Cracking down on highly effective pain medications will make patients suffer for no good reason
By Maia Szalavitz on May 10, 2016

Both the FDA and the CDC have recently taken steps to address an epidemic of opioid overdose and addiction, which is now killing some 29,000 Americans each year. But these regulatory efforts will fail unless we acknowledge that the problem is actually driven by illicit—not medical—drug use.
You’ve probably read that 80 percent of heroin users started with prescription medications—and you may have seen billboards that compare giving pain medication to children to giving them heroin. You have probably also heard and seen media stories of people with addiction who blame their problem on medical use.
But the simple reality is this: According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer.
And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction, according to a study by Richard Miech of the University of Michigan and his colleagues. For this research, the authors analyzed data from the nationally representative Monitoring the Future survey, which includes thousands of students.
While medical use of opioids among students who were strongly opposed to alcohol and other drugs did raise later risk for misuse, the overall risk for this group remained small and their actual misuse occurred less than five times a year. In other words, it wasn’t actually addiction. Given that these teens had generally rejected experimenting with drugs, an increased risk of misuse associated with medical care makes sense since they’d otherwise have no source of exposure.
But for the majority of students, who weren’t morally opposed to recreational chemicals, medical use made no difference. Here, heavy recreational drug use was what mattered, and that was probably a sign that this group was was at highest risk of addiction in the first place.
In general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.
Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.
All of this this means that steps to limit prescribing opioids for chronic pain run a great risk of harming pain patients without doing much to stop addiction. The vast majority of people who are prescribed opioids use them responsibly—recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.
If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment. Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes. We need to help abused, neglected and otherwise traumatized children before they turn to drugs for self-medicatation when they hit their teens.
Further, at least half of people with opioid addictions also have a mental illness or personality disorder. The precursors to these problems are often evident in childhood, too. For example, children who are extremely impulsive are at high risk—but on the opposite end of the scale, so, too are children who are highly cautious and anxious. To reach these kids, we don’t need to label them, but we do need to provide tools that are tailored to their specific issues to prevent them from using drugs to manage those issues.
The final major risk factor for addiction is economic insecurity and poverty, particularly unemployment and the hopelessness, social marginalization and lack of structure that often accompany it. For example, heroin addiction rates among people who make less than $20,000 a year are 3.4 times higher than in people who make over $50,000. To those who study the effects of inequality on health, it is no coincidence that the collapse of the white middle class has been accompanied by a rise in all types of addictions, but especially addiction to opioids.
Many people would prefer it if we could solve addiction problems by busting dealers and cracking down on doctors. The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better. Only when we can steer them towards healthier—or at least, less harmful—ways of self-medication, and only when we reach children before they develop this type of desperation, will we be able to reduce addiction and the problems that come with it.

By Janice Wood

A new study shows that the age at which an adolescent starts using marijuana affects which parts of the brain will be affected.

Researchers at the Center for BrainHealth at the University of Texas at Dallas found that study participants who began using marijuana when they were 16 or younger had brain variations that indicate arrested brain development in the prefrontal cortex, the part of the brain responsible for judgment, reasoning, and complex thinking.

Those who started using after age 16 showed the opposite effect, demonstrating signs of accelerated brain aging, according to the study, which was published in Developmental Cognitive Neuroscience.

“Science has shown us that changes in the brain occurring during adolescence are complex. Our findings suggest that the timing of cannabis use can result in very disparate patterns of effects,” said Francesca Filbey, Ph.D., principal investigator. “Not only did age of use impact the brain changes, but the amount of cannabis used also influenced the extent of altered brain maturation.”

For the study, the researchers analyzed MRI scans of 42 heavy marijuana users; 20 participants were categorized as early onset users with a mean age of 13.18, while 22 were labeled as late onset users with a mean age of 16.9.

According to self-reports, all the participants, who ranged in age from 21 to 50, began using marijuana during adolescence and continued throughout adulthood, using at least once a week.

According to Filbey, in typical adolescent brain development, the brain prunes neurons, which results in reduced cortical thickness and greater gray and white matter contrast. Typical pruning also leads to increased gyrification, which is the addition of wrinkles or folds on the brain’s surface.

However, in this study, MRI results reveal that the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users.

This indicates that when participants began using marijuana before age 16, the extent of brain alteration was directly proportionate to the number of weekly marijuana use in years and grams consumed.

In contrast, those who began using marijuana after age 16 showed brain changes that would normally manifest later in life: Thinner cortical thickness, and stronger gray and white matter contrast.

“In the early onset group, we found that how many times an individual uses and the amount of marijuana used strongly relates to the degree to which brain development does not follow the normal pruning pattern,” she said.

“The effects observed were above and beyond effects related to alcohol use and age. These findings are in line with the current literature that suggest that cannabis use during adolescence can have long-term consequences.”

Source: Center for BrainHealth at The University of Texas at Dallas

By Janice Wood
A new study shows that the age at which an adolescent starts using marijuana affects which parts of the brain will be affected.

Researchers at the Center for BrainHealth at the University of Texas at Dallas found that study participants who began using marijuana when they were 16 or younger had brain variations that indicate arrested brain development in the prefrontal cortex, the part of the brain responsible for judgment, reasoning, and complex thinking.

Those who started using after age 16 showed the opposite effect, demonstrating signs of accelerated brain aging, according to the study, which was published in Developmental Cognitive Neuroscience.

“Science has shown us that changes in the brain occurring during adolescence are complex. Our findings suggest that the timing of cannabis use can result in very disparate patterns of effects,” said Francesca Filbey, Ph.D., principal investigator. “Not only did age of use impact the brain changes, but the amount of cannabis used also influenced the extent of altered brain maturation.”

For the study, the researchers analyzed MRI scans of 42 heavy marijuana users; 20 participants were categorized as early onset users with a mean age of 13.18, while 22 were labeled as late onset users with a mean age of 16.9.

According to self-reports, all the participants, who ranged in age from 21 to 50, began using marijuana during adolescence and continued throughout adulthood, using at least once a week.

According to Filbey, in typical adolescent brain development, the brain prunes neurons, which results in reduced cortical thickness and greater gray and white matter contrast. Typical pruning also leads to increased gyrification, which is the addition of wrinkles or folds on the brain’s surface.

However, in this study, MRI results reveal that the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users.

This indicates that when participants began using marijuana before age 16, the extent of brain alteration was directly proportionate to the number of weekly marijuana use in years and grams consumed.

In contrast, those who began using marijuana after age 16 showed brain changes that would normally manifest later in life: Thinner cortical thickness, and stronger gray and white matter contrast.

“In the early onset group, we found that how many times an individual uses and the amount of marijuana used strongly relates to the degree to which brain development does not follow the normal pruning pattern,” she said.

“The effects observed were above and beyond effects related to alcohol use and age. These findings are in line with the current literature that suggest that cannabis use during adolescence can have long-term consequences.”

Source: Center for BrainHealth at The University of Texas at Dallas

Written by Marie Ellis

The health detriments of cigarette smoking are, by now, very well known to the general public. But what about hookah smoking? Though some people believe the myth that because hookahs employ a water bowl, it makes them safer by drawing the smoke through the water, a new study unveils some shocking discoveries about just how harmful hookah smoking is.

Just one hookah session delivers 10 times the carbon monoxide of a single cigarette, prompting researchers to caution that hookah smokers are exposed to more toxicants than they likely realize.
Hookahs are water pipes from which people can smoke specially made tobacco with flavors, including apple, mint, cherry, chocolate and watermelon.

Use of the hookah – also known as narghile, argileh, shisha, hubble-bubble and goza – began centuries ago in Persia and India. It is typically used in groups, and users share the same mouthpiece as it is passed around.

Hookah cafes around the world are becoming more and more popular, with locations springing up in countries including the UK, France, the US and Russia.

Although cigarette smoking rates are beginning to fall, researchers from this latest study – published in the journal Public Health Reports – note that more people are using hookahs to smoke tobacco.

However, the University of Pittsburgh School of Medicine researchers say their study shows that such smokers are taking in a large load of toxins.

Hookah delivers 10 times carbon monoxide of single cigarette
To conduct their research, the team conducted a meta-analysis, which is a mathematical summary of previously published data. The benefit of a meta-analysis is that it produces more precise estimates based on available data.

Dr. Smita Nayak, study coauthor and research scientist, says that individual studies “have reported different estimates for inhaled toxicants from cigarettes or hookahs, which made it hard to know exactly what to report to policy makers or in educational materials.”

Fast facts about hookahs
Hookahs are water pipes used to smoke specially made tobacco
They have been used for centuries, likely originating in Persia and India
Hookah smoking carries many of the same risks as cigarette smoking.

In total, the researchers reviewed 542 scientific articles that were relevant to cigarette and hookah smoking. From this, they narrowed the articles down to 17 studies with enough data to make reliable estimates on toxicants inhaled from cigarettes or hookahs.

Their research revealed that one hookah session delivers about 125 times the smoke, 25 times the tar, 2.5 times the nicotine and 10 times the carbon monoxide of a single cigarette.

Lead study author Dr. Brian A. Primack says their findings demonstrate the dangers that hookah smoking present, and he cautions that “it should be monitored more closely than it is currently.”

“For example,” he adds, “hookah smoking was not included in the 2015 Youth Risk Behavior Surveillance Survey System questionnaire, which assesses cigarette smoking, chewing tobacco, electronic cigarettes and many other forms of substance abuse.”

The issue of teen hookah smoking is currently being addressed by the Centers for Disease Control and Prevention (CDC). They recently reported that – for the first time – past 30-day use of hookah was higher than past 30-day use of cigarettes among high school students in the US.

Because about one third of US college students have smoked tobacco for the first time from a hookah, there are concerns that the device could be a gateway to regular tobacco use.

‘Hookah smokers exposed to a lot more toxicants than they realize’
The researchers acknowledge that comparing a single hookah smoking session to smoking a single cigarette is problematic, due to smoking pattern differences.

For example, a regular cigarette smoker may smoke 20 cigarettes each day, while a regular hookah smoker may only use a hookah a few times each day.

“It’s not a perfect comparison because people smoke cigarettes and hookahs in very different ways,” says Dr. Primack. He explains that the reason they had to carry out their analysis in this way is that it is how underlying studies report their findings.

He adds:

“So, the estimates we found cannot tell us exactly what is ‘worse.’ But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize. After we have more fine-grained data about usage frequencies and patterns, we will be able to combine those data with these findings and get a better sense of relative overall toxicant load.”

According to the CDC, hookah smokers may be at risk for some of the same diseases smokers face, including oral cancer, lung cancer, stomach cancer, reduced lung function and reduced fertility.

In 2015, Medical News Today reported that almost 20% of high school seniors report using hookahs.

Written by Marie Ellis

By Rick Nauert PhD

New research suggests the practice of using benzodiazepines to treat psychiatric conditions should be abandoned as evidence suggests the drugs heighten the risk for dementia and death.

Benzodiazepines include branded prescription drugs like Valium, Ativan, Klonopin, and Xanax. This class of drug received FDA approval in the 1960s and was believed to be a safer alternative to barbiturates.

Despite new psychiatric protocols, some physicians continue to prescribe benzodiazepines as a primary treatment for insomnia, anxiety, post-traumatic stress disorder, obsessive compulsive disorder, and other ailments.

“Current research is extremely clear and physicians need to partner with their patients to move them into therapies, like antidepressants, that are proven to be safer and more effective,” said Helene Alphonso, DO, a board-certified psychiatrist and Director of Osteopathic Medical Education at North Texas University Health Science Center.

“Due to a shortage of mental health professionals in rural and underserved areas, we see primary care physicians using this class of drugs to give relief to their patients with psychiatric symptoms. While compassionate, it’s important to understand that a better long-term strategy is needed.”

