Maybe they’re being secretive and have even stolen money from your wallet. Maybe their physical appearance has changed with rapid weight loss or red eyes. Maybe you’ve noticed a change in their sleep habits, energy level and mood. Maybe you’ve actually found marijuana or other drugs in their room.

Naturally, the thought and possible confirmation of your child using drugs trigger a rush and range of emotions: anger, frustration, disappointment, sadness, fear.

If you think your child is using drugs, how do you approach them? Where do you start?

Two parenting experts shared their insight below.

1. Be direct and calm.

“This issue is too serious for subtlety,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. He suggested readers approach their kids “directly and immediately.”

Avoid letting your anger and frustration spill over into the conversation. According to Lisa Kaplin, Psy.D, a psychologist and life coach who teaches parenting classes, “The best way to approach your child is with delicacy, not drama. If you approach them with panic, anger, aggression or accusations, you can be sure your child will tell you absolutely nothing.”

Yelling, threatening and lecturing your child typically leads them to withdraw, sneak around and lie, she said.

Duffy also suggested approaching your child “from an emotional space of genuine concern for well-being.” He understands that being calm and centered is a lot to ask of parents. “But it is, without a doubt, the approach that works best in my experience.”

It’s common for kids to deny their drug use, or to respond casually (e.g.,” It’s just pot, and I don’t smoke it that often, anyway”). If this happens, “give a brief response in which you tell them that you do not want them to use drugs of any kind,” Kaplin said. Reiterate your house rules about drugs and alcohol use and “the consequences that come with that behavior.”

2. Talk when your child is lucid.

Don’t try to have a serious conversation when your child is drunk or high, Duffy said. “This might seem like common sense, but I have worked with many parents who have attempted to lecture an inebriated teenager.”

3. Ask open-ended questions.

It’s more likely that your child will be honest, and talk about their drug use if you ask open-ended questions. According to Kaplin, these are several examples: “Can you tell me more about that?  How did you feel in that situation? What will you do if that happens again? How can I help you with this?”

If your child admits to using drugs, again, “ask them with open-ended, non-judgmental questions about what drugs they have used, how often, and if they plan on using again.” You also can ask “for their input on how to proceed.”

4. Don’t punish your child.

Avoid punishing your kids, Duffy said. It rarely works. For instance, “Taking a cell phone away will never keep a drug user away from using.”

5. Show your support.

If your child reveals their drug use, “Thank [them] for being honest with you,” Kaplin said. Let them know that you’re “here to help them. Tell them you love them.”

6. Get your child treatment.

It’s key to take your child to see a qualified therapist who specializes in working with teens and young adults. When talking about professional help, don’t negotiate with your child, or take “no” for an answer, Duffy said.

Instead be brief, firm and clear, he said. Duffy gave the following example of what you might say to your child: “It is clear to us that you have been using something, and we are really concerned for your safety. As your safety is our domain as Mom and Dad, we are going to pull rank here and schedule an appointment for someone for you, and all of us, to talk to about this issue.”

Depending on the situation, you can “give [your child] options regarding therapists or treatment centers,” Kaplin said.

Even if your child is over 18 years old, Duffy suggested having a similar conversation. While you can’t force your older child to attend therapy, you can leverage other things, such as your financial position, he said.

It’s also important to get clear on your limits, communicate them to your adult child and follow through, Kaplin said. For instance, “can your child still live with you if they’re using drugs? If not, when must they leave and will you help them with treatment or other living arrangements?”

Knowing your child is possibly using drugs is stressful, scary and painful. And it can be incredibly hard to have a calm conversation. If you feel yourself losing control, take a break, and return when you’ve cooled off. Whether your child admits to using drugs or not, having them see a qualified therapist is critical.

Further Reading

Here’s more on symptoms of teen substance abuse, what parents can do, and reasons your child might use drugs and how to help them.

By inhibiting a small region of the prefrontal cortex — region of the brain responsible for planning and thought — the scientists were able to break the mice’s habits, but, to their surprise, the mice immediately began forming new behavior patterns.

Until now, psychologists and behavioral therapists believed that habits were hidden in the illusive “subconscious.”

But the MIT study shows that the brain is not just aware of habits: it controls them completely, moment by moment. And no matter how long the habits have existed, we can now shut them off, as by the flip of a switch.

The researchers formed habits through repetition and aural cues in mice running through a simple maze over the course of a few weeks. Once they had shown that the habit was fully ingrained, the researchers broke it by interfering with a part of the prefrontal cortex known as the infralimbic (IL) cortex. Using optogenetics, a technique that allows researchers to inhibit specific cells with light, the researchers blocked IL cortex activity for several seconds as the rats approached the point in the maze where they had to decide which way to turn.

The mice’s brains turned from a reflexive, habitual mode to a more cognitive and engaged mode, focused on a goal. Once the mice had broken their old habits, they formed new ones, which the researchers were then able to break again. But the researchers were in for another surprise: the mice immediately regained their original habit. This suggests that habits are never really forgotten, just overwritten or replaced with new ones.

From an evolutionary standpoint, habits make survival simpler by allowing us to make decisions almost automatically, freeing our brain to think about other things as we perform routine tasks. Our brain tends to find familiar, repeatable behaviors out of a sense of security. The problem with “automatic” behaviors is that they leave us vulnerable to forming negative habits, such as procrastinating on bigger projects or smoking cigarettes when driving.

Many fledgling habits go unnoticed because people rarely engage in meta-cognition when undertaking everyday tasks, where habits are likely to form. In fact, as behaviors are repeated in a consistent context, there is an incremental increase in the link between the context and the action — the behavior becomes more automatic. Our habits are a reflection of how we choose to spend time interacting with the world, guided by our short and long term goals — some of which we have had since childhood or seem inexplicable.

