Tag Archives: addiction

Believe that there is more to you

It is a sad and common theme.

A person is struggling: with an addiction, or obsessions and compulsions, or moral injury, or the impact of trauma, and has come to a place where the sense of self has been entirely subsumed by the problem and its pain.

The definition of self becomes “the addiction,” or “the monster who did (whatever has led to moral injury)” or “the mental disorder diagnosis.”

And, of course, as a therapist, I believe it is critical to address mental health troubles with the best of the science we have, with the particular approaches suited, as discerned ongoing, with the specific needs of that client.

But I also believe that a parallel need is extant and urgent: the need for this person, who is suffering, to come back to an awareness of self as a deeply beloved child of God. Not generically loved, like we may say that we “love” some food or activity or type of animal – but particular, personal, and intense.  Women who, like me, have been blessed to give birth will recall that wild wave of emotion that engulfs us when we meet that little person face-to-face after the peculiar intimacy of pregnancy. It makes us irrationally jealous of everyone and anyone; what mother doesn’t remember resenting the nurses and physicians who separated us from the baby long enough to do the general assessments and necessary care? Well, that is a reflection God’s love for each person.

If a person who is suffering is willing to enter into, and do, the hard work of therapy, which will include lifestyle changes and “homework,” and also becomes open to reconsidering his or her existence as a deeply loved person, someone who is more than the addiction, or bad choices, or terrifying memories, or intrusive thoughts and painful compulsions, then true and deep healing can happen.  This is what I would wish for every person struggling with emotional wounds.

An Alcohol Dilemma

Alcohol can be a touchy subject. Addictions, generally, are frequently considered to be only something other addicts, including those in recovery, can help with.  Someone like me, who never drank regularly and now, since surgery a few years ago that included a bad anesthesia reaction, can’t drink any alcohol except, oddly, 3 or 4 ounces of Guinness on a couple of holidays each year, is automatically considered ineligible to be helpful. Despite my ineligible status, in a previous post, I included the life lesson that, for many, alcohol is not a friend.

This assertion flies in the face of much research, perhaps most famously Blue Zones data, which includes moderate alcohol use as a generally positive factor for long life. On the other hand, avoiding alcohol is well-supported by substantial research in the medical field.  Shake or stir in my non-drinker status and, well, it seems like I am a fun-killing fuddy-duddy looking for an excuse to ruin my clients’ good time.

What are the benefits of alcohol? Much research has focused in particular on resveratrol and relaxation.  There ways to get antioxidants and relaxation that don’t carry the risks of cancer, liver and brain damage, and some of the regrettable behaviors that alcohol can carry along. This might be a worthwhile topic of discussion with your healthcare provider. Eating grapes, prayer and meditation, physical activity and laughing might hit all the right keys on this.

If you are misusing alcohol – relying on it to “unwind” after the day, to “help you sleep” (it doesn’t, actually), or to get through social situations (there are ways to deal with social anxiety that don’t interfere with functioning) – please seek help. Other signs your relationship with alcohol is unhealthy? Using more than the recommended amount – 1 serving max per day for females, 2 for males. Feeling anxious if you run out, or worrying you will run out. If you worried more about stocking up with booze than water, batteries and nonperishable food for the past two hurricanes, that’s a bad sign, too. Any binge drinking is a danger sign. Binge drinking raises your blood alcohol to .08 in two hours or less, usually four or five single drinks. Any changes in your functioning at home, work, or socially are likewise danger signs. Pretending that these signs don’t apply to you is itself a sign.

Where to go for help?  Go to an AA meeting. Call a therapist. Call 866-210-1303, or 211, or another helpline. See your physician. Tell someone you trust you’re ready to make a change. Just take that first bold step towards help. There are good people eager to help you change the course of your life for the better, preferably before it becomes unmanageable.  

Are we now voting on mental health?

Here in Florida, we have a process in which citizens can gather enough signatures and put an initiative on the ballot to alter the state constitution.

I vote no, even if in principle the idea seems good, because I don’t think that a majority vote is the way to treat a constitution. I would vote no, even if the amendment proposed to preserve, in perpetuity, the tax-exempt status of dark chocolate due to its obvious necessity to life. The whole idea of a constitution is that it sets forth basic principles: natural law, the essentials. All other laws and rules get held up to it to see if they fit within the boundaries of that constitution.  