Alphonso will review current treatment protocols, outpatient benzodiazepine detox strategies, and alternative anxiety treatments at OMED 15, to be held October 17-21 in Orlando. OMED is the annual medical education conference of the American Osteopathic Association.

A Canadian review of 9,000 patients found those who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken one. Taking the drug for three to six months raised the risk of developing Alzheimer’s disease by 32 percent, and taking it for more than six months boosted the risk by 84 percent. Similar results were found by French researchers studying more than 1,000 elderly patients.

Experts say the case for limiting the use of benzodiazepines is particularly compelling for patients 65 and older, who are more susceptible to falls, injuries, accidental overdose, and death when taking the drugs. The American Geriatric Society in 2012 labeled the drugs “inappropriate” for treating insomnia, agitation, or delirium because of those risks.

“It’s imperative to transition older patients because we’re seeing a very strong correlation between use of benzodiazepines and development of Alzheimer’s disease and other dementias. While correlation certainly isn’t causation, there’s ample reason to avoid this class of drugs as a first-line therapy,” Alphonso said.

Source: American Osteopathic Association/EurekAlert

By Christine Schoenwald for YourTango.com
I’m addicted to Facebook. I don’t just go on there once or twice a day — I’m constantly on there. But there are a lot of things I don’t see on my feed, some things (and people) that I’ve blocked and other content that the Facebook algorithm has randomly decided not to show me.

Still, there’s so much on Facebook that I don’t want to see and that I wish I’d never seen. If I never see another over-the-top conservative rant from that nice boy from second grade again, or the endless pictures and videos of my middle school friend’s son learning how to potty, I’d be forever grateful.

But even more than the annoying and sometimes just plain gross shares are the amazing successes and overwhelming joys people share, which cause me to focus on what other people have. I find myself comparing my life to those lives of others, and my life (though a wonderful life) falls short.

Of course, I could unfriend, unfollow or block the spectacular over-sharers, but then who would I have to promote all my crap… I mean, cool activities and milestones to?

I’m just not sure I have the determination I need to take myself off Facebook, though almost everything suggests that, if I did, I’d be most definitely happier.

Meik Wiking, CEO of the Happiness Research Institute said, “Facebook is a constant bombardment of everyone else’s great news, but many of us look out of the window and see grey skies and rain, especially in Denmark.”
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In order to really look at how social networks, specifically Facebook, influence our sense of well-being, the Happiness Research Institute conducted a study of 1,095 Facebook users, 94 percent of whom visit Facebook as part of their daily routine, 86 percent who browse their Facebook news feed often or very often, and 78 percent who use Facebook 30 minutes or more per day.

The researchers polled the participants on their Facebook usage, then divided them into two groups for a week-long experiment. One group (the control group) was told to continue using Facebook the way they would normally, and the other group (treatment group) was asked to not use Facebook for an entire week.

At the end of the seven days, 88 percent of the treatment group (those who gave up Facebook) reported feeling happy compared to the 81 percent of the control group. The treatment group also reported feeling more enthusiastic, more decisive, wasted less time, and felt as if they enjoyed life more.

The control group (still connected to Facebook) were 55 percent more likely to feel stressed, experience trouble concentrating, and described feelings of loneliness. Researchers came to the conclusion that those negative feelings were most likely caused by Facebook envy.

The study stated that 5 out of 10 people envy the amazing experiences of others posted on Facebook, 1 out of 3 people envy how happy other people seem on Facebook, and 4 out of 10 envy the apparent success of others on Facebook.

“The main takeaway from this study is awareness of the negative aspects that social comparisons have, and how we should be mindful of how Facebook and social media affect how we evaluate our lives,” Wiking said.

Instead of depending on Facebook to show me only the good or the annoying, I should try to spend less time on it and focus on making my own happiness.

By Janice Wood
A new study has found that 14- and 15-year-olds are at a higher risk than other young people of becoming dependent on prescription opioids within a 12-month period after using them beyond the prescribed amount.

“Many kids start using these drugs other than what’s prescribed because they’re curious to see what it feels like,” said Maria A. Parker, a doctoral student in the Department of Epidemiology and Biostatistics at Michigan State University who led the study.

“The point of our study was to estimate the risk of dependency after someone in this age group starts using them beyond the boundaries of a doctor’s orders.”

The study, based on a nationally representative sample of 12- to 21-year-olds taken each year between 2002 and 2013, focuses on what happens when young people start to use these drugs for other reasons.

Out of about 42,000 respondents, the researchers found that 14- and 15-year-olds were two to three times more likely to become opioid-dependent within a year compared to 20- and 21-year-old users.

The research also reconfirmed earlier studies that found that peak risk for starting to use prescription painkillers above the prescribed intent is seen at 16 and 17 years old, according to the researchers.

The study’s findings come at a time when states, including Michigan, are increasing efforts to combat the growing prescription drug problem.

Earlier this year, Michigan Gov. Rick Snyder created a 21-member task force to tackle the issue and offer recommendations to curb prescription drug abuse.

Statistics show that the use of some prescribed pain relieving pills, such as Vicodin, have quadrupled in the last eight years in Michigan. This increase has contributed to the use of other drugs, such as heroin, according to some researchers.

“It’s important to identify when young people are starting to use these drugs because it allows us to provide prevention or intervention outreach strategies around these ages and much earlier on so things don’t escalate into something worse,” Parker said.

Knowing where the drugs are coming from and educating parents on the prescribed dosages appropriate for their children, as well as the proper places to store drugs, are all ways to help ensure they are using them safely, she added.

Other types of prevention efforts often include peer-resistance programs such as keepin’ it REAL and Botvin LifeSkills Training.

“No age group is free from risk though,” Parker concluded.

The study was published in the journal PeerJ.

Source: Michigan State University

By Traci Pedersen

After Violent Video Games, Study Finds Teens Eat and Cheat MoreIn a new study, teens who played violent video games ate more chocolate and were more likely to steal raffle tickets during a lab experiment than were teens who played nonviolent games.

These findings were strongest among teens who scored the highest on tests of moral disengagement — the ability to convince oneself that ethical standards don’t apply to in particular situations.

“When people play violent video games, they show less self-restraint. They eat more, they cheat more,” said Dr. Brad Bushman, co-author of the study and professor of communication and psychology at Ohio State University. “It isn’t just about aggression, although that also increases when people play games like Grand Theft Auto.”

The study included 172 Italian high school students, ages 13 to 19. They played either a violent video game (Grand Theft Auto III or Grand Theft Auto: San Andreas) or a nonviolent game (Pinball 3D or MiniGolf 3D) for 35 minutes.

During the study, a bowl of chocolate M&M’s was placed next to the teens, who were told they could freely eat the candy, but were warned that eating a lot of candy in a short time was unhealthy. Interestingly, teens who played the violent games ate more than three times as much candy as did the other teens.

“They simply showed less restraint in their eating,” Bushman said.

After playing the game, the teens worked on a 10-item logic test in which they could win one raffle ticket for each question they answered correctly. The raffle tickets could then be redeemed for prizes.

After being told how many answers they got correct, the teens were asked to take the appropriate number of raffle tickets out of an envelope — without supervision. Unbeknownst to the players, the researchers were aware of how many tickets were in the envelope so they could later determine if a player took more than he or she had earned.

Results showed that teens who played violent games cheated more than eight times more than did those who played nonviolent games.

The players were also told that they were competing with an unseen “partner” in a game in which the winner got to blast the loser with a loud noise through their headphones. (There was actually no partner.) Teens who played the violent games chose to blast partners with louder noises that lasted longer than did teens who played the nonviolent games.

“We have consistently found in a number of studies that those who play violent games act more aggressively, and this is just more evidence,” Bushman said.

The participants also completed the Moral Disengagement Scale, a measure of how well individuals hold themselves to high moral standards in all situations. One sample question was “Compared to the illegal things people do, taking some things from a store without paying for them is not very serious.”

Among teens who played the violent video games, those who scored higher in moral disengagement were more likely to cheat, eat more chocolate, and act more aggressively. There were no such differences among those who played nonviolent games.

“Very few teens were unaffected by violent video games, but this study helps us address the question of who is most likely to be affected,” Bushman said. “Those who are most morally disengaged are likely to be the ones who show less self-restraint after playing.

“One of the major risk factors for antisocial behavior is simply being male,” he said. “But even girls were more likely to eat extra chocolate and to cheat and to act aggressively when they played Grand Theft Auto versus the mini golf or pinball game. They didn’t reach the level of the boys in the study, but their behavior did change.”

The study is published online in the journal Social Psychological and Personality Science.

Source: Ohio State University

By Marianne Riley

“Ah, I can’t do lunch, but would you want to grab coffee later on?” This is something I would say often to my friends. My circle was growing smaller. I rarely saw friends or even family. My apartment was my temple. The holder of all things healthy.

I prepared all of my meals after returning from my trip to Whole Foods. It was Sunday, my meal prep day, where I would hover over a stove baking bland free-range chicken, grass-fed steaks, organic broccoli and sweet potatoes.

After cooking and carefully putting my food into plastic containers, I ate. I ate in solitude. Mealtime was very important to me. All I cared about was food, feeding myself, perfectly timing out when I would eat and what I would eat.

Upon finishing my meal, I reached for the medicine cabinet where I would throw back a variety of vitamins and minerals, which I believed, were healing a host of “problems” ranging from digestive issues to anxiety. “Success, I feel healthy,” I would say to myself.

I picked coconut sugar over Splenda, grass-fed butter over olive oil, grass-fed steaks over salads, and full-fat grass-fed yogurt over sugar-free yogurt. Calories were not my concern, health was. I didn’t get an inch close to sugar-free anything. I was terrified of anything processed or artificial. Terrified it would make me unhealthy. Healthy was all I cared for.

Food aside, I certainly was concerned with my body image as well. Sure, I would avoid extra calories but the main fear was ‘bad’ food. Food that would take away my perfect health and body. I was orthorexic.

Orthorexia is the term for a condition that includes symptoms of obsessive behavior in pursuit of a righteous and healthy diet. Orthorexia sufferers often display signs and symptoms of anxiety disorders that frequently co-occur with anorexia nervosa or other eating disorders. A person with orthorexia will be obsessed with defining and maintaining the perfect diet, rather than a thin weight. He or she will fixate on eating foods that give them a feeling of being pure and healthy. Their health typically defines them.

An orthorexic may avoid numerous foods, including those made with artificial colors, flavors or preservatives; anything considered “processed,” fat, sugar or salt; animal, dairy, or gluten. There are many overlaps between orthorexia and other eating disorders; however, there are a few symptoms that are distinctive to orthorexia. According to Timberline Knolls, a residential eating disorder treatment center, the following are signs of someone who may be suffering from orthorexia:

Obsessive concern over the relationship between food choices and health concerns such as asthma, digestive problems, low mood, anxiety or allergies.
Increasing avoidance of foods because of food allergies, without medical advice.
Noticeable increase in consumption of supplements, herbal remedies or probiotics.
Drastic reduction in opinions of acceptable food choices, such that the sufferer may eventually consume fewer than 10 foods.
Irrational concern over food preparation techniques, especially washing of food or sterilization of utensils.
While orthorexia is less well known than other eating disorders, it is just as serious and potentially fatal. My spell under orthorexia ended me up in the hospital eight times for attempted suicide. I was experiencing OCD, anxiety, and depression as a result of my eating disorder.

After a number of therapists, psychiatrists, nutritionists, and medications, I hit my knees. Crying on the floor in my living room after having a panic attack for not being able to go to the gym at the time I wanted to go, it hit me like a ton of bricks: I had to beat this thing. Do I want to spend hours thinking about food? Planning my workouts? Doing rituals and compulsions around food and exercise? Lose more friends? Be miserable? No. I don’t.