When we enjoy certain stimulation, chemicals such as dopamine are released into the brain, relieving stress, improving mood, and providing a sense of reward. But as we repeat the behavior, our tolerance builds, requiring more stimulation to trigger the dopamine receptors.

Sometimes we keep using just to feel normal (dependence), but if the consequences of our behavior become significant and harmful, and the behavior cannot be controlled, our habit is then considered a behavioral addiction, or a process addiction; if it involves illegal or misused substances, it is considered a drug addiction. Those who form “drug habits” often struggle with them for the rest of their lives due to the lasting effects of dependence and dopamine withdrawal on the brain. Like the mice, our old habits are always lurking in the back of our minds.

The ability to break habits in mice may seem like the nexus of a “cure” for addictive behaviors, but it is unclear how inhibiting the IL cortex will affect humans, whose prefrontal cortex is considerably more complex. It is not absurd to imagine a surgery or drug which could hinder the IL cortex in humans, allowing us to escape our negative habits and live reasonably, consciously, unburdened by our old, learned behaviors, but it may not be necessary.

The key to breaking bad habits is becoming aware of the behavior (through friends, family or any support group available); identifying the factors which trigger and encourage its persistence; and altering them however possible.

Similar to describing the feeling of a dream, the context of a habit is important, too: look for indicators and symbols in your everyday life that may stand for something of greater significance and purposefully change their meaning. Keeping a varied schedule is also a passive way to curb habit formation (variety is the spice of life!).

Once you’ve broken the habit, however, remember the mice: you must seek new, positive behaviors that give you a cerebral boost, such as exercising creativity or problem-solving, to keep your brain balanced and healthy.

Or not.

The holidays are stressful. There are the challenges of too much family, not enough family, not enough money, continual exposure to food and alcohol, and perhaps worst of all, the gap between our actual life and our fantasy life. As if gazing into the perfect happy scene within a snowglobe, we might fall into a trance of how our life should be.

We might feel torn apart by nostalgia and grief over the good times and good people of the past, and wracked with guilt and inadequacy for failing to create a more wonderful life for ourselves. We might feel scared about our dissatisfaction and hypnotized by the promise of fulfillment just beyond the hard glass.

Addictive and codependent behaviors thrive during this season of fantasy.

We use our drugs and habits to escape the pain, while imagining how we will miraculously make changes, always tomorrow, or next week, or next year. We frantically try to keep our idea of the all-good holiday alive through our codependent behaviors, imagining that we have the power to make sure that everyone else is happy and no one gets upset, while suppressing our own feelings of anger and disappointment.

So what should we do about our addictive or codependent behaviors during the holidays? Should we just give up and wait until January 1? Or is there hope for progress now?

One option involves using the holiday season to take an honest and compassionate look at our current behaviors. Instead of using up all of our mental energy imagining how our life used to be better, or how our life should be different, or how we need to change, we can turn our minds and eyes toward simply observing present reality.

We can watch our relationships with alcohol, marijuana, cigarettes, chewing tobacco, prescription and non-prescription drugs, gambling, pornography, video games, television or Internet videos, social media, food, exercise, work, and shopping. We can ask ourselves: How much are we using? How much of our time does it consume? How much money are we spending on our habits? How long have we been using? Is it increasing, decreasing, or remaining constant?

We can watch our relationships with our loved ones. We can ask ourselves: How much of our energy is being devoted to worrying about or trying to control other people’s addictive behaviors? How much are we being controlled by fear of others’ reactions to our boundaries or limits?

Then we can ask ourselves: why are we doing this? What purpose does it serve? What immediate rewards do we attain? In what ways are our behaviors fulfilling our needs? Are there feelings of shame, anger, sadness, loneliness, anxiety, or depression tangled up in our habits? How do these feelings lead to our behaviors? How do these feelings result from our behaviors?

How are our habits affecting our physical health? How are our behaviors affecting our relationships with others? How are our drugs, habits, or relationship patterns affecting our work life? What are the short- and long-term benefits and costs?

As we watch and explore our behaviors in an open and neutral manner, we set the stage for our growth toward increased health. We emerge into the New Year with information about ourselves that we need in order to develop a plan of action, if we so choose, toward change. And by being more honest with ourselves and more present in the life we currently are living, we have broken the paralyzing spell of fantasy: We have begun moving toward a better life.

I was able to stop drinking but, like many recovering addicts, I find holidays particularly tough. They can be a dangerous time when recovering from addiction.

My family and friends celebrate the holiday season as many people do — with lovely meals and gifts, gratitude and festive drinks.

I recall my first Christmas sober, three years ago, and the concerted effort my family made, celebrating with more eggnog and less rum. They knew that, early in my sobriety, I was triggered by even the sight of alcohol. Driving past a liquor store would cause my heart to beat quicker. But as the years have passed, and I have become more comfortable in my sobriety, so have they.

Last year, I was surrounded by the bottles I once loved, the liquids I still adore in memory, as my family held their annual Christmas party. No longer did they tip-toe ’round my sobriety and while I was grateful for this sense of normalcy, I was frightened.

I was not frightened because I felt I would relapse and pour rum in my eggnog. I was frightened because alcohol, once a fast and best friend, surrounded me.

I spent a couple of hours talking to people, just enough to pass for being social, and then locked myself in a spare room with a book. The hours passed and laughter become light conversation until the house was blissfully quiet again.

With this year’s holiday season quickly approaching, I plan to deal with the situation differently. I plan to stay sober, just as in previous years, but with less fear.  I have, thankfully, found and maintained relationships with those who are also recovering addicts. I asked them how they felt about sobriety and the holidays. They find it difficult as well. It’s a bit like walking into a bar except you cannot walk quickly away.