In the upcoming election, Floridians will be asked to vote on a proposed amendment that would legalize non-medical marijuana for adults age 21 and over in Florida.  My libertarian side doesn’t much care what people do until it impacts other people. People who mess up their brains with drugs often seem to feel entitled to drive; ultimately, they demand their healthcare be paid for by other people; they clutter up emergency rooms, and do all sorts of other things that do impact others, making drug use a social, not a merely personal, issue.

Professionally, this deserves a resounding “no.” Not just because popular votes are not the way to treat a constitution; but because there is so much information not being openly and clearly presented on this.

To begin with, it is fairly laughable that there is so much so-called medical use of marijuana, when the research is sketchy for even the handful of possibly legitimate uses.  Anxiety? Insomnia? Marijuana is practically a recipe for anxiety, and in fact, can lead to very severe anxiety, especially among younger users.

Secondly, most people have been effectively shielded from information on the impact of marijuana on mental health, physical health, and crime. Why? Whose interest is served by hiding the number of ER visits for psychosis, panic, and/or hideously violent vomiting due to marijuana or other forms of THC use? Whose interest is served when the impact of THC in criminal activities is hidden? There is evidence that use of the modern, stronger forms of marijuana is leading to substantial increases in psychosis, self-destructive behavior and violence against others. Most people seem quite unaware of this. Did you know that the emergency room visits due to marijuana use – psychosis, panic and/or “scromiting” (screaming and vomiting) increased 53 to 400% in the first few years, from city to city? Or that even in Europe, the rate of marijuana psychosis slipping into schizophrenia has increased between 300 and 400% in the past twenty years?  In Colorado, a tragic experiment in progress on pot legalization, emergency room visits related to marijuana use increased 500% in the 5 years post-legalization, with severe psychiatric symptoms including psychosis and panic attacks. Then there is the pain and terrifying projectile vomiting typical of cannabinoid hyperemesis syndrome.

Critically, marijuana is not safe. It is prescribed medically (despite the evidence being rather variable and inconclusive) with a shrug: “well, the possibility of benefits outweighs the risks.” Fair enough; no reasonable person is worried about someone who needs appetite support or help with pain while in treatment for cancer or AIDS having long-term effects from marijuana; the possibility of benefit outweighs the risks.

That doesn’t make it safe. In 2021, about one-third of high school seniors were using marijuana in some form. We ought to be very worried about the effects on teenagers and young adults, whose brains are still in development and whom, evidence shows, will have long-term impacts years after they have stopped using marijuana. That, of course, assumes that they stop. About 17% – 1 in 6 – of people who start using marijuana in their teens will become addicted. The addiction rate is about 9% for adults, and that is old data from 2015, and thus trails the upticks in use and in potency.

The increased risks, especially for young males, for unremitting anxiety, psychosis, and a lingering apathy and lack of initiative ought not be brushed off or laughed off with stories of the late 1960s. Then, the available marijuana caused hallucinations for many people and was far less potent that modern varieties. In the past 40 years or so, the potency has increased about 4-fold.  For adolescents, the rate of suicidal ideation triples in those with cannabis use disorder; the rate of depression nearly triples; truancy, fighting, poor concentration all increase markedly with regular cannabis use.

Interestingly, we are urged to accept psychiatry when it comes to destigmatizing mental disorders and treatment, but this enthusiasm for psychiatric expertise melts away when it comes to legalizing weed in all its forms. The American Psychiatric Association still officially opposes the use of marijuana, noting it is not research-supported for psychiatric diagnoses and bears substantial risks for psychiatric side effects. The experts are discounted on this one thing. What could possibly drive that behavior?

Stepping back and gazing at these points – and I am sure there are others – I ponder why there is so much interest in promoting this particular amendment.  Is it because, as the old Judas Priest song goes, “Out there is a fortune, waiting to be had”? Is it really the case that so many people who are enthusiastic about bossy rules about the size of people’s American flags, house colors or the time people roll out their trash cans are libertarian on this one thing? How will they feel when it is their son or daughter who slips away into depression, relentless anxiety or psychosis?

The argument is made that legal marijuana will be pure – not laced with fentanyl or other deadly substances. Assuming this is the case, and that there arises no underground market to avoid taxes – moonshiners versus revenuers, remember? – the question remains as to whether the risk is worth it in terms of psychiatric and gastric impacts.