So, I embraced recovery and I am still on that journey. I work closely with a professional body image/orthorexic coach who is helping me take the actions needed to move forward. I chose not to work with a therapist at this time. After years of therapy, I decided to take a different route. I also knew myself very well. I knew exactly what I needed to challenge. I learned that I am better with action-oriented behaviors versus talk therapy.

Challenging my eating disorder behaviors was my goal. I set out to eat one food off of my “feared foods” list each week. I also made myself tweak my workout schedule each week. For instance, instead of working out five days, I would work out four days. I also made a challenge list that included things I never let myself do because the eating disorder was holding me back. I can’t tell you how helpful this has been.

I am still in recovery and very fresh to the whole experience. I am still working on my challenge lists. But I can tell you this has been a very eye-opening experience. I am feeling small moments of freedom every day. No matter how hard or uncomfortable it is to challenge a negative or unhelpful thought, I do it. The more you entertain your negative thoughts, the more they will hover.

While I am not currently working with a therapist, I do recommend seeing one. I also recommend working with your doctor and having a complete workup done to rule out any underlying medical conditions. Psychiatrists are incredibly beneficial as well, if you are looking to identify whether medications are going to be helpful for you during your recovery.

Initially, I also worked with a nutritionist weekly. She helped me to integrate “fear” foods back slowly and in a way I didn’t find scary.

Lastly, please confide in someone. It doesn’t have to be a parent; it can be a boyfriend or girlfriend, relative, or friend. Just make sure it is someone you can trust and feel comfortable talking to.

You can recover. Don’t let yourself live in this misery any longer. Embrace freedom.

By David Sack, M.D.

For most, drinking is something that is done on occasion, in moderation, and forgotten about in the interim. For others, because of a variety of factors that can include genetics, biology and environment, alcohol becomes more than an accompaniment to life; it becomes the main event.

Facing that reality, however, is tough, especially when the natural reaction when drinking first begins to spin out of control is to stack up all the reasons why cutting back or perhaps even eliminating alcohol altogether isn’t an option.

Those of us who work in addiction treatment hear these reasons often, and much of the process of healing is helping the person recognize them for what they are: excuses. Here are a few of the most common:

I don’t really have a problem but if I stop or cut down, people will think I do.
Stigma around addiction remains strong, and that can make coming to terms with the possibility that you have a drinking problem doubly disturbing. But here’s the reality: Those around you are probably more aware of your drinking than you realize, and letting them know you are taking a step back from alcohol is more likely to be met with relief than judgment — at least from those who truly have your best interests at heart.
Rather than getting too caught up in what people think or trying to convince yourself that you don’t drink any more than anyone else, allow yourself to take a personal journey to determine if you are one of the people who can moderate or not. If you can set limits and stick with them, great. If not, it’s time to reach out for help.

My social life will evaporate if I’m not drinking.
No one will invite me to a party. Everyone will feel awkward around me. I’ll be the Debbie Downer in the corner just saying no. We hear such phrases often, but here’s the truth: You set the tone. If you think it’s a big deal, it will be. If you don’t, it won’t. It may take a little work to overcome the unease that so many feel in social situations without a few drinks under their belt, but it will pay off much more to work on any anxiety issues you have than to work on how many shots you can down.
If you do discover your friends really don’t want you around unless you are matching them drink for drink, it’s an indication of a couple of things:

They’re not really your friends, they’re your drinking buddies, and it’s likely they have problems of their own that they don’t want to face.
You are better off without them.
I only drink wine, and that’s healthy.
It’s important to keep this in perspective. Several studies suggest that alcohol — red wine in particular — may benefit the heart and improve cholesterol levels. Other research, however, has challenged these findings. A recent study out of Sweden, for example, noted that it may well be that only people with a certain genetic profile see any improvement. One thing is certain: All of the studies that point to health benefits are talking about alcohol in very moderate amounts. In fact, U.S. health agencies recommend no more than two drinks a day for men and one for women.
If you really want to boost your health, there are many things you can do with much more power to prompt improvement than drink — most notably, exercise.

If I stop, I’ll never have fun again.
For many, especially the young, alcohol and good times seem synonymous, and a life without drinking seems flat and boring. But what we see again and again is that with continued sobriety comes a growing realization that you can still connect with friends, still laugh, still dance, still flirt, still enjoy yourself. In short, all you’ve lost by limiting or ending your drinking is what’s not fun: waking up feeling sick, wondering what you said and did, and dealing with the sometimes serious consequences.
Most also come to see that not everyone turns to alcohol to try to inject some fun in their lives. They’ve just been surrounding themselves with those who do.

I need it for stress relief.
We all know that stress can do terrible things to your physical and emotional health. So how can something that seems to take the edge off be bad? The issue is, it’s far too easy for one drink to become two or three or more, and that can prompt more problems that you’re solving. Research also shows that if having a drink normally mellows you out, it can have the opposite effect when you’re stressed. That can lead you to drink more as you chase the feeling you’ve come to expect. Stress and alcohol then feed off each other.
Pay attention when you find yourself saying, “I need a drink,” and if stress is becoming an unmanageable part of your life, reach out for help from a mental health professional, not a bottle.

I would miss it too much.
Those considering giving up alcohol often assume that even if they are successful, they’ve doomed themselves to a life of feeling sorry for themselves as they long for a drink. Talk to any of the 23 million people in successful addiction recovery and you’re likely to hear a very different story. Far from pining for their past life as a drinker, most come to view giving up alcohol as not much of a sacrifice when the payoff is better health, better relationships with those who are important to them, and the ability to live life to its fullest. Indeed, far from feeling sorry for themselves, they come to experience a much different sensation — gratitude.
David Sack, MD, is a psychiatrist, addiction blogger and CMO of Elements Behavioral Health, a nationwide network of addiction treatment programs that includes The Sundance Center alcohol rehab in Arizona and Clarity Way alcohol treatment center in Pennsylvania.

Game-playing can boost coordination and computer literacy. Here’s how to keep a good thing from turning destructive.
by Larry Silver, M.D.

Children love computer games, and that’s not always a bad thing. Whether played on a handheld device, a computer, or a television set, the games can provide hours of quiet fun. (That’s one reason parents often rely on them to keep the peace on family vacations.) The games can boost computer skills and improve eye-hand coordination. One 2004 study showed that surgeons who play computer games commit fewer surgical errors than do their non-game-playing counterparts.

Computer games are emotionally “safe.” When a child makes a mistake, no one else knows (unlike the public humiliation of, say, striking out in a real-life baseball game). And because each error made in a computer game helps the player learn the specific action needed to advance the next time, the player gets the satisfaction of steadily improving and ultimately winning.

Big downsides
But computer games carry some big downsides. Besides being very expensive, many popular games involve graphic sex and violence. Perhaps most worrisome, they can be extremely habit-forming. Any child can become “addicted” to computer games, but kids with AD/HD seem to be at particular risk. Many of them have poor social or athletic skills, and this doesn’t matter in the world of computer games. Such games level the playing field for children with AD/HD. And kids bothered by distractibility in the real world are capable of intense focus (hyperfocus) while playing. The computer game “trance” is often so deep that the only way to get the player’s attention is to shake her or “get in her face.”

Do you find yourself monitoring how much time your child spends with his Gameboy? Do you constantly urge him to turn off the X Box? Does the desire to play computer games dominate her life? When you insist that the set be turned off, do you get an angry outburst? If so, the time has come to help this child or adolescent (and the whole family).

Finding alternatives
To make the games less seductive, find ways to minimize your child’s downtime at home, especially those times when he is alone. Maybe your child would be interested in arts and crafts, theater, or movie-making. Maybe a social-skills group would be a good idea. Maybe he could join a youth group at your church or synagogue.

If she has trouble with a particular sport because of poor motor skills, or has difficulty understanding the rules or strategies, look for another sport that might be more accommodating – for example, martial arts, bowling, or swimming. Help your child find some activity that he likes and a place where he can do it.

My Child Is Addicted to Computer Games!
Setting limits
Children with AD/HD often lack the “internal controls” needed to regulate how much time they spend playing computer games. It’s up to parents to rein in the use of the games.

The first step is often the hardest: Both parents must agree on a set of rules. How much time may be spent playing the games on school nights? Must homework be done first? Chores? How much time may be spent on a weekend day? Which games are taboo, and which are O.K.? If the child plays Internet-based games, which sites are acceptable?

Once parents agree, sit down with your child and discuss the rules. Make it clear which rules are negotiable and which are not. Then announce that the rules start right now. Be sure you can enforce the rules. For example, if your child is allowed to spend 30 minutes at computer games on school nights – and only after homework and chores are done – the game and game controls must be physically unavailable when she gets home from school.

If games involve a computer or a television set, find a way to secure the system until its use is permitted. When the 30 minutes of playing are up, retake the controls. If she balks, she loses the privilege to play the game the following day. If you come into her bedroom and find her playing the game under the covers, she might lose the privilege for several days.

Avoiding confrontations
Give warning times: “You have 15 more minutes… You now have 10 minutes… There are only five minutes left.” A timer that is visible to the child can be helpful. When the buzzer rings, say, “I know you need to reach a point where you can save the game. If you need a few more minutes, I will wait here and let you have them.”

If he continues to play despite your step-by-step warnings, do not shout or grab the game or disconnect the power. Calmly remind him of the rules, then announce that for each minute he continues to play, one minute will be subtracted from the time allowed the next day (or days). Once you get the game back, lock it up. When he finally regains the privilege to play, say, “Would you like to try again to follow the family rules?”

By TRACI PEDERSEN Associate News Editor

Cannabis use is linked to an increase in both manic and depressive symptoms in people with bipolar disorder, according to a new study by Lancaster University.

The study is the first to examine the use of cannabis in the context of daily life among people with bipolar disorder. In the U.K., where the study took place, around two percent of the population suffers from bipolar disorder, with up to 60 percent of those using cannabis at some point in their lives.

Research in this area is limited, however, and reasons for this high level of use are unclear.

Clinical psychologist Dr. Elizabeth Tyler of the Spectrum Centre for Mental Health Research at Lancaster University led the study with Professor Steven Jones and colleagues from the University of Manchester, Professor Christine Barrowclough, Nancy Black, and Lesley-Anne Carter.

“One theory that is used to explain high levels of drug use is that people use cannabis to self-medicate their symptoms of bipolar disorder,” said Tyler.

For the study, the researchers evaluated people diagnosed with bipolar disorder who were not experiencing a depressive or manic episode during the six days the research was carried out. Each participant reported daily on their emotional state and drug use at several random points over a period of week. This enabled people to log their daily experiences in the moment before they forgot how they were feeling.

Here are a few comments from the daily reports:

“I do smoke a small amount to lift my mood and make myself slightly manic but it also lifts my mood and switches me into a different mind-set.”
“I do not use weed to manage depression as it can make it worse, making me anxious and paranoid.”
“I have found though that if I have smoked more excessively it can make me feel depressed for days afterwards.”
The researchers found that the odds of using cannabis increased when individuals were in a good mood. Cannabis use was also associated with an increase in positive mood, manic symptoms and paradoxically an increase in depressive symptoms, but not in the same individuals.

“The findings suggest that cannabis is not being used to self-medicate small changes in symptoms within the context of daily life. However, cannabis use itself may be associated with both positive and negative emotional states. We need to find out whether these relationships play out in the longer term as this may have an impact on a person’s course of bipolar disorder,” said Tyler.

By JOHN D. MOORE, PHD

Hi there – my name is sex addiction. You know me by several other names, including sex addict, behavioral addiction and process addiction. I’m an insidious form of dependency that is often not discussed with anyone because I use shame and guilt to silence you.