A friend who has over a decade of sobriety under her belt told me that the longer one stays sober the easier it becomes to attend events with alcohol and not feel anxious and afraid. Another, new in his sobriety, recognizes his limitations. If he feels uncomfortable in a situation he gracefully leaves. Maintaining sobriety is the most important thing a recovering addict can do.

Addiction is a dangerous disease and the road to recovery is paved with events, holidays and gatherings that remind us that we may still be fragile. But it is this knowledge that allows us to grow.

This year, when I see a bottle of red wine, I will not hide in a spare room with the door locked. I will remember that my sobriety is defined by sanity and in order to stay sober I need to expose myself to the things which scare me.

Someone enjoying eggnog and rum? That’s a good place to start.

There’s a space between normal behavior and an official diagnosis called “almost addicted” that has serious consequences, according to Dr. J. Wesley Boyd, MD, Ph.D, an assistant professor at Harvard Medical School and author of the book Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?

People who are almost addicted still struggle because of their drug use. They may have problems in their personal or professional lives. They also might meet criteria for drug abuse or dependence in the future — at which point it becomes tougher to treat. Intervening now can lead to healthy changes and prevent a full-blown crisis, said Dr. Boyd, also a staff psychiatrist at Cambridge Health Alliance.

Warning Signs of Almost Addiction

People with drug problems are easy to spot. This is actually the biggest myth about drug use, Boyd said. One of his first patients was a professional who was using hundreds of milligrams of oxycontin, every day, for over a year. His wife had no idea. His co-workers had no clue. And there were no complaints about his work performance.

(He finally got caught after a pharmacist called the police. Fortunately, after treatment, years later, he was still drug-free.)

But there are signs to look for. In Almost Addicted Boyd features the Drug Abuse Screening Test (DAST) along with other key questions. These are some of the obvious and not-so-obvious signs he mentioned:

• Abusing prescription drugs
• Inability to get through the week without using drugs
• Feeling guilty about drug use
• Having loved ones worry about your drug use
• Being told by loved ones that your behavior is strange
• Losing friends over drug use
• Losing a job over drug use
• Engaging in illegal activities to get drugs
• Not giving your full effort at work because of drug use
• Writing work emails or doing other things online while under the influence and regretting them later
• Divulging important information about work while under the influence
• Embarrassing your family
• Berating loved ones while under the influence
• Cheating on your spouse while under the influence

How Loved Ones Can Help

There are many things loved ones can do, Boyd said. These are his suggestions:

Don’t enable the behavior. Don’t make it easy for your loved one to keep abusing drugs, Boyd said. Consider how you might be feeding their habit. Take the example of a mom who was giving her teenage son money for lunch and the mall. He kept asking for more money more often. Turns out, as he told Boyd, he was using the cash to buy drugs.

A loved one also might make excuses for a family member who misses work after a night of drug use. “Covering for the behavior allows it to continue longer than it might,” Boyd said.

Talk to your loved one – and stick to the facts. When approaching your loved one, be as straightforward and objective as possible, Boyd said. It’s certainly easier said than done, but try to keep your emotions out of the conversation.

“Whether they’re almost or full-on addicted, most people live in denial,” he said. So if you tell someone “I think you’re abusing drugs,” they’ll likely just deny it. Instead, let the facts drive your conversation. Say “I noticed your eyes were bloodshot and you showed up late to work.”

Ask others to step in. If your loved one is in denial, gather support. For instance, if the person is religious, ask a clergy member to speak to them, Boyd said. If they’re not religious, ask a primary care physician, he said.

Employ leverage. If your loved one refuses help — or again is still in denial — Boyd encourages families to employ any leverage they can (within legal limits, of course). In the adolescent substance abuse program at Boston Children’s Hospital, Boyd and his colleagues use the 7 Cs of leverage: cash, credit card, checks, car, cell phone, computer and curfew.

When you have little or no leverage, rely on the law. For instance, while it’s incredibly difficult, if your loved one is facing legal charges, Boyd advises families to “let the law run its course.” Often, he said, these individuals will be put on probation, which includes drug testing. As he said, “any period of enforced sobriety is better than no sobriety.”

What You Can Do

If you’re the one who’s almost addicted, consider your relationship with the drug openly and honestly, Boyd said. See a mental health professional who specializes in substance use or a primary care physician, he said. Attend support groups such as Narcotics Anonymous or Alcoholics Anonymous. “The only request for going to these meetings is the desire to stop using your substance,” he said.

Some people may be able to quit on their own, Boyd said. For instance, since her teenage years, Boyd’s mom smoked two packs of cigarettes every day. After learning she had early emphysema, she quit cold turkey.

However, if any aspect of your life is at risk – such as your ability to work or keep your home – or there’s an immediate threat to your health, seek professional help right away, he said.

No one is immune to addiction, Boyd said. One of his supervisors, a substance abuse expert, used to say, “As far as I know the reason I’m not a heroin addict is that I haven’t tried heroin.”

Even casual use can become too much. If you’re almost addicted, seek help. If your loved one is almost addicted, offer help.

Learn more about Dr. J. Wesley Boyd at his website. More on the book Almost Addicted here.

Is it cupcakes, potato chips, bread, a big bowl of pasta, cheese fondue, fried chicken, pizza, ice cream or something else?

Do you crave something creamy that melts in your mouth or a salty crunch that takes the edge off?

If you do, you’re similar to 100% of women and 75% of men who reported food cravings in the last year, according to a report in the Wall Street Journal.

Cravings, once considered the body’s way of signaling that we’re missing important nutrients, are now understood to be something quite different.  If they were merely a signal that we were short on, say, magnesium (a nutrient found in chocolate), then why do we tend to crave salty and sweet snacks, rather than healthier options of nutrient rich foods?

