSalts, it’s no secret why they’ve become so ubiquitous—for both adult smokers and non-smokers alike. These JuulSalts are compounds of nicotine salts formed in the same heat-dried tobacco leaves used in most cigarettes but are much less harsh when inhaled compared to other e-cigarettes that contain “freebase” nicotine. Instead, Juul combines freebase nicotine with benzoic acid in its e-liquid that comprise each flavor-filled JuulPod.

Though these flavored pods are argued by public health groups to be the reason teens are taking up this habit, the companies insist that the “flavors are critical to helping nicotine-addicted adult smokers switch from conventional cigarettes.”

Regardless of Juul Labs’ insistence that Juul is to be used solely as a product to help adult smokers , the FDA still isn’t discounting the risks for teens and young adults. “The nicotine in these products can rewire an adolescent’s brain, leading to years of addiction,” says Dr. Scott Gottlieb in an FDA press release . Paired with the latest data, not yet published, which shows a 75 percent increase in e-cigarette use among high school students this year compared with data from 2017, it’s clear the FDA is hard-pressed to find a solution for this growing epidemic.

As a result, the US Food and Drug Administration has recently announced the e-cigarette startup has 60 days to keep its devices out of the hands of kids or they run the risk of being taken off the market. However, past efforts have proven that the company’s momentum is hard to derail. With both its explosion in popularity and the heavy dose of nicotine it delivers (the same as a pack of cigarettes ), the e-cigarette market expanded by 40 percent ($1.16 billion) in 2017—its growth due in large to sales by Juul Labs .

While the FDA has garnered some praise from public health groups with its latest announcement and campaign against the devices in efforts to curtail youth’s use of e-cigarettes, the Vapor Technology Association calls the move “a giant step backward.”

“By threatening an industry—and technology that millions of adult smokers are successfully using to reduce or quit smoking deadly cigarettes—FDA is venturing into dangerous territory,” reads a statement from the association. To that end, Juul has pledged $30 million for research and education geared toward keeping young people from vaping.

With Kevin Burns, chief executive of Juul Labs, further stating the company “Will work proactively with FDA in response to its request,” it seems we’re gearing up for yet another round of back-and-forth—which continues to beg the question: Will Juul live to see another day? Or, will they be smoked out after a long run of lawsuits and public scrutiny? Only time will tell.

Is your teen using Juuls or engaging in other behaviors that concern you? It can be difficult to set limits with a teen, but the parent-teen relationship is crucial for preventing serious substance and behavioral problems. Call us to schedule a consultation at 314-222-5830, visit our website or send us an email for more information.

How to Master Stress Management

Tue, 02 Oct 2018 17:59:56 GMT

Fidget spinners and weighted blankets are only the latest in a slew of products contributing to anxiety consumerism . From essential oils and aromatherapy to adult coloring books, the growing popularity of stress relief products has made one thing clear: Americans are stressed, and they’re looking for a solution.

However, there’s little—if any—scientific evidence to support that these products actually work.

With the latest American Psychiatric Association (APA) poll showing the first significant uptick in stress levels in a decade, it’s no shock that Americans are looking for a quick way to relieve stress. However, stress management is not a one-size-fits-all endeavor.

While stress is universally experienced, finding the best way to manage stress should come down to what’s best for you. Whether you suffer from chronic stress or anxiety, or simply want to alleviate the effects of daily stressors, we’re here to help you discover a variety of stress management options.

Effects of Stress

According to the Anxiety and Depression Association of America , around 40 million American adults—roughly 18 percent of the population—have an anxiety disorder . Though degrees to which people experience it may differ, stress generally refers to two things: the psychological perception of pressure and the body's response to it.

Whether physical or mental, stress triggers a rush of hormones such as cortisol and cortisone-like compounds called glucocorticoids . In reaction, our blood starts pumping, increasing our heart rate and mobilizing fat and sugar for fast energy, focus, muscle reaction and more. Though a natural, adaptive reaction , prolonged or repeated stress responses can have serious effects on our physical and mental health.

Stress Management Techniques

One study from the University of Connecticut found that 20 minutes was an effective amount of time to build resilience toward future stress. However, finding the right technique for you still makes all the difference.

Daily Stress

Though day-to-day stressors may seem more mundane, repeated daily stress over time can have can have a profound effect on our health, making it all the more important to take a proactive approach to finding relief. For those who aren’t overly stressed, certain hobbies can provide a source of eustress —a healthy type of stress that comes with a sense of motivation, performance and emotional well-being. Activities like exercise or engaging in art and drawing have shown to work particularly well in relieving daily stress.

Acute Stress

Acute stress often comes quickly and unexpectedly, which means taking quick mental breaks through meditation or breathing exercises can help you take the step back you need to calm down, regroup and resume your daily tasks. One study found that mindfulness techniques such as counting your breaths can result in a positive effect on mood as well as reverse your stress response , which, if continuously triggered, can lead to chronic stress.

By making some of these acute stress-relieving activities a habit, you’ll be less reactive to common stressors in the future and have a strategy to overcome them.

Chronic Stress

Managing chronic stress often requires a combination approach. Whether it be short-term stress relief strategies or long-term approaches such as medication or therapy sessions —it’s essential to have at least one consistent, stress-relieving practice to turn to.

For chronic stress , relief may include things like exercising regularly, journaling or practicing yoga in order to reduce stress and increase overall wellness. Even listening to music has been proven to help combat both the physical and emotional effects of stress. Research has found that the change in brainwave activity brought on by music can enable your brain to shift speeds, regulating your state of mind and improving your mood, along with other long-term benefits.

Though these techniques may not be able to eradicate your stress completely, finding healthy habits and strategies to cope with stress can have tremendous positive effects on both daily life and your overall mental health.

__________________________________________________________________________

Looking for a more in-depth approach to managing your stress? Clayton Behavioral offers a variety of resources to help cope with stress, anxiety and other mental disorders. Feel free to call Feel free to call Madeline Goodwill, our CBT Program Director, at 314-222-6320 for a free 15-minute consultation to answer any questions you may have.

How Fitness Can Help With Recovery

Tue, 02 Oct 2018 17:50:15 GMT

Recovery is hard. And it’s no secret that, even if you’re committed, cutting the addictive substances out of your life comes with all kinds of stress on both your body and mind.

