Whether it is deciding to break open the gifted bourbon from a grateful client, sipping Aunt Sue’s holiday eggnog all evening on Christmas eve, or having more than a few cocktails at the never-ending string of holiday parties, we know that this season of comfort and joy may find us going a little heavier on the “comfort,” which can be especially troubling for those with a substance use disorder.

The holidays certainly offer plenty of occasions to use alcohol in a celebratory fashion. However, multiple studies have shown that levels of unhealthy drinking habits skyrocket during the holiday season. This can take the form of justifications such as, “It’s fine! I always have a few glasses of wine when we decorate,” to “It doesn’t really count. It’s the holidays!” Regardless of the rationale used, even those who are moderate drinkers throughout the year can be found giving themselves permission to consume more alcohol during this time of year than what is usual for them at other times.

Substance Use During The Holidays Statistics

According to a study conducted by the American Psychological Association (APA), 38% of people surveyed said their stress increased during the holiday season. Increased stress levels can lead to physical illness, depression, anxiety, and substance misuse. The reasons attributed to this behavior were lack of time, financial pressure, gift-giving, and family gatherings to name a few.

Interestingly, a separate survey reported that that the average American drinks 27% more during the holiday season as compared to the rest of the year. The Distilled Spirits Council of the United States notes that a quarter of the $49-billion-a-year distilled spirits industry’s profits come from the month between Thanksgiving and the New Year.

On an even more serious note, New Year’s Day is the deadliest day for alcohol-related crashes, with 58% of crashes being alcohol-related according to the U.S. Department of Transportation (DOT) and the National Highway Traffic Safety Administration (NHTSA). They also report drunk driving-related deaths spike 116% above the baseline average, making it the most dangerous holiday of the year for drunk driving. Other causes of alcohol-related deaths during the holidays include alcohol poisoning and incidents at home such as falls, domestic violence, or accidental deaths due to firearms.

Given these surveys, statistics, and behaviors, the question then becomes: why? Why during the season that promotes so much romanticized idealism, magical folklore, and messages of peace and goodwill do we report experiencing so much stress and anxiety? Perhaps the following categories reported by individuals experiencing holiday stress can provide some insight.

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Comparative Thinking/Unrealistic Expectations

The perception of the “perfect holiday” looms large in the minds of those who find themselves responsible for pulling together all the festivities. The pressure, whether self-imposed or imposed by others, is to have “the best holiday ever” with no hiccups or let downs. When reality doesn’t meet our expectations, it is inevitably a disappointment waiting to happen. Comparative thinking is a fast track to depressive thinking, and resentments are fuel for our entitlement to indulge ourselves in any number of behaviors.

Holiday Events

The increase in entertaining, social obligations, and the demands on our time during the holidays almost goes without saying. Friends, family, co-workers, and everyone in between may have parties, dinners, or events they’d like for you to attend, all of which may present the opportunity to be surrounded by triggers.

The likelihood that we can attend every event is unrealistic. What’s worse is choosing whom you’re willing to disappoint can be stressful and produces a lot of anxiety. The logistical challenge of an overly committed calendar creates opportunities for conflict as well as a level of tension that can drive many to self-medicate with drugs or alcohol.

Stressful Family Dynamics

Most everyone is familiar with the common saying, “you can choose your friends, but you can’t choose your family.” Family dynamics can certainly be a recipe for triggers, over-drinking, and relapses. For many, the anticipation of encountering certain situations can cause panic even weeks before the actual events. Ruminating on old wounds and unreconciled trauma can be a source of pain that justifies self-medicating in the minds of those who experience it. Holidays often force us to engage in family situations we can keep at bay during other times of the year.

Busy Schedules

Many people report feeling “over-committed” during the holidays. Living into the demands of our schedules is exhausting physically as well as emotionally. Without proper time to decompress we will most often return to our medications of choice. An overly-filled calendar leaves no time for self-care or the practices that go along with a healthy recovery or daily life.

Traveling

The mere thought of airports during holiday season can cause even the most well-tempered individuals to experience panic and frustration. The anxiety of catching flights, rescheduling cancelled flights, and long layovers in airports can create stressful scenarios where drinking can become more than just a pastime in the airport lounges.

Holiday Shopping/Overspending

Finding the perfect gift, staying within the agreed budget for spending, and the general atmosphere in most retail establishments during this season can be daunting. Watching the credit card balance go up daily can also create a sense of angst and overwhelm. Financial pain is often in the top reasons for relapses and is what many in treatment cite as a motivator for continuing to self-medicate. Creating healthy spending limits not only helps our finances, but also minimizes opportunities to feel triggered by the stress of overwhelming credit card debt.

Alcohol Related Family Traditions

Many families have holiday traditions that lean heavily on alcohol consumption. Nana’s sangria, Uncle Bob’s spiked cider, or simply the obligatory cocktails before a big dinner can create the perception that partaking is a part of belonging and connecting. This subtle sense of expectation to join in can derail our recovery if we buy into it.

Grief/Nostalgia

The first years without certain loved ones we have lost is beyond disheartening, and is something many people are unable to comprehend. Grief and looking back at years past where there were more people around the table, the family was a bit larger, and the laughter a little louder can be a very difficult adjustment to navigate. Grief and disappointment can give way to despair which can certainly open the door to drugs or alcohol.

Isolation

The reality that some people have very few, if any, loved ones to share holidays with can be a silent pain that they are reluctant to share. For those people, isolation is an alienating pain that often has no empathetic witness. Isolation is very often the catalyst for over-drinking and self-medicating. Being alone in our pain is never going to produce a best outcome.

Don’t Let The Holidays Ruin Your Sobriety

These reported scenarios can explain why a season that proclaims comfort and joy on one hand can result in anxiety, frustration, and a desire to escape on the other. What we may refer to as the holiday blues is often the hangover of a combination of these experiences coming together to create the perfect emotional whirlwind. Without support, boundaries, and an intentional game plan to help us navigate these realities, we can be very susceptible to overmedicating or a relapse with consequences that live far beyond the holiday blues.

If you or someone you know is struggling with drugs or alcohol, don’t wait until the holidays are over to get help. If you’re ready to take the first step, contact a treatment provider today to get started.

The post Why Does Drug And Alcohol Use Spike During the Holidays? appeared first on Addiction Center.