Bran, pumpkin seeds and molasses all contain magnesium, but rarely rank high on anyone’s cravings list.

Instead, The Wall Street Journal reports that studies suggest that cravings are a complex combination of different factors.  Social, cultural, psychological and environmental cues all play a part in whether you experience a craving or not. Craving mom’s apple pie or creamy mashed potatoes are often more about the emotion they evoke than the taste of the actual food or the nutrients found in them.  A hot dog at a ball game or popcorn at a movie are often more about the environment than hunger.

Cravings are powerful things.  They are triggered by our environment, our internal need to soothe ourselves or evoke a particular feeling, our cultural expectations and by the people around us.  Not only are they triggered by a wide variety of circumstances, they also affect our bodies like an addiction.

Research on the brain indicates that food cravings activate the same parts of the brain as drug and alcohol cravings.  And, like drug and alcohol, giving in to the craving results in a release of dopamine, the neurotransmitter in the brain that plays an important role in the experience of pleasure.

But, when we give in to cravings too often, our dopamine receptors become flooded.  The neurons compensate for this overload of dopamine by becoming less sensitive.  What this means is that with continued overindulgence, more and more food is required to create the same pleasurable experience.

Instead of craving one cookie, you crave a whole box, and even that doesn’t feel satisfying.  Pam Peek, a physician and author of the book “The Hunger Fix” notes that food addiction changes the brain in the area associated with impulsivity and addictive urges.

The idea that we are constantly surrounded by circumstances that cause us to crave food—often that which is sugary, salty or otherwise unhealthy—can be disheartening.  However, studies show that as we learn to delay gratification and hold off on satisfying our cravings, our urges become weaker.

Although curbing cravings can be difficult, particularly if you’re already in a pattern of indulging, you don’t need to live at the mercy of your cravings.

By calling myself a manic-depressive would I trap my psyche in “sick” mode? By accepting my diagnosis of bipolar disorder, would I prevent healing? By writing the words “I am mentally ill,” was I holding myself to a place that I was, but not where I am now, or where I could go?

I spent a fair amount of time pondering this (I’m a natural ruminator)…. I thought about attracting bad karma by writing about my illness, about feeding my anxiety by connecting with others who also struggle with depression, about stifling my spirit by posing all of my questions and frustrations online in an effort to figure out and assemble this humongous, Anchisaurus (a kind of dinosaur) 500-plus piece puzzle of mental illness.

And then I arrived at this guess (because there are no answers): No.

I looked to my mental health heroes — Abraham Lincoln, Winston Churchill, Art Buchwald, William Styron, and Kay Redfield Jamison — and realized that they slapped on their labels with pride so to educate and inform an ignorant world about mental illness. Because of these label-wearers, millions of people suffering from depression and other mood disorders have been properly diagnosed and treated.

I thought back to the first days of my sobriety, when abstaining from booze was like running a daily marathon. (I quit drinking right as I left for college… the worst possible time in a person’s life to jump on the wagon.) For three years I attended three or more meetings a week, in which I would say something like, “Hi, I’m Therese and I don’t like what happens to me when I drink alcohol,” because I just couldn’t utter the word “alcoholic” two words after the word “I.”

I stumbled and stalled at step one–accepting that I was powerless over alcohol–unable to progress to step two (came to believe in a power greater than ourselves–which I was cool with.) And I obsessed for three years, as my classmates got drunk at the Linebacker bar, about whether or not I was, in fact, an alcoholic.

Toward the end of my junior year, I attended a meeting devoted to the first step.

“Without the first step, you may as well give up the program,” said one guy.

“It’s the foundation,” said another.

I’m doomed, I thought, so I guess I should get drunk.

I drove my Ford Taurus up to the Indiana-Michigan state line from South Bend. (It was a Sunday night and Indiana was dry on the Lord’s day.) I bought a six-pack of Coors, drove back to Saint Mary’s College, parked the car in the student lot, and downed the cans. Then I waited to see what would happen–if puss would start dripping from my nose, if my fingernails would start to curl–some tangible sign that I was, in fact, allergic to these types of beverages.

The next day I confessed to my therapist what I had done, and how I wanted to end my life I was so disgusted with myself. How could I have done something so stupid? Ruin three years of sobriety? And so close to my three-year chip?

“But I can’t do that bloody first step!” I said. “And if I can’t do the first step, I can’t move forward.”

“Therese,” she said very calmly, “you just told me that you are ready to end your life because you are so obsessed with this question and your struggle with alcohol. I’d say, then, that you are powerless over it. If you can’t say that you are powerless over alcohol itself, then say you are powerless over your obsession with alcohol.”

Oh. Now that made sense. Because there were times when I drank that I could stop after two. I didn’t always pass out in a friend’s coat closet or wake up between two trashcans on a neighbor’s lawn. But the obsession about alcohol — well, yeah, that drove me absolutely crazy.

The week of my Michigan road trip was hellish. Friends, hearing that liquor and I were a pair again, invited me to parties that I wanted to attend in the worse way. After all, I deserved to taste the college experience after living three years as a cloistered monk. With one foot in the Linebacker and the other in the monastery, I was more confused than ever. And the puzzlement was poison to my mind and soul, my body and spirit.

Finally I walked to the gazebo on the campus that overlooks the St. Joseph’s river like I did so many times after my runs.

And somehow I let the obsession go. Because I didn’t care if I wore the label of alcoholic or not. I just wanted peace.

“Like a diagnosis, a label is an attempt to assert control and manage uncertainty,” writes Rachel Naomi Remen, M.D, one of the first pioneers in the mind, body, health field. “It may allow us the security and comfort of a mental closure and encourage us not to think about things again. But life never comes to a closure, life is process, even mystery. Life is known only by those who have found a way to be comfortable with change and the unknown.”

