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Jul 30

Marijuana Use Linked to Psychosis


By Traci Pedersen Among individuals with psychosis who are also heavy marijuana users, the age they first used marijuana is strongly linked to the age of their first bout of psychosis, according to a study of 57 patients.

Although marijuana use by itself is neither sufficient nor needed to trigger schizophrenia, “if cannabis use precipitates the onset of psychosis, efforts should be focused on designing interventions to discourage cannabis use in vulnerable individuals,” Dr. Juan A. Galvez-Buccollini and his associates said.

This caution pertains to someone with a first-degree relative with psychosis, which is “the highest risk factor for schizophrenia,” said Dr. Lynn E. Delisi, senior investigator for the study, a psychiatrist at the Boston VA Medical Center in Brockton, Mass., and professor of psychiatry at Harvard Medical School, Boston.

If someone had a first-degree relative, “I would caution them about the consequences of cannabis use and the association with schizophrenia,” she said.

Findings from previous research has shown that marijuana use is associated with an earlier age of psychosis onset in people abusing multiple substances, but studies have not looked at a possible link between the onset of cannabis use itself and resulting psychosis.

Because of this, Dr. Galvez-Buccollini, a psychiatry researcher at VA Boston Healthcare System and Harvard, and his colleagues interviewed 57 patients with a current diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, or psychosis not otherwise specified, who also had a history of heavy cannabis use before the onset of psychosis. They defined heavy cannabis use as 50 or more uses during a one year period.

Average age of the subjects was 25 years with a range of 18-39 years. Of the total, 83 percent were men, and 88 percent were not married. The average age of psychosis onset was 22 years, and the average age for first psychosis-related hospitalization was 23.

Schizophrenia was the most common psychosis (42 percent), followed by schizoaffective disorder (32 percent). The average age of first marijuana use was 15, preceding psychosis onset by an average of 7 years.

During the study period, the prevalence of daily cannabis was 59 percent with another 30 percent reporting use 2-5 days per week, and the remaining 11 percent reporting weekly use. Alcohol abuse was 16 percent and alcohol dependence was 8 percent.

The researchers found a statistically significant link between the age when cannabis use first started and the age when psychosis was first diagnosed. This association was consistent after researchers excluded patients with any diagnosis of alcohol abuse or dependency during their lifetime.

The analysis also showed a strong link between the time a patient first smoked marijuana and their age of first psychosis hospitalization.

Marijuana affects dopamine receptors and can have other neurochemical effects.

“There are two components of cannabis, one that potentiates and another that antagonizes psychotic symptoms,” said Delisi. The balance between these two effects can differ among various strains of cannabis, she added.

Jul 30

One of the ways in which people base their emotional responses to others is by assessing the facial expressions of those around them. If a person is confronted with an angry facial expression, they may respond with fear and worry. In contrast, when confronted with a neutral facial expression, an individual may have little or no emotional response. This technique of eliciting emotional response through facial expressions is one that is widely used in the research of psychological issues such as depression and anxiety. It has been shown that people with mental health challenges are often unable to accurately assess the expressions of others. Further facial expression research could help to untangle the factors that lead to maladaptive responses.

To better understand how facial expressions impact responses in people with anxiety, Oliver Langner of the Behavioral Science Institute at Radboud University Nijmegen in the Netherlands recently conducted a study that evaluated how people responded to low spatial frequencies (LSFs) as compared to high spatial frequencies (HSFs). LSFs refer to the facial expressions a person makes, while HSFs refer to the intricate details of a person’s face, such as the shape of the face and fine lines and wrinkles. In the study, Langner enlisted 39 college students, half of whom had been diagnosed with social anxiety. He created hybrid faces designed to elicit different emotional reactions on both LSF and HSF levels. The participants were instructed to rate the facial expressions and also to assess them during a learning experiment.

Langner discovered that the participants with social anxiety had more negative reactions to the LSF data than the nonanxious individuals. In addition, the anxious participants exhibited increased levels of sensitivity to the expressions of the hybrid faces during the learning task. Although all of the participants were aware of the HSF nuances, neither group demonstrated any noticeable impairment as a result of HSF specifics. The LSFs, the expressions of anger or ambiguity, were what drove the responses in the participants. These findings suggest that facial expressions influence the early emotional reactivity of individuals with anxiety but that the effects of HSF are less evident. Langner added, “Consequently, future research is needed that combines stimulus variations in spatial frequencies with varying tasks that are more sensitive to early processing stages.”

Langner, O., Becker, E. S., Rinck, M. (2012). Higher sensitivity for low spatial frequency expressions in social anxiety: Evident in indirect but not direct tasks? Emotion. Advance online publication. doi: 10.1037/a0028761

Jul 28

ADHD and Working Memory


Working memory is part of executive function. Working memory refers to a “mental workspace” where information is stored and used for a short time. “A short time” means just a few seconds.

When we need to do something that takes sustained effort, working memory helps us to:

control attention
resist distraction
Working memory is different from short-term memory:

Short-term memory involves storing information for a short time and then repeating it. For example, we use short-term memory when we hear and repeat a telephone number. Working memory involves storing and manipulating or changing the information to reach a goal. For example, to do mental addition, a child must read or hear the numbers, hold them in mind, and add them to get the answer. When playing a card game, a child must keep track of who just played and what he needs to do next based on the changing situation in the game. Working memory can only hold a certain amount of information. If children need to keep a large amount of information in mind while working on a task, they may make more mistakes.

Working memory weaknesses are linked to:

learning disabilities
problems with spoken language
Working memory and attention

Working memory and the ability to control attention are linked:

People who do poorly on tests of working memory also do poorly on tests of attention control. When people are asked to do something that puts high demands on working memory, they find it harder to ignore distracting information.

The “Cocktail Party Phenomenon”

The “Cocktail Party Phenomenon” is an example of the link between working memory and attention control. In a recent study, researchers asked people to:

repeat a message that they heard in one ear
ignore irrelevant information (their name) that they heard at the same time in the other ear
People with lower working memory scores were three times more likely to hear their name, the message they were supposed to be “tuning out.” This suggests that people with poor working memory have trouble controlling their attention when they are distracted.

Working memory and ADHD

Children with ADHD have weaknesses in working memory. These weaknesses may be moderate to severe.
Compared to their peers without ADHD, children with ADHD do worse on verbal and non-verbal working memory tasks. These weaknesses cannot be explained by reading disorders or other disorders.

Recent studies show that working memory weaknesses are more strongly related to inattention than to hyperactivity/impulsivity. This means that children with the Inattentive or Combined subtype of ADHD may have more trouble with tasks that need working memory.

In children with and without ADHD, working memory problems are linked to:

behaviour problems
academic problems
This suggests that even small weaknesses in working memory can make it harder for a child to do well in school.

Also, children whose kindergarten teachers felt they were at risk for literacy and numeracy weaknesses score lower on tests of working memory and executive function. Teachers also said they showed more behaviour and attention problems than other children. These findings suggest that there is a very early association between working memory, executive function, behaviour, and academic achievement.

Medication for ADHD does not address working memory weaknesses. Children with ADHD may need extra support at home and at school to help them compensate for poor working memory, even if they are taking medication for ADHD.