From outpatient programs to rebuilding personal relationships, the road to recovery isn’t short of substantial hurdles to climb along the way. Although this can be a frustrating and overwhelming experience at times, it’s all the more reason to have a healthy outlet to relieve your stress.

While there are many obvious benefits to physical activity, there are a few that can directly impact the outcomes of substance abuse treatments. In fact, science suggests that exercise doesn’t just help facilitate recovery—it’s crucial.

Improving Mood and Lowering Stress

No matter what you’re recovering from, an integral part of maintaining your sobriety means finding new, healthier ways to cope with stress.

Many recovery efforts involve working to restore your brain’s balance. More specifically, reintroducing natural levels of “happiness-inducing” chemicals like dopamine and endorphins to your body—a balance that drug and alcohol abuse disrupts.

As a natural way to reset the scale, a quick sweat session releases both endocannabinoids and the same endorphins you crave during recovery. Together, these biochemicals can release a similar feeling of euphoria, making it easier to cope with daily life during recovery.

Further, studies show that exercise can actually help reduce addiction-related withdrawal symptoms and even lessen cravings. As a result, you get the same kind of boost in a much healthier way. Coupled with your addiction treatment , exercise can be a gratifying outlet and useful stress-management tool during rehabilitation.

Exercise and the Brain

Physical activity may not be your forte, and it may even be the last thing you want to do while working on your sobriety, but it can be an essential part of recovery for both your body and mind—specifically, your brain.

In addition to helping reduce cravings, exercise can also begin to repair parts of the brain that have been damaged by substance abuse. Several studies have shown that individuals with a history of substance abuse show a reduced volume in the hippocampus along with decreased volume and function in the prefrontal cortex.

Of extreme importance to mental health, the hippocampus is the area of the brain mainly responsible for memory and learning. The direct benefits of exercise to your brain include reduction of insulin resistance and inflammation, stimulating the release of growth factors. This can even result in an increase in size in certain regions of the brain—including parts of the hippocampus.

Results of a study published in NeuroImage showed that, although a hippocampal volume increase in response to aerobic exercise was typically observed in animals, the evidence from human studies were equivocal, showing an increase in size of the left hippocampal region.

The long-term, and perhaps most attractive benefit of these results is the effect exercise can have on neurogenesis —the creation of new brain cells in an already mature brain. Exercising regularly can not only improve the delivery of oxygen and nutrients to the brain but also increase neurohormones, which support neuron signaling, growth and connections. Through creating these new nerve connections, your brain can begin to heal from the harm previously inflicted by addictive substances.

Healing Yourself and Your Body

During recovery, it’s more than just ridding yourself of harmful substances—both your body and mind have some significant healing to do.

Addiction looks different for everyone and its treatment can come in many forms—whether it be counseling, support groups and/or medication —but there are other natural ways to help your recovery, too.

The stressors that accompany recovery can take a toll on your body and mind. Which is why working out is one of the best things you can do to help ease these stressors and better focus on your sobriety. Even just 10 minutes of aerobic exercise can reduce tension, fatigue and anger while increasing feelings of vitality and energy.

Studies also show that adding exercise in addition to your addiction treatment can amplify the effects of recovery. In one study of patients being treated for substance abuse published in Mental Health and Physical Activity , the results showed that exercise can provide a sense of accomplishment, improved health and most importantly, an increased drive and confidence in staying sober.

Put It to the Test

In summary, exercise can be a valuable part of the recovery process for a number of reasons, and you don’t have to become a fitness fanatic to see the benefits of exercise. From improved sleep, more energy or a greater sense of physical well-being, the rewards you and your body can reap by engaging in exercise will help make your time during recovery more enjoyable and sustainable.

While exercise by itself is no cure for addiction, it can be an additional tool to help build (or rebuild) a healthy life. All you need to do is take those first steps.

_______________________________________________________________________

Recovery from Alcoholism can be helped by medication

Fri, 02 Feb 2018 03:01:08 GMT

Do you or a loved one drink too much? You don't have to white knuckle your recovery. FDA-approved medications for alcoholism can make the difference between chronic relapse and long-term recovery. Call me directly to schedule a free individual or family consultation 314-222-5896. Or email me: ned@claytonbehavioral.com

Marijuana: Risk or cure?

Wed, 31 Jan 2018 12:28:31 GMT

Ned Presnall, Clayton Behavioral Executive Director hosted 97.1 Eye on Health to discuss changing policies and perspectives on marijuana with Richard Grucza, PhD., Professor of Psychiatry at Washington University in St. Louis. Click here to LISTEN .

Dying High

Mon, 13 Mar 2017 20:08:10 GMT

The news of the death of Phillip Seymour Hoffman from a heroin overdose and of finding him with a needle still in his arm have been shocking. Yet heroin deaths are a common, daily and painful occurrence: about 100 people die across the country from heroin every day. They are not celebrities but mostly middle-class, suburban and young (some as young as 12). Heroin slows down the respiratory drive and can some times cause addicts to stop breathing and turn blue (cyanosis) almost immediately. Although technically a suicide, in reality those who OD hardly ever do so intentionally. In fact, only 10% of heroin ODs end up in death. Users are simply unable to factor in the purity and strength of what they are shooting, or may not be fully aware if heroin was cut with something else that also shuts down the respiratory brain center. Police and EMS workers frequently encounter these situations and can save lives by promptly administering an antidote, naloxone . Heroin kills in many ways, both in the short and in the long run (think of hepatitis, HIV and endocarditis). None is more dramatic and unexpected than the almost instantaneous shut down of the respiratory drive.

Most street heroin is cut (mixed) with an adulterant. The adulterant is cheaper, allowing the dealer to maximize profit. The internet is full of websites where addicts (using the acronym SWIM, Someone Who Isn't Me, to avoid self-incrimination) comment on how to spot how much has heroin been cut, and with what adulterant. St Louis SWIMs report that local street heroin is routinely cut 50:50 with over the counter diphenhydramine, sold under the brand name Dormin. Finding Dormin capsules in your child's room is a strong indicator that they may be dealing heroin. SWIMs are extremely adept at spotting overly adulterated heroin since it burns, looks, smells and dilutes differently. For example, Dormin's capsules are pink, and heroin cut in a blender with them will have pink freckles. Too many freckles means the drug was cut with more than the customary 50% of Dormin. Other adulterants include sugar, coffee and quinine (used for this purpose for more than a century).