If left unchecked, I grow in power – making you take greater and greater risks. I will lie to you, twist your thoughts and ultimately destroy your relationships. I can make you lose your family, your job and even your freedom.

I use emotions like depression to fuel acting out behaviors and will distort your thinking to justify getting what I want. Even though you recognize the negative consequences for your actions, I always win out. You see – I am so much stronger than will power!

Here is what you may not know – I am vulnerable to 7 specific things that weaken my hold. If you engage in any one of these 7 things, you lessen my power. When you combine several of these items together however, I cower in the corner like a scared puppy.

I really should not be sharing this information with you – but I am going to do it anyway.

Are you ready? Let’s jump right in!

7 Things Sex Addiction Doesn’t Want You To Know!

1. Facing fears of intimacy

One of the things that tighten my grip on you is your fear of intimacy. I love it when you repeat unhealthy patterns of attachment and become distant from people in your life. However, when you address your fear of being close to others and take steps that promote personal healing, I shake like a leaf!

2. Healing your wounded self-esteem

When your self-concept is damaged, I will try to bolster your self-esteem by making you act out in an empty attempt at personal validation. This is particularly true if you have body image issues or if you were once sexually abused. Once you are able to identify this pattern of attention seeking and address it through forums like 12-step meetings and talk-therapy, I lose my intensity.

3. Talk-Therapy

When you use sex to “numb up” or emotionally “check-out” it’s like pouring gasoline on a fire – I love it! On the flip-side, I can’t stand it when you stop hiding from your feelings and begin the process of taking inventory. Oh – and when you talk to your therapist about how you use sex as a form of emotional medication, you send me running for the hills! Argh!!!!

4. Recognizing patterns

One of my greatest strengths is my ability to ritualize destructive behaviors. Here, I am talking about things like wasting hours on the Internet looking at imagery or spending money on “services” for hire. When you call me out on my toxic patterns and how they have become deeply woven into your life, it’s like taking a sword and plunging it through my heart. Oh – how I hate that I just told you this!

5. Mindfulness

A natural consequence of recognizing patterns is increasing mindfulness. Obviously, I hate this too because it means you are paying attention to how I have been screwing up your life. When you do things like mediate or bring your awareness on the here and now, I lose massive amounts of power.

6. Support of others

I am at my strongest when you isolate yourself from others and retreat into yourself. This allows me to distort your thoughts and engage in all sorts of psychological mischief. On the other side of the coin, when you start sharing with others who are struggling like you, my power starts to evaporate. Groups like Sex and Love Addicts Anonymous are kryptonite to me!

7. Self-care

When you are acting out and allowing me to be in the driver’s seat, I am at my happiest. But when you make the conscious choice to focus on taking care of yourself with the inclusion of healthy boundaries around different life areas, you make me miserable and weak. Now why the hell did I just tell you this!!?

Final Thoughts

There are boatloads of other things you can do to keep me at bay but I have run my mouth too much already. Yeah baby – I’m not going to give away the store.

Remember this – I am always here – just waiting for you to cope with your feelings in unhealthy ways. I love it when you live in denial because it allows me to flourish.

Oh – and I hate that I just told you that too!

By JANICE WOOD Associate News Editor

A new study has found that a lower IQ is clearly associated with greater and riskier drinking among young men.

However, researchers at the Karolinska Institutet in Stockholm, Sweden, note that the men’s poor performance on the IQ test may also be linked to other disadvantages.

“Previous results in this area have been inconsistent,” said Sara Sjölund, a doctoral student at the Karolinska Institutet and corresponding author for the study.

“In two studies where the CAGE questionnaire — a method of screening for alcoholism — was used, a higher cognitive ability was found to be associated with a higher risk for drinking problems.

“Conversely, less risk has been found when looking at outcomes such as, for example, International Classification of Diseases diagnoses of alcoholism, alcohol abuse, and dependence.”

“In this study of a general population, intelligence probably comes before the behavior, in this case alcohol consumption and a pattern of drinking in late adolescence,” added Daniel Falkstedt, Ph.D., assistant professor in the department of public health sciences at Karolinska Institutet.

“It could be the other way around for a minority of individuals — that is, when exposure to alcohol has led to cognitive impairment, but this is less likely to be found among young persons, of course.”

The researchers analyzed data collected from 49,321 Swedish males born during 1949 to 1951 and who were conscripted for Swedish military service from 1969 to 1971.

IQ results were available from tests performed at conscription. Questionnaires also given at conscription provided data on total alcohol intake and pattern of drinking, as well as medical, childhood, and adolescent conditions.

Adjustments were made for socioeconomic status as a child, psychiatric symptoms, and emotional stability, and the father’s alcohol habits, the researchers noted.

“We found that lower results on IQ tests in Swedish adolescent men are associated with a higher consumption of alcohol, measured in both terms of total intake and binge drinking,” said Sjölund.

“It may be that a higher IQ results in healthier lifestyle choices. Suggested explanations for the association between IQ and different health outcomes could be childhood conditions, which could influence both IQ and health, or that a socio-economic position as an adult mediates the association.”

The main message of the large cohort study may be that poor performance on IQ tests tend to go along with other disadvantages, added Falkstedt. He noted that poorer social background and emotional problems may explain the association with risky alcohol consumption.

“In reality, other differences of importance are likely to exist among the men, which could further explain the IQ-alcohol association,” he added.

“I think a higher intelligence may give some advantage in relation to lifestyle choices,” Falkstedt said.

“However, I think it is very important to remember that intelligence differences already existing in childhood and adolescence may put people at an advantage or disadvantage and may generate subsequent differences in experiences, and accumulation of such experiences over many years.

“Therefore, another important explanation of ‘bad choices’ among lower-IQ individuals may be feelings of inadequacy and frustration, I think. A number of studies have shown that a lower IQ in childhood or adolescence is associated with an increased risk of suicide over many years in adulthood.”

Both Sjölund and Falkstedt noted that results may vary among cultures and countries.

“I think that large parts of the association between IQ and alcohol consumption may be indirect and mediated by experiences in everyday life and differences in social situations,” said Falkstedt.

“It is not necessarily about making intelligent or unintelligent choices. For instance, in countries with weak social safety nets and high alcohol consumption among low-wage workers and the unemployed, I assume the association could be stronger than in economically more-equal countries, perhaps also among the young.”

Sjölund added that “we must be very careful in making any attempt to generalize our results to women, since their level of consumption and patterns of drinking likely differ in comparison with men.”

The study was published in Alcoholism: Clinical & Experimental Research, the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Source: Alcoholism: Clinical & Experimental Research

By LINDA SAPADIN, PH.D

Shoe shoppingMany people mistake affluence for self-worth. You can buy what you want to buy. Live where you want to live. Own what you want to own. You’ve made it! What a worthy, wonderful person you are!

So how come you’re still feeling that it’s not enough? You bought what you wanted to buy. You feel great. Yet, a day later, rather than feeling pleased, you’re bored.

So, you rack up additional purchases on your favorite digital device. It’s so easy to shop these days. Or, tired of shopping, you plan another trip. You create another social event. And still it satisfies only for the moment.

In the quietness of your solitude, you wonder what’s wrong.

A reassuring voice quickly tells you, “It’s going to be all right.”

“Umm, maybe it’s not,” whispers another voice. Deep down, addicts always know that something’s wrong, even when they are vehemently denying it.

So what’s the problem here? Isn’t affluence supposed to make life easier? More carefree? More tranquil? Yes, but not if one mistakes affluence for self-worth. Having a lot of money does not alleviate your anxiety or depression. Indeed, it can make it worse.

The adage, “little kids, little problems; big kids, big problems,” has much truth to it. Since big kids act out their difficulties on a bigger stage, problems that arise from their bad behavior have more serious consequences.

Similarly, people who live modest lives are so busy simply trying to keep themselves afloat that their problems are typically more mundane. In contrast, those who live life on a larger scale may find that their neurotic behavior creates emotional, social and financial debacles, worthy of headlines in People magazine. This is true not only for those who are affluent but for those who falsely convey an image of wealth and success but are deeply in debt.

If you are addicted to affluence (or the appearance of affluence), know that it does not cure the anxiety of insignificance. It does not provide you with a life purpose. It does not satisfy a neurotic need, which, by definition, is a need that can never be satisfied. In short, affluence does not equate to self-worth.

So, during this holiday season, if you are affluent (or a wannabe affluent), be aware of whether your riches are liberating or enslaving:

Are you being led astray by your ability to get (or consume) whatever you want, or are you controlling your impulsivity, getting what you truly want or need?
Are you having difficulty choosing what to buy (or do) because you know you can have it all, or are you making good choices and maintaining good discipline even though it’s not an imperative ?
Are you letting your affluence destroy your ability to find a purpose in life, or are you using your affluence to better your life and the lives of others?
Are you letting the tumultuous parts of your personality guide you into perilous pastimes, or are you willing and able to tame those impulses?
Are you only enticed by the superlative (the biggest and the best), or do you make your choices utilizing a wide range of options?
Are your kids adversely affected by their easy access to money, or are you making it a point to raise them with good values?
If, in your experience, affluence is not everything you thought it would be, be sure to admit what your issues are and take appropriate action before your problems become too big to solve.

By KARLEIA STEINER
High-functioning alcoholics might be one of the most dangerous types. They often are in denial about their alcoholism. They don’t realize how hard their drinking is on family members and friends, and since they seem to function normally, they don’t see a problem with it.

High-functioning alcoholics do not fit the “drunk” stereotype. They might reason that because they go to work and school, interact with their family, manage a household, and fulfill their everyday responsibilities, they can’t possibly have an alcohol problem.

Unfortunately, it’s not only the alcoholic who is in danger of denial. Family and friends often fail to see the danger signs. They refuse to believe that their loved one has a problem, and even congratulate him or her on his or her ability to function under the influence. The first step to helping a high-functioning alcoholic is to stop denying that they need help.

Recognizing a high-functioning alcoholic isn’t difficult if you know what to watch for. No matter how well they might function, drug or alcohol use affects everyone in some way. Here are some signs to watch for:

They start skipping social events uncharacteristically.
They have a sudden lack of focus or change in attitude.
They suffer from typical signs of alcoholism such as insomnia, paranoia, or shakiness.
They miss deadlines at work or call in sick often.
Once you have determined that your loved one needs help, understand that they don’t think they need it. Realize that to them, these signs are not symptoms of a problem, but something they can handle and don’t need to worry about. It will be difficult to convince them otherwise, so be prepared for a challenge.

When you approach a high-functioning alcoholic, make sure that he or she is sober first. Talking to a loved one when he or she is under the influence will be a useless exercise. The best time to open a serious conversation about getting addiction help is when they are hungover or feeling remorse or guilt, but before they need legal help for a DUI charge.

Do not go on the offensive. Explain to them how their drinking is affecting you and your family, and be careful to express your own personal feelings so that they don’t get defensive. Telling them how difficult it is for you to watch them when they are drunk or drinking might help them see that their addiction does not just affect them.

Alcoholism isn’t a simple problem to have, and it isn’t easy to cure. It will be particularly difficult to break through your loved one’s barriers since they can’t even admit that they have a problem. Ultimately, however, alcoholism is a choice and can be overcome.

The most important thing to remember is to approach the alcoholic with compassion. However, do not let your love for them cloud your judgment. You must be willing to walk away when their chosen lifestyle becomes too much for your emotional health. You have a responsibility to yourself too, and running yourself ragged will not do either of you any good.

Like anyone with an addiction, high-functioning alcoholics will have plenty of excuses for their behavior. Do not accept them. There is no excuse for alcoholism, and if you let them justify their addiction, they will never have a reason to change.