Having a great sense of self-esteem is a critical factor and a necessary component of success and is important in being able to help us handle the daily rigors of modern day life. With a great sense of self-esteem we can make the right choices in different aspects of our lives as well as our careers.

Doubt is one factor which leads to low self-esteem which can affect our abilities to succeed in the long run. If you want to know if you or other people close to you have started exhibiting any signs of low self-esteem you should take a careful look for any of the following symptoms:

■Apprehension of any changes in life or any new experiences.
■Need for perfection in everything and need to appear perfect to everyone they meet.
■Always apologetic about everything they do whether it’s really their fault or not.
■Talking negatively about themselves. People with low self-esteem are always putting themselves down by making unnecessary and negative statements.
■Shows symptoms of addiction. People with low self-esteem tend to get affected by negative addictive behavior and this addiction may be to substances or harmful habits.
■Lack of individuality. People with such behavior show a complete lack of self-belief and often choose to follow others blindly instead of seeking their own paths.
■Unhappiness with their current status. Such people are always unhappy with what they have no matter how perfect their lives are. They fail to appreciate what they have with them and are always looking for more.
■Put down behavior. People with low self-esteem often criticize others frequently in a bid to look better to people and feel better about whom they are.
■People suffering from low self-esteem frequently lack energy to do anything else and find the smallest and simplest of chores inundating.
■Over exaggeration of failures and problems in their lives.
■Constantly feel hopeless and distraught about issues that they shouldn’t.
■Tend to either neglect their appearances a great deal or focus too much on preening themselves constantly.
■Never like to own up when they are wrong.
■Constantly think about past mistakes instead of focusing on the present.
■Always complaining about non existent physical symptoms.
■Find it difficult to resolve simple issues without involving other people.
If you see these signs in yourself or in other people it makes it easier to understand that you suffer from self-esteem. It is then up to you to find ways to help yourself or the other individual get the necessary courage to take care of their lives as well as their feelings.


Jul 19

Experts Share Solutions to Their ADHD Obstacles


By Margarita Tartakovsky, M.S.

Experts Share Solutions to Their ADHD ObstaclesSome symptoms of attention deficit hyperactivity disorder (ADHD) can easily turn everyday activities into obstacles in life. (For instance, if you’re constantly distracted, it may be difficult to get work done at your job.)

But that doesn’t mean that they have to remain hurdles and hamper your days. The key is to forget what works for people without ADHD and find the tools and techniques that work for you.

Below, several coaches and clinicians who both specialize in and suffer from ADHD share their biggest challenges and the successful strategies they use. Maybe these approaches will resonate with you, too.

1. Obstacle: Balancing work with a personal life.

Jennifer Koretsky, a senior certified ADHD coach and author of Odd One Out: The Maverick’s Guide to Adult ADD, used to struggle with “keeping work at work.” “I used to be one big ball of stress because I’d worry about work on my personal time, and worry about personal stuff during my work time,” she said.

Solution: Today, Koretsky is strict about separating her professional and personal lives. For instance, if a work-related thought pops into her head, she doesn’t disrupt her personal time by attending to it right away. Instead, she just emails herself a reminder about the idea or issue.

2. Obstacle: Constant distractions.

As Koretsky said, at work, her ADHD brain has a hard time returning to a task after she’s been interrupted. And distractions such as ringing phones, increasing inboxes and chatty co-workers are aplenty.

Solution: When she wants to work uninterrupted, Koretsky carves out specific blocks in her schedule for “Meetings with Me.” She treats this time like she would any other meeting: “I close my door, I turn the ringer off my phone, and I shut down email.” This prevents distractions and helps Koretsky make progress on her projects.

3. Obstacle: Hyperfocusing.

Stephanie Sarkis, Ph.D, a psychotherapist and author of 10 Simple Solutions to Adult ADD, finds it difficult to sustain the same energy on every task. Consequently, hyperfocusing on some tasks can sometimes lead to a crash.

Solution: Whenever she’s working on activities that require great attention, Sarkis takes frequent breaks. She also practices healthy sleep habits – such as going to bed at the same time all week – knows when her body needs rest and exercises regularly. Plus, she avoids foods with refined sugar or high fructose corn syrup.

4. Obstacle: An overactive mind.

For both Sarkis and David Giwerc, MCC, founder and president of the ADD Coach Academy, an overactive mind can be a challenge. For Giwerc, new ideas or thoughts can fly in so fast and furious that his brain simply shuts down, he said.

Solution: Giwerc, also author of Permission to Proceed, has learned to work with his speedy thoughts. For instance, to capture his cascade of ideas, he uses voice-activated software, types on his computer or creates mind maps. He also keeps a pad of paper outside the shower, since that’s when he gets many of his ideas.

Exercise helps Sarkis quiet her overactive brain. She also suggested readers try yoga, prayer, meditation and deep breathing along with writing out your concerns and brainstorming specific solutions.

5. Obstacle: Feeling overwhelmed.

“If I don’t actively manage my stress, my time, and my to-dos, then I will succumb to overwhelm,” Koretsky said. She views overwhelm as one of the biggest challenges people with ADHD face.

She described it this way: “You feel frantic because no matter how hard you work or how much you think about things, you always seem to be further behind at the end of the day than you were when you started.”

Solution: Koretsky makes time management a priority. Every morning she spends 15 minutes managing her calendar and to-do list. She described her process like this:

First, I look at my to-do list and make sure it’s up to date. I become familiar with what I have to do, and what needs to happen in the immediate future.

Then, I take a look at my calendar and see when I have meetings and other commitments, and when I have time to actually get some things crossed off my list. If at all possible, I schedule one of those “Meetings with Me.”

This way, my day is planned out and my expectations are realistic.

Then, at the end of the day, I’ll take another look at my to-do list and happily cross off what I got done that day. It’s a great way to focus on the positive and build momentum!

Koretsky also makes time to relax in the evenings. “I know that I need my downtime every day in order to wind down, recharge, and truly avoid overwhelm.”

6. Obstacle: Eating too fast or too little.

People with ADHD often forget to eat — and only remember once they’re already ravenous, Sarkis said. She finds that she also rushes through eating.

Solution: Sarkis makes a conscious effort to eat more slowly and doesn’t let too much time lapse between meals or snacks. She also ditches distractions like watching TV while she eats.

7. Obstacle: Getting bored easily.

Like most people with ADHD, Giwerc has struggled with accomplishing tasks that are less interesting to him.

Solution: Giwerc tackles the most interesting tasks first. These tasks are aligned with his true passions and values (such as compassion and creativity). But he limits the amount of time he spends on these tasks (usually several hours), so he can transition to the more mundane activities.

8. Obstacle: Dwelling on perceived weaknesses.

People with ADHD tend to fixate on their supposed flaws and struggle with low self-esteem. Giwerc has experienced the onslaught of negative thoughts, which can be immobilizing.

Solution: Giwerc has learned to pause — with the help of visual prompts such as his poster with a giant stop sign and hand — and instantly ask himself: “How is what I’m paying attention to serving me?” If these thoughts are paralyzing, Giwerc works out.

Another strategy he uses — and suggests to his clients — is keeping a success diary, which helps shift the focus from demoralizing thoughts to positive ones. In it, you can jot down at least three events in your life when you’ve experienced success (along with why).