Some addicts claim that using Dormin saves them money, since they can get a longer-lasting high with less heroin. Tragically, heroin can also be cut with stronger psychoactive drugs (pain killers) to maximize and prolong the high. This makes the mix even more dangerous, since these added agents are also strong respiratory depressants. We are currently experiencing an epidemic of ODs (many lethal) with the widespread use of heroin cut with Fentanyl. It is extremely difficult for addicts to evaluate the potential lethality of this combination.

SAMHSA (The Substance Abuse and Mental Health Services Administration) alerted this week that a dangerous increase in heroin+Fentanyl ODs are being reported. In a 2-week period, 17 such deaths were seen in Pittsburgh, and 22 in Rhode island. Additional deaths are being reported in New Jersey and Vermont, and the problem is likely to expand across the nation rapidly. You can find free copies of SAMHSA's Opioid Overdose Toolkit here .

Drinking Problems and Problem Drinkers

Wed, 01 Mar 2017 17:06:42 GMT

What differentiates heavy drinkers from alcoholics? The answer is not necessarily based on the frequency or the amounts drunk. The essential features of alcoholism include an inability to abstain and, once drinking starts, an inability to stop.

One of the most reliable ways of finding out if someone is an alcoholic ( Alcohol Dependence , in previous psychiatric nomenclature) is verifying their inability to stay sober despite numerous efforts to do so. Alcoholics are often remorseful and apologetic after getting drunk and in trouble, and will make promises never to start again. Yet, they will invariably find a rationalization or justification for drinking, no matter how severe or devastating the consequences. A heavy drinker (or Alcohol Abuser ) on the other hand, is able to abstain in the presence of powerful reasons to do so. Alcoholics see their lives spin out of control in front of their eyes, yet they invariably hit the bottle again and again. Some heavy drinkers could conceivably end up drinking larger amounts and/or more often than certain alcoholics. What sets them apart is not the amount or frequency of their alcohol use, but the seemingly hopeless inability of the real alcoholic to stay sober.

A second telling sign of alcoholism is the inability to stop once drinking has started. The powerful effects of the first drinks trigger strong cravings to continue. Stopping becomes impossible: " one drink is too many and ten are not enough ". Alcoholics will constantly try to drink in moderation ("normal drinking") only to find out, over and over again, that once the first few drinks are consumed they have no control over how much they will drink, or over when will they stop. The delusion of every alcoholic is that, some day, somehow, they will be able to drink in moderation.

An alcohol abuser drinks despite negative consequences (such as DWIs, problems at work or home, etc) but, unlike real alcoholics, is able to sober up if compelling reasons appear (severe medical problems, impending divorce, etc). Binge, sporadic drinkers may or may not progress to full-blown alcoholism, although most alcoholics were first alcohol abusers or binge drinkers. The current psychiatric classification ( DSM-V ) no longer separates Alcohol Abuse from Alcohol Dependence. It simply diagnoses "Alcohol Use Disorders" as mild, moderate or severe. In practice, two simple questions: "Have you tried repeatedly and unsuccessfully to stay sober?" and "Do you lose control of your drinking once you start?" often suffice to establish a strong suspicion of alcoholism.

For a folksy, clever, insightful, engaging and at times hilarious description of the alcoholic mind, alcoholism and AA, download for $2.99 J oe and Charlie's talks at the itunes store. Charlie P. and Joe McQ. gave numerous workshops around the country for 30 years, presenting in an accessible way the teachings of the Big Book of AA. "People often say that it took Bill and Bob to write the Big Book but it took Joe and Charlie to explain it".

Am I getting Alzheimer's?

Wed, 01 Mar 2017 17:06:40 GMT

It is now possible to get an early diagnosis of Alzheimer's Disease (AD). Scientific advances allow us to tell if, at some point, the "senior moments" we notice in ourselves or our loved ones will develop into full-blown AD. However, these exciting advances have not been followed by equally significant breakthroughs in AD's treatment. Do we want to know that we will get AD, if there is not much we can do about it?

About 13% of those 65 and older, and 45% of those 85 and older, will experience memory problems suggestive of AD. Answering "yes" to 2 or more of the AD 8 questionnaire (the Washington University Eight-item interview to differentiate aging and dementia) suggests the presence of dementia and warrants further assessment. The AD 8 is especially sensitive when answered by an informant on behalf of the patient.

It used to be that AD could only be diagnosed unequivocally after death (by autopsy). Since the late 80s, a few familial cases can be diagnosed at any time in at-risk individuals by finding mutations in specific genes. These genetic cases represent a tiny fraction of all cases of AD. Cases of AD due to a single gene mutation tend to have very early onset, with some families showing cases of dementia in their 30s and 40s. In a majority of cases, AD is not caused by a single gene mutation, although certain genes (like Apo E4) can increase our risk of developing AD while Apo E2 may provide protection against it .

Exciting research developments allow now for an early diagnosis of AD by using biomarkers . These biomarkers measure the presence of amyloid in the brain (a substance that accumulates in the AD brain). They also measure evidence of brain cell's injury and degeneration both in blood and in cerebrospinal fluid. Sadly, all these reserach breakthroughs have not yet improved our ability to reverse, stop or significantly slow down the progression of the disease.

Who benefits from early diagnosis? The answer is still unclear (read this ). Do we really want to find out if we'll develop Alzheimer's at a certain unknown point in the future, if there really is no proven way of significantly changing the course of the disease? We need to answer this individually . For some, the opportunity of joining a clinical trail to test a new drug is both a personal and an altruistic incentive that favors knowing. For others, it's best to live in the present and enjoy every day: why worry about something we can't control?

The other eating disorder

Wed, 01 Mar 2017 17:06:21 GMT

We are all familiar with the terms Anorexia Nervosa and Bulimia Nervosa. How much do you know about Orthorexia Nervosa?

Anorexia Nervosa and Bulimia Nervosa are well defined psychiatric disorders. Patients with these conditions focus obsessively on food quantity . Orthorexia Nervosa , on the other hand, is a disorder (not yet included in the official psychiatric classification) where patients are obsessed with food quality . They have an extreme preoccupation with avoiding certain foods that are perceived (often mistakenly) as unhealthy.