Whether people are being dishonest about whether they have been exercising, eating healthy, or taking their medications as prescribed, many are not honest with the professionals that they have put their trust in to provide health care. Disclosing drug or alcohol abuse is no different, and if anything, it adds an additional level of anxiety for patients. It’s understandable to feel vulnerable when self-disclosing substance abuse with a primary care provider as many individuals fear judgment, being reported, or receiving mistreatment.

However, it is crucial to be completely honest with your doctor about how much you are drinking or if you are abusing any drugs. This will not only help you receive effective treatment, but may save your life.

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Why Are People Dishonest About Substance Use?

Before discussing why it is a good idea to be honest about substance use with your doctor, let’s review why individuals may be dishonest in the first place.

In a recent study published in JAMA Network Open, researchers explored why some patients are not telling the truth to their healthcare providers. Their findings included:

• 82% of patients identified as not wanting to be judged, stigmatized, or lectured.
• 76% of patients said they didn’t want to know that what they were doing was harmful.
• 61% of patients said they were embarrassed.

The study also found that people were more willing to be honest about their mental health symptoms to an online bot than a human face-to-face. Beyond what the study found, there are other reasons why an individual may not be honest about their substance use history with a primary care provider.

Abusing drugs or alcohol adds additional patient motives for dishonesty. Some patients said that they:

• Did not want their substance use included in their medical record.
• Feared mistreatment and not getting or receiving fair medical treatment.
• Did not want to come across as difficult.
• Feared being reported to some authority or agency.
• Are not ready to admit their substance misuse.
• Did not want to take up more of the doctor’s time.
• Disagreed with the treatment recommendation.
• Did not understand what the doctor was saying.
• Failed to comply with the recommended treatment plan.
• Did not want help.

Consequences Of Dishonesty

For some of the reasons stated above, it is understandable why some people find it difficult to be honest about their substance use with their primary care provider. However, not being truthful about substance use can have significant implications and consequences on your health ranging from mild to potentially fatal. 

For example, suppose the initial assessment of a patient identifies the incorrect problem because the patient did not disclose their substance use history. In that case, this inaccurate assessment could lead to misdiagnosis and mistreatment (e.g., incorrect medications, wrong treatment plan), causing ineffective results and wasting money and time.

Here are a few examples of these implications:

• Substance use history is directly related to your medical treatment. While this is something that people often do not want to disclose when they are admitted to the hospital, not disclosing substance use could create more health problems. For example, if you’ve been using Cocaine and are having a heart attack, certain standard treatments might actually make it worse.
• Common mild to moderate symptoms of withdrawal from alcohol and Benzodiazepines can feel like anxiety symptoms and can even lead to panic attacks. Sometimes people obtain a mental health therapist or psychiatrist or inform their primary care provider of their symptoms without sharing information about their substance use. Not disclosing one’s substance use history can lead an individual to endure potentially ineffective treatment. Withdrawal from alcohol or Benzodiazepines can cause seizures, convulsions, and strokes, and withdrawal symptoms can be potentially fatal if not medically treated.

• Specific drug interactions can be harmful. Some combinations make the medications stronger or weaker; some can even cancel each other out so they become ineffective.
• If you are admitted to the hospital for an overdose, it is imperative that you share with your doctor exactly what substance you took so they can administer the proper medication to save your life.

How To Be Honest About Substance Use With Your Doctor

While being honest with your primary care provider may feel difficult, remembering the following things might make it easier:

Doctor-Patient Confidentiality:

First, you don’t have to worry that disclosing your drug use to your doctor will get you in any legal trouble. Your doctor is bound by confidentiality and can’t release your information to a third party without your permission per federal law. Additionally, a prosecutor can’t call your doctor against you in a legal trial.

Teamwork:

The relationship with your doctor works best if you can collaborate and work as a team for your treatment. 

Resource:

Your doctor may be able to provide objective feedback about the severity of your substance use and make referrals to specialists to determine the level of care that you need. 

No Surprises:

It is likely that your doctor has spent many years or decades tending to a wide variety of needs for their patients. While you may feel like your situation is too difficult or unique for a doctor to deal with, they have likely treated similar cases in the past.

Time For A Change:

If you do not feel that you can be honest with your primary care provider, it may be time for a new doctor. It is imperative that you feel comfortable and supported by your primary care provider.

Tests:

Even if you do not disclose your substance use, your blood work and urine can indicate a high possibility of substance use.

Honesty:

To ease your anxieties about being honest about your health, you can think of your primary care provider as a scientist simply collecting data. They need to have honest answers from you in order to assess and treat the presenting concern accurately and effectively.

Put Your Health First

Disclosing substance abuse to your health care providers is imperative to effectively tending to your health. Not being honest with your primary care provider can have serious implications and consequences. Find a compassionate and knowledgeable doctor that you can trust and be honest with about your substance use history.

If you are struggling with drug or alcohol abuse, your doctor may recommend that you seek professional addiction treatment. This is meant with your best interest in mind so that you can work towards living a healthy and fulfilling life.  

If you or a loved one has an addiction and are ready to find a rehab, contact a treatment provider today to discuss treatment options.

The post Why It’s Important To Be Honest About Substance Use With Your Doctor appeared first on Addiction Center.

In the midst of a global pandemic the United States is also dealing with an epidemic. The devastating synthetic Opioid (primarily Fentanyl) use and overdose epidemic is taking lives at astounding rates.

For starters, let’s do a quick review of the 4 categories of Opioids commonly seen in Opioid overdose:

• Natural Opiates (including Morphine and Codeine) and semi-synthetic Opioids (drugs like Oxycodone, Hydrocodone, Hydromorphone, and Oxymorphone). Commonly prescribed as an analgesic (pain reliever).
• Methadone, a synthetic Opioid. Typically used for medication assisted treatment of Opioid use disorder and also pain management.
• Synthetic Opioids other than Methadone (drugs like Tramadol and Fentanyl). Commonly prescribed as an analgesic (pain reliever). Fentanyl is a synthetic and short-acting Opioid analgesic that is 50-100 times more potent than Morphine.
• Heroin, an illicit (illegally made Schedule I) Opioid synthesized from Morphine that can be a white or brown powder, or a black sticky substance. Schedule I substances under the Controlled Substances Act have a high potential for abuse and no currently accepted medical use for treatment in the United States.