Excuses cannot shield them from the consequences of their alcoholism. High-functioning alcoholics might believe that their lives are unaffected by their drinking, but there will always be negative consequences, both in their own life and the lives of those they love. Alcoholism takes an emotional, spiritual, and physical toll on family and friends. It also results in emotional distress, lack of self-esteem, hangovers, drunk driving, and health risks for the alcoholic.

Recovering from alcoholism is not easy, but approach your loved one with patience, firmness and honesty. The ultimate decision to quit drinking is theirs, but your attitude and support might make all the difference.

PETER UBEL, MD JULY 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our willpower is weak but also because, after exhausting our willpower, the cake looks even more mouthwatering to us than it did before. Our ability to overcome temptation is reduced at the same time that the power of the temptation increases.

In this study, participants first underwent an exercise meant to exhaust their willpower. They watched a seven minute documentary on Canadian bighorn mountain sheep. Believe it or not, that documentary on its own doesn’t delete people’s willpower significantly. Instead, it was distracting words scrolling across the screen that exhausted people’s willpower. You see, half the participants were told to watch the documentary and read the words if they wanted to, as they scrolled in front of their field of vision. No willpower needed there. If you are curious what the word looks like, you look at it. If not, you don’t.

But the other half of the participants were told specifically not to read the words — they were told to maintain their focus on the sheep. Nothing but the sheep. Seven minutes of ignoring words while watching sheep? Exhausting just to think about it!

And willpower exhaustion was an important part of the study, because previous research has shown that willpower is depletable. Exert willpower for seven minutes and you have less willpower to draw upon in the near future.

Which leads us to part two of the study. The researchers placed these participants in an fMRI machine (a brain imager) and flashed pictures of deliciously unhealthy foods. They wanted to see which parts of people’s brains lit up in front of these tempting delicacies. I should tell you that the participants in this study were all trying to lose weight, and had all fasted before the study (which, by the way, probably means their willpower was already beginning to be depleted before they began the research).

Here is what happened. The fMRI images revealed differences across the two groups of participants in their ability to resist temptation. They found neurologic evidence of depleted willpower among the people who spent seven minutes not reading those pesky words. But that is not all that the researchers found. Those people whose willpower had been relatively depleted also showed increased activity in regions of the brain associated with “Q reactivity” — something to do with the OFC portion of their brains. (Sorry, neuroscience is above my pay grade.) Basically, the activity in these brain regions revealed that the food pictures looked tastier to depleted participants than it did to non-depleted ones.

Think of it this way. You’re on a diet. You have a tough day at work, and an awful commute back home (where it took all your remaining willpower not to flip off that @$&hole who cut in front of you on the highway) and now you open up your fridge to have a healthy salad. But you see a tempting container of macaroni and cheese. Not only are you too exhausted to resist the temptation, but the macaroni and cheese actually strikes you as something that would be so delicious to eat!

By JANICE WOOD Associate News Editor

Brain’s Reward System Affects Efforts to Stop SmokingWhy can some smokers quit, but others can’t, no matter what method they try or how much money they might be offered?

The answer may be in how the brain responds to rewards, according to new research.

For their study, researchers at Pennsylvania State University (or Penn State) observed the brains of nicotine-deprived smokers with functional magnetic resonance imaging (fMRI) and found that those who exhibited the weakest response to rewards were also the least willing to not smoke, even when offered money.

“We believe that our findings may help to explain why some smokers find it so difficult to quit smoking,” said Stephen J. Wilson, Ph.D., assistant professor of psychology.

“Namely, potential sources of reinforcement for giving up smoking — for example, the prospect of saving money or improving health — may hold less value for some individuals and, accordingly, have less impact on their behavior.”

The researchers examined 44 smokers’ striatal responses to monetary rewards to not smoke.

“The striatum is part of the so-called reward system in the brain,” explained Wilson. “It is the area of the brain that is important for motivation and goal-directed behavior — functions highly relevant to addiction.”

The smokers, who were between the ages of 18 and 45, all reported that they smoked at least 10 cigarettes a day for the past 12 months. The researchers told them to abstain from smoking and from using any products containing nicotine for 12 hours before arriving for the experiment.

Each smoker spent time in an fMRI scanner while playing a card-guessing game with the potential to win money. Each was informed that they would have to wait approximately two hours, until the experiment was over, to smoke a cigarette.

Partway through the card-guessing task, half of the participants were informed that there had been a mistake, and they would be allowed to smoke during a 50-minute break that would occur in another 16 minutes.

However, when the time came for the cigarette break, the participants were told that for every five minutes they did not smoke, they would receive $1, with the potential to earn up to $10.

The researchers reported that the smokers who could not resist the temptation to smoke also showed weaker responses in the ventral striatum when offered monetary rewards while in the fMRI.

“Our results suggest that it may be possible to identify individuals prospectively by measuring how their brains respond to rewards, an observation that has significant conceptual and clinical implications,” said Wilson.

“For example, particularly ‘at-risk’ smokers could potentially be identified prior to a quit attempt and be provided with special interventions designed to increase their chances for success.”

The study was published in Cognitive, Affective and Behavioral Neuroscience.

Source: Penn State

By LINDA HATCH, PHD

young man and wemen at the barFlirting is a normal part of life. Not only is it enjoyable, it is a healthy part of courtship. And yet flirting is problem for a large proportion of the sex addict patients I see, I’m guessing maybe a third or more of them. For some it is the only sexually compulsive behavior that is out in the open. And if they are in a relationship, compulsive flirting often drives their partners up the wall and across the ceiling.

When should you or your partner be concerned that excessive flirtatiousness is the tip of the iceberg? When is excessive flirtatiousness a sign of a secret sexual addiction?

Part of a larger pattern of sexually addictive behavior

When I say that excessive flirting may be part of a larger addictive picture, I do not mean that it necessarily indicates that the person is engaging in affairs, although this could be the case. But if a person has a problem with sexual addiction and compulsive sexual behavior they will usually (although not always) have more than one type of sexual behavior. In other words a person who flirts a lot may also be engaging in cybersex, or frequenting sexual massage parlors or any of a number of other hidden activities.

So what should you look for if you don’t know how big the problem is?

Sexual preoccupation

For one thing, sex addicts are excessively focused on sex. One of the accepted core beliefs of the addict is: “Sex is my most important need”. So the flirting is one area among several in which you may see the addict as viewing the world through sex colored glasses. The addict may exhibit their sexualized world view by:

making off color remarks more than other people
frequently telling sexual jokes even with people he or she doesn’t know that well
frequent scanning for and ogling of sexually attractive people, often combined with
giving a running commentary on people’s looks, their age, their bodies and their sexiness or lack of it.
The extreme focus on sex goes hand in hand with the sexual objectification of people. If the person has a sexual addiction they will very likely see people in terms of sex to the exclusion of other factors. People are then not really people in the fullest sense (are they happy? Sad? Studious? Kindly? Struggling? Instead they are seen as objects of sexual utility. If the sex addict attributes any inner life to the person they are looking at it will usually be some fantasy or projection about that person’s sexuality.

This doesn’t mean that addicts want to have sex with every attractive person they see, but it does imply that they can go off into a sexual fantasy or store an image into a database in their mind for later use in fantasy.

Compulsiveness

Sex addicts by definition cannot control their problematic sexual behavior. A person who is not an addict may just be an outgoing, charming, playful person. But if their partner feels threatened and asks them to tone it down they will be able to do so. Addicts, on the other hand, will be more likely to guilt trip their partner and defend their right to flirt, or try to re-frame it as something that is not really sexual.

If the person agrees to rein in their flirting and doesn’t seem able to do so they could have a problem. Or if the person does stop flirting an addictive person may find other ways to subtly put out sexual signals, such as pointedly staring or making ambiguous remarks that could be taken as suggestive. See also my post on predatory flirting and ogling.

Self-objectification and negative self-concept

Sex addicts who flirt a lot are often indiscriminately seductive. Although this can be a sign of problematic sexual behavior, it does not necessarily mean that the addict has any intention of trying to have sex with the person toward whom they are being seductive.

Many sex addict patients are flirtatious and seductive across the board with almost anyone; a colleague, the checker in the market, the nurse, even their therapist. This can mean that the addict is scanning his/her environment for sexual possibility, but it can also mean that the addict tends to objectify him/herself.

Somewhere along the line most addicts have acquired the belief that they are unworthy, and some have come to feel that the only reason anyone could possibly want to associate with them is sexual attraction. Therefore these addicts express their insecurity by needing to be sexually interesting to everyone they associate with.

Excessive flirting, ogling and seductiveness can be signs that there are other sexually addictive behaviors or they can be sexual addictions/compulsions of a sort in their own right. It will not always be possible to get to the bottom of the issue without a full assessment by a professional. This only underscores the fact that what is an addiction or a problem is very often self-identified in terms of the amount of distress or destructiveness experienced by addicts and those around them.

Caroline Cassels
February 13, 2014
Far from the conventional wisdom that it is better to overlook psychiatric patients’ smoking in favor of treating the predominant mental illness first, 2 new studies suggest that reducing cigarette consumption or butting out altogether is significantly linked to improved mental health outcomes.

“Clinicians tend to treat the depression, alcohol dependence, or drug problem first and allow patients to ‘self-medicate’ with cigarettes if necessary. The assumption is that psychiatric problems are more challenging to treat, that quitting smoking may interfere with treatment,” lead investigator Patricia A. Cavazos-Rehg, PhD, Washington School of Medicine in St. Louis, Missouri, said in a statement.

However, the investigators found that quitting or reducing the daily number of cigarettes smoked was linked to lower risk for mood disorders as well as drug and alcohol abuse.

“We don’t know if their mental health improves first and then they are motivated to quit smoking or if quitting smoking leads to an improvement in mental health. But either way, our findings show a strong link between quitting and a better psychiatric outlook,” said Dr. Cavazos-Rehg.

The study was published online February 12 in Psychological Medicine.

By ALEXANDRA KATEHAKIS, MFT, CST, CSAT

In my work with partners of sex addicts, I always want to look at the role that anger has played for the partner.

Anger is a normal response to the traumatic experience of having been betrayed by your mate.

But it can also be a feeling that is difficult to tolerate. Some people dive into anger fully, while others avoid experiencing feelings of rage, and sometimes, people are afraid of their own angry feelings.

As a force, anger can be put to positive and constructive uses, and it can also be very destructive.

An important piece regarding anger is the acknowledgement of the emotion. Being in touch with your feelings and identifying that you are angry is crucial toward this process of releasing the anger. This is followed by an examination of the underlying issues.

Some have an easier time expressing anger. But the anger can become out of control, and we may find ourselves engaging in explosive, irrational behaviors that we later may regret.

Others fear expressing anger and avoid it. Perhaps they fear losing control. Regardless, if anger is not appropriately acknowledged and expressed, it can be turned inward, and there is a risk of engaging in self-defeating or self-destructive behaviors, such as blaming oneself for others’ inappropriate or hurtful behaviors or actions.

Anger in and of itself often is a coverup for other painful feelings, such as embarrassment, shame, humiliation, fear and sadness. When not expressed in a healthy way, anger can come out “sideways” as being distant, expressing sarcasm, or creating ruminative thoughts and fantasies about the object of one’s anger having bad things happen to them.

Sideways anger often simmers just beneath the surface and can be very vengeful and destructive. While the revenge may provide fleeting moments of satisfaction, indirectly expressing anger can lessen one’s self-esteem and self-worth.

Some helpful techniques to deal with anger are: journaling or writing down emotions; engaging in exercise or physical activity; calling a trusted friend; and talking about the feelings of anger openly. It’s important to be able to sit with the anger, and not brush it under the rug or ignore it.