Every orthorexic has his or her own unique, individual and idiosyncratic set of rules regarding which foods are allowed to be consumed, and which foods are to be avoided. As a result, their diets can become quite restricted, and large amounts of time are spent preparing their "OK foods". Eating out is almost never an option for orthorexics, and they routinely avoid socializing and family events centered on food.

Frequently, orthorexics will obsess about healthy foods and go to extremes to avoid those containing additives or preservatives of any type. They may fixate on avoiding any kind of fat, or any animal products. Restrictive diets often lead to emaciation and malnutrition. The orthorexic patient, however, persists on his or her obsessive fixation with what is perceived as healthy eating and will reject any suggestions to do otherwise. Soon, patient's rules become arbitrary, unpredictable and illogical. A patient may refuse to eat chicken livers but may eat other organs from the same animal, citing obscure references about liver metabolism that do not fly in the face of evidence.

Orthorexics can become extremely thin. However, unlike anorexics, they do not wish to lose weight and do not see themselves as overweight. Their obsession is with eating and staying pure, uncontaminated and healthy. To learn more about orthorexia, rawfoodism , paleolithic diet, fruitarianism, anopsology and other interesting edible topics, visit BeyondVeg .

Stigma

Tue, 21 Feb 2017 15:59:56 GMT

Stigma derives from a Greek word that means "sign", "point" or "branding mark". It originally referred to a type of marking or tattoo that was cut or burned into the skin of criminals, slaves or traitors in order to easily identify them as blemished or morally corrupt. Stigmatized individuals were to be avoided and shunned.

It is a common experience among those struggling with mental illness. Stigma can be obvious and direct (someone making a negative comment about mental illness or its treatment) or subtle (when it is assumed that someone with mental illness is dangerous, unstable or violent). Patients may even judge themselves ( self-stigma ), wrongly assuming there are certain goals they can't accomplish, or that they won't get better. Stigma leads to prejudice, discrimination, avoidance and rejection. Those who experience it go through shame, blame, secrecy, isolation and social exclusion.

When properly treated, people with mental illness are no more dangerous than anyone else. In fact, they are far more likely to be the victims of violence rather than the perpetrators. The media often reports distorted and inaccurate representations of the mentally ill, inviting unwarranted generalizations and widespread prejudice. Every year, there are over 16,000 murders in the US, yet the few involving the mentally ill get disproportionate front-page coverage. Astonishingly, after the Sandy Hook tragedy, louder voices advocated for arming school guards than for education and early detection of mental illness. The shortage of mental health services have turned jails and prisons into the new psychiatric hospitals. Correctional psychiatry is, sadly, among the fastest-growing mental health specialties. A person with mental illness has much easier access to guns than to mental health. That is an ongoing tragedy.

Several public figures are giving their names to the cause of fighting stigma. Former congressman Patrick Kennedy and actress Glenn Close are among the most vocal ones. Legal efforts to support parity in mental health insurance coverage have also contributed to leveling the playing field between physical and mental illness. The National Alliance on Mental Illness conducts an active StigmaBusters campaign to challenge stereotypes portrayed in the media.

What can we do? Prejudice arises from ignorance. People tend to distrust and fear what they don't know or don't understand. Stigma decreases when people meet those afflicted by mental illness who are able to live as good neighbors in their communities. Strategies that include educational interventions and promote inclusiveness of the mentally ill contribute to a better understanding. It is said that the greatness of a society is measured by the way it treats its most vulnerable members: how well are we doing with the mentally ill?

Did Hans Asperger have Asperger´s syndrome?

Tue, 21 Feb 2017 15:59:38 GMT

Hans Asperger (1906-1980) was a Viennese physician who published the first definition of Asperger's syndrome in 1944. He identified a pattern of behavior and abilities that included "a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements." Asperger called children with AS "little professors" because of their ability to talk about their favorite subject in great detail. Asperger was convinced that many of the children he identified as having autistic symptoms would use their special talents in adulthood. He followed one child, Fritz V., into adulthood. Fritz V. became a professor of astronomy and solved an error in Newton’s work he originally noticed as a child.

Asperger died before his identification of this pattern of behavior became widely recognized, because his work was mostly in German and barely translated. The term "Asperger's syndrome" was popularized in a 1981 paper by British researcher Lorna Wing, MD, who had an autistic daughter and became involved in researching developmental disorders.

Interestingly, as a child, Hans Asperger appears to have exhibited features of the very condition named after him. He was described as a remote and lonely child, who had difficulty making friends. He was talented in language; he was interested in the Austrian poet Franz Grillparzer, whose poetry he would frequently quote to his uninterested classmates. He also liked to quote himself and often referred to himself from a third-person perspective, typical symptoms of what we now call Asperger's syndrome.

There are many resources to help patients and families better understand this condition. The australian psychologist Tony Attwood has one of the more comprehensive websites ( www.tonyattwood.com.au ). His philosophy (very much like the one supported by Hans Asperger) is to view the patients as differentially abled rather than disabled. A thorough inventory of strengths and weaknesess can help patients become active members of society. Many AS patients have great computer skills and, not surprisingly, a vibrant virtual community exists (for an interesting perspective from patients, visit www.aspiesforfreedom.com ). You may also want to learn about the www.aspiequiz.com or the autism spectrum quotient ( aq.server8.org ).

Overall, kids on the autism spectrum have wonderful potentials and should be given every opportunity to succeed. They often have a unique way of viewing the world, which can be surprisingly insightful. They are capable of great accomplishments. Temple Grandin, PhD, is one of the best examples of success within the spectrum. She didn't talk until she was three and a half years old, communicating her frustration instead by screaming, peeping and humming. In 1950, she was labeled "autistic," and her parents were told she should be institutionalized. She tells her story in her book Emergence: Labeled Autistic , a book which stunned the world because, until its publication, most professionals and parents assumed being diagnosed "autistic" was virtually a death sentence to achievement or productivity in life.

AA, God, and the Big Book

Tue, 21 Feb 2017 15:59:15 GMT

Ever since its beginnings, AA has struggled with the issue of God and a Higher Power. Bill Wilson, the iconic AA founder (and one of TIME magazine's 100 most influential people of the 20th century) was himself an agnostic and an atheist at various points in his life. Those struggling with alcoholism who refuse to attend AA because "it's too religious" may be missing the point.....