For most of my 30-year career in the field of substance use treatment, I have seen the impact of this epidemic morph, grow, and just like the disease of addiction itself, it has become insidious and progressively worse.

The Opioid epidemic predates the pandemic with the first wave beginning in the 1990’s with increased prescribing of Opioids. Most overdose deaths during this time involved prescription Opioids (natural and semi-synthetic Opioids and Methadone).

In 2010, the second wave began with rapid increases in overdose deaths involving Heroin.

The third wave began in 2013, with significant increases in overdose deaths involving synthetic Opioids, particularly Fentanyl manufactured illicitly in clandestine ways. Fentanyl was initially developed in 1959 and introduced to the United States in the early 1960’s as an effective anesthetic to be used during medical procedures.

As a foreshadowing of sorts, my first introduction to the potency of Fentanyl was even earlier than 2013 when I worked for health practitioners’ monitoring program from 2003-2007. I had anesthesiologists on my caseload whose drug of choice was Fentanyl. I recall one instance where the anesthesiologist, during surgery, had one IV line going into a patient and another line going into themselves under the table; they overdosed during surgery.

It was during this time frame when we would say that the first sign that someone had relapsed on Fentanyl was death. Meaning, most people did not have the same progressive use and tolerance leading to overdose and subsequent revival stories we would typically see with other Opioids/Opiates. Instead, their first return to Fentanyl use was immediate overdose and death.

Deaths From The Synthetic Opioid Epidemic

The market for illicitly manufactured Fentanyl continues to grow and change. Fentanyl can be found mixed in Heroin, pain killers, and Cocaine. Synthetic Opioids, illicitly made Fentanyl in particular, are the primary driver of the increases in overdose deaths.

According to the Center for Disease Control’s (CDC) National Center for Health Statistics, there was a decline in Heroin overdose deaths 4.1% from 2017 to 2018; however, the Fentanyl related overdose deaths continued to increase as Heroin users were introduced to the more potent Fentanyl. Sometimes they unknowingly had Fentanyl mixed in their Heroin as drug dealers sought more profit. Other times Heroin users abandoned Heroin for what they thought and hoped was Fentanyl which led to their demise.

The number of overdose deaths increased 18.2% from the 12-months ending in June 2019 to the 12-months ending in May 2020.

Overdose death estimates indicate that the largest monthly increases in drug overdose deaths occurred in the 12-months ending in April 2020 (77,842 deaths) to the 12-months ending in May 2020 (81,230 deaths). These one-month increases of 2,146 deaths and 3,388 deaths, respectively for the 12-month periods, are the largest monthly increases documented since 12-month estimates began to be calculated in January 2015.

Where Is The Synthetic Opioid Use And Overdose Epidemic Now?

As stated above, the increases in drug overdose deaths appear to have accelerated during the COVID-19 pandemic. We are learning that many variables during the pandemic are the cause of this increase (e.g. social isolation, decrease in healthcare insurance for substance use treatment, waiting list for substance use treatment, increase in untreated mental health disorders, changes in access to medication and subsequent drug supply, financial strain, stress, pre-existing medical conditions exacerbated, poor coping skills, etc.).

Data from the CDC National Center for Health Statistics indicate that there were an estimated 100,306 drug overdose deaths in the United States during the 12-month period ending in April 2021, an increase of 28.5% from the deaths during the same period the year before.

Overdose deaths from psychostimulants such as Methamphetamine also increased in the 12-month period ending in April 2021.

Official CDC Health Advisory Recommendations

The CDC has generated many health alerts and health advisories related to the pandemic and the epidemic as they both are significant public health concerns. Below is an abbreviated sample of the Emergency CDC Health Advisory #CDCHAN-00438 entitled, “Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic.”

1. Expand the provision and use of Naloxone, a medication that can immediately reverse an overdose to an Opiate, and overdose prevention education by:
2. Increasing awareness, access, and proper administration of the general public through the use of public health departments and community-based organizations.
3. Increasing awareness about potency of drugs, consequences of mixing drugs and using drugs alone.
4. Healthcare providers:

• Talk to patients about the changing illicit risks for overdose and exposure to highly potent Opioids such as illicitly manufactured Fentanyl.
• Prescribe Naloxone to individuals at risk for Opioid overdose.
• Co-prescribe Naloxone to patients with high Morphine milligram equivalents and those receiving Opioids and Benzodiazepines.
• Expand locations in which overdose prevention education and take-home Naloxone are provided.
• Counsel patients that multiple doses of Naloxone may be needed for a single overdose event because of the potency of illicitly manufactured Fentanyl and Fentanyl analogs.

1. Harm reduction organizations:

• Increase the provision of overdose prevention education and take-home Naloxone to people who use drugs, their friends, and others likely to witness or experience an overdose.
• Ensure that individuals have sufficient doses of take-home Naloxone to account for the potency of illicitly manufactured Fentanyl and Fentanyl analogs.
• Call 911 immediately after recognizing an overdose or resuscitating a patient. Naloxone available in the field may not be sufficient to reverse the overdose.
• Prioritize Naloxone distribution to people who use drugs following periods of abstinence and during transitions where Opioid tolerance may have waned. There is a higher risk of overdose during these periods.

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A Look Ahead

March 28, 2022, President Biden called for increased funding to address addiction and the overdose epidemic. “A core component of President Biden’s Unity Agenda is beating the Opioid and overdose epidemic that claims an American life every five minutes,” said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP).

“The requested increased funding would support the expansion of evidence-based prevention, treatment, harm reduction, and recovery support services, with targeted investments to support underserved communities, reduce the supply of illicit drugs like Fentanyl and stop drug trafficking,” says the March 28, 2002 press release.

Finding Help

If you or someone you love is using illicit drugs, there is no guarantee for safety. Illicit drugs can contain dangerous levels of Fentanyl that is unrecognizable by the human eye. Ceasing drug use is the only real way to protect yourself from an overdose. As the synthetic Opioid epidemic continues, take advantage of free resources available to you, and reach out to a treatment provider here. A treatment provider can have a confidential conversation with you about the admission process into a licensed treatment facility.

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The post The Synthetic Opioid Epidemic appeared first on Addiction Center.