At the same time, healthful expression of anger means knowing we are angry. Make the choice to examine what the consequences of acting out in anger are prior to engaging in hurtful behaviors that could potentially damage our relationships and self-esteem.

Anger can be positive. It can protect us from threats, and mobilize us to act. Anger also can be negative. It can create more chaos and destruction, and keep us in toxic cycles of retaliatory behaviors. Learning how to harness our feelings of anger through acknowledgment, validation, and integration of positive coping tools is crucial to keeping our lives in balance.

Dr. Peggy Drexler
The new film Lovelace recounts the days when viewing porn meant looking both ways before slinking into a dark and dubious establishment. These days, of course, there are no dark rooms required. A widely-reported University of Montreal study concluded 90 percent of all pornography comes from the web; boys, the study reports, seek out porn by age 10. And as for breadth of content, a few quick search terms can direct you – often unintentionally — to a hardcore porn site that proclaims itself “the largest bestiality” source online. You might want to be there when your child searches: “My Little Pony.”

While usage numbers vary, it’s clear that the supply of porn is bountiful, and much of it is free. Predicted consequences, however, tend to depend on agenda. For boys (still the prime consumer), porn use may poison attitudes toward women, create confidence-sapping comparisons of dimensions and performance, crowd out actual relationships and even carve new neural pathways. Seen often enough, the unusual or bizarre can seem usual, setting up new expectations for both genders. Recall an early episode of HBO’s Girls in which Hannah passively allows herself to be flipped over while her partner performs anal sex until he’s satisfied. Boys see rougher, less mutually agreeable sex through porn and act it out in real life. Girls acquiesce.

Is it any surprise? Excessive violence in films and on TV has been joined by excessive sex, much of it acted out according to porn-established norms: The girl dresses up like a porn star; the boy ejaculates immediately. Even Disney films contain veiled references and insinuations, never mind what they’re seeing on cable TV. Even if much of this is artistic commentary, without discussion, kids begin to believe this is how sex really works. As for porn, blocking and filtering are simply denial. Kids are naturally sexually curious, and will find their way to it. Parents should know how to respond before the questions are even asked.

Questions like: What is porn? Is it the Victoria’s Secret catalog? Am I ‘bad’ if I like looking at porn? What does ‘normal’ sex look like? For parents, the job is to keep the answers frank and honest. And frequent. Say that porn is part of sexuality, but it doesn’t define it. It’s a commercial enterprise that makes money by taking a natural and beautiful part of being human to the extreme, saturating it with lurid excess. Watch it if you want to, but remember: What you see has nothing to do with who you are, or how you’ll interact with a partner in real life. Teenagers in particular have a need to understand what is real and what is made for entertainment. Help them figure it out — which includes watching it yourself to find out what, exactly, they’re seeing. (Chances are you’ll be surprised.) Break down scenes and relay truths: No, stamina is not a measure of manhood; yes, both partners should experience pleasure from the act. Let kids of all ages know that porn is not a taboo topic; that they can, and should, ask you about anything they might have seen, or think they want to see. Then direct the conversation to their feelings — how did you feel about what you saw? — and assure them that all feelings are normal.

And if kids don’t have questions, or seem too shy to ask, it’s the parents’ job to both start and continue the dialogue. Silence doesn’t mean lack of curiosity. Let them know that sexuality is complicated, and that people often have complicated feelings about it that may take years to understand. Keep in mind that girls are just as curious as boys, so don’t leave daughters out of the conversation. And most of all, don’t freak out when you walk in on them watching. Their interest is normal, and they shouldn’t be made to feel otherwise. Remember that the way to live with porn is to help kids put it in perspective and to develop a critical eye towards what they’re seeing.

by Lisa Frederiksen

Underage drinking – as in repeated binge drinking – is one of the key risk factors for developing a long-term problem with drinking.

It is often considered a right of passage; something most teens and young adults under 21 go through. As such, the focus is often on keeping young people safe, whether that be parents hosting a party with alcohol and taking away all car keys or offering to drive, no questions asked. Yet, young adults, ages 18-20, have the highest rate of alcohol dependence (alcoholism) in the United States, according to the U.S. Surgeon General’s “2007 Call to Action to Prevent and Reduce Underage Drinking” report.

New and/or advances in brain imaging technologies (e.g., fMRI, SPECT, PET) of the past 10 – 15 years and the resulting research is shedding new light on this issue. Neuroscientists, doctors and other medical professionals are now able to observe how the brain develops and the impact of alcohol (and other drugs — illegal or prescription) on the developing brain.

The image below is a time-lapse of brain imaging studies reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging. This image study shows brain development, ages 5 through 20 and beyond. It was thought (until these new brain imaging capabilities) that the brain was fully developed by adolescence. We now know it’s not. There is a great deal of brain development — brain changes — occurring between ages 12-20, often through age 25. These brain changes are related to:

1) Puberty. Puberty triggers new hormonal and physical changes, as well as new neural networks instinctually wired into the species to encourage the species to take risk and turn to their peers. See video, “It’s Time We Tell The Whole Truth About Puberty” for a more full explanation.

2) Development of the cerebral cortex (front area) — the “thinking” part of the brain. This involves neural networks wiring within the Cerebral Cortex — the idea of learning calculus vs. memorizing multiplication tables, for example. It also involves neural networks in the Cerebral Cortex writing to those in other areas of the brain — the idea of controlling emotions, which originate in the Limbic System, with logical thought, which originates in the Cerebral Cortex, for example.

3) “Pruning” and “strengthening” of neural networks. Pruning is when neural connections (explained below) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one). This concept is explained in more detail at The Partnership at Drug Free.org website, A Parent’s Guide to the Teen Brain.

Underage drinking is one of the five key risk factors for developing a life-long problem with drinking. 18-20 year-olds have the highest rate of alcoholism in the United States.
The middle brain image is approximately age 12, the 2nd from far right brain image is approximately age 16. The lag-time between puberty and the start of cerebral cortex development – a time when the species’ brain is instinctually wired to take risks and turn to their peers – is often the time when teens start experimenting with drugs and alcohol and other risky behaviors.

About Neural Connections

We are born with about 100 billion brain cells — billions of them — also known as neurons but only a relatively small fraction are ‘wired.’ From birth to around puberty, our brains are ‘wiring’ neural networks like crazy — a wiring process that allows neurons to “talk” to one another via neural connections. Neural connections in the brain control everything we think, feel, say and do.

A neural connection requires brain cells (neurons), synapses (the gap between the branchlike extensions of a brain cell) and neurotransmitters (the chemical messenger that takes a message from one brain

cell’s branchlike extension, across the synapse, to receptors on the receiving brain cell’s branchlike extension). There is an expression sometimes used to describe this process — “neurons that fire together, wire together“ and this wiring together is sometimes called a “brain map.” (Norman Doidge, M.D. The Brain That Changes Itself)

Over the course of our lives, we create neural connections (brain maps) for all of the functions our bodies and brains do. In other words, we create neural connections for riding a bike or typing on a computer or talking on the phone or reading a book or running, breathing, reciting multiplication tables, eating, talking with our hands — everything!

Alcohol works on neural connections in many parts of the brain, but the neural connections initially most affected are those in the Limbic System (the pleasure/reward/pain center of the brain) because those connections require the neurotransmitter, dopamine. Dopamine is our “feel good” neurotransmitter — without it, we have a hard time feeling pleasure. Thus, when we drink, it’s these neural networks that “tell” the brain that drinking makes us feel good. We develop a memory of that feeling (thanks to other neural networks), which is why people want to drink, again. Think about it — if there were no feel good feelings from drinking alcohol, we likely wouldn’t drink it.

About Alcohol Use / Abuse / Addiction — Why It Matters How Much A Person Drinks

It’s important to understand there are three stages of drinking — use / abuse / addiction. It’s common to assume that drinking is either normal or alcoholic. With this assumption, it’s common to excuse some rotten drinking behaviors (e.g., fights, DUIs, arguments) because we don’t want to think of our loved one as an alcoholic. Understanding the differences and the consequences can help us want to intervene earlier rather than later in order to help young people stop their abusive drinking before they cross the invisible line to addiction.
•Alcohol use is defined as moderate drinking — 7 standard drinks per week, with no more than 3 of those 7 drinks in a day, for women, and 14 standard drinks per week, with no more than 4 of those drinks in a day, for men. A standard drink is either 5 ounces of wine OR 12 ounces of beer OR 1.5 ounces of spirits (vodka, for example). [Note: 35% of American adults do not drink any alcohol — none.]
•Alcohol abuse is when a person exceeds these drinking limits and has problems related to their drinking, such as arguments with family and friends about their drinking, binge drinking (defined as 4 or more drinks for women and 5 or more drinks for men), blackouts, lying about how much they’re drinking, driving while under the influence, work or school performance problems, arrests, unplanned or unprotected sex — in other words, doing things they just would not do if they hadn’t been drinking.
•Alcohol addiction (aka alcoholism) is a chronic, relapsing brain disease caused by biological, environmental and developmental factors. It occurs when a person’s alcohol abuse causes chemical and structural changes in their brain (by interrupting normal neural connections), which sets up the characteristics of alcoholism: tolerance, cravings, loss of control and physical dependence, in addition to the behaviors just described under alcohol abuse.

According to the World Health Organization’s AUDIT, all alcoholics go through the alcohol abuse stage but not all alcohol abusers become alcoholics. Alcoholism cannot be cured (meaning you can not go back to drinking after a period of time of abstinence), but it can be treated. Alcohol abuse drinking patterns, on the other hand, can be changed.

The Impact of Underage Drinking on the Developing Brain

As you look at the time-lapse image, again, notice how the brain develops from back to front (yellow/green to purple/fushia). This means that the portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop and, as such, are the most deeply affected by alcohol (or drug abuse) during ages 12 through 20, often through age 25.

For example, if a young adult repeatedly abuses alcohol (or drugs), the neural connections associated with memories and experiences related to alcohol abuse are the ones that are strengthened and thus embedded. By the same token, neural connections damaged by or not used because of alcohol abuse (those related to learning or judgment, for example) are pruned or not strengthened. This late stage brain development also explains why teens don’t know why they do some of the things they do, and why they take risks they likely would not engage in if they had a fully developed brain and the hindsight (memories and experiences) that go with it. Because the brain is NOT fully developed, adolescents are more vulnerable than adults to many of the effects of alcohol (e.g., memory, long-term cognitive deficits), and less vulnerable to others (e.g., sleepiness, loss of balance).

The Addiction Project’s section, Adolescent Addiction, explains these concepts further, as does this section, “Five Things to Know About Adolescent’s Brain Development and Use.”

Facts About Alcohol Abuse During Brain Developmental Ages 12 – 25
•According to NIAAA, nearly half of all people who ever met the diagnostic criteria for alcoholism in their lifetime were addicted (aka alcoholics) by age 21 and two-thirds were addicted by age 25. Thus, alcoholism is really a young person’s disease, but it often takes a person another 10 – 15 years before they seek treatment, which is why we generally think of alcoholism as something that happens to older adults.
•Age of first use is the most significant risk factor for a person becoming alcohol dependent (an alcoholic).
•Teens who start drinking before age 15 are 5 times more likely to develop alcohol problems as adults.

Understanding the impact of alcohol on the brain — especially during its critical developmental stage of ages 12 through 20 and beyond — is shedding a whole new light on the issue of underage drinking. In closing, it may also be helpful to know that the BRAIN CAN CHANGE and go back to “normal” if alcohol abuse is stopped.