“Every person with ADHD is so unique,” Giwerc said. Again, that’s why it’s important to find your own approach to overcoming obstacles. Your strategies also will vary with each situation. For instance, when Giwerc is learning a new concept, he needs total silence or classical music. However, when he’s in a meeting, he needs to squeeze something or shake his legs.

Jul 18

By Jean Rothman Are you concerned that your child has ADHD? Many parents are, especially if they think their child has ADHD-related symptoms, such as impulsive behavior, forgetfulness, or difficulty concentrating.

But just because a child constantly runs around, refuses to do what you say, or has a room that looks like a tornado tore through it, doesn’t mean attention deficit hyperactivity disorder is the cause.

ADHD: Is It or Isn’t It?

While it’s possible your child’s behavior is due to ADHD, it may also be due to:

Normal growth and development
Another medical condition (such as a thyroid imbalance)
Simple immaturity

There are many situations during which children behave erratically, such as after a recent move or when a new baby joins the family.

ADHD: Three Subtypes

Before you start thinking about ADHD as a possible explanation, it’s helpful to know that there are three forms of ADHD and each has different symptoms.

The subtypes of ADHD are:

Inattentive subtype
Hyperactive-impulsive type
Combined type

ADHD Symptoms: Inattentive Type

Children with this diagnosis are usually not hyperactive and, in fact, may even move in a slow, sluggish manner. They may sit quietly and look like they are daydreaming. Symptoms of inattentive ADHD include:

Being distracted very easily
Regularly losing things like pencils, homework
Not paying attention to details
Making careless mistakes
Not following instructions
Tendency to start one activity before finishing another
Difficulty understanding information as quickly as other children
Finding it hard to be organized

ADHD Symptoms: Hyperactive-Impulsive Type

Symptoms of the hyperactive-impulsive type of ADHD are:

Restless behavior with a frequent desire to run around
Being impatient and fidgety
Being unable to stay seated when appropriate, for example in the classroom or during family meals
Talking nonstop and sometimes blurting out things
Finding it hard to wait in line and take turns.

ADHD Symptoms: Combined Type

Children with the combined type of ADHD have both inattentive and hyperactive-impulsive symptoms listed above.

ADHD: What to Look for

If you’re concerned that your child may have ADHD, the American Academy of Pediatrics suggests that you consider the following questions:

Is your child paying attention to details, or rushing through homework and making careless mistakes?
Do you think your child is listening to you?
Does your child find it hard to organize activities?
Does your child avoid tasks that require thinking?
Does your child just refuse to do what you ask?

ADHD: Symptoms Don’t Equal a Diagnosis

If you see these kinds of behaviors in your child once in awhile, there’s probably no need for concern. For a child to be diagnosed with ADHD, your pediatrician will look for some other telltale signs. These signs will begin early in a child’s life, sometimes even during the preschool years.

According to the American Academy of Pediatrics, the diagnosis of ADHD requires, among other things:

Symptoms must begin before the age of seven and last longer than six months.
Your child’s symptoms have to happen more often than in other children of the same age.
The behaviors don’t occur only at home. They need to appear in other situations as well, such as while the child is at school or playing with friends.
The symptoms must compromise the child’s school performance and ability to interact with others in social situations.

As a parent, it’s understandable to worry when your child behaves poorly, but don’t jump to conclusions that your child has ADHD. Be sure to talk to your pediatrician about your concerns.

Jul 17

Shasta Nelson, M.Div. What should you do when you know that your friend’s significant other is cheating on her?

You might expect a friendship advocate to champion, “Always tell your girlfriend the truth! Our loyalty is to each other!” And while I agree with that second sentence, I don’t think the first sentence always leads to that result. How we tell that truth is often what matters most.

Principles to Consider Before Confessing News that Could Ruin Her Life

Do you tell a girlfriend when her husband is cheating on her? Most women say they want to know… but how we do it can determine whether the friendship is protected. Every friendship is different, every marriage is different and every affair is different. There is no one answer to the question that will fit everyone, all the time. Some of us will have added complications if we also feel loyal to the person we know is cheating, if we all hang out together regularly as couples or families, if we know she’s had painful history with this subject, if she thinks her relationship is perfectly fine, if she’s pregnant or has young kids or any other number of variations.

Here are some things to consider before you tell her what you know about her husband or boyfriend that could devastate her.

First, know that your burden isn’t the priority. Yes, it feels like the worst secret ever. And you’re sick to your stomach with what you know. Unfortunately, that is not the biggest concern here. What you are feeling is nothing compared to what she will feel. Your feelings are big and scary, but if you’re thinking of confessing the truth so that you feel better — that is the worst reason to do so. Even if it is causing fights in your own marriage or keeping you up at night — that is not her fault. Vomiting the truth so that she hurts and you feel better is not friendship. Maturity means we learn to find our peace in the midst of painful situations. So if you do tell her, don’t breathe a word about how it’s impacting you, what you would do in this situation, or how mad at him you are. As much pain as you are in, don’t make this about you. This is her nightmare.

Women know when they’re ready to know, usually. I’ve talked to many women after they found out that their husbands were cheating and almost all of them saw warning signs and red flags when they looked back at the relationship. We might act like we don’t know, for a while, because we’re not ready to face the truth or because we’re not ready to have it called into question. So think long and hard about whether you think your friend doesn’t already know. In the coaching world we say, “Don’t have their ah-ha for them.” It’s usually more life changing for her to come to her own truth, than for us for force feed it to her. So if you do tell her, I’d start with the least amount of information you need to give. Being loyal to her doesn’t mean telling her everything you know, it means telling her enough so that she can try it on and make her best decisions. It’s usually best to tell her what you know with a little bit of doubt, allowing her to save face if she chooses denial for a little longer. Don’t force a long conversation or intervention now, just move on. You can know she’ll undoubtedly keep thinking about it.

You need to know that most women stay. I think it’s worth reminding you that most women stay in marriages even after an affair. And unless you’ve been there, you can’t judge it. Sometimes there are higher values at stake, other needs being met and alternative priorities that she chooses. That is not a choice of weakness; to stay is hard and it takes tremendous strength. But you need to know this because it’s not a given that she’s going to thank you for the information and leave him tomorrow. Supporting her means supporting her relationships, choices, decisions and timing. Supporting her means accepting her no matter whether you approve. So if you do tell her, then be sure you tell her that it’s okay if she stays or wants to try to work it out and that you can still understand what she loves about him. You should feel no invested stake in what choice she makes (even if it affects your ability to go out on double-dates — that is not the highest priority right now!), when she makes it, or how; let her know that you will fully support her and journey with her in any direction. And you’ll support her if she changes her mind down the road, too. Life is a journey, let her take hers.

Women don’t want to have to defend their family. Even when we know our mom is impossible, we don’t want someone else to say it. Even when we know our children are trouble-makers, we don’t want everyone else to think less of them. Even when our spouse makes us madder than mad, we don’t want our friends to not admire him. In fact it’s common that most women will blame the “other woman” more than they will their own spouse — its how we react to people we love. Like a mama bear with her cubs, chances are high that she will defend him; it’s partly how she defends herself. So if you do tell her, be very, very careful to still speak highly of him, to only share the bare minimum and to never speak poorly of him or their marriage. Even if she reacts with anger toward him, tell her you understand the feelings, but don’t agree with her or express your own opinion. What he did was a hurtful thing, but he is not a bad man. Even if she leaves him eventually, she will heal better if people around her aren’t devaluing him or feeding her anger.