Bill W. and Dr. Bob started what is now known as AA in 1935 in Akron, Ohio. Shortly thereafter, Bill W. wrote (with the input of AA's first 100 members) the Big Book of Alcoholics Anonymous, introducing for the first time the Twelve Steps model of recovery. Chapter 4 of the Big Book is titled "We agnostics" and explores the meaning of a Higher Power. In this chapter, Bill W. explains the famously italicized statement that follows the word God in Steps 3 and 11 of the Twelve Steps: "God as we understood him" . It is clear that the AA fellowship knew since its beginnings that non-believers could also get sober in their program.

Jim Burwell ("Jimmy the atheist") was one of AA's first members. He wrote his personal story, "The Vicious Cycle", for the 2nd edition of the Big Book. He took his last drink on June 16th, 1938. After months of lively discussions with other AA founders on the issue of God, he was the first to conceptualize the AA group as his own Higher Power . "Those who honestly try to find a Power greater than themselves", he wrote, "were much more composed and contended than I have ever been, and they seemed to have a degree of happiness which I have never known." In his article "Thirty Years Sober" published in 1968 he elaborated on the concept of how the Good all human beings have, deep in their hearts, could serve him perfectly well as his Higher Power. "By meditating and trying to tune in on my better self for guidance and answers, I became more comfortable and steady."

Beyond Belief (BB) is a secular spinoff of AA started by non-believers who didn't feel comfortable in certain AA groups where religious beliefs played a significant role. In their website they list several secular versions of the Twelve Steps. Overall, they fully endorse the principles of AA but try to offer a friendlier environment to those firmly rooted in atheism or agnosticism. Quad A (AAAA, AA for Agnostics and Atheists) started in Chicago in 1972. Both of these groups' understanding of the Twelve Steps follow "Ed the atheist": God as a Higher Power is replaced by AA and its members.

Those fulfilling AA's only requirement for membership ( a sincere desire to stop drinking ) should have no problems accommodating their religious beliefs to AA, including lack of any religious beliefs. AA (or BB or Quad A) will certainly accommodate them. To date, one of the most successful, consistent and effective long-term ways of staying sober is to embrace both the fellowship of AA (becoming a friend of Bill W. ) and to diligently work the Twelve Steps.... one day at a time .

What do you fear?

Fri, 13 Jan 2017 17:15:27 GMT

We all hold (sometimes secretly) certain fears or phobias. For these to be of clinical significance, they need to be severe enough to cause impairment in functioning. Clinically, a phobia is a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding. The fear is typically disproportional to the actual danger posed, and is often recognized as irrational. In the event the phobia cannot be avoided entirely, the sufferer will endure the situation or object with marked distress and significant interference in social or occupational activities

Coulrophobia is the fear of clowns. Astraphobia is the fear of thunder and lightning. Taphophobia is the fear of being placed in a grave while still alive. Xanthophobia is the fear of the color yellow (in chinese tradition, if a general lost a battle, the Emperor would send him a yellow scarf, an imperial order to commit suicide). Triskaidekaphobia is the fear of the number 13. The term nomophobia was recently coined to describe the fear of being out of mobile phone contact

Homophobia or Xenophobia are not real phobias. These terms refer to attitudes and prejudices that involve hate rather than fear. A more proper way of describing hateful beliefs is to use the suffix misia instead of phobia. Homomisia, then, correctly describes the irrational hatred of homosexuality. Iatromisia is, by the way, the intense dislike and hatred of medical doctors and the medical profession.

Phobias can end up being mostly an inconvenience. For example, fear of flying may result in very long car rides. However, they can also be truly debilitating, like social phobia. They are treatable. Often, the best treatment results are obtained with a combination of CBT (Cognitive Behavioral Therapy) and SSRIs (Serotonin-Specific Reuptake Inhibitors: Prozac, Paxil, Zoloft, Lexapro, etc). CBT should be a first-line treatment: after all, fears are often nothing more than stories we tell ourselves.

The Disease of Isolation

Fri, 13 Jan 2017 16:43:49 GMT

the View from "Rat Park"

Remember the research from the 1950’s in which lab rats self-administered cocaine and ignored their food supply as they starved to death? These studies help us understand the brain science of addiction and to make sense of the apparent insanity of addictive behavior—of patients and loved ones giving up everything for the sake of drugs or alcohol. We now know what was happening to those rats. Drugs of abuse stimulate dopamine in the survival center of the brain and make continued use so reinforcing that other human “goods” lose their appeal.

Fewer people know of the “Rat Park” study of drug self-administration. In that and related studies, researchers hypothesized that the social environment plays a big role in the rats’ willingness to self-administer addictive drugs. Rat Park was Disneyland for rats—lots of food, lots of tunnels and things to do and play with, as well as other rats to play and mate with. The rats were given a choice of two fluid dispensers: one contained a morphine solution and the other plain tap water. The rats in Rat Park repeatedly selected the plain tap water by substantial margins. Even rats that were made dependent on morphine and then detoxified chose to avoid morphine self-administration when they were in Rat Park and had opportunities for social interaction. The isolated rats, on the other hand, continued to use morphine when given the opportunity.

So what does Rat Park tell us about human addiction? We know that addictive substances and behaviors are extremely rewarding. But people who achieve recovery don’t just stop using drugs; they find security and connection in healthy, supportive social relationships. Successful treatment must accommodate this social need. When we help patients overcome social anxiety, depression, trauma, grief, family dysfunction and other obstacles to develop and maintain human connection, we help them achieve health and recovery. Addiction is a disease of isolation as well as a disorder of brain function. Recovery necessarily involves social support and connection.

Panic Attack...

Mon, 09 Jan 2017 18:29:51 GMT

Panic attacks are common and often debilitating episodes of sudden onset that include a number of symptoms such as palpitations, shortness of breath, a choking sensation, chest pain, sweating, shaking, nausea, dizziness and fear of losing control or dying. Other less common symptoms include derealization (an alteration of the way we see the world so that it seems unreal) or depersonalization (the feeling of watching ourselves act without having control of the situation). In severe cases, many activities of daily living are associated with attacks, and as a result patients become homebound ( agoraphobic ).

