16 Danger Signs of Relapse

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This list is from an excellent Facebook post. Even though the list seems it's from AA (Alcoholics Anonymous) for AA members, I think we can all benefit from this list even if we are not struggling with a severe addiction. I feel addicted can also mean we compulsively repeat certain patterns of behavior based on a set of beliefs, which can hold us back from growth.

For those of you who say you are "allergic" to the AA model,  go ahead and read the list and replace AA, sponsor, meetings with family, friend, get together, etc...

Relapse can mean returning to an old behavior which you attempted to change or correct. Or it can mean actual addiction to alcohol and drugs.

Basically, be present and be mindful of what's going on in yourself.

DANGER SIGNS OF RELAPSE

1. Exhaustion — Allowing oneself to become overly tired; usually associated with work addiction as an excuse for not facing personal frustrations.

2. Dishonesty — Begins with pattern of little lies; escalated to self-delusion and making excuses for not doing what's called for.

3. Impatience — I want what I want NOW. Others aren't doing what I think they should or living the way I know is right. Instant gratification is a monster that needs to be tamed.

4. Argumentativeness — No point is too small or insignificant not to be debated to the point of anger and submission.

5. Depression  — All unreasonable, unaccountable despair should be exposed and discussed, not repressed: what is the "exact nature" of those feelings?

6. Frustration  — Controlled anger/resentment when things don't go according to our plans. Lack of acceptance. See #3. Being a baby.

7. Self-pity — Feeling victimized, put-upon, used, unappreciated, disrespected: convinced we are being singled out for bad luck.

8. Cockiness — Got it made. Know all there is to know. Can go anywhere, including frequent visits just to hang-out at bars, boozy parties or an other potentially complicated setting where the addiction monster may get tempted.

9. Complacency - Like #8, no longer sees value of daily program, meetings, contact with other(s) alcoholics, (especially sponsor!), feels healthy, on top of the world, things are going well. Heck may even be cured!

10. Expecting too much of others — Why can't they read my mind? I've changed, what's holding them up? If they just do what I know is best for them? Leads to feeling misunderstood, unappreciated. See #6.

11. Letting up on disciplines — Allowing established habits of recovery - meditations, prayer, spiritual reading, emotional support system or AA contact, daily inventory, meetings or getting together with a pal — to slip out of our routines; allowing recovery to get boring and no longer stimulating for growth. Why bother?!

12. Using mood-altering chemicals — May have a valid medical reason, but misused to help avoid the real problems of impending alcoholic, drug or a behavioral addiction relapse.

13. Wanting too much — Setting unrealistic goals: not providing for short-term successes; placing too much value on material success, not enough on value of spiritual growth.

14. Forgetting gratitude — Because of several listed above, may lose sight of the abundant blessings in our everyday lives: too focused on # 13.

15. "It can't happen to me." — Feeling immune; forgetting what we know about the disease of addiction, including alcoholism and its progressive nature.

16. Omnipotence — A combination of several attitudes listed above; leads to ignoring danger signs, disregarding warnings and advice from fellow members or emotional support network.

The Examined Life

Some books are to be tasted, others to be swallowed,
and some few to be chewed and digested.
Francis Bacon, the philosopher, not the painter.

Sometimes a book can come along and make your life better. Reading it feels as though it was meant to enter your life at that exact time.
And isn’t this why we have a life-long love affair with books?

Books can help us answer questions we haven’t yet to formulate. At their best, they rouse us to carry on an inner dialogue and deepen our self-awareness. And awareness is the first step in the process of change.
Yes, change is possible. It’s a slow-going, subtle shifting of your attitude, first to your self, and, over time, it will manifest outwardly in your interactions with the world.

Stephen Grosz’s The Examined Life is one such book. Grosz is an American psychoanalyst based in London. I love this book because the writing is superb; language is simple and precise, without psychological jargons to showcase the author’s expertise. He writes for an audience interested in living a deeper, more authentic life (don’t we all?). Though I am not a book reviewer, if you are interested the literati love his book!

My clinician self found important lessons in how to be a better therapist, both in technique and in philosophy. And as a general reader, I very much appreciate the clinical cases he presents, because I identify with many of the enduring “issues” that had brought people to his office. Some of these universal themes are: the search for and keeping of loving relationships, forgiveness, resolving the hurts from our imperfect childhoods, loneliness, sexuality, raising children, facing death.

If there were to be a syllabus for therapy The Examined Life would be a required reading. 

Quick note about psychoanalysis: It is a type of psychotherapy I DO NOT practice. However, I hope to start training in it in the near future. Its aim is to affect or change the personality structure of the client over an unspecified period of time. Usually a client brings in a complaint of a non-urgent nature, something that nags her but does not interfere with her overall functioning. Free association is the primary technique used in analysis; it means that the client is encouraged to think out loud, to say whatever comes to her mind. The analyst then interprets what was said, noting patterns or other significant content to which the client was unaware. There is little advice giving, and progress or insights are made by the client on their own.