The messenger can become the threat. If she’s defending him (or herself, since we all want to believe that we chose the perfect person, are worthy of their love and have a great marriage), you are at risk for being seen as the threat. At her very healthiest, she would be able to separate you from the message, but when we’re scared, we don’t always react rationally. She may accuse you of lying, see it as evidence that you’ve never really supported her relationship with him, or simply be so ashamed she can’t face you anymore for what you come to represent to her. If the truth comes out later, she may not want to face you and feel the embarrassment of an “I told you so,” and if she decides to stay, she may feel like she can never talk about it with you. So if you do tell her, know this distance is normal and a likely consequence of telling the truth. The best way to minimize this is by never placing yourself against him; rather just keep expressing how much you love her and will stick by her no matter what. Express deep regret for having to tell her, but simply tell her you would regret it more if she someday found out you knew and didn’t tell her.

Be ready and willing to handle the grief. If you’re not close enough to her to be someone who is ready to go through the grief cycle with her, you may not be close enough to her to tell her this news. She will likely need to grieve; whether it ends her relationship or not, there is still some loss. The stages of grief include denial, anger, bargaining, and depression — all of which she may take out on you. All of which are healthy and normal stages. Pray for the courage and tenacity to not take things personally. So if you tell her, you need to be committed to showing up in all those stages, reminding her how much you love her and support her. That might mean doing all the initiating for a while. That might mean being her place to vent or her person to ignore. No matter what she does, you should just keep saying to her, “You have a right to be mad. I would be to. That’s okay. But I’m going to still be here no matter what. You can yell at me, but I still love you.” It means being ready to clean up the vomit that was spewed. Because that’s real loyalty.

You’ve been put in a tough place knowing this information. But you can handle this choice. Loyalty may mean protecting her from this news for now if you feel that’s the best option. Loyalty can also mean helping her face her feelings, no matter how reactionary they are. Either way, you can love her and help her see her best self, so that when she goes through phases when she can’t see it herself — she can see herself through your eyes.
For more articles that deal with friendship break-ups, drift-aparts and rifts, go to Shasta’s Friendship

Jul 17

by John Ratey, M.D., Catherine Johnson, Ph.D. For the adult with mild attention deficit disorder, high energy levels and the ability to hyperfocus can lead to a flourishing career while the real trouble surfaces at home in an ADHD marriage.

Harvard’s John Ratey, M.D.coined the term “Shadow Syndrome” to describe a psychological disorder in so mild a form that diagnosis can elude even a trained therapist. Just as a cloud can cast a pall across an otherwise sunny day, a mild case of attention deficit disorder casts its cloud over our day-to-day lives. In the following excerpt from his book, John Ratey offer some examples of domestic mini-dramas, caused by mild ADD, that can “trap” our attention and cause major discord.

To understand the mild case of ADHD, it helps to look at ADHD in its full-blown form, where precipitous actions tumble forth as quickly as do impulsive words. The adult with attention deficit disorder may quickly jump in and out of jobs, relationships, projects, and commitments, swerving from one to another. The classic story of untreated full-blown ADD is the intelligent person who cannot get her life together, and who becomes increasingly demoralized, anxious, and depressed as the years wear on.

But the person with mild ADHD is not simply the less chaotic sibling of his severely afflicted twin. In fact, the adult with mild ADD may be a brilliant success on the job. High energy, enthusiasm, and the ability to hyperfocus can take a person to great heights in some professions. The mildly hyperactive adult can survey herself and see what she needs to work on. Thus, she might deliberately cultivate an obsession with her datebook, checking and rechecking it throughout the day. The mild ADDer may be the top salesman who can never finish his paperwork on time, or the financial executive who cannot file his own taxes. With a good assistant, these limitations won’t cripple your career.

But the two ends of the attentional spectrum – hyperfocus on the present moment and the constant search for the next high-energy task – that can be assets on the job may not work to the same advantage in the mild ADDer’s personal life. With mild ADD, as with many shadow syndromes, the real trouble registers in the social realm.

ADD and Love

A person who has a problem with paying attention is not going to be any more “attentive” to relationships than he was to school as a child. So, when the disorder goes undiagnosed, the ADD adult’s lack of attentiveness looks like poor judgment or a lack of intimacy and consideration. The mild ADDer is probably not going to be a social klutz, but he may have problems in the subtler realm of deciding whom to approach and whom to avoid. A mild ADDer may repeatedly choose the wrong person to love, in part because he does not absorb all the social cues other people may see from the start.

Or the ADDer’s need for stimulation may actually cause her to seek out trouble when choosing a mate. A mildly hyperactive adult may choose mates who are “bad” for her because they hold her interest in a way that the “nice guys” don’t. Some individuals know this about themselves; they know they are not looking for a calm and steady presence, as this leaves them feeling starved for stimulation.

One of Dr. Ratey’s patients came for help when she found herself consistently provoking fights with the one good man she had finally been able to love. The last straw had been a recent romantic evening. Despite wine, good food, and candlelight, she could not relax, could not unwind, and was horrified to find herself subtly sabotaging the mood until the evening was ruined. The diagnosis of ADD came as a revelation, although she was certainly no stranger to its symptoms. She had not made the connection between being hyper and her previous pattern of falling in love with men who were not good for her.

What she learned was that, she was, in short, self-medicating with the drug of a bad relationship. Life changed radically once she received a diagnosis and began treatment. For the first time, she could sit still; she could not only tolerate a calm day in the presence of a benevolent love, she could enjoy it. The difference was so startling that she took to calling the medication she had been prescribed her “love potion.”

Jul 14

Beat ADHD Anxiety and Stress


By Marie Suszynski If Simma Lieberman isn’t careful to lower her stress and anxiety levels, her mind will race so much that she can’t get much done. “It’s like I’m on a highway and I don’t take an exit, ever,” says Lieberman, an organizational development consultant in Albany, Calif., who has adult attention deficit hyperactivity disorder, or ADHD.

Dealing with anxiety and stress is vital for managing ADHD symptoms, partly because people with ADHD have more stress in their lives than the average person, says Ari Tuckman, PsyD, a clinical psychologist in West Chester, Penn., and author of More Attention, Less Deficit.

Still, Lieberman has learned stress-busting strategies to keep her ADHD symptoms under control and has become a successful consultant.

The Connection Between ADHD and Anxiety

People with ADHD genuinely have more things to be stressed over than people without the disorder, Tuckman says.

By definition, people with ADHD have trouble paying attention, controlling impulses, and dealing with hyperactivity. As a result, they’re less efficient at getting work done and they tend to make more mistakes than people without ADHD, he says. Adults with ADHD are more likely to lose their jobs and tend to make less money than the general population, he says.

In the meantime, the medications used to treat ADHD, like methylphenidate (Ritalin) and dextroamphetamine-amphetamine (Adderall), are stimulants and can cause people to feel more jittery and anxious.