For article sources and additional information:
•To learn more about addiction: www.hbo.com/addiction
•To assess your own or someone else’s drinking: www.rethinkingdrinking.niaaa.nih.gov
•To learn more about the teen brain and alcohol/drugs: www.drugfree.org/TeenBrain/science/
•For a variety of information about alcohol abuse and alcoholism: www.niaaa.nih.gov/AboutNIAAA/
•For a statistical snapshot of underage drinking: http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm
•For a variety of posts and comments on a variety of alcohol related topics, especially those that can help the family and friends of someone who drinks too much: www.breakingthecycles.com

By Linda Hatch, PhD

Some people can look at internet pornography now and then and not become porn addicts. Others get hooked on porn very quickly and spend hours online, often jeopardizing their work, neglecting their families and wrecking their relationships.

Why are some people more at risk for internet porn addiction?

We look immediately for childhood trauma but there may be other contributing mental health issues which can be treated in order to reduce the risks and optimize the result.

ADHD and hyperfocus

There is enough research to strongly suggest that adults with ADHD are at much higher risk for addiction in general, including sex addiction. (See also my blog on ADHD and sex addiction.)

Being glued to the computer screen for hours on end looking at pornography can be seen in adults with ADHD as a symptom of that disorder, namely hyperfocus (or more properly perseveration) which is a form of rigid attention. The ADHD adult is more likely to be a porn addict because he cannot tear himself away from the pornography, meaning he cannot shift his attention away from one thing and onto another as easily as someone else.

ADHD testing involves evaluating 4 main factors or dimensions of attention.

•Inattentiveness
•Distractibility
•Problems Splitting Attention
•Problems Shifting Attention
The last of these, the ability to shift your attention from one thing to another as needed, is the factor that most obviously relates to the fixation that ADHD folks can have on internet porn.

Autism Spectrum” Disorder and hyperfocus

Dr. Russell Barkley has argued that what we call the ADHD “hyperfocus,” should really be called “perseveration” a symptom of the frontal lobe issues in ADHD.

He argues that “hyperfocus” is a term that more appropriately relates to autism spectrum disorders, where the person has a problem connecting different areas of the brain. The two terms seem to be used popularly to describe similar behavior of disappearing into the stimulus or activity.

However the reference to autism intrigued me because I have noticed that some sex addicts who have great difficulty staying abstinent form internet pornography also seem to have some symptoms of high functioning autism or Asperger’s Disorder. They have trouble with social relating, trouble understanding social/emotional cues, are obsessive and may have special talents.

The hyperfocus of the mildly autistic or Asperger’s Disorder person (as well as their social disconnect) would tend to place that person at risk for getting drawn into a compelling activity like porn viewing and would make it harder for them to abstain.

Posttraumatic Stress and Dissociation

Dissociation is a symptom of PTSD, a “zoning out” that can be mild or very severe. It is likely that posttraumatic stress and its resulting dissociative symptoms would add to the risk for internet pornography addiction.

Research suggests that it is not only the adult with a history of childhood trauma but also the veteran with service related stress or anyone with acute or chronic stress could have a greater risk for dissociation and addiction in general, including a fixation on internet porn.

To complicate matters, there is research that found prior ADHD leads to greater vulnerability to PTSD in veterans.

Trauma and ADHD seem to be intertwined and create a chicken-egg issue for further research. But regardless, both PTSD and ADHD separately or together create the risk for attentional issues related to porn addiction.

Evaluate and treat attention issues for a better outcome

Anyone with pornography addiction should be fully assessed for co-occurring psychological issues. ADHD, trauma and high functioning autism can stand in the way of progress. If they are identified and treated the outcome looks much brighter.

by Lisa Frederiksen
Parents of a child with a drug or alcohol problem need support, too – and there are millions of parents – there are millions of children who need treatment.

Nine million young people between the ages of 12 and 25 need treatment for substance abuse or addiction. Of those nine million, two million are 12 – 17. Of the two million, ninety percent are not getting the help they need.*

Lorraine McNeill-Popper, Mom and Parent Advisory Board Member of The Partnership at Drug Free.org, says of The Partnership’s new online resource, Time to Get Help:

“Receiving support from others who have been through what you are going through can be very powerful and often one of the most effective ways to stay hopeful, inspired and sane. You will find out that you are not alone in this fight against addiction. You can learn from other parents. And even though your child may be different than theirs, you’ll discover there are many similarities.”

According to The Partnership’s introductory email regarding this new online resource, “By listening to parents and working with experts in the field of teen substance abuse and treatment, we’ve developed Time To Get Help.

“Time To Get Help [is designed to] help parents of teens and young adults gain a better understanding of adolescent alcohol and drug abuse, dependence and addiction; get support from experts and other parents who have been there; and find the right treatment for their child and family.”

The key to losing weight, or saving for the future, is avoiding temptation all together, according to a new study from the Universities of Cambridge and Dusseldorf. The study on self-control suggests avoidance is a better strategy than depending on will power alone.

The study, published in Neuron, compared the effectiveness of willpower versus voluntarily restricting access to temptations, called ‘precommitment’. For example, precommitments can include avoiding purchasing unhealthy food and putting money in savings accounts with hefty withdrawal fees. The team also examined the underlying mechanisms in the brain that play a role in precommitment in order to understand why this strategy is so effective.

“Our research suggests that the most effective way to beat temptations is to avoid facing them in the first place,” said Molly Crockett, who undertook the research while at the University of Cambridge and is currently a Sir Henry Wellcome Postdoctoral Fellow at UCL.

The study participants were healthy male volunteers. The researchers gave the men a series of choices where the men had to decide between a tempting “small reward” available immediately, or a “large reward” available after a delay. The small rewards were mildly enjoyable erotic images. The large rewards were extremely enjoyable erotic pictures. Such pictures are immediately rewarding at the time of viewing, allowing the researchers to probe the mechanisms of self-control as they unfolded in real-time. The pictures were chosen instead of rewards like money, which could only provide a reward after the subjects had left the laboratory.

The small reward was continuously available during some of the choices, making it necessary for the subjects to exert willpower to resist choosing it until the large reward became available. For other choices, however, the participants were given the opportunity to precommit. Before the tempting option became available, the subject had the ability to prevent themselves from ever encountering the temptation.

Participants’ choices and brain activity were measured as they made these decisions. The researchers found precommitment was a more effective self-control strategy than willpower. The participants were more likely to get the large reward when they had the opportunity to precommit. The team found those with the weakest willpower, the most impulsive of the subjects, benefited the most from precommitment.

The study allows the team to identify the regions of the brain that play a role in willpower and precommitment, finding that precommitment specifically activates the frontopolar cortex, a region involved in thinking about the future. When the frontopolar cortex is engaged during precommitment, the team found it increases communication with the dorsolateral prefrontal cortex, a region of the brain that plays an important role in willpower. Identifying the brain networks responsible in willpower and precommitment opens new avenues for understanding failures of self-control.

“The brain data is exciting because it hints at a mechanism for how precommitment works: thinking about the future may engage frontopolar regions, which by virtue of their connections with the dorsolateral prefrontal cortex are able to guide behavior toward precommitment,” said Tobias Kalenscher, from the University of Dusseldorf.
http://www.redorbit.com/news/health/1112906706/willpower-alone-not-enough-for-self-control-072513/

By Robert Weiss LCSW, CSAT-S
As an addiction and sexual disorders specialist, I often write about sexual addiction. As most readers are “psychologically minded” in venues like this one, I typically assume that you already understand what that term means and does not mean. Nevertheless, it seems like a good idea to at least occasionally state what sexual addiction – aka, sexual compulsion, hypersexuality, hypersexual disorder, etc. – means to those of us who treat it. To that end I have provided below a brief overview of what sexual addiction is and is not.

Sexual Addiction: The Disorder

The criteria for sexual addiction are similar to the criteria for any other addiction. Addicts of all types (substance and behavioral) experience:

Ongoing obsession/preoccupation with their drug/behavior of choice
Loss of control over use
Directly related negative life consequences

Diagnosing a chemical addiction is usually fairly straightforward – an individual is hooked on drugs, alcohol, or some other substance and can’t seem to quit, even though he or she is experiencing, as a result, relationship issues, trouble at work or in school, declining physical and emotional health, financial turmoil, loss of interest in previously enjoyable activities, legal issues, and/or other negative life consequences.

Diagnosing process addictions (behavioral addictions) can be more difficult, especially when the activity in question is a natural and even necessary part of life, as is the case with things like food and sex. Sometimes it helps to look at why an individual is engaging in compulsive sex (or eating, gambling, shopping, etc.) If the person is compulsively abusing sex (or any other potentially pleasurable behavior) as a way of self-soothing and/or dissociating from intolerable emotions and/or underlying psychological conditions such as early trauma, attachment deficits, social deficits, depression, anxiety, and low self-esteem, that is usually an indicator of potential addiction. Short of that, the behavior may be compulsive and causing problems but not equate to addiction.

Unfortunately, the powers behind the DSM-5 chose to not include sexual addiction as an official diagnosis, making it much harder for many therapists to identify and treat this very real issue. For now, clinicians who rely on the DSM can utilize the “impulse control disorders not elsewhere classified” diagnosis when dealing with sexual compulsivity.

Misdiagnosis

Unfortunately, some people use the term “sex addiction” to define virtually any type of sexual behavior that doesn’t meet their values (religious, relationship, cultural).

He’s had two affairs in the past few years so he must be a sex addict.
In our church you can be excommunicated for looking at porn. I hear that he looked at porn at least half a dozen times, so he must be a sex addict. Why else would he take risks like that?

Other individuals toss around “sexual addiction” as a catch-all excuse for virtually any type of sexual misconduct. In other words, some people who get caught red-handed engaging in inappropriate, problematic, possibly even illegal sexual behavior will blame their actions on an addiction, hoping to avoid or minimize the judgment and/or punishment they experience. Occasionally these individuals really are sex addicts, but just as often they are not. Either way, a diagnosis of sexual addiction is never intended to justify bad behavior or to let people “off the hook” for what they’ve done.

Unfortunately, it’s not just layperson-generated “diagnoses” that are a problem. Plenty of well-meaning but under-informed therapists are willing to label all sorts of things as sexual addiction. Frankly, the mental health profession provides minimal training in terms of what constitutes healthy (and unhealthy) human sexual behavior. Because of this, some therapists mistakenly believe that any form of sex/gender driven dysphoria equates to sexual addiction. This is simply not the case. The fact that an individual feels bad about his or her sexualized thoughts, feelings, desires, or actions does not mean that he or she is a sex addict. That individual might be a sex addict, but only if the above-stated criteria (obsession, loss of control, and negative consequences) are met.

Rule Outs…

Sexual Orientation ≠ Sex Addiction

Neither homosexual nor bisexual arousal patterns are factors in the diagnosis of sexual addiction, even if those arousal patterns are ego-dystonic. Being gay, lesbian, or bisexual does not make you a sex addict any more than being straight makes you a sex addict. Sometimes self-loathing homosexuals or bisexuals will seek out sex addiction treatment, hoping it will change their unwanted sexual orientation. Occasionally they do this at the behest of a misguided clinician. However, changing one’s arousal template is not possible. If you’re attracted to men, that’s the way it is; if you’re attracted to women, same story; and if you like both genders, you’d better get used to it, because that’s not going change no matter how much analysis you have or how many 12-step meetings you attend. In other words, sexual addiction is not in any way defined by who it is that turns you on.

Concurrent Drug Use ≠ Sex Addiction

Sometime drug addicts, especially those who abuse cocaine, methamphetamine, GHB, and other stimulant/party drugs, can become hypersexual while high – especially if they add Viagra or other erection enhancing drugs to the mix. This does not, however, make these people sex addicts. If the sexual compulsivity only occurs with drug use, a diagnosis of sexual addiction is not appropriate. However, sexual activity must be identified as a trigger for drug relapse in individuals for whom drug use and sexual activity are co-occurring behaviors.