Who will pretend, later, to not have known how dangerous what will no doubt be called something like “Big Weed” really was, and rush to sue because of brain damage, the loss of loved ones to suicide or cancer? What about those whose death is due to initiating violence while “high” and being killed by someone in self-defense? What class action suits will emerge to right the wrongs of mass hospitalizations for psychosis and its long-term medical management? Will it in fact be the same ruse of not-knowing used against tobacco, despite its having been referred to as “coffin nails” even in the 1800s? And beyond these major effects, what about the many lives and talents wasted by indifference and ennui as the years-long lingering apathy steals young adulthood and early middle age?

What would make sense:  this proposition as a possible law, not as an amendment, with publicly available hearings and testimonies from all sides: those incarcerated for years for petty possession charges and those whose loved ones spiraled into psychosis and suicide.  Let’s hear sworn testimony and evidence from medical experts on both sides and statisticians who can break down the data on crime and medical impacts.  Then, having heard the information, we can, through the legislative process, pass a law that adheres to the principles of the state constitution and best suits the facts of the situation.

Internet Gaming Disorder? Is that a thing?

Yes, it’s a thing.

Are you (or someone you love) hooked on internet gaming?

An excellent recent article on parenting in Real Simple, “Parenting Against the Internet,” cited a statistic that the average adolescent male spends 20 hours a week playing internet games, and the average adolescent female spends 10 hours a week.

The internet can be great: I can look up all sorts of research, read the news, check the weather, contact family and friends around the world, find obscure used books in a mom-and-pop used book store somewhere across the country…

But for some people, the something good turns into a real problem. The American Psychiatric Association, in its 2013 update on diagnoses, the DSM-5, named Internet Gaming Disorder as a “condition for further study,” rather than an official diagnosis with its own billing code. Tune in within a few years; no doubt, that will change.

Twenty hours a week is a lot of time to spend doing something that teaches little, if any, useful knowledge; isolates a person from contact with real people and real life; is sedentary; and creates a world that is not real but full of very real gratification in terms of the brain’s dopamine system. That’s the average; that means for some people, there’s little or none and for some, it’s the equivalent of a full-time job, absorbing time, energy and mental space that could be dedicated to learning real-life skills, creativity, and other parts of life. Please don’t bother emailing me with examples of games where prosocial behavior is rewarded or you have to know useful stuff to be successful; I know. I also know that at some point it’s unhealthy to live in an artificial land of make-believe, instead of taking that pro-social behavior and useful knowledge and using it to make the world, and yourself, better.

What are the warning signs of this disorder that warrants further expert study? Persistent preoccupation; withdrawal symptoms such as irritability when the games are taken away; tolerance (more time playing games as time goes by); unsuccessful attempts to control the amount of time playing (for example, promising to cut back now that school has begun and sliding right back into excess); losing interest in other activities; continued excessive use of games in spite of problems in relationships, job, school, etc.; lying about how much time is spent playing; using games to deal with other problems (the game is a drug to feel better at this point); jeopardizing or already lost significant relationship, job, educational or career opportunities because of involvement in playing internet games (American Psychiatric Association, 2013). Note that these are games – gambling on the internet is already an official diagnosis when carried too far.

Most people can easily see the degree to which these signs are awfully similar to what we would use to assess a problem with alcohol or drugs: preoccupied with drinking? Cranky or shaky when they can’t get their “fix?” Unable to cut back; getting behind in life in all sorts of areas; lying about how much is used…so why are parents apparently turning a blind eye to how much time their kids spend in this world?

Some theories:

  1. Some parents are as active in gaming as their children and have convinced themselves that those excessive hours are better than other things their child might do. Well, yeah; I suppose you could also argue that it’s better for your child to get drunk than to inject heroin, but that doesn’t make getting drunk a desirable behavior.
  2. Some parents are unaware. They do not realize what their kids are doing in their rooms, on their phones, half the night, or when they’re supposedly doing homework, or when they are in a college classroom, not paying attention.
  3. Some parents think it will be outgrown…although the social skills deficits these young addicts have will often interfere with their ability to successfully navigate college, trade schools and work.

Of course, it’s not just teens. There are adults who sometimes work full time, or part-time, and spent 30+ hours gaming each week. They tend to have marital problems, job problems, or both. Perhaps they have neither a relationship nor a job, but do have angry parents who want very much to be empty-nesters, any decade now.

Don’t think this applies to your child, or to you? Try cutting it off for a week. A week’s not that long. No exceptions. Notice what happens. If you’re afraid to even bring it up because you “don’t want to deal with it,” you have just told yourself something very powerful, and somewhat frightening, about your confidence as a parent and your child’s relationship with gaming.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.