The work I do is more hands on and goal directed. The issues I deal with tend to exist on the surface of day-to-day life, whereas psychoanalysis deals with issues that are more deeply imbedded.

Addiction, Depression and Antidepressants

I read with great interest this piece on The Fix called The Dumbest Article You'll See About Addiction, and that's about right. The writer, Maia Szalavitz, is responding to a criticism of her original piece, in which she shares how Zoloft had saved her from a deep depression after kicking a serious heroin and cocaine habit she picked up during college. Twenty years later, while still prescribed Zoloft, she describes how it dramatically improved her mood and the way she responded to the world (depressed people, she says, tend to misread other people's facial expressions), that she has had a successful writing career and a very satisfying life. 

The second writer, critiquing on Slate, says that Szalvitz merely replaced one addiction with another, and asks the astoundingly naive question why we are easier on pill poppers than alcoholics. It's difficult to believe that her editor or anyone else on staff, let slide her ignorance and insensitivity to issues of mental health. While it’s true Big Pharma has integrity issues, the fact is anti-depressant medications and other psychopharmaceuticals dramatically improve, if not save, the lives of many, many people.

Be sure to read the many comments on both pages. It's a serious subject matter that affects many people.

Pain Killing

More women are dying from overdoses of narcotic pain medication than cervical cancer or homicide. They tend to be poor, older white women living in rural areas who are also taking medications for depression and anxiety.

Some of the reasons for this trend are as follows: Pain medications are readily available; women are prescribed pain medication at higher doses; women are diagnosed with depression and treated with medications at a higher rate. Women who are single mothers struggling financially are more likely to experience symptoms of depression and anxiety (duh!).

It’s somehow rational that an unhappy or depressed person would succumb to the quick, narcotic relief delivered in a pill. Why not take a respite from pain when it simply means swallowing a pill, even though taking this short cut can mean dealing with serious consequences such as full-blown addiction and even overdose. One symptom of depression is a shortened sense of time or the inability to consider the future at all; so the depressed person is not likely to consider the risks involved when self-medicating with an opiate.

This phenomenon illustrates the fact that substanceabuse and mental illness are two sides of the same coin. It also shows that personal choices and lack of proper planning can cause stresses later on. At the same time, government policies also create hardship that contribute to poor mental health. And, pharmaceutical industry is guilty of profiting from products that are often abused as a quick fix to escape the hardships.

It also shows us that managing symptoms with medication alone is inadequate because it only cushions our ability to handle anguish. A pill cannot change the facts of a life and its context. Experience of pain can be temporarily delayed but it cannot be erased. Soon or later one must begin the tough work to locate the source or the cause of emotional pain. And, if the source of pain is outside ourselves then we must adapt to it or work on changing the environment.

Molly Will Make You Pay

Disclaimer: I am not a medical professional nor a scientist. Following article may contain inaccuracies, and it is not my intention to disseminate medical information or advice. It is my personal take on drug use and its effect on mood and emotional health. Also, I am not endorsing or condoning recreational or pharmaceutical drug use.

In my work as a drug/mental health clinician at an outpatient mental health clinic, I was recently introduced to Molly. I wasn’t sure what it was and thought it was one of the newer synthetic drugs that are named to sound either like a candy or a cleaning agent. But The New York Times set me straight in a recent article. Molly is supposedly short for "molecule," convincing the user that it's pure MDMA (concocted in a laboratory by scientists!). And, it is a white powder, making it more difficult to adulterate than as a pill. Users are marketed to believe that it's purer and cleaner than Ecstasy, making it safer. And, because of its reported potential benefit as a tool for psychotherapy and treatment of PTSD, Molly can't possibly be harmful, and it may be actually beneficial! So goes the justification. 

The article quotes a drug user of notoriety who says cocaine is grimy and dirty (First World drug user's awareness of War on Drugs and narcotrafficking?) and marijuana is smelly and no longer fashionable. It's entered popular culture big time, and its touchy feely, feel good vibe makes it all the more attractive. It promotes a heighten state of sensuality (not just sexuality), and a simple loft dance party has the potential to become a spiritual happening among one's tribe. 

But is there ever a free ride for a neurotransmitter flood that makes you feel euphoric and at peace with yourself and strangers? Unless you are a disciplined meditator or a runner who experiences runner’s high, the short cuts, such as Molly, comes with a hefty price tag. The serotonin rush, Molly-induced euphoria, depletes the brain of serotonin and so for a few days afterwards, until the brain rebalances itself, you will experience depression and dysphoria.