I disagree. My labels have freed me to live in better harmony with the person I wish to be.

But unlike most Sundays, when you drive this Sunday coming home from your Super Bowl Party, be especially careful. Why?

Because unlike other Sundays when a football game is televised, researchers found that both non-fatal and fatal car accidents increase 41 percent on average. The risk is highest within an hour of the game’s end, when most people are driving home.

What causes this rise in automobile accidents? Not surprising, alcohol was involved in most fatal injury accidents, as well as a majority of non-fatal accidents. Inattention and fatigue are two additional factors implicated.

Researchers (Redelmeier & Stewart, 2003) examined 27 consecutive Super Bowl games from 1975 to 2001, and then looked at motor vehicle crash data for those same years. They examined accident rates before, during, and after the Super Bowl game, as well as a sample of control Sundays earlier in the year to see if the effect also carried over to normal football games.

Their findings?

We observed a 41 percent relative increase in the average number of fatalities after the telecast. In contrast, we observed no significant difference between Super Bowl Sundays and control Sundays in fatalities before the telecast. [...]

The increase in fatalities after the telecast was evident for 21 of 27 years and amounted to about seven added deaths on the average Super Bowl Sunday as compared with the average control Sunday.

Fatal injuries were largest in states who had a losing team, versus those who had a winning team or had no team in the Super Bowl.

And the results are larger than those for other popular holidays where large amounts of alcohol may be consumed:

The 41 percent relative increase in fatalities after the Super Bowl telecast exceeds the relative increase in fatalities on New Year’s Eve that has prevailed for the past two decades in the United States.

The upshot?

Be careful and especially attentive driving home this Super Bowl Sunday if you’re attending a Super Bowl party, or just watching the game with some friends or family members. Especially if you’re in the losing team’s state. Designate a driver beforehand, and drive defensively.

And of course, enjoy the game. Go Pats!

Reference:

Redelmeier, D.A. & Stewart, C.L. (2003). Driving Fatalities on Super Bowl Sunday. New England Journal of Medicine.

Drug and alcohol addiction remain a serious problem in this country, as well as many others. Surprisingly, nearly 75 percent of all adult illicit drug users are employed, as are most binge and heavy alcohol users, according to the National Institute on Drug Abuse. In the United States, it’s estimated that companies and organizations lose up to $100 billion a year due to employee alcohol and drug abuse, according to the The National Clearinghouse for Alcohol and Drug Information. The destruction to a person’s private life, relationships, friends and family is often immeasurable.

Substance abuse and alcohol abuse treatments are effective and do work. Not only does it help the abuser, it also begins the recovery process to help them repair their relationships with others.

So learning more about how addictions work and what methods are used in their treatment seems like a good idea. That’s why I’m happy to welcome our newest blog, Addiction Recovery by Dr. David Sack, a board-certified addiction psychiatrist and CEO of Elements Behavioral Health. He’ll be blogging here on the topic of addiction and addiction recovery. You can learn more about him here.

Please give a warm Psych Central welcome to Dr. Sack over at Addiction Recovery now!

“Having a mental illness is the same as having any chronic illness,” said Elvira G. Aletta, Ph.D, a clinical psychologist and founder of Explore What’s Next, a comprehensive psychotherapy practice. So it helps to have a plan and take good care of yourself.

Here are nine tips for coping with the holidays.

1. Make yourself a priority.

During the holidays, as we’re hosting, shopping, cooking, cleaning, attending get-togethers and checking off other tasks on our to-do lists, self-care often takes a backseat. But “your health comes first,” said Dr. Aletta, who’s also a Psych Central contributor.

This also means maintaining your routine as much as possible. “Make sure you get the sleep you need and keep up any activities that make you feel good such as exercise or time with friends,” Dr. Mininni said.

2. Avoid feeling guilty.

During the holiday season, many of us want to be many things to our loved ones. And we don’t want to hurt anyone’s feelings. So we put pressure on ourselves along with a hefty side of stress-inducing guilt.

Remind yourself that pleasing everyone is unrealistic. “Set aside the guilt, push the pause button on it or throw it out completely if you can. Put it on a shelf, in a box, labeled ‘I will talk about this later with my therapist,’” Dr. Aletta said.

3. Keep connected.

If you aren’t feeling well, you might be tempted to isolate yourself. But this will just make you feel worse, Dr. Mininni said. “If you’re not in the holiday mood, consider spending time with a friend or calling a person who cares about you. Connecting with just one person can make you 10 times less likely to get depressed,” she said.

4. Tune into your feelings—and be honest.

You may love your family very much. But if you’re honest with yourself, you might realize that being with them also can be stressful. Coming to this realization, while uncomfortable, will help you figure out better ways to cope, Dr. Aletta said.

5. Identify what you really want to do.

For instance, you might want to spend the entire day with your family or just go for dessert, Dr. Aletta said. “Once being with [your family] is a choice instead of a gun-to-your-head obligation maybe you can relax a bit.”

6. Plan a timeout when stress strikes.

Dr. Aletta encouraged readers to give themselves permission to leave a stressful situation. Your “strategic retreat” may be anything from walking the dog to getting tea at a café to listening to soothing music to having a good cry, she said. Then decide whether the healthier choice is to return to the get-together or go home.

7. Buddy up.

“Have a confidant close by or on speed dial: a friend, cousin, sister or niece who ‘gets it,’” Dr. Aletta said. In fact, “She may need your help to get through as much as you need hers,” she added.

8. Avoid alcohol.

Alcohol can interfere with medication and exacerbate symptoms. It also might spark an altercation or two. “You do not want to be disinhibited when there is even one person in the room who can hit your buttons with an emotional Taser,” Dr. Aletta said. On a similar note, she suggested that readers avoid confronting people in general.