Fetishes and/or Paraphilias ≠ Sex Addiction

Fetishes and paraphilias are recurrent, intense, sexually arousing fantasies, urges, or behaviors involving nonhuman objects, specific body parts, the suffering of oneself or one’s sexual partner, or non-consenting sex (in appearance or actuality). Fetishes and paraphilias may cause a person to keep sexual secrets, to feel shame or distress, and even to feel out of control, but they are not indicators of sexual addiction. In fact, they are only considered pathologic when: 1) they become obligatory for sexual functioning; 2) they involve inappropriate partners (meaning minors or unwilling participants); or 3) they cause significant distress and/or impairment of social, occupational, or other important areas of functioning. And even when a fetish or paraphilia does qualify as pathologic, it is not considered sexual addiction, per se.

Mania, OCD, Adult ADD ≠ Sex Addiction

In order for the diagnosis of sexual addiction to be made, professionals must first rule out any number of major mental health disorders that sometimes include hypersexuality or impulsive sexual behavior as a primary symptom. Some of these include the active stages of bipolar disorder, obsessive-compulsive disorder, and adult attention deficit disorder. The problem here is one of differential diagnosis. Not everyone who is impulsively or compulsively sexual has a problem driven by sex addiction, as hypersexual and impulsive sexual behaviors are legitimate symptoms of many other disorders.

Sexual Offending ≠ Sex Addiction

An unknown percentage of sexual offenders do sexually act out in a compulsive/addictive manner, but not all sex offenders are sex addicts. Usually sexually addicted sex offenders start out by engaging in non-offending behaviors (porn, casual/anonymous sex, serial affairs, etc.), but over time their sexual acting out escalates into offending. That said, sexual offending is not, per se, indicative of sexual addiction (or vice versa). The criteria for sexual addiction need to be very strictly applied when dealing with sexual offenders, as these individuals are the group most likely to self-identify as sex addicts in an attempt to avoid judgment and punishment for their problematic sexual behaviors. (As mentioned above, the diagnosis of sexual addiction is NEVER an excuse for bad behavior. Sex addicts are ALWAYS responsible for the hurt and pain they have caused.)

Why We Need to Get it Right…

Sadly, some mental health professionals choose to inappropriately incorporate the label of “sex addict” into treatment. This sometimes occurs through ignorance; other times this choice is the result of agendas more focused on moral, cultural, or religious values than clinical ones. These clinicians do a great deal of harm by abusing the term “sex addict.” Their actions have created a great deal of confusion and even acrimony within the treatment community, which makes diagnosing and treating people who truly are sexually addicted all the more difficult. It also has a tendency to send media members on the proverbial “wild goose chase” every time a celebrity, sports hero, or community leader has an affair, gets caught with a prostitute, or acts out in some other sexually inappropriate way. An official DSM Sexual Addiction (or Hypersexual Disorder) diagnosis would certainly help to clarify matters, but that is not coming anytime soon. Thus, it is up to those of use working in the field to help other clinicians learn how to clearly identify (and, equally importantly, not misidentify) people who are struggling with compulsive, addictive, and impulsive sexual disorders, diagnose them properly, and direct them toward useful, accurately planned models of treatment.

Clinicians (and clients) who are interested in learning more basic information about sexual addiction may want to grab a copy of my recently published book, Sex Addiction 101, available in both eBook and paperback formats.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous treatment centers throughout the United States, Europe, and Asia.

by Lisa Frederiksen
Coping with secondhand drinking | drugging is especially problematic for a young person because of the brain development that occurs from birth through one’s early 20s – especially if the parent or sibling’s drinking or drug use behaviors involved verbal, physical or emotional abuse. Why is this such a problem? Because it actually changes the way the brain works and in the case of substance abuse, those brain changes around childhood trauma become one of the five key risk factors for developing a substance abuse problem and/or an addiction.

For more on this concept, consider reading: “Secondhand Drinking, Secondhand Drugging,” “Childhood Trauma Leaves Lasting Marks on the Brain” and browsing through “The Adverse Childhood Experiences Study (ACEs)” website.
Affects of Coping with Secondhand Drinking | Drugging as a Young Person

In previous posts, such as: “How Teens Can Become Alcoholics Before Age 21,” I’ve written about how the brain’s developmental processes from ages 12 – 25 make a person’s brain especially vulnerable to developing a problem with alcohol abuse, even alcoholism.

The same is true of wiring coping skills for dealing with a family member’s substance abuse and/or substance addiction (alcohol or drugs); in other words, wiring skills to cope with secondhand drinking/drugging (SHDD) — coping skills such as those developed to “handle” a loved one’s verbal, physical or emotionally abusive drinking behaviors. Examples of these kinds of SHDD coping skills include retreating inside one’s mind or physically when confronted with abusive or scary drinking behaviors; carrying pent up, explosive rage that spills out in other situations because it cannot be expressed to the person abusively drinking/drugging for safety reasons; attempts to be especially “good” to make up for or “fix” the problem; or ….

When a person, especially a young person, does not understand drinking behaviors as a consequence of brain changes (and in the case of addiction, a brain disease) caused by the substance abuse, they think “it” (the behaviors) are their loved ones. Thus, they think their loved one’s behaviors are something they have to accommodate or thwart or believe, because, after all, it is their loved one! So they internalize — wire — coping skills to respond to the drinking behaviors.

As you’ve also likely read on this blog, the brain embeds brain maps (neurons talking to one another to produce a particular activity) for everything we think, feel, say and do — including how we cope with SHDD. The brain is especially vulnerable to how it wires these coping skills during the development that occurs from ages 12-25 — the time of brain maturity shown in the image below, a time-lapse of brain imaging studies reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging.

Brain development occurring ages 12-25 makes a young person especially vulnerable to wiring unhealthy coping skills that they will carry throughout their life, unless and until, they understand that substance abuse / addiction causes brain changes and the resulting behaviors are not a reflection of them (the young person), they are the result of those brain changes that cause the drinking behaviors (further described in the “related posts” listed below).

The developmental brain changes occurring between ages 12-25 referenced above are related to:

1) Puberty. Puberty triggers new hormonal and physical changes, as well as new neural networks.

2) Continued development of the cerebral cortex (front area) — the “thinking” part of the brain. This involves neural networks wiring within the Cerebral Cortex — the idea of learning calculus vs. memorizing multiplication tables, for example. It also involves neural networks in the Cerebral Cortex writing to those in other areas of the brain — the idea of controlling emotions, which originate in the Limbic System, with logical thought, which originates in the Cerebral Cortex, for example.

3) “Pruning” and “strengthening” of neural networks. Pruning is when neural connections (i.e., brain cells talking to one another) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one). This concept is explained in more detail at The Partnership at Drug Free.org website, A Parent’s Guide to the Teen Brain.

Image: Thompson, Paul. Ph.D., Time-Lapse Imaging Tracks Brain Developing from ages 5 to 20, UCLA Lab of Neuro-Imaging and Brain Mapping Division, Dept. Neurology and Brain Research Institute, http://www.loni.ucla.edu/~thompson/DEVEL/PR.html Permission: Dr. Paul Thompson 5.7.09

By Traci Pedersen Associate News Editor

No Link Found Between ADHD Drugs and Future Substance AbuseChildren with attention-deficit hyperactivity disorder (ADHD) are far more likely than their peers to engage in serious substance abuse as teens and adults.

But do ADHD meds contribute to the risk?

In the most comprehensive research ever on this topic, UCLA psychologists found that children with ADHD who take medications such as Ritalin and Adderall are at no greater risk of using alcohol, marijuana, nicotine or cocaine later in life than kids with ADHD who don’t take these medications.

The researchers looked at 15 long-term studies, including data from three studies not yet published. The studies followed more than 2,500 children with ADHD from childhood into their teen and young adult years.

“We found the children were neither more likely nor less likely to develop alcohol and substance-use disorders as a result of being treated with stimulant medication,” said Kathryn Humphreys, a doctoral candidate in UCLA’s Department of Psychology and lead author of the study. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine.”

The children had a mean age of 8 years old when the research began and 20 at the most recent follow-up assessments. They came from a broad geographical range, including California, New York, Michigan, Pennsylvania, Massachusetts, Germany and Canada.

“For parents whose major concern about Ritalin and Adderall is about the future risk for substance abuse, this study may be helpful to them,” Humphreys said.

“We found that on average, their child is at no more or less at risk for later substance dependence. This does not apply to every child but does apply on average. However, later substance use is usually not the only factor parents think about when they are choosing treatment for their child’s ADHD.”

The researchers report that children with ADHD are two to three times more likely than children without the disorder to develop serious substance-abuse problems in adolescence and adulthood, including the use of nicotine, alcohol, marijuana, cocaine and other drugs.

This new study does not oppose those results but finds that, on average, children who take stimulant medication for ADHD are not at additional risk for future substance abuse.

Ritalin is associated with certain side effects, such as suppressing appetite, disrupting sleep and changes in weight, said Steve S. Lee, a UCLA associate professor of psychology and senior author of the study.

“The majority of children with ADHD—at least two-thirds—show significant problems academically, in social relationships, and with anxiety and depression when you follow them into adolescence,” Lee said.

“For any particular child, parents should consult with the prescribing physician about potential side effects and long-term risks,” said Lee.

“Saying that all parents need not be concerned about the use of stimulant medication for their children is an overstatement; parents should have the conversation with the physician. As with other medications, there are potential side effects, and the patient should be carefully evaluated to, for example, determine the proper dosage.”

As the study participants get older, researchers will be able to study the rate at which they graduate from college, get married, have children and/or get divorced and to assess how well they function, Humphreys said.

As children with ADHD enter adolescence and adulthood, they typically fall into one of three groups of similar size, Lee said: one-third will have significant problems in school and socially; one-third will have moderate impairment; and one-third will exhibit only mild impairment.

The research is published in the journal JAMA Psychiatry, a psychiatry research journal published by the American Medical Association.

Source: JAMA Psychiatry

By Therese Borchard
“There is no question that the most common destructive behavior affecting depressed patients, barring suicide, is alcoholic or any substance abuse,” writes J. Raymond De Paulo Jr., M.D., of the Johns Hopkins School of Medicine in his book “Understanding Depression.” He does not mince words on the seriousness of alcoholism and drug addiction to the recovery of depression:

Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs. The most difficult treatment situations that I have ever seen patients and families confront, since I started my training in psychiatry twenty-seven years ago, occur when the patients’ illnesses are complicated by what we call addictive behaviors. While I have seen many successful outcomes, none were easy to achieve.

Here are some important facts you need to know about the relationship between depression and substance abuse: why addiction impedes recovery from depression and why depression sustains drug dependence.
1.Depressive illness makes people prone to destructive behaviors.
2.Destructive behaviors make depression and mood disorders worse.
3.Depressed people drink and use drugs to self-medicate.
4.There is a greater risk of abusing alcohol or drugs by people who have moderate depression than those who have depression that is severe.
5.There is a high relapse rate with drugs and alcohol when it occurs along with depression and mania. Depressed people who drink or abuse drugs are far more likely to suffer a relapse.
6.Approximately one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses also experience substance abuse.
7.More than one-third of all alcohol abusers and more than one-half of all drug abusers are also battling mental illness.
8.People with manic depression are particularly at risk. One study suggests that as many as 60 percent of people with Bipolar I have substance abuse problems at some point in their life.
9.The likelihood of developing alcoholism or substance is abuse is far greater in people with bipolar disorder than in those with unipolar depression or the general population.

A new study in the Archives of General Psychiatry found that alcohol abuse may actually cause major depression. The research results showed that alcohol use could trigger genetic markers that increase the risk of depression. In other words, the depressant effect of alcohol could lead to depression itself.