For those of you who are susceptible to symptoms of depression or clinically depressed (now or in the past), post MDMA blues can mean suicidally dark moods, or it can trigger another major depressive episode. And continued use (abuse) of MDMA can permanently upset the balance of serotonin, which I interpret to mean that your ability to experience pleasure and happiness is permanently lowered, in addition to higher likelihood of memory and attention problems. However, it’s impossible to predict how someone will react, not just to one-time use but repeated use over time. This is especially worrisome with people with preexisting mental health issues.

I also want to caution that if you are taking one of the more popular antidepressants such as SSRIs (selective serotonin reuptake inhibitors: Prozac, Celexa, Zoloft, Lexapro, Paxil) or SNRIs (serotonin-norepinephrine reuptake inhibitors: Effexor, Pristiq, Cymbalta), you won’t feel Molly’s full effects since your brain is being treated to avoid serotonin flooding to maintain a steady supply. So it’s really just a waste of money and effort. But, more importantly, why mess with your brain while you are being treated for a mental illness?

And if you are taking something more serious like older antidepressants or antipsychotics (Nardil, Parnate, Abilify, Seroquel), please reconsider using Molly or any other street drugs. Combining serious prescription drugs with street drugs can be dangerous and it is never a good idea. If you are considering using, I hope you feel comfortable enough to bring it up to your psychiatrist or GP, whoever is doing the prescribing of your psychiatric medications.

Even though I try not to advise, one bit of advice I find myself repeating is, especially to clients with substance abuse issues, to consider the consequences of a decision before acting on it. It’s a simple act of reflection, checking in with yourself before acting on a desire mindlessly. Of course, it’s easier said than done, but with practice it does get easier. 

We are constantly offered short cuts and conveniences that promise quick jolts of pleasure instantly. Drugs such as Molly can deliver what it promises, but like making a major purchase on credit, you have to pay it back, with interest. 

Sort of a Film Review: Silver Linings Playbook

http://www.kentuckytheater.com

Initially, I was skeptical about Silver Linings Playbook, but it disabused me of the misconception that all rom-coms are silly affairs in which an attractive young woman and man fall in love after overcoming a series of obstacles. SLP, like other movies of the genre, shows us that the quest for love is universal. Its two protagonists, played by Bradley Cooper and Jennifer Lawrence, are very pretty, as you would expect. I had dismissed Bradley Cooper as an exceptionally good-looking comic actor, and I wasn't familiar with Jennifer Lawrence. However, she won me over as the wounded yet feisty and self-aware young woman; I found her character so intriguing I forgave her being so young, talented and beautiful. And, I gained an appreciation for Bradley Cooper as a man with bipolar disorder just released from a long stay in a psychiatric hospital. His performance did not embarrass; he didn’t simply play “crazy.” Instead, he played a man whose capacity for suffering emotional pain was monumentally greater than most people’s because of the illness. 

As a mental health professional, I appreciated how the film treated mental illness with depth, humour and fairness; I am hoping that it can lift the some of the stigma that keeps people from accessing mental health services. 

These are some of the reasons why I recommend Silver Linings Playbook:

1. By no means should Cooper’s character be mistaken for a clinical case study of bipolar disorder, but it portrayed BD's main features in a believable way. Also, his father's (played by Robert DeNiro) compulsive and superstitious dependence on numbers was a lighthearted look at OCD-like behavior, perhaps to suggest that predisposition to mental illness can be hereditary. 

2. The movie shows that character's bizarre behavior of Bradley Cooper's character did not come about in a vacuum (it's important to note that he did not have delusions or hallucinations, symptoms of psychosis). The distress of catching his wife with another man had triggered his hypersensitivity to a full-blown episode of mania and depression (although we did not see his depressive symptoms). His reaction went above and beyond the "functional range" of emotional response, and, as a result, he was hospitalized. Symptoms of mental illness, especially mood disorders, are extreme (pathological) reactions to life’s inevitable ups and downs, and they are disruptive and upsetting to the sufferer and their family and friends. But, the point is that everyone of us have experienced these symptoms to some degree, because this is what it means to be human. 

3. Medication works. It does not “cure” but, under the care of an able psychiatrist, it can manage and control the symptoms and improve the quality of life for the patient and their family. It enables the patient to work, be in relationships and seek talk therapy to complement the pharmacotherapy, which only addresses brain chemistry. The most effective treatment for mental illness is drug therapy with concurrent psychotherapy. 

4. People diagnosed with mental illness have unique personalities and real lives, and they are capable of great achievements. They are more than their symptoms or diagnosis. One can LIVE with mental illness.

5. Mental health professionals are real people. We have real lives that are sometime messy and have interests outside work that may seem incongruent with what we do professionally. However, I am not a fanatical fan of any sports team.