When we take a look a look around, we cannot escape the fact that there are many things happening in our lives, homes, communities, states, countries, the world, and our planet that are having an effect on us. It can often be difficult to manage stress.

In my 30 years as a substance abuse counselor, life recovery coach, employee assistance professional, and corporate trainer, I have never seen such a dramatic collective increase of stress, anxiety, and depression.

Building resilience is one effective way to improve symptoms related to these mental health concerns.

Merriam-Webster’s dictionary defines resilience as, “An ability to recover from or adjust easily to misfortune.” Most people think of resilience as the ability to bounce back after adversity or a stressful situation.

As resilience research has evolved, we have come to understand that resilience is the ability to successfully adapt and effectively cope in the face of adversity such that recovery is beyond bouncing back or “surviving” to an improved state of being or “thriving.”

The experience of stress, anxiety and depression is not only emotional but also physical and physiological. Learning healthy ways to cope and manage has never been more important. This article provides practical and healthy suggestions for building resilience by managing symptoms related to stress, anxiety, and depression.

23 Actions You Can Take Today

1. Do a physical activity for at least 20 minutes, 3 to 4 times a week.

Taking a walk, dancing to your favorite playlist, cycling, roller skating, yoga, swimming, carefully going up and down stairs, or jumping jacks are a few options. Our bodies have a natural desire to relieve or release stress-related hormones, like cortisol, adrenaline, and norepinephrine. Doing a physical activity, regularly and consistently, releases stress hormones versus having them build up inside in our body which can lead to toxicity and stress-related illness. It also increases “feel good” chemicals like endorphins, serotonin, dopamine, and stress neutralizing chemicals like oxytocin.

2. Spend time in the sun to re-energize.

The sun increases Vitamin D, a necessary nutrient to boost immunity, bone health, and improve cognition and symptoms related to depression.

3. Body of water.

Try looking at a lake or pond, laying on the beach, swimming, or being on a boat. Stay in the present by focusing on what you are experiencing through your senses (What do you see, hear, smell, and feel?). This is a mindfulness practice that can quiet your thoughts by shifting your focus.

4. Take a bath or foot soak with Epsom salt (minimum 20 minutes).

The magnesium in the salt will help to ease muscle tension and promote sleep. Add an essential oil like lavender to boost results.

5. 4-7-8 Breathing.

This breathing technique has been scientifically proven to decrease symptoms of stress, anxiety and help with sleep if practiced regularly. Proper form is important: Sit up straight or lay down on your back. Start with a 4 second inhalation through your nose. Keep your shoulders and chest down and expand your belly with air; this is called diaphragmatic breathing. Hold for 7 seconds, then exhale through an open mouth for 8 seconds. Do 4 repetitions at least once a day. Doing a breathing exercise increases oxygen in our blood and decreases a build of carbon dioxide.

6. Drink chamomile tea.

Chamomile tea can naturally promote sleep and help with relaxation.

7. Limit caffeine, Nicotine, and sugar.

These chemicals have a stimulating effect.

8. Unplug to recharge.

When we see and hear too much fear-provoking or violent information (news and social media) it causes the release of stress hormones. Just as your phone needs time to recharge, so do we. Disconnecting by taking a digital detox each day can help you manage stress, sleep better, and spend time doing other activities.

9. Listen to music.

Happy, soothing, dancing, or sing-along music. Listening to the right kind of music can improve our mood.

10. Do some gardening.

Whether it’s pulling weeds or planting seeds, both can be helpful in relieving stress.

11. Release oxytocin.

Oxytocin is a chemical that neutralizes stress hormones. Release it by laughing, hugging a loved one, eating chocolate, and petting a pet.

12. Meditation, used for thousands of years, is very effective to help you center and relax.

There are many free apps and videos for beginners. Put your earbuds in and limit distractions. Beginner meditations are less than 15 minutes. Developing a regular meditation practice will give you a few minutes of mental rest.

13. Try a weighted blanket.

Adding heaviness to you comforter or buying a weighted blanket can help ease anxiety, manage stress, and promote sleep.

 14. Use essential oils or candles.

Lighting a scented candle or diffusing essential oils like lavender, ylang-ylang, and chamomile can promote relaxation and take the edge off nerves.

15. Focus on gratitude.

When negative thoughts become overwhelming, focusing on gratitude can help to neutralize them. Write a daily gratitude list of 5 things you are thankful for (try to make them different each day).

16. Grounding technique.

While there are many others, the Five Senses technique is a common grounding technique. In this exercise, you’ll identify 5 sights, 4 sounds, 3 physical sensations, 2 smells, and 1 taste (say them out loud). This increases awareness of your surroundings and can make you feel more present and connected versus future focused which often increases anxiety.

17. Practice progressive muscle relaxation technique.

Tighten and relax muscle groups in your body from head to toe. For example, starting with your forehead, tighten and squeeze your facial muscles, hold for 10 seconds (breath in and exhale) and release, then work your way down your body (shoulders, biceps, triceps, hands, etc.).

18. Clean and organize.

Cleaning a drawer, closet, or room exerts energy and relieves stress. The result helps us to feel accomplished, have clearer thoughts, and feel at peace.

19. Sound therapy.

Listen to white noise, rain, ocean waves, or the song of a singing bowl. All of these can be found with a search online. Find one that is soothing and relaxing.

20. Use a heated a blanket.

If you don’t have a heated blanket, you can put a towel, robe or blanket in the dryer for 15-20 min. Take it out and wrap yourself in it like a warm hug. Feel your stress melt away.

21. Herbal Supplements.

Talk with your health provider about taking natural herbal supplements: St. John’s Wort (depression), or Ashwagandha (managing stress and anxiety), melatonin (sleep), or valerian root (stress and anxiety).

22. Find your words.

Check out an online resource designed to make it easier to open up about mental health and empower more people to ask for help, take action, and support others like FindYourWords.org

23. Shift your focus.

Remember that your peace of mind can be determined by your point of focus. What you chose to focus on will determine how your feel. Focus on positivity, health, and healing.

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Help Is Always Available

24/7 hotlines are always available to you. Access the National Suicide Lifeline at 1-800-643- TALK (8255) or the Anxiety/Panic Disorder Information Hotline at 1-800-64-PANIC (72642). To get in touch with someone to discus rehabilitation options for substance abuse or mental health disorders, call a treatment provider for free here.