9. Laugh—a lot.

“See the humor wherever and whenever you can,” Dr. Aletta said. That’s because humor heals. (If you’d like some proof, Therese Borchard’s piece on humor is a must-read.)

Anyone who doubts the relationship need only to spend a night in our house and see what type of behavior happens when two kids consume 12-ounce cans of Coke or Sprite — and the demonic demonstrations that happen after a 7-11 slurpee, especially if it’s red or blue, or God forbid, a mix.

People who suffer from depression are especially vulnerable to sugar’s evil power. I am so sensitive to white-flour, processed foods that I can practically set an alarm to for three hours after consumption, at which time I will be cursing myself for inhaling the large piece of birthday cake at the party because I am feeling so miserable. That doesn’t stop me from eating dessert at the next gathering, of course, but the awareness between sugar and mood does help me better understand some of my crashes.

What, exactly, is going on inside our brain when we take a bite of that fudge cheesecake?

I found a cool site called “Food for the Brain” that offers this simple explanation:

Eating lots of sugar is going to give you sudden peaks and troughs in the amount of glucose in your blood; symptoms that this is going on include fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, excessive thirst, depression and crying spells, digestive disturbances and blurred vision. Since the brain depends on an even supply of glucose it is no surprise to find that sugar has been implicated in aggressive behavior, anxiety, and depression, and fatigue.

Lots of refined sugar and refined carbohydrates (meaning white bread, pasta, rice and most processed foods,) is also linked with depression because these foods not only supply very little in the way of nutrients but they also use up the mood enhancing B vitamins; turning each teaspoon of sugar into energy needs B vitamins. In fact, a study of 3,456 middle-aged civil servants, published in British Journal of Psychiatry found that those who had a diet which contained a lot of processed foods had a 58% increased risk for depression, whereas those whose diet could be described as containing more whole foods had a 26% reduced risk for depression.

Sugar also diverts the supply of another nutrient involved in mood – chromium. This mineral is vital for keeping your blood sugar level stable because insulin, which clears glucose from the blood, can’t work properly without it.

So what do you do if you want to level out your blood sugar so that it’s behaving more like the Dalai Lama than Michael Jackson inside your brain? In her national bestseller “Potatoes Not Prozac,” Kathleen DesMaisons offers a seven-step dietary plan for sugar-sensitive people like me. I’ve tried to implement her suggestions into my diet because, as a recovering drunk and depressive, too much sugar can get downright ugly.

Here’s what DesMaisons proposes:

• Keep a food journal. The journal keeps you in relationship to your body. It reminds you of the connection between what you eat and how you feel.
• Maintain your blood sugar level. Stay steady and clear. Always have breakfast. Eat three meals a day at regular intervals. Eat brown things (whole grains, beans, potatoes, and roots), green things (broccoli and other green vegetables), and yellow things (squash and other yellow vegetables). Choose foods with the least sugars and the most fiber.
• Enhance your serotonin level. Eat protein at each meal. Make sure that enough tryptophan is swimming around in your blood. Have a complex carbohydrate (without any protein) three hours after your protein meal to boost tryptophan into your brain. The baked potato as a nightcap is a powerful tool.
• Enhance your beta-endorphin level. Reduce or eliminate sugars and white things to minimize the beta-endorphin priming that comes with a hit of sugars. Make life changes to enhance behaviors and activities (meditation, exercise, music, orgasm, yoga, prayer, dancing) that evoke or support the production of your own beta-endorphin in a steady and consistent way.

Image courtesy of Cup-Cake.com.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.

You begin your book with the quote from Khaled Hosseini’s book, The Kite Runner: “And that, I believe, is what true redemption is … when guilt leads to good.”

Do you believe your work with other addicts is partly what keeps you clean and sober? Why compels you to enter into such hopeless situations and try to fix things?

Joani: I think as the quote infers “when guilt leads to good,” my work with addicts and alcoholics assuages my own continued ambivalence about my responsibility about having this disease. It is not at all logical. There is no “choice” about having this disease. That has been proven by medical science.

But the behavior that is manifested during the active state of addiction is not pretty and I think that is where the lingering guilt comes from. So sometimes my frenetic work with other alcoholics is an atonement of sorts, turning guilt into good!

And yes it keeps me sober. If I didn’t see the addict sick so much, I am sure I could get addicted again. Even though it is hell, it is a familiar hell. What keeps me sober is seeing the families in pain. I don’t want my kids or husband to live with that insanity. I don’t want my children to be negatively affected as adults as a result of living with my addiction.

I don’t see the situations as hopeless. That is probably one of the biggest gifts I give to the addicts for whom I do interventions. I see them as exhibiting a very treatable disease. A paycheck compels me to do interventions as well. Not a popular answer I know, but we are a two-income family with a special needs son with autism. I am a working mom! Also I just plain love it. It is never boring, I am a bit of an adrenaline junkie. Every day at work is different. You never know exactly what is going to happen when the addict/alcoholic walks into the room.



Both of your parents were alcoholics/addicts. And you explain in your pages how hard it is for an offspring of two addicts to rise above the bad genes and live a life of recovery. You have done it. What steps can you give others who were also raised by alcoholics or addicts?

Joani: I started in a 12-step fellowship Adult Children of Alcoholics (ACOA). I think I stayed in this group for seven years. It really helped me to see how many of my aberrant coping styles and general craziness were a direct result of having lived in an alcoholic home. I learned that it wasn’t so unusual … that many of us shared a common “pathology.” Then I was hit with my own addiction, which really pissed me off. Even with all my knowledge of my family, I still did not dodge the addict/alcoholic bullet. But genes are very hard bullets to dodge. So, yes, it was tough, being a product of an alcoholic home and then becoming one myself. But life is not always fair and you have play the hand your dealt.