Anxious patients tend to monitor (scan) their bodies for trivial background sensations. They fixate on them, magnify their intensity and catastrophize their meaning. We all have occasional "body noises": aches, pains, itches, mild dizziness, etc. The anxious patient will monitor , focus , amplify and catastrophize these feelings. Consulting "Dr. Google" tends to worsen the problem since it often gives more ammunition to the anxious mind to wrongly conclude that a serious health problem is taking place.

Medications and/or Cognitive Behavioral Therapy (CBT) are excellent treatment modalities for this debilitating disorder. The benzodiazepines (Xanax, Ativan, Klonopin, etc) are effective in aborting an attack and turning off the symptoms once they appear. The SSRIs (Prozac, Paxil, Zoloft, Celexa, Lexapro, etc) and the SNRIs (Cymbalta and Effexor) are very successful in preventing panic attacks from occurring. Often, patients need to combine a benzodiazepine with an SSRI/SNRI at the onset of treatment, since the latter will take a few weeks to work. Once attacks no longer occur, benzodiazepines are rarely necessary and may be used only "as needed" for high-risk situations, like flying on airplanes.

A cognitive approach to panic teaches the patient to recognize its symptoms as inconsequential and not as evidence of a serious disease, such as a heart attack. This workbook is a good source of information on how to de-escalate the anxiety that a patient feels upon the onset of symptoms. If, soon after the appearance of the first panic symptoms, a patient's anxiety escalates, the patient becomes convinced that a serious health problem is taking place, and a full attack ensues (hence, a self-fulfilling prophecy). Panic symptoms are mostly the appropriate response we have to a dangerous situation...but they happen when no real danger exists!

Five conditions that look like adult ADHD

Mon, 09 Jan 2017 18:23:24 GMT

Clinicians routinely see patients self-diagnosed with ADHD. Many adults are now taking stimulants without a convincing reason. Stimulants are highly addictive medications that are not free of potentially dangerous side effects; their use should be limited to those carefully evaluated and properly diagnosed. In reality, most adult patients seen in clinical settings bitterly complain about noticing increasing problems with inattention and distractibility, and assume that they must therefore be suffering from undiagnosed ADHD. ADHD is a neurodevelopmental disorder present since childhood. Nobody develops ADHD as an adult. The following 5 conditions explain the majority of cases of adult-onset inattention and distractibility.

Depression and anxiety. Poor concentration, short-term memory loss, inattention and distractibility are very common symptoms of both mood and anxiety disorders. It is very difficult to diagnose cross-sectionally ADHD in the presence of a major depressive episode or an active anxiety disorder (GAD, OCD, etc.)

Drugs and Alcohol. In the addition of the well-known deleterious cognitive effects of alcohol and commonly abused drugs (including marijuana), clinicians need to be extremely careful when prescribing stimulants to those with potential chemical dependency issues.

Certain prescription medications. Benzodiazepines and sleep medicines (Ambien, Lunesta, Sonata) are well known for causing daytime probems with focus and attention. Statins (medications used to lower blood cholesterol levels) are showing increasing, convincing evidence thay thay can also cause cognitive problems that may be misinterpreted as ADD. Cholesterol is essential for brain functioning. Antidepressants (SSRIs, SNRIs) as well as some mood stabilizers such as Lamictal, Depakote and Tegretol can cause annoying word-finding difficulties that patient could misinterpret as cognitive impairment.

Non-restorative sleep. Patients with certain sleep disorders (typically, obstructive sleep apnea – OSA) suffer from excessive daytime sedation and sleepiness. They find it very hard to concentrate and stay focused. Even when properly trated, OSA may produce residual problems with cognition, short-term memory, inattention and distractibility.

Overwhelmingly busy schedules. How much water can a sponge take? How many computer programs can you open in your laptop before it slows down and makes mistakes? We live such busy, overcommitted lives that is not hard to understand how the multiple demands simultaneously placed on our brains lead to processing mistakes.
Most adults seen in clinical practice complaining of inattention and distractibility are far more likely to suffer from one or more of these five problems than from the complex, multifaceted neurodevelopmental condition that is ADHD. Careful screening for these conditions may guide treatment and avoid long-term, unnecessary use of addictive medications.

Attention-Deficit Hyperactivity Disorder in Adults, by Paul Wender, MD is a classic textbook of what really is (and is not) ADHD in adults: a serious and potentially devastating condition when not properly treated.

OCD Variants

Sat, 07 Jan 2017 23:22:14 GMT

OCD is typically associated with symptoms such as the obsessive fear of germs and contamination and/or ritualistic behaviors such as compulsive hand washing. Other conditions share some of the characteristics of OCD and may represent variants of this disorder.

Scrupulosity arises when OCD has a religious component. Sufferers have pathological guilt surrounding moral or religious issues. They become obsessed about having committed a sin or acted in contradiction to their religious morals and beliefs. This condition appears to have been present in certain historical religious figures. St. Ignatius, for example, described that "after I have trodden upon a cross formed by two straws...there comes to me from without a thought that I have sinned...this is probably a scruple and temptation suggested by the enemy". The Catholic Church provides help for this condition through Scrupulous Anonymous .

Popularized by the TV show Buried Alive , Hoarding (pathological collecting) is conceptualized as an OCD variant. Sufferers show inability (or unwillingness) to discard large amounts of typically useless objects. They develop intense anxiety when needing to throw something away, since they feel these objects could be useful in the future. Unlike most OCD sufferers, hoarders do not find their habits problematic, and often appear comfortable and at ease in their overcrowded living environments.

BDD (Body Dysmorphic Disorder or imagined ugliness) also has overlaps with OCD. BDD patients are obsessively and excessively preoccupied with a slight or imagined defect in their physical appearance. They perceived themselves as physically flawed and spent large amounts of time in front of mirrors, trying to cover what they believe is a defect (a facial asymmetry, an unusual head shape, etc). They often seek help from plastic surgeons and aestheticians. BDD can be severely debilitating and cause much suffering and isolation. This article shows pictures of the way four women really look versus the way they perceive themselves.

Some patients suffer from what has been called "Sexual Orientation OCD". They are intensely preoccupied with their sexual orientation and identity. This can be seen, for example, among people who are not gay or lesbian, yet have intense doubts that they may not be heterosexual. Homosexuals may also suffer from this disorder, obsessively worrying if they are straight. They will constantly seek reassurances from their loved ones about their behaviors, and will ruminate if the way they act may be perceived as gay/lesbian (or straight, in the case of homosexuals).