The post 23 Tips For Building Resilience And Managing Stress appeared first on Addiction Center.

A study in 2019 published in the National Library of Medicine found that gaming addiction positively correlated with depression, loneliness, and social anxiety especially in the young adult population. They also reported that young adults addicted to video games showed increased depression and anxiety and felt more socially isolated. Males were shown to be more negatively affected than females and were also more prone to isolate and withdraw.

Some say this phenomenon as a bit of the “chicken and egg” scenario. In other words, do depressed young adults gravitate to isolating behaviors like gaming, or do otherwise well-adjusted young adults get so immersed in the gaming culture that it eventually pulls them out of circulation with their friends and family? The answer is likely both.

While many depressed individuals look for any number of ways to get a dopamine hit for their thirsty, isolated minds, a growing number of young adults are finding that the more screen time they engage in, the less likely they are to develop relationships and can begin to interpret their virtual screen worlds as their social networks. The invention of characters to hide behind, virtual worlds to explore, and the lack of any external realities to distract us makes an inviting place to immerse oneself, especially if school, relationships, and life in general becomes too overwhelming.

Young Adults Seeking Help For Video Game Use

In the last three months I have had several young adult males come to me with nearly the exact same presenting circumstances. Friends, classmates, Greek life, and anything else many college students find stimulating were simply unwelcome distractions for these young men. Statistics show that we are in a time of unprecedented levels of depression and anxiety. While COVID-19 and the culture wars can take their share of the blame, much of our growing emotional exhaustion is trying to find connection and emotional satisfaction in areas that we are not designed to stay in long-term.

Whether it is the comparative thinking brought on by staying saturated in social media, or the dopamine saturation of a day of gaming alone the result is a residual anxiety once the dopamine rush subsides, and we are left with our empty relationship tank leaving us more depressed and anxious than we were before we started. Ultimately, the behaviors we are engaging in to mask the depression and anxiety are in fact exacerbating it.

Recovery Plan For Video Game Addiction

Below is a synopsis of a general recovery care plan including abstaining from gaming/technology devices for a 30-day period. This plan (along with neurofeedback and regular therapy sessions) has been very helpful in breaking the cycle of the unwanted isolation and thereby diminishing the presenting depression and anxiety. We would stress that this plan is NOT a punitive exercise whatsoever. This is to be thought of as a cleanse or a “detox” so that the devices can be introduced again later. This 30-day period is meant to give undistracted opportunity to develop a “self” apart from video games and/or character role playing and allow the brain to reset.

Our three main objectives in the first 30-day period are establishing habits around Structure, Activity, and Connection.

Structure

A consistent bedtime and wake up time daily. Having a flexible but working daily routine which includes intentionally setting three small goals you would like to accomplish each day (one thing from each category of structure, activity, or connection). A healthy diet of regular mealtimes is important. Setting a daily timeline to accomplish small tasks is also recommended.

Activity

Some type of daily exercise, even simply walking for 20-30 minutes outdoors, experiencing something that requires movement for at least a half hour is a great start. Engage in something enjoyable that doesn’t require technology, i.e., boardgames with family, creative artistic endeavors, music, something that brings joy and stimulates the prefrontal cortex. The endorphins that the brain manufactures during exercise is nature’s antidepressant.

Connection

This can begin with being more intentional about socializing with work or school friends during the day, meeting people for coffee or lunch, recovery group support meetings, some type of interest group that does not involve gaming or a character. The goal in connection is to show up as yourself and become comfortable with your true self in social and relational situations.

At an agreed upon time, be willing to turn in your computer power cord, Xbox, smart phone, laptop, and any other device other than a TV to parents or a supportive friend or partner who has agreed to hold you accountable.

At that time your smart phone can be replaced by a “disposable” flip phone which will have your current phone number assigned to it. At the end of the agreed hiatus the temporary flip phone will be exchanged, and your smart phone will be returned to you.

How To Offer Support

Encouragement from loved ones and friends is imperative as well. If you are trying to encourage someone who is working to beat this dependency to technology, consider writing them an uplifting note at the beginning of this endeavor: “We know this is going to be difficult, stressful, and emotional for you. We know we are disrupting a relationship you have with technology and other virtual friends and that it is not an easy thing to step away from, even for a short season. Your family wants to be engaged in your process as well as engage you!”

We must understand that the willingness to change is the first step but giving up a behavior can exacerbate anxiety and will often be a very emotionally unsteady time at first. Abandoning the technology will make space for us to explore what is truly lacking in our lives and how to reclaim it. Learning to ask for help and realizing that the absence of the old behavior is making space for self-love. Self-acceptance is a pivotal part of the therapeutic process of coming back to ourselves.

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In the practice of medicine, physicians will come across patients who present with unofficial self-diagnosis at some point in their careers. Patients who have basically identified themselves as having a certain condition. Well, who knows their own bodies better than a patient themselves, right? Well yes, and no. Not as it relates to diagnosis. Additionally, many practitioners, possibly more mental health practitioners, will come across individuals who are misdiagnosed or undiagnosed. This is not criticism of the mental health field, but more the nature of the mind being an abstract concept and behavioral and mental changes across the lifespan. And with the mainstay tool for diagnosis of mental illness being an interview, it can be a difficult endeavor. It is a less concrete specialty. This can be sometimes be seen in cases of Attention Deficit Hyperactivity Disorder (ADHD) and addiction.

On one hand, a patient recognizes “something is wrong” with their body as they present with the signs and symptoms, and on the other hand the medical practitioner properly assesses these signs and symptoms. There are many factors that need to be considered when any diagnosis is made. Appropriate history taking, physical and mental examinations, relevant diagnostic testing such as blood work or scans, the training and expertise of the clinician, the motivation and reliability of the patient, as well as many other factors need to be considered. One very important factor as it relates to substance use disorders especially, is the chronology and the context in which the signs and symptoms are occurring. This helps with both the diagnosis, as well as ruling in or out other differential diagnoses mainly due to the fact substance and alcohol use/misuse can mimic or mask many different mental health and physical conditions.

Are ADHD And Addiction Associated?