However, Tuckman says those side effects typically fade after taking the medication for about a week. Ultimately, the medications should make you feel more in control and calm because they should help you feel on top of things and manage ADHD symptoms
The first step for treating anxiety, of course, is to take your prescribed medication. Here’s what else you can do:

1.Get educated about ADHD. Tuckman tells his patients to learn everything they can about ADHD. It helps to see yourself in a different light, and to understand that “it’s not that I’m lazy or passive-aggressive,” he says. “I have this brain-based information processing disorder.” That alone can help you feel less anxious about your symptoms.
2.Take practical advice from a coach. Working with an ADHD coach or therapist on gaining the practical skills you need to be more successful with things like time management will help you get better control of your life and your symptoms, which will help you feel less stressed.
3.Consider neurofeedback. Lieberman has started doing neurofeedback to work on calming her brain. A practitioner measures her brain waves while she watches a movie. During the session, she works on staying focused and relaxed.
However, Tuckman says neurofeedback is still in the “maybe” category of treatments that work. One problem is the lack of good quality studies on it. But practitioners may also be using different neurofeedback techniques, some more effective than others.

His advice: Go to a licensed psychologist for the treatment and be realistic about the results. “Some people out there make outlandish promises” about what neurofeedback can do, he says.

4.Center yourself. This is a term Lieberman uses to slow her mind when she feels it’s running too fast. She stops and asks herself, “What are you doing right now?” Then she visualizes herself doing what needs to be done in a calm way.
5.Try meditation. When Lieberman meditates first thing in the morning, she’s able to start the day in a very calm, focused place. Meditation makes you feel less anxious, so that alone will help you feel better, Tuckman says. Because people with ADHD tend to have trouble sitting still, it’s perfectly fine to meditate while you’re pacing around the room, he says.
6.Breathe. Lieberman uses breathing exercises almost every day during meditation and at night before going to sleep. “It really makes me calm and I can close my eyes and fall asleep quickly,” she says. “I separate from stress.”
7.Simplify your life. It’s advice everyone can benefit from, especially people with ADHD anxiety. “Have less stuff and fewer commitments so that what you have is easier to manage,” Tuckman says.
8.Set yourself up for success. Being organized is a big part of managing ADHD and anxiety, so Lieberman does everything she can to help her day go smoothly. She uses an appointment book, but also puts Post-It notes on her computer to remind herself to make phone calls and do other tasks.
Lieberman is also working on a book proposal, but sitting at a computer long enough to write can be difficult. So she works once a month with three people who also are writing book proposals. “We keep each other focused,” she says.

But perhaps the most important thing: Accept that when you have ADHD you have to deal with anxiety and stress. Once you’ve done that, Lieberman says, keep trying new strategies to manage them, until anxiety attacks are a thing of the past.

As a divorced parent, what lessons and behaviors are you modeling for your children? The messages you convey will influence your children into adulthood. Here is valuable advice on leaving a positive imprint on your innocent children.

Bad things can happen to good people. Divorce is a prime example. Good people get divorced. Responsible people who are loving parents get caught in the decision to end a loveless or deceitful marriage.

The consequences of that decision can either be life affirming or destroying, depending upon how each parent approaches this transition. Parents who are blinded by blame and anger are not likely to learn much through the experience. They see their former spouse as the total problem in their life and are convinced that getting rid of that problem through divorce will bring ultimate resolution. These parents are often self-righteous about the subject and give little thought to what part they may have played in the dissolution of the marriage.

Parents at this level of awareness are not looking to grow through the divorce process. They are more likely to ultimately find another partner with whom they have similar challenges or battles and once again find themselves caught in the pain of an unhappy relationship.

There are others, however, for whom divorce can be a threshold into greater self-understanding and reflection. These parents don’t want to repeat the same mistakes and want to be fully aware of any part they played in the failure of the marriage. Self-reflective people ask themselves questions and search within — often with the assistance of a professional counselor or coach — to understand what they did or did not do and how it affected the connection with their spouse.

These introspective parents consider how they might have behaved differently in certain circumstances. They question their motives and actions to make sure they came from a place of clarity and good intentions. They replay difficult periods within the marriage to see what they can learn, improve, let go of or accept. They take responsibility for their behaviors and apologize for those that were counter-productive. They also forgive themselves for errors made in the past and look toward being able to forgive their spouse in the same light.

These parents are honest with their children when discussing the divorce — to the age-appropriate degree that their children can understand. (That doesn’t mean confiding adult-level information to children who cannot grasp these issues!)They remind their children that both Mom and Dad still, and always will, love them. And they remember their former spouse will always be a parent to their children and therefore speak about them with respect around the kids.

By applying what they learned from the dissolved marriage to their future relationships, these mature adults start the momentum to recreate new lives in a better, more fulfilling way. From this perspective, they see their former marriage as not a mistake, but rather a stepping-stone to a brighter future — both for themselves and for their children. When you choose to learn from your life lessons, they were never experienced in vain. Isn’t this a lesson you want to teach your children?

* * *

Rosalind Sedacca, CCT is a Divorce & Parenting Coach and author of How Do I Tell the Kids about the Divorce? A Create-a-Storybook Guide to Preparing Your Children — with Love!

Jul 12

By Katherine Lee Hypoactive sexual desire disorder is the most common form of female sexual dysfunction. It’s defined as a chronic lack of interest in sexual activity that causes a woman distress — if a woman doesn’t view the lack of sexual interest as a problem, then it isn’t one.

Many physiological factors can dampen the libido’s fire. Menopause or a chronic medical condition can lead to physical changes that can affect a woman’s sex drive or lead to discomfort or decreased pleasure during sex.

And so can some drugs.

Drugs (and an Herb) That Affect Libido

Certain medications can interfere with the balance of hormones and transmission of chemical messengers in the brain, causing problems with libido and a woman’s ability to achieve orgasm. A few common medications can cause hypoactive sexual desire disorder. These include:

Antidepressants. Medications used to treat depression and anxiety symptoms are the most common drugs that can lead to hypoactive sexual desire disorder and other types of sexual dysfunction.

As an example, some commonly used antidepressants that can decrease sexual desire include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). These drugs are SSRIs (selective serotonin reuptake inhibitors), which means they work by making the “feel-good” hormone serotonin more available in the brain, thus improving mood. The problem: “Serotonin has a positive effect on mood but can have a negative effect on libido and orgasm,” says Jennifer Berman, MD, a urologist, a specialist in female sexual medicine, and the director of Berman Women’s Wellness Center in Los Angeles.
Birth control pills. As many as 30 percent to 40 percent of women who take birth control pills, such as Loestrin, can experience hypoactive sexual desire disorder, says Dr. Berman. “Birth control pills lower testosterone, which can lower libido,” says Berman.
Antihypertensives. Some medications commonly prescribed for high blood pressure like diuretics (such as furosemide or Lasix) and beta blockers (such as metoprolol) can lead to hypoactive sexual desire disorder. These drugs can dampen libido and cause difficulty reaching orgasm.
Chemotherapy, anti-cancer drugs. Drugs used to treat cancer are also associated with a reduced lack of sexual interest and hypoactive sexual desire disorder. For example, tamoxifen, a breast cancer drug, can lower estrogen levels, which can lower libido, says Berman. Cyclophosphamide, a chemotherapy drug, can cause vaginal dryness, reduced libido, and difficulty reaching orgasm.
Acne medications. Spironolactone is a drug that is usually prescribed to treat acne. It is also a diuretic that can be used to treat blood pressure or heart failure. It can have a negative effect on libido and lead to hypoactive sexual desire disorder.
Saw palmetto. This herbal remedy may lower testosterone and can play a role in hypoactive sexual desire disorder.