Seasonal Affective Disorder

Sat, 07 Jan 2017 23:10:54 GMT

Seasonal Affective Disorder (SAD) is a type of depression that starts in the fall and lasts through the winter months. In addition to typical symptoms of depression (sadness, hopelessness, fatigue, crying spells, anhedonia and problems concentration) SAD often presents with some atypical symptoms: increased sleep, increased appetite (especially carb cravings) and a heavy, "leaden" feeling in arms and legs. These atypical symptoms are also frequently encountered during the depressed phase of bipolar disorder. In fact, many bipolar patients tend to get depressed in the fall and winter months, and get manic or hypomanic during the spring and summer. It is therefore important to screen SAD sufferers to rule out the possibility of a bipolar disorder diagnosis.

The efficacy of light therapy has been scientifically documented since the 1980s, that include over 2,000 sufferers. Numerous carefully controlled studies have shown the potential efficacy of light therapy for SAD. In a 2004 Canadian study (CAN-SAD), for example, light treatment was essentially identical in its efficacy to fluoxetine (Prozac) after 8 weeks of treatment.

Light therapy for SAD consists of exposure of the open eyes to an adequate light intensity, at an adequate distance, and for an adequate time period. Standard recommendations include light boxes that emit 10,000 lux of UV-filtered light. Staring at the light is not recommended; a tilted lamp indirectly bathing open eyes is sufficient. Standard light therapy devices are widely available commercially, and typically emit 10,000 lux. At that intensity, most patients respond to 30-minute daily morning sessions at arm's length. At 2,500 lux, much longer exposure times (up to 2 hrs) may be needed. Light intensity is a critical component of successful treatment.

It is best to concentrate on activities taking place on the surfaces illuminated by the light and not on the light itself. Indoor lamps and ceiling light fixtures are inadequate treatments for SAD, since they fail to reach the eyes at an adequate intensity. Therefore, increased exposure to normal room light tends to be insufficient. Most patients report improvement when sessions are in the morning. During long winter nights, early morning exposure (6:30 am, while it is still dark outdoors) can be particularly helpful. In most studies of light therapy for SAD, improvement may appear as early as after 1 week of treatment. It also takes about 1 week for the benefits to vanish once light therapy is stopped. Therefore, for most SAD sufferers, daily light exposure since the onset of symptoms and throughout the winter seems to be the best option.

In addition to light therapy, other treatment options being explored for SAD include Dawn Simulation and Negative Ion Therapy .

When depression means bipolar

Sat, 07 Jan 2017 22:54:30 GMT

When assessing a person with depression, how can we tell if their depression is part of Bipolar Disorder? Accurately making this distinction has significant treatment implications: antidepressants can worsen Bipolar Disorder, while mood stabilizers can greatly improve it. Every person with depression should be assessed for a history of symptoms suggestive of mania or hypomania. A good screening tool is the Mood Disorder Questionnaire ( MDQ ). Diagnosing Bipolar Disorder is not always easy. It can have soft presentations ( Bipolar Spectrum) rather than present with clear-cut, full-blown episodes of mania. Often, it is necessary to obtain collateral information, since patients are unlikely to report or realize that episodes of feeling extremely good are related to their episodes of depression.

There are several clinical clues suggesting that an episode of depression is part of Bipolar Disorder. Atypical depression is often associated with bipolarity, especially when it appears early in life. It is characterized by increased sleep, increased appetite, a feeling of heaviness in arms and legs (leaden paralysis) and hypersensitivity to what others say or think about us. Other hints of bipolarity include having episodes of depression since adolescence, episodes that are more frequent or worse in the winter months (seasonal changes), and/or that appears in the post partum period. Episodes of Bipolar depression tend to be brief (less than 3 months long) and highly recurrent.

Patients whose depression is due to Bipolar Disorder tend to have difficulties when taking antidepressants. They may experience rapid relief followed by loss of efficacy (the "poop-out" effect). They may get paradoxical reactions, and feel more depressed, agitated, wired and irritable when taking them. Often, antidepressants are tried one after the other and none seems to work. Failure to respond to 3 or more antidepressants is a clinical clue that bipolarity may be present . Bipolar spectrum patients can be extremely creative, artistic and successful. Bipolarity should be suspected in high-achieving, gregarious, engaging and at times flamboyant individuals who keep experiencing repeated bouts of depression.

Bipolar Disorder is treatable. When a patient with depression is properly diagnosed as suffering from Bipolar Disorder, the use of mood stabilizers (lamotrigine, lithium, divalproex, carbamazepine and atypical antipsychotics) is indicated. They greatly improve the chances of adequately controlling the symptoms. Antidepressants may still be needed, but should be used cautiously and in conjunction with mood stabilizers. In addition, several studies have shown that psychoeducation of the bipolar patient significantly increases treatment compliance and decreases relapses and hospitalizations.

From the National Institute of Drug Abuse (NIDA)

Sat, 07 Jan 2017 22:51:57 GMT

Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
• An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
• Many drug–addicted individuals also have other mental disorders.
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
• Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle.

Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.

Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as—

• Cognitive–behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
• Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

Call 314-222-5858 or email ned@claytonbehavioral.com for a free consultation.

What makes us happy?

Mon, 12 Dec 2016 00:00:00 GMT

It's a question we all face in our lives: what does it mean to be happy, and how can we reach happiness? Such a simple question turns out to have an elusive answer.

For more than 7 decades, researchers at Harvard University have been trying to answer this question. To do so, they have been following 268 men who entered college in the late 1930s through war, career, marriage and divorce, parenthood and grandparenthood, and old age. The project (managed by psychiatrist George Vaillant for the last 42 years) is most certainly one of the longest-running longitudinal studies of mental and physical well-being in history. Begun in 1937 as a study of healthy, well-adjusted Harvard sophomores (all male), it has followed its subjects for more than 70 years trying to measure their levels of happiness and find its correlates. Such wealth of data provides a unique view into how and why some people live happy lives while others don't.