When it comes to the practice of addiction medicine, one diagnosis that appears to occur often is Attention Deficit Hyperactivity Disorder (ADHD). Studies have looked into ADHD itself to see if it is a risk factor for future substance use, and to see if undiagnosed or untreated ADHD is associated with future addiction. But often in clinical practice, ADHD is diagnosed at a time when substance use disorders are being treated. These times may be when someone is in detox or rehab, or someone intoxicated or in withdrawal ends up in the emergency room, hospitalized, jail, or they are involuntary admitted to a psychiatric unit.

Therefore, an important question arises: is it the drugs that are causing these symptoms or is it a true ADHD? This is a huge question and one that needs to be asked by both the patient and the clinical practitioner. I highlight ADHD here in this article, but this could apply to any condition which substance abuse mimics or is the result of, from depression to bipolar disorder or psychosis.

Breaking Down ADHD

Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is a neurodevelopmental disorder often diagnosed in childhood, where the prevailing symptoms of inattentiveness and/or hyperactivity cause impairment of functioning in two or more major areas of someone’s life. Often this is seen first in children, when after passing through stages of life where being hyperactive, restless, or inattentive is part of development, are subsequently identified at school as, compared to their peers, being persistently more hyperactive, inattentive, or the combination of both. And because of these features, their academic performance and subsequent success in multiple areas of life is being affected, and often is convoluted with co-occurring mental or behavioral disturbances.

What about in adults? There has been recent question as to if ADHD can, “begin or have onset in adulthood.” So far, this has not been accepted into the diagnostic criteria, so it still remains that a ADHD diagnosis still has to have some symptom onset in childhood. So, what happens when adults are struggling with inattention, having difficulty concentrating, and/or feeling restless where it is felt to be causing dysfunction in multiple areas of their lives from work to their personal relationships? This is a common question that occurs, but sadly, when it comes to those who suffer with addiction, may be inadequately treated or inappropriately diagnosed.

ADHD And Addiction

It is important for those who suffer with addiction that before they jump to any conclusion that they have ADHD, they receive a proper assessment by a professional who specializes in diagnosing such conditions. For example, psychiatrists, certain neurologists, psychologists, and clinicians proficient in mental health diagnosis. The assessment should take into consideration symptoms which occur, “while not being on the drugs of abuse” and placed in appropriate chronology and context. Criteria for the diagnosis has to be met, even unspecified diagnosis, and those symptoms which occur exclusively during or secondary to substances of abuse do not qualify. Many conditions other than ADHD can cause someone to feel or be “inattentive” as manifested by having difficulty concentrating, focusing, sustaining attention, and struggling to stay on task. Feelings of restlessness, fidgetiness, or hyperactivity may occur as well. These conditions can include depression, anxiety, bipolar disorder, thyroid and other metabolic conditions, neurological conditions, and even stress as well as substance use and addiction.

During my time in practice, I have assessed many people that report having ADHD because someone else diagnosed them or they feel they have it. After proper evaluation, their symptoms were purely secondary to their alcohol or substances of abuse. However, it becomes difficult for the patient to give up that identity. They are so accustomed to taking a “pill” to gain mental clarity or focus, they don’t want to hear that they do not have ADHD. Mind you, many patients also do have ADHD and need to be properly treated, but the caveat here is that drug and alcohol abuse screws up our brains and not taking that into consideration when diagnosing ADHD is simply wrong.

Unfortunately, addiction is hallmarked by certain characteristics, such as the inability to abstain from drugs/alcohol, behavioral loss of control, cravings, dysfunctional recognition of negative consequences, and emotional ups and downs. Additionally, those suffering from addiction often have the inability to tolerate negative situations and the inability to delay one’s self-gratification. This can be a dangerous combo when mixing an inaccurate diagnosis of ADHD with their substance use, where stimulant medication is a mainstay of treatment, yet one that is simultaneously abused. Yes, people suffering with addiction often abuse well intended medication and manipulate their presentation when drug seeking. If you get high over time, your brain gets fried, you don’t think rationally, you can’t focus, you can’t think, and you need something to fix that. It’s like speed balling. This is difficult for someone struggling with addiction as impulse control is a major problem, and if truly diagnosed with ADHD, it’s a double whammy. True ADHD is not simply symptoms caused by the substance of abuse or long-term brain deconditioning.

I would compare it to someone who historically was able to work-out, run 5 miles, lift weights, felt strong, and was eating right. Who then, after no longer following their routine, performs no exercise, gets deconditioned, eats poorly, and attempts to go back to working out and cannot lift the same weights or perform the same way. Imagine if they ask a doctor for steroids to get back in shape. Let us even consider this. It may be that the person has a true hormone deficiency or medical issue which led to their inability to perform like before and should be properly evaluated. But, most often, it is the poor nutrition, the lack of activity, and the deconditioning that has resulted in their body not performing as it did.

The same goes for problems focusing, paying attention, and concentrating like once before after using drugs. Asking for a stimulant to help focus or to be diagnosed with ADHD in the context of substance use is not correct. Don’t ask for the steroid; try and get back in shape. Get treatment, stop the drugs, get a proper assessment that takes a comprehensive history and information from multiple sources. Not just symptoms while using drugs.

If you are diagnosed with ADHD or believe you have ADHD, please speak with you doctor. Be honest to the best of your ability. Below you will find a review of the diagnostic criteria for ADHD.

Diagnostic Criteria For ADHD

According the DSM-V, Diagnostic and Statistical Manual of Mental Disorder, 5th Edition, the following criteria exists regarding ADHD:

ADHD Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning.

In patients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary.

Inattentive Type Diagnosis Criteria

• Displays poor listening skills.
• Loses and/or misplaces items needed to complete activities or tasks.
• Sidetracked by external or unimportant stimuli.
• Forgets daily activities.
• Diminished attention span.
• Lacks ability to complete schoolwork and other assignments or to follow instructions.
• Avoids or is disinclined to begin homework or activities requiring concentration.
• Fails to focus on details and/or makes thoughtless mistakes in schoolwork or assignments.

Hyperactive/ Impulsive Type Diagnosis Criteria Hyperactive Symptoms:

• Squirms when seated or fidgets with feet/hands.
• Marked restlessness that is difficult to control.
• Appears to be driven by “a motor” or is often “on the go.”
• Lacks ability to play and engage in leisure activities in a quiet manner.
• Incapable of staying seated in class.