Women and Sexual Dysfunction: Replacing Medications

Women who experience hypoactive sexual desire disorder due to medications can try switching medications or finding alternative treatments. If the problem stems from oral contraceptives, the woman can consider switching to other forms of birth control such as an intrauterine device, says Berman.

If antidepressants are the cause, you may want to discuss with your doctor the possibility of reducing your dose or even consider looking for other causes of your mood disorder. (One often-overlooked cause of depression is hormonal imbalance, says Berman.) You can also consider switching to a more dopamine-driven drug, which is less likely to cause hypoactive sexual desire disorder.

As an alternative to hypertensive drugs that may cause hypoactive sexual desire disorder, you may want to consider calcium channel blockers or ACE inhibitors. “These drugs are less likely to have a negative impact on libido,” says Berman.

If you have hypoactive sexual desire disorder, discuss your options with your doctor. If medications are causing your hypoactive sexual desire disorder, you have options that can help you achieve a more satisfactory sex life.

Learn more in the Everyday Health Sexual Health Center.

Jul 11

How to Have a Healthy Relationship


By Wyatt Myers If you read gossip pages or celebrity magazines, you may think that no relationship lasts in this country anymore. Unfortunately, the reality of our romantic relationships isn’t too far from that. It is currently estimated that almost half of all marriages in the United States end in divorce.

With so many breakups going on, how is it that some couples thrive while the rest fail to survive? The truth is that it takes some work to keep relationships healthy. And most people find that the work is well worth the effort when their relationship is still going strong decades after it began. Some simple strategies can help couples strengthen their romantic relationships, no matter what obstacles they face together.

Maintain the Right Ratio

Christine M. Allen, PhD, knows about maintaining a romantic relationship. Not only is she a psychologist and a life coach, but she has also had a strong, healthy relationship with her husband for more than 25 years in the hustle and bustle of New York City.

The secret, Dr. Allen says, is to make sure the positives in the relationship outweigh the negatives by at least a 5:1 ratio. “If you have a lot of complaints, it helps to counterbalance that with a lot of praise, recognition, and affection for all the things that go right in your life,” she says.

Allen has important suggestions to help you maintain that special balance. “When possible, turn a complaint into a request,” she says. “In other words, rather than say, ‘It is thoughtless to be late,’ say, ‘I would like you to call me if you are going to be late.’ Also make any complaining specific to an action. For example, say, ‘When you do X, I feel Y.’”

Striking a Balance

This idea of finding the right ratio in a healthy relationship applies not only to the positives and negatives, but to all aspects of the relationship. Says Allen, “It is important to have shared activities, whether they be going to the movies, playing golf, or having conversation. Each partner in a couple can enjoy time together and time apart from the other. In a healthy romance, you do not expect to get all of your needs met by your partner in some idealized or unrealistic way.”

When there are children in the relationship, the same rules of balance need to apply, says Allen. “Have a date night, even if you don’t go out of the house,” she suggests. “Have dinner together without the children one night a week. Feed them early, and let them watch a DVD while you have a grown-up dinner.”

Handling Arguments

Of course, some fighting is inevitable in a relationship, but Allen says it’s how you handle those disagreements that marks the difference between healthy and unhealthy relationships. “Do not avoid conflict, as avoiding conflict can be the kiss of death over time in relationships. But don’t vent anger toward each other in a conflict,” she says. “Instead, manage hurt and anger, so it is neither withheld nor vented on your partner. Use awareness of hurt and anger to express more directly and constructively your needs and concerns.”

Keeping the Romance Real

The other critical component of a healthy relationship is to make physical contact and intimacy a priority. Here again, you have to actively work at this part of your relationship to keep it fresh and vital through the years. And this aspect of the relationship doesn’t always have to be about sex, says Elaine Ducharme, PhD, a licensed clinical psychologist and an adjunct professor at at the University of Hartford in Connecticut.

“People can actually feel more intimate just sharing a cup of coffee in a small café or walking hand-in-hand than having sex,” Ducharme says. “Take time in the evening to touch, not necessarily have sex. Lie in bed together, or sit on the sofa and gently massage your partner’s arm or neck. It is a wonderful way to connect and have feelings of relaxation connected to each other.”

Ultimately, a healthy, long-lasting relationship is a partnership. “A healthy romance is one in which each partner sees the best in the other and each of you becomes better than you would have been on your own,” says Allen. “Your partner’s love for you and appreciation of you helps you continue to believe more in yourself. We also accept the other person’s foibles and do not judge him or her on the small stuff.”

Learn more in the Everyday Health Emotional Health Center.

Jul 10

By Rick Nauert PhDSenior News Editor

Have you tried meditation and felt it wasn’t for you? If the answer is yes, don’t despair, you may have simply selected a method that did not match your profile. A new study published online in EXPLORE: The Journal of Science and Healing discusses the importance of ensuring that new meditators select methods with which they are most comfortable, rather than those that are most popular. If they do, they are likely to stick with it, says Adam Burke, the author of the study. If not, there is a higher chance they may abandon meditation altogether, losing out on its myriad personal and medical benefits.

“Because of the increase in both general and clinical use of meditation, you want to make sure you’re finding the right method for each person,” he said. Despite the surge in meditation practice, very few studies have compared multiple methods head to head to examine individual preference or specific clinical benefits. To better understand user preference, Burke compared four popular meditation methods — Mantra, Mindfulness, Zen and Qigong Visualization — to see if novice meditation practitioners favored one over the others.

In the study, 247 participants were taught each method and asked to practice at home and, at the end of the study, evaluate which they preferred. The two simpler methods, Mantra and Mindfulness, were preferred by 31 percent of study participants. Zen and Qigong had smaller but still sizable contingents of adherents, with 22 percent and 14.8 percent of participants preferring them, respectively.

Researchers say the results show the value of providing new practitioners a simpler, more accessible method of meditation. But they also emphasize that no one technique is best for everyone, and even less common methods are preferred by certain people. Older participants, who grew up when Zen was becoming one of the first meditation techniques to gain attention in the U.S., in particular were more likely to prefer that method.

“It was interesting that Mantra and Mindfulness were found to be equally compelling by participants despite the fact that they are fundamentally different techniques,” Burke said. Currently, the mindfulness meditation technique enjoys widespread popularity, and is often the only one with which a novice practitioner or health professional is familiar. Not surprisingly, Mindfulness was the method most preferred by the youngest participants.

“If someone is exposed to a particular technique through the media or a healthcare provider, they might assume because it’s popular it’s the best for everyone,” Burke said. “But that’s like saying because a pink dress or a blue sport coat is popular this year, it’s going to look good on everybody. In truth, different people like different things. One size does not fit all.”
Being comfortable and content with a technique is critical for success.

If an individual is not comfortable with a specific method for any reason they may be less likely to continue meditating and would lose out on such benefits as reduced stress, lower blood pressure or even treatment for addiction, says Burke. Burke hopes to see more comparative meditation studies, especially to determine if particular methods are better at addressing specific health issues, such as addiction.