Interestingly, it is not how much or how little trouble people encounter in life, but rather precisely how they respond to that trouble that predicts happiness. We all face adversity, and happy people certainly have their share of it. What makes a difference is that happy people develop coping skills that allow them to minimize the toll adversity takes on their lives. Having mature coping skills is an essential component of being happy. Additionally, happy octogenarians tend to be educated and enjoy a life of the mind, are in stable, long-term marriages, don't smoke, drink minimally, exercise, and keep a healthy weight. Another main contributor to happiness was warm relationships. “It is social aptitude,” writes Vaillant, “not intellectual brilliance or parental social class, that leads to successful aging.” For Vaillant, the main finding of the Harvard study is that "the only thing that really matters in life are your relationships to other people.”

Some call the Buddha the first scientific researcher on happiness. The main goal of buddhism is, after all, simply to remove suffering. His teachings focus on how desires (wants) and attachments are at the root of human suffering. Learning how to skillfully remove them from our lives is the path to enlightment and happiness. It was the Buddha 2,500 years ago who first articulated the notion that it is not what happens to us, but how our minds handle it, that makes the difference between happiness and unhappiness. Summarizing this in one sentence, John Milton wrote in Paradise Lost: “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven....”.

According to the Buddha, dwelling in the past often leads to depression. Worrying about the future makes us anxious. Living in the present (being mindful) is therefore key. The idea of mindfulness is not a religious or even a spiritual concept. It is strictly cognitive.

Psychologist Matt Killingsworth built an app, Track Your Happiness, that lets people report their feelings in real time. His research also supports the key role that mindfulness plays in happiness: we're often happiest when we're lost in the moment. The more our mind wanders, the less happy we are. You can download the app at www .trackyourhappiness.org .

Results from the Harvard study and of many others converge on the importance of building relationships with others as an essential component of happiness. So, how can we be happy? Healthy habits, being mindful, enjoying the moment, and giving and helping others are all part of the answer.

Try this today: Want what you have and don't want what you don't have.

How heroin hijacks the brain

Sat, 10 Dec 2016 16:02:12 GMT

The word “addiction” is derived from a Latin term for “enslaved by” or “bound to.” Anyone who has struggled to overcome an addiction — or has tried to help someone else to do so — understands why.

Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences. While overcoming addiction is possible, the process is often long, slow, and complicated. It took years for researchers and policymakers to arrive at this understanding.

In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.
The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. Recovery from addiction involves willpower, certainly, but it is not enough to “just say no” — as the 1980s slogan suggested. Instead, people typically use multiple strategies — including psychotherapy, medication, and self-care — as they try to break the grip of an addiction.

Another shift in thinking about addiction has occurred as well. For many years, experts believed that only alcohol and powerful drugs could cause addiction. Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain. Although the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) describes multiple addictions, each tied to a specific substance or activity, consensus is emerging that these may represent multiple expressions of a common underlying brain process.

From Liking to Wanting

Nobody starts out intending to develop an addiction, but many people get caught in its snare. According to the latest government statistics, nearly 23 million Americans — almost one in 10 — are addicted to alcohol or other drugs. More than two-thirds of people with addiction abuse alcohol. The top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine.

Genetic vulnerability contributes to the risk of developing an addiction. Twin and adoption studies show that about 40% to 60% of susceptibility to addiction is hereditary. But behavior plays a key role, especially when it comes to reinforcing a habit.

Pleasure principle . The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex (see illustration). Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.
All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release. Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.

Learning process . Scientists once believed that the experience of pleasure alone was enough to prompt people to continue seeking an addictive substance or activity. But more recent research suggests that the situation is more complicated. Dopamine not only contributes to the experience of pleasure, but also plays a role in learning and memory — two key elements in the transition from liking something to becoming addicted to it.

According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward. The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure. Addictive substances and behaviors stimulate the same circuit — and then overload it.

Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens and the prefrontal cortex (the area of the brain involved in planning and executing tasks) to communicate in a way that couples liking something with wanting it, in turn driving us to go after it. That is, this process motivates us to take action to seek out the source of pleasure.

Tolerance and compulsion . Over time, the brain adapts in a way that actually makes the sought-after substance or activity less pleasurable.

In nature, rewards usually come only with time and effort. Addictive drugs and behaviors provide a shortcut, flooding the brain with dopamine and other neurotransmitters. Our brains do not have an easy way to withstand the onslaught.

Addictive drugs, for example, can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably. In a person who becomes addicted, brain receptors become overwhelmed. The brain responds by producing less dopamine or eliminating dopamine receptors — an adaptation similar to turning the volume down on a loudspeaker when noise becomes too loud.

As a result of these adaptations, dopamine has less impact on the brain’s reward center. People who develop an addiction typically find that, in time, the desired substance no longer gives them as much pleasure. They have to take more of it to obtain the same dopamine “high” because their brains have adapted — an effect known as tolerance.

At this point, compulsion takes over. The pleasure associated with an addictive drug or behavior subsides — and yet the memory of the desired effect and the need to recreate it (the wanting) persists. It’s as though the normal machinery of motivation is no longer functioning.

The learning process mentioned earlier also comes into play. The hippocampus and the amygdala store information about environmental cues associated with the desired substance, so that it can be located again. These memories help create a conditioned response — intense craving — whenever the person encounters those environmental cues.

Cravings contribute not only to addiction but to relapse after a hard-won sobriety. A person addicted to heroin may be in danger of relapse when he sees a hypodermic needle, for example, while another person might start to drink again after seeing a bottle of whiskey. Conditioned learning helps explain why people who develop an addiction risk relapse even after years of abstinence.

The Long Road to Recovery

Because addiction is learned and stored in the brain as memory, recovery is a slow and hesitant process in which the influence of those memories diminishes.

About 40% to 60% of people with a drug addiction experience at least one relapse after an initial recovery. While this may seem discouraging, the relapse rate is similar to that in other chronic diseases, such as high blood pressure and asthma, where 50% to 70% of people each year experience a recurrence of symptoms significant enough to require medical intervention.

Fortunately a number of effective treatments exist for addiction, usually combining self-help strategies, psychotherapy, and rehabilitation. For some types of addictions, medication may also help.

The precise plan varies based on the nature of the addiction, but all treatments are aimed at helping people to unlearn their addictions while adopting healthier coping strategies — truly a brain-based recovery program.

Suboxone (buprenorphine/naloxone) allows for a safe and efective way of ambulatory detoxification from heroin and opioid pain killers