Overly Talkative Impulsive Symptoms:

• Difficulty waiting for their turn.
• Interrupts or intrudes into conversations and activities of others.
• Impulsively blurts out answers before questions completed.

Additional Requirements for Diagnosis:

• Symptoms present prior to age 12 years.
• Symptoms not better accounted for by a different psychiatric disorder (e.g., mood disorder, anxiety disorder) and do not occur exclusively during a psychotic disorder (e.g., schizophrenia).
• Symptoms not exclusively a manifestation of oppositional behavior.

Classification Combined Type:

Patient meets both inattentive and hyperactive/impulsive criteria for the past 6 months.

Predominantly Inattentive Type:

Patient meets inattentive criterion, but not hyperactive/impulse criterion, for the past 6 months.

Predominantly Hyperactive/Impulsive Type:

Patient meets hyperactive/impulse criterion, but not inattentive criterion, for the past 6 months.

Symptoms may be classified as mild, moderate, or severe based on symptom severity.

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Resilience. The set of characteristics one possesses to overcome difficult situations. A positive response versus a maladaptive one when faced with adversity. Resilience is something we are born with and develop over time as we interact with the world around us. Resiliency is something that can also be broken down.

How resilient someone is depends on multiple factors including innate genetic qualities, coping styles, attitude, personality traits, positive relationships, supportive environments, healthy modeling, and the cultivation of capacities as we grow from infancy towards adulthood. In order for our brains to develop healthy and adaptive capabilities, we need to expose ourselves to a certain amount of stimuli which molds how we respond to life events. If supportive external components are absent, or significant trauma or adversity is profound, the brain’s health is compromised. The risk of lessened resilience occurs, while the risk of psychological and physical illness increases. However, we do need to face circumstances, even difficult ones, in order to give ourselves an opportunity to learn from them and strengthen ourselves.

Resiliency Of The Body And Mind

Our brains work off of a feedback mechanism, both internally with our organs and externally with the outside world. Too much imbalance can result in the brain and body being unable to fight or defend itself against illness. One of the ways we gain physical immunity (resilience to disease), for example, is that we develop antibodies via our immune system in order to fight off disease. Through exposure with the world, we develop our immune system little by little. Another example is through vaccination, which introduces a small amount of a substance, often an illness producing particle itself, triggering our bodies to build immunity to help defend against a more significant blow later on. Either way, this system of defense is a result of us being exposed to something. This allows our body to recognize it and react to it in order to properly defend against a similar, larger attack. Our physical body is constantly learning.

Compare this to psychological immunity, or mental resilience of our mind. It works similarly. In order for our minds to be able to overcome adversity, we need to be “inoculated” with life’s experiences themselves, both good and bad. We deal with many stressors throughout our lifespan, many which our brains will process and develop resistance against. These processes warn us, allow us to cope, or nurture us to help navigate more adaptively when a similar situation occurs at a later time. We need that recognition and feedback mechanism intact in order to mount a healthy psychological response. Adolescence for example, a critical time of anatomic and physiologic brain growth, should occur within an environment which grooms healthy brain development. Unfortunately, that is also a time when one first starts experimenting with drugs or alcohol.  If we continue to use, our healthy progression is that much more impeded.

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How Drugs And Alcohol Break Resiliency

When we use drugs or alcohol to defend ourselves against difficult experiences of the mind, we have broken that recognition and feedback mechanism. We are essentially living in a bubble as we stop the inoculation process. We stop the brain’s ability to identify the psychological threat, analyze and process it, digest it, absorb or extract from that experience what is beneficial, while spitting out or eliminating the waste that is not. We fail to give ourselves an opportunity to develop immunity and cope with that circumstance. Unfortunately, when a pattern of drug or alcohol use spirals into addiction, there is a consistent cycling of absence from both healthy and unhealthy experiences. The brain is no longer benefitting from any positive experiences which could cultivate our mind and make us strong, or negative experiences which could produce an adaptive response to help us cope during difficult experiences which are later thrown at us. Addiction deprives the mind and body of being inoculated, or vaccinated, with life. As drugs or alcohol consume the body from the inside out, we further weaken our mind and body. This is most evident when we stop using these substances. When we come out of this bubble, we have developed no mental immunity. The negative experiences and trauma that went unresolved and unprocessed, now creep up on us making us sick. The realities which we have not become accustomed to, seem overwhelming and terrifying. Normal processes seem strange, and difficult processes seem unbearable. This often triggers us to use again.

Breaking The Cycle

There is hope within the cycle of drug and alcohol abuse. Gaining sobriety helps heal this broken resiliency. In spite of the difficulties we face when first stopping drug and alcohol use, the healing process starts right away. It is not an easy process, but our brains are remarkable in that they can actually heal. Our minds can rebuild resiliency. Seeking treatment and getting help is often the first step in this process. Medically supervised detoxification often is needed to help safely come off drugs and alcohol and help prepare the body and brain to achieve a level of stability that allows things to start making sense for us. Therapy is often needed to help us process those unresolved experiences and bring clarity to our emotions and behaviors. As time goes on, we learn to cope with our lives again, and have the ability to once again become resilient.

For more information about addiction and finding treatment, contact a treatment provider today.

The post Inside The “Bubble” Of Addiction And Broken Resiliency appeared first on Addiction Center.

If we look at time as a continuum, most of us will agree that the concept of time has been divided. The past, the present, and the future. Of those, the time that we have that is real is “now,” the present moment. Yes, these are concepts and one can argue that everything we perceive is the result of our mind, true, but the present moment is the most palpable place of interaction with the world and those around us. The past and the future tend to live solely in our minds, both times which are not real in comparison. Being mentally present is a key to being mindful. It is hard to live in the present moment and be mindful all the time, especially when we are often consumed by our busy lives. As we grow from the clean slate of infancy, we experience good and bad along the way as we maneuver the path of life. We develop coping skills to deal with these experiences. Having good coping skills and developing resilience is a key component to staying healthy, both in the mental sense and the physical sense. Healthy living is not simply being present, but living in the present.