Having spent time in ACOA gave me a working knowledge of 12-step recovery to fall back on when I became addicted. But first I had to go to hell. Like many addicts, the pain of the addiction had to outweigh the benefits I received from doing the drug before I seriously gave it up. That pain came from a near death from an overdose and an ache in my heart that my children could very possibly lose me and grow up without a mommy. That was the turning point.

You have battled both a mood disorder and an addiction. Do you think the recovery cultures of both clash? The 12-step world is harsher on a person than, say, a psych unit to someone with bipolar. How do you navigate that territory of both mood disorder and addiction?

Joani: You are right. You get more respect with a psychiatric diagnosis versus substance abuse. There are still many misconceptions and moral prejudices around addiction. I think though they are blending better in both the medical field and the 12-step community. It used to be that in some 12-step meetings you would hear “no psycho babble” rules.

But that is passing. I am not sure of the exact statistics but many, many addicts have co-occurring psychiatric diagnoses. One of the questions I always ask families as I am planning an intervention for their loved ones is “Has the patient ever had a psychiatric diagnosis?” This is very important when determining where you are going to place the patient. Some rehabs do a better job with co-occurring patients. Some rehabs take “mild” mental health problems, while others will take more severely affected patients.

Personally I take three psych meds and I am very stable! Finding the right mix is a challenge from time to time. My psych diagnosis is general and social anxiety, with mild panic and mild depression or dysthymia. I am not crazy about some of the side effects, but I am not well off of them. In 12-step meetings we primarily talk about our addictions and the 12 steps. When psych stuff is brought up, most folks respectfully listen. There are specific meeting for people with extreme mental illness and addiction.

Addiction, in general, is easier for me to deal with than mental illness. Most likely because it is not my expertise. But I am learning all the time from my brave patients.

But one finding stood out for me as being a bit sensationalistic. That finding was that pathological gambling — something other studies have consistently pegged in the 0.8% to 2.0% range of adults (see Stucki & Rihs-Middel, 2007) — is more common than alcohol dependence (which studies put in the 3.8% range, see Keyes et al., 2009). Past research has shown that alcohol dependence (also known as alcoholism) is something that occurs in the adult population at twice the rate of pathological gambling.

In Welte’s (2011) study, however, the researchers found something different altogether. They found that from age 22 onwards, pathological gambling is more prevalent than alcoholism. And in the age 31 to 40 group, they found it nearly 3 times as prevalent (at over 5 percent of that age group)!

So what’s going on here? What could account for this significant discrepancy between this new study and much of the previous research?

How Researchers Define Something is Key

One of social science researchers’ dirty little secrets is that they can make statistical data pretty much show anything they want, as long as they design the study correctly from the start. And there’s no better way to do this than to create definitions that favor your hypotheses.

For instance, if you’re a researcher who studies a lot of gambling, you’re going to start off making sure that the definition of gambling you use is as broad as possible. While this is great for inclusiveness, it also means that the “problem” of gambling is going to cast a much wider net, including things that most of wouldn’t ordinarily even consider gambling.

How did the current study’s researchers define gambling?

Both surveys included questions on the frequency of past-year gambling on specific types of gambling. These were: (1) raffles, office pools, and charitable gambling, (2) pulltabs, (3) bingo, (4) cards, not in a casino, (5) games of skill, e.g., pool, golf, (6) dice, not in a casino, (7) sports betting, (8) horse or dog track, (9) horses, dogs off-track, (10) gambling machines, not in a casino, (11) casino, (12) lottery, (13) lottery video-keno, (14) internet gambling, and (15) other gambling.

I’m not sure the researchers understand the meaning of the word “specific” when they then go ahead and list every possible type of activity that involves money and chance. As well as that very specific category we’re all used to playing, “other gambling.”

Would most of us consider playing the lottery “gambling,” in the same league as playing craps at the casino? It’s no wonder the researchers found that more than 70 percent of people “gambled” in the past year in all adult age groups. And that, when we reach our 30s, 25 percent or more of us gamble more than 52 times a year. To put you in that category, all you need do is buy one lottery ticket a week. Or play the college basketball brackets.

The other issue is how researchers use a phrase — “problem gambling” — that isn’t actually defined in the DSM-IV (the psychiatric reference manual that defines mental disorders). Researchers have long used a largely arbitrary cutoff of three symptoms, out of a possible 10, to define this “problem gambling.” (A person needs five symptoms to qualify for a pathological gambling diagnosis.)

Here’s what the researchers in this study did:

Endorsement of five or more criteria is considered DIS (Diagnostic Interview Schedule, Robins et al. 1996) pathological gambling (APA 1994), and endorsement of three or more criteria was considered to be DIS problem or pathological gambling.

This has been done so often now, the researchers didn’t even bother with a rationale for using the number three.

Chasing down when and how exactly researchers began accepting three as the magic number to define “problem gambling” is like trying to research your family genealogy. Researchers keep referring back to other research, which refers back to other research, and so on. If you follow this path long enough, ostensibly you’ll get to a study that demonstrates this is a reliable and valid method for defining “problem gambling.”

The problem here is that, as far as I can tell, that study was never done.

For instance, Toce-Gerstein et al. (2003) states:

For our analysis, we labeled gamblers meeting three or four criteria “problem gamblers,” consistent with much of the existing literature (Lesieur & Blume, 1987; Shaffer et al., 1997; Abbott & Volberg, 1999).

Then you go and look all of those studies up and read them. The Shaffer meta-analysis divided gambling into three levels (Level 1 = no problem, Level 2 = subclinical problem, Level 3 = pathological gambling), but only because they found lots of studies with varying criteria that didn’t always match up quite properly. This was their way of modeling the problem in order to properly categorize and analyze the research. It’s also important to note that Shaffer et al. considered Level 2 to be “bi-directional” — that is, people could be moving toward becoming a pathological gambler, or they could be moving away from pathological gambling.