If that’s the case, he said, healthcare professionals would be able to guide patients toward techniques that will be most effective for them. Finally, as the practice of meditation grows in popularity, studies are also needed to determine if there is a way to predict which method will be best suited for any particular individual.

Jul 4

Why Brains Are More Important Than Billions


Published on July 3, 2012 by Jonathan Wai, Ph.D. in Finding the Next Einstein
Mark Zuckerberg and Priscilla Chan are in the top 1 percent in wealth. What has not been discussed is that both of them are also likely in the top 1 percent in brains. We know that Zuckerberg is because he was identified by a talent search and attended a summer program for gifted youths which means he had to have scored in the top 1 percent (plus he was accepted by and attended Harvard). Chan was valedictorian of her high school, was accepted by and attended Harvard, and then was accepted by and graduated from UCSF medical school which taken together indicate that she is also likely in the top 1 percent in brains.

I discuss the connection between the top 1 percent in brains and the top 1 percent in wealth in my feature article for the July 2012 issue of Psychology Today:

“I wanna be a billionaire so [freakin’] bad,” sing Bruno Mars and Travie McCoy in their eponymous hit single. They’re hardly the only ones. Americans are as enamored of extreme wealth as they are infuriated by it. Post-Occupy Wall Street, the spotlight shines more starkly than ever on the top 1 percent of earners, a fact not lost on Mars and McCoy, who rap, “And yeah, I’ll be in a whole new tax bracket/ We in recession, but let me take a crack at it.” Whatever one’s political and ideological stance, there is no dispute over the power wielded by the nation’s highest earners.

Yet the national obsession with wealth bypasses another group of elites, who overlap in a critical way with the top 1 percent in income, and who, in the age of big data and relentless globalization are arguably as important in determining the nation’s economic course. This group is the top 1 percent in brains. The world is drowning in data, rendering stellar quantitative skills more critical than ever. The majority of the smartest are those with a demonstrated aptitude for math and spatial reasoning, the cognitive toolkit increasingly in demand in the age of information.

Yet ironically, America undervalues math and spatial skills—it is socially acceptable to be bad at math. (Not exactly the case when it comes to reading.) Overlooking the need for basic proficiency in STEM (science, technology, engineering, and mathematics) fields and the pedagogical needs of the most gifted students may have dire creative and economic repercussions.

Read more here.

Jul 3

ADHD Parenting Tips: Better Discipline


by John Taylor, Ph.D. Like all kids, children with attention deficit disorder (ADD ADHD) sometimes make bad choices regarding their own behavior. No surprise there. But to make matters worse, parents could often use a few parenting tips themselves, and err in the way they discipline misbehavior. Instead of using firm, compassionate discipline, they move into what I call the ignore-nag-yell-punish cycle.

First, the parent pretends not to notice the child’s misbehavior, hoping that it will go away on its own. Of course, this seldom works, so the parent next tries to urge the child not to do such and such. Next, the parent starts yelling and scolding. When this doesn’t produce the desired result, the parent becomes extremely angry and imposes harsh punishments. I think of this fourth stage as the parent’s temper tantrum.

This four-part strategy (if you could call it that) isn’t just ineffective. It makes life needlessly unpleasant for every member of the family.

How can you avoid it? As with any other pitfall, simply being aware of it will help you steer clear of it. At the first sign of starting on the wrong path, you can stop what you’re doing and make a conscious decision to try something else. Take an honest look at how you respond when your children misbehave. What specific situations are likely to cause you to go down this path? How far down the path do you typically proceed? How often?

Let’s examine the ignore-nag-yell-punish strategy more closely to see why it doesn’t work — and come up with some strategies that do.

Why ignoring doesn’t work
By ignoring your child’s misbehavior, you send the message that you neither condone nor support his misbehavior. At least that’s the message you hope to send.

In fact, your child may read your silence as “I won’t give you my attention or concern” or even “I reject you.” That can wound a child. On the other hand, your child may assume that your silence means that you approve of his behavior or will at least tolerate it. “Mom hasn’t said I can’t do this,” he thinks, “so it must be OK.”

Even if your child correctly interprets the message that you’re trying to send by ignoring him, he has no idea what you want him to do instead. In other words, ignoring your child doesn’t define better behavior or provide guidance about how your child should behave next time.

Instead of ignoring him when he does something you disapprove of, I recommend another “i-word”: interrupting. That is, quickly move people or objects so that your child is unable to misbehave.

For example, if your children start quarreling over a toy, you might say, “Alex, sit over there. Maria, stand here. I’ll take this and put it up here.” Similarly, if your teen comes for supper with dirty hands, immediately take his plate off the table and silently point to his hands. If you feel the need to tell your child what you expect of him, tell him once, very clearly. Then stop talking.

Jul 3

Pharmacologist Michael Klein, Ph.D., is director of the Food and Drug Administration (FDA) Controlled Substance Staff.

During more than 30 years of federal service, he has amassed extensive experience with issues related to drug regulation, abuse, misuse, and addiction. Prior to joining FDA 20 years ago, Dr. Klein worked as a senior scientist with the Drug Enforcement Administration (DEA).

Q: What is misuse and abuse of prescription drugs?

A: When a person takes a legal prescription medication for a purpose other than the reason it was prescribed, or when that person takes a drug not prescribed to him or her, that is misuse of a drug. Misuse can include taking a drug in a manner or at a dose that was not recommended by a health care professional. This can happen when the person hopes to get a bigger or faster therapeutic response from medications such as sleeping or weight loss pills. It can also happen when the person wants to “get high,” which is an example of prescription drug abuse.

Q: What’s the difference between misuse and abuse?

A: It mostly has to do with the individual’s intentions or motivations. For example, let’s say that a person knows that he will get a pleasant or euphoric feeling by taking the drug, especially at higher doses than prescribed. That is an example of drug abuse because the person is specifically looking for that euphoric response.

In contrast, if a person isn’t able to fall asleep after taking a single sleeping pill, they may take another pill an hour later, thinking, “That will do the job.” Or a person may offer his headache medication to a friend who is in pain. Those are examples of drug misuse because, even though these people did not follow medical instructions, they were not looking to “get high” from the drugs. They were treating themselves, but not according to the directions of their health care providers.

However, no matter the intention of the person, both misuse and abuse of prescription drugs can be harmful and even life-threatening to the individual. This is because taking a drug other than the way it is prescribed can lead to dangerous outcomes that the person may not anticipate.

Q: What are the dangers linked to misuse and abuse of prescription drugs?

A: It’s important to note that all drugs can produce adverse events (side effects), but the risks associated with prescription drugs are managed by a health care professional. Thus, the benefits outweigh the risks when the drug is taken as directed.

However, when a person misuses or abuses a prescription drug, there is no medical oversight of the risks. A person can die from respiratory depression from misusing or abusing prescription painkillers; for example, opioids. Prescription sedatives like benzodiazepines can cause withdrawal seizures. Prescription stimulants such as medications for attention deficit hyperactivity disorder (ADHD) can lead to dangerous increases in blood pressure. The risks from these drugs are worse when they are combined with other drugs, or alcohol.

Additionally, when a person misuses a prescription drug, even on a single occasion, that individual might enjoy the experience so much that they begin to seek out the drug more often. Thus, drug abuse and drug dependence are serious risks of misusing prescription drugs.