How Drugs And Alcohol Cause The Absence Of Presence

When we use drugs or alcohol to cope with things going on in the “now”, they remove us from that real present moment. We are under the influence of a mind-altering substance. While intoxicated, we often lie, cheat, steal, fight, get depressed, anxious, manic, or psychotic, as well as potential other behaviors or emotions that could occur. We are being influenced by a substance we abuse. If we look at it, we could say the substance is really abusing us. When this substance use develops into addiction, the effect on someone truly capable of living in the present moment is significantly compromised, as addiction is not a momentary situation.  With addiction, we are no longer living in the now, but a cycle of craving, intoxication, emotional deregulation, withdrawal, and the inability to abstain for the most part.

When the substance we are abusing does wear off, it drops us back into reality. In the moment we start to become clear and lucid, our minds tend to take us back, making attempts to recall what may have transpired while intoxicated, what now has become the past. It is human nature to try and focus on what we have done wrong in an attempt to course correct. We start to question ourselves and create doubt, asking ourselves if we did indeed lie, steal, cheat, fight, or whatever else. Feelings of remorse, regret, and depression set in. The next place our mind takes us is the future. What will we have to face? Job loss, marital discord, legal consequences, physical withdrawal? We start to feel anxious, apprehensive, and fearful about what will become. As this process is going on, withdrawal could be setting in, causing tremendous physical and psychological pain and dysphoria.

The irony of this whole thing is that drugs and alcohol remove us from the only time that is real, the present, to drop us back off and live in 2 times that are not real, the past and the future, in our minds. We disconnect, we detach, we isolate, we abandon, and we pursue the drugs or alcohol again. As this cycle of abuse and withdrawal sets in, it conditions us to associate the momentary glimpses of present time, the sober moments, as an uncomfortable place to live, both mentally and physically, constantly thinking of yesterday’s regrets and tomorrow’s consequences. We are consumed with our thoughts. We no longer seek presence, but an escape from the present, as time spent substance free is too depressing and too anxiety provoking. We have conditioned the only time that is real, the present sober moments, to be an uncomfortable place to live. So, we repeat our cycle of addiction, which renders us absent from the present.

For more information on addiction treatment, contact a treatment provider today.

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Synaptogenesis is a hallmark of brain development that involves synapse formation between neurons in the nervous system. While it occurs throughout an individual’s lifetime, there is a surge of synaptogenesis during infancy and a second during adolescence, which facilitates learning, memory, and adaptation. MRI studies have demonstrated a surge of neuronal growth and thickening of the grey matter in the brain right before puberty, similar to neuronal growth during infancy. Crucial developmental changes occur in a young person’s brain that are incomplete until around age 25. While there is no set age range to define adolescence, it is generally described as a time including puberty and teenage years and a transition from childhood into adulthood. In terms of brain development, some researchers define adolescence as the time between age 10 and 24.

The brain plasticity of adolescence allows a time for intellectual and emotional growth, an ability to adapt, and acts as a time to develop lifelong interests, talents, and passions. Dopamine, serotonin, and melatonin are 3 neurotransmitters that play a major role in adolescent behavior and produce both positive and negative emotions and reactions. Impulse control is impacted by decreased levels of serotonin, earning teenagers the reputation of being risk-takers. Taking risks is a part of growth and personal development, but when these risks involve drug and alcohol abuse, oftentimes it is no longer a method of temporary self-exploration but an action that can have serious and long-time effects on brain development.

Drug Use During Brain Development

Due to the neurodevelopmental processes that occurs during adolescence, teenagers are more likely to take risks, including drug use, than children and adults according to research published by the National Institutes of Health. This drug use can be particularly dangerous, as drug use as an adolescent significantly increases the risk of developing a substance use disorder later in life. Some research has found that the earlier the onset of drug use, the higher the chance that a person will develop a drug problem. When drug use and other negative occurrences, like trauma and chronic stress, take place during early brain development, this can have a damaging impact on brain maturation.

When someone uses certain drugs, the substances flood the brain with dopamine. Dopamine is the neurotransmitter often referred to as the “feel good” neurotransmitter, as it plays a large role in feelings of pleasure. When the brain is overloaded with dopamine because of a drug, the brain responds by producing less dopamine naturally. With continued drug use, a person may be unable to feel happy without their drug of choice. Depending on the substance and frequency of use, it can take hours or weeks for the brain to regain balance.

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Alcohol Abuse During Brain Development

Among American youth, alcohol is the most widely abused substance. In fact, over 29% of teens have already tried alcohol by age 15. Young people drink in larger quantities than adults, with 90% of the alcohol consumed by young people being alcohol consumed via binge drinking. Binge drinking is defined as a female having 4 or more drinks within a 2-hour period, and a male having 5 or more drinks within a 2-hour period. Drinking heavily during adolescence should not be considered a normal part of growing up, as it can come with serious and long-term effects.

Research by the EEG and Clinical Neuroscience Society found that, “Abnormalities have been seen in brain structure volume, white matter quality, and activation to cognitive tasks, even in youth with as little as 1–2 years of heavy drinking and consumption levels of 20 drinks per month.” The critical period of brain development in youth may be interrupted by alcohol abuse, and cause issues later in life related to academic, occupational, and social functioning. Drug and alcohol abuse may also put people more at risk for mental health disorders and risky sexual activity. Some research has suggested that heavy alcohol abuse can reduce the size of the hippocampus; the part of the brain that is involved in the formation of memories as well as learning.

In one study examining alcohol, Marijuana, and stimulant use among youth, the youth with a history of light drinking performed better on cognitive tasks than youth with a history of heavy drinking. Those who had displayed alcohol withdrawal symptoms like nausea and irritability had decreased performance skills, primarily on tests of spatial functioning. Another study found that the prefrontal cortexes of adolescent drinkers were smaller in heavy drinkers, compared to non-drinkers. This difference was especially pronounced in females. Animal studies have also demonstrated long-lasting changes in functional brain activity when adolescent rats were administered ethanol vapors.

Substance Abuse Treatment For Youth

Many adolescents take unnecessary risks and make decisions that can be difficult for the adults in their lives to understand. While a young person needs the freedom to start making their own choices and figuring out who they want to be, it is important to intervene when drug and alcohol abuse become present. A professional diagnosis that examines any underlying mental health disorders and understands their pattern of abuse is crucial for formulating the most appropriate treatment option for each individual. Early intervention can make a world of difference during a time when youth are so susceptible, and it could prevent the development of a substance use disorder later in life. Contact a treatment provider to find out more about treatment options for people of all ages.

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