Abbott & Volberg refined this criteria in a 159 page report (not a peer-reviewed journal article) prepared for the New Zealand government. They suggested the DSM-IV criteria could range in the 3 to 4 symptoms for a present gambling problem. Somehow, over time, we see the criteria moving from “3 to 4″ to just three. Three will naturally include more people.

The Lesieur & Blume study refers to the South Oaks Gambling Screen, a 20-item test that was later shown to greatly overestimate pathological and problem gambling (see, for example, Thompson et al., 2005). So that doesn’t exactly help us here.

None of these citations actually conducted a study to demonstrate that three criteria defined a clinically and statistically significant “problem gambling” category. They were just researchers who theorized these numbers “felt right.”

I suspect the reasoning went something like this: “If five is the current diagnostic cutoff for pathological gambling, and four was the old cutoff (prior to the DSM-IV), then three feels like a good number to consider something a ‘problem gambling’ behavior.”

Ostensibly, you could do this with any disorder in the DSM-IV. You could create a whole new set of “subclinical disorders” that suggest a person is “at-risk” and therefore would benefit from treatment. From super-mild depression (since mild depression is already a diagnosis) and “problem attention disorder”, to “problem bipolar disorder” and “problem anxiety disorder.” The list is endless! Better yet, you now categorize a whole class of people that previously didn’t have a disorder to one that does.

Put the two issues together — liberal “gambling” definition + arbitrary definition of “problem gambling” — and what you have is — ta da! — researchers finding a non-diagnosis (“problem gambling”) is far more common than an actual diagnosis (“alcohol dependence”).

Now, don’t get me wrong. I’m not saying that there might not be a continuum of gambling disorders and their severity. But in the current diagnostic schema, you either have pathological gambling or you don’t. You might be “at risk” for pathological gambling if you find you meet 2 or 3 or even 4 of those criteria. But you also may not be; the research can’t say.

Indeed, three might be the “magic number” that separates problem gambling from just people who enjoy gambling, but the research — to me — is unconvincing.

Gambling can turn into a serious problem in societies that offer it to their citizens. We benefit from studies that provide us an accurate understanding of the extent of the problem, and its comparison to other serious mental health issues and concerns. I’m not convinced the current study does this.

Read the full news release: Gambling Problems are More Common than Drinking Problems, Study Finds

References

Keyes, Katherine M.; Geier, Timothy; Grant, Bridget F.; Hasin, Deborah S.; (2009). Influence of a drinking quantity and frequency measure on the prevalence and demographic correlates of DSM-IV alcohol dependence. Alcoholism: Clinical and Experimental Research, 33(5), 761-771.

Stucki, S. & Rihs-Middel, M. (2007). Prevalence of adult problem and pathological gambling between 2000 and 2005: An update. Journal of Gambling Studies, 23(3), 245-257.

Toce-Gerstein, M., Gerstein, D.R., & Volberg, R.A. (2003). A hierarchy of gambling disorders in the community. Addiction, 98, 1661-1672.

Welte, J.W., Barnes, G.M., Tidwell, M-C., Hoffman, J.H. (2011). Gambling and Problem Gambling Across the Lifespan. Journal of Gambling Studies, 27(1), 49-61. DOI: 10.1007/s10899-010-9195-z

A lot of people have trouble with Alcoholics Anonymous. AA is full of people and people can be messy and flawed.

The human train wreck formally known as Charlie Sheen is a common sight in the AA meeting halls. The only difference between Mr. Sheen and other self-absorbed, delusional, frantic addicts is the size of the audience to which they rant. These people do not last long in AA. They mock the Fellowship and the 12 Steps (PDF) as too religious or simplistic. AA is beneath them.

Here are a few possible reasons why Charlie Sheen might hate AA so much.

Reasons Why Charlie Sheen May Hate AA

1. He would have to admit he is powerless.
2. He would need to embrace Humility.
3. Deep tissue Change would be required.
4. He would have to be Anonymous!
5. His Higher Power could not be Charlie Sheen.
6. He couldn’t blame anyone else for his troubles.
7. He would need to learn to be Grateful.

People can get sober without AA. It is not necessarily for everyone, by any means. Even so, I have a deep respect for it.

For a few years after getting my B.A. and before going to graduate school, I was a substance abuse counselor at the Substance Abuse Center of Johnson County, close to Kansas City, Kansas. What I learned there was worth five Ph.D.s. Not being an alcoholic, I thought it was important for me to know as much as I could about my clients’ experience. That’s why I attended as many open AA meetings as I could. It was an eye opener. The members made me feel welcome everywhere I went. One of my proudest possessions is my 30 day coin.

What did I learn? I learned that you can’t just go to one AA meeting and think you know AA. Every meeting, every location had its own kind of culture. There were the hard-core biker meetings, the white-collar professional meetings, the womens’ meetings, huge open meetings, more intimate closed meetings…. you get the picture.

There were also the religious meetings, yes, and the agnostic ones. I learned my higher power did not have to be God in the Judeo-Christian tradition, although a lot of people were comfortable with that. If I wanted my dog Snoopy to be my Higher Power I was encouraged to go for it, as long as I gave up my need to Control and was willing to give it to something meaningful outside myself.

I learned that AA was a great leveler. Everyone was the essentially same: the lawyer and the short-order cook, the doctor and the housewife. Each were equally brave. Each deeply respected for the courage it took to just show up.

Sadly, all this Mr. Charlie Sheen, gripped by his illness, cannot comprehend. It must be terrifying for him to imagine a place where he would no longer be CHARLIE SHEEN!

He would just be Charlie.