Q: Why do people misuse and abuse prescription drugs?

A: Prescription drugs are often readily accessible in the home, so it’s easy to take more of them than recommended for a therapeutic reason, or to sneak a few from someone else’s bottle to see if you can “get high.”

One feature of prescription drug abuse is when a person continues to take the drug after it’s no longer needed, medically. This is usually because the drug produces euphoric responses. Prescription drugs are often preferred for abuse because of the mistaken belief that the drugs provide a “safe high.” But as I mentioned before, all drugs carry risks, and if these risks are not being managed by a health care professional, people can get into serious trouble.

Q: How big is this problem?

A: The prevalence of misuse and abuse of prescription medications is concerning. The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal health agency, reports that in 2008, 52 million persons in the United States age 12 or older had used prescription drugs nonmedically at least once in their lifetime, and 6.2 million had used them in the past month. SAMHSA also reported that between 1998 and 2008, there was a 400 percent increase in substance abuse treatment admissions for opioid prescription pain relievers.

A recent Centers for Disease Control and Prevention (CDC) survey found that one in five high school students had taken a prescription drug without a doctor’s prescription. According to SAMHSA, the majority of these teenagers are obtaining the drugs from friends or relatives for free. Most concerning, the perception of risk of prescription drug abuse declined 20 percent from 1992 to 2008, based on data from a National Institute on Drug Abuse survey.

Q: What prescription drugs are being misused and abused?

A: SAMHSA reports that in 2008, nonmedical use of psychotherapeutic prescription drugs fell into four major classes: pain relievers, tranquilizers, stimulants, and sedatives.

Nearly 35 million Americans reported that they had nonmedical use of prescription pain relievers—including opioid-containing drugs such as hydrocodone (Vicodin), oxycodone (OxyContin, Percodan, Percocet), and fentanyl (Duragesic)—at least once during their lifetime.

Approximately 21.5 million Americans have used prescription tranquilizers for nonmedical purposes at least once. These include drugs prescribed for anxiety or insomnia, such as benzodiazepines—including diazepam (Valium), alprazolam (Xanax) and clonazepam (Klonapin)—and non-benzodiazepines such as zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta).

Similarly, about 21.2 million Americans have used prescription stimulants nonmedically at least once. These include drugs prescribed for ADHD such as amphetamine (Adderall), methylphenidate (Ritalin, Concerta, and Daytrana), and methamphetamine. Notably, almost 13 million people reported they had used prescription methamphetamine at least once during their lifetime.

Finally, nearly 9 million Americans have used prescription sedatives nonmedically at least once. These sedatives include barbiturates such as amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal).

Q: Who is misusing and abusing these medications?

A: Prescription drugs are being misused and abused by a wide variety of people. According to SAMHSA, about 26 million Americans between the ages of 26 and 50 report they have used prescription drugs non-medically at some point in their life. Other age groups have lower lifetime incidents: 13 million who are age 50 or older, 9 million who are age 18 to 25, and 3 million who are 12 to 17 years of age.

There also appears to be regional differences across the U.S. For example, SAMHSA reports that the highest past-year rates of nonmedical use of prescription pain relievers occur in Arkansas, Kentucky, Nevada, Oklahoma, Oregon, Tennessee, and Wisconsin.

Q. Should a person’s health care professional tell them about the risks associated with a medication with abuse potential?

A: Yes. The health care professional should talk to a patient about all of the warnings and precautions listed in the drug label for the medication being prescribed. In addition, if a medication guide is available, it will explain the risks of the drug in plain language. The pharmacy will provide the medication guide when a person picks up the prescription.

FDA also recommends that patients be vigilant when it comes to matters of their health. Reading information and asking questions are good practices, though they are only the first steps. For instance, individuals may not realize they are developing a drug abuse problem with a prescription drug, especially if they were initially using the drug as directed when they were patients.

Health care professionals should encourage patients to be aware of early signs of drug abuse, which can include using the prescription more frequently or at higher doses, but without medical direction to do so. Using the drug compulsively or not being able to carry out normal daily activities because of drug misuse are also signs of abuse.

Finally, health care professionals and pharmacists have a responsibility to remind patients not to share their medications with friends or family. Not only is this a dangerous practice health-wise, it is also illegal.

Q: How does FDA help prevent misuse and abuse of prescription medicines?

A: FDA works hard to meet the challenges of preventing misuse and abuse of prescription drugs, while making sure that medically appropriate drugs are available for the patients who need them.

The primary way FDA works to prevent misuse and abuse is through educating patients, caregivers, and health care professionals. This often occurs through the information FDA provides to each of these groups, such as in drug labels, medication guides, and alerts.

But long before a patient can obtain a prescription, FDA has already evaluated whether the drug is safe and effective for a particular medical condition. FDA only approves those drug applications that have been shown to be safe and effective for a specific indication, and the data from this review is then used to create informational materials.

FDA is also part of the wider national strategy involving other government agencies, the pharmaceutical industry, medical organizations, and community groups, among other entities. This combined effort addresses improved treatment, prevention, enforcement, and emerging drugs of abuse.

Q: How is a prescription medication classified as having potential for abuse?

A: During FDA’s drug review process, certain data can give indications that a drug has abuse potential. The chemical structure may be similar to a known drug of abuse. When the drug is given to animals, it may produce behaviors that are like those produced by abusable drugs. In humans, the drug may produce a high rate of euphoria.

FDA considers these and all abuse-related data to make a determination regarding abuse potential, which is a part of the safety evaluation of a drug. If a drug is deemed to have abuse potential, DEA is informed and they may add the drug to the list of substances covered by the Controlled Substances Act (CSA).

In addition, FDA can become aware that a drug has abuse potential through other means. For example, there may be epidemiological reports of abuse that only became evident after the drug was marketed. Also, DEA informs us that there is an increase in law enforcement actions related to a specific drug. In both cases, FDA reviews all available data and makes a scientific and medical assessment of whether the drug has abuse potential. If it does, DEA is informed and may schedule the drug under the CSA.

Q: What are the keys to preventing abuse of prescription medicines?

A: Be informed about the effects of prescription drugs and be vigilant. Know what medications your loved ones are taking and watch for signs of changes in behavior. For instance, have you noticed negative changes in your child’s behavior or grades? Is your spouse evasive about how much medication he or she is taking? Do you have friends that you suspect might be pilfering prescription drugs from your medicine cabinet?

SAMHSA has a great website on signs of prescription drug abuse.

If you are taking medications that have abuse potential, use the drugs only as directed. Don’t share them, and store them in a safe, secure place. Count the pills regularly to make sure no one else is using them. If you are having a house party or an open house, make sure the medications are properly secured.

Finally, all drugs should be disposed of properly after they are no longer needed. If no specific disposal directions are given with the medication, discard the drugs by mixing with undesirable substances, sealing them in a container, and placing them in the trash. You can also call your local DEA office for advice on alternative disposal methods.

Q: What can I do if I find that someone I know is abusing prescription drugs, or if I find myself becoming dependent on them?

A: SAMHSA has a website ( and a telephone hotline (800–662–HELP [4357]) to aid in finding treatment facilities in different areas of the country. I recommend contacting them and a health care professional, as no single type of treatment is appropriate for everyone who is abusing prescription drugs.

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