stuff #1 – we are on vacation in arizona right now – on our last leg, in a tiny place called congress, which is close to wickenburg with the huge population count of 5,000. supposedly, wickenburg is known for its fancy addiction treatment centres. i had a quick look at the websites of four of them but so far nothing looks like something i would recommend. as much as i think the 12 steps are great, i have a problem with them being a required part of a treatment centre. that’s not how the 12 steps work. and i have a problem with a treatment centre where the only books you’re allowed to read are AA’s big book and the bible. but i guess it works for some people.

stuff #2 – been thinking a lot lately about how to keep blogging and partaking in social media. to what degree do i want to contribute to the overwhelming symphony (cacophony?) of virtual voices out there? how will i help make the world a better place if i do that?

stuff #3 – the second edition of my poetry book is out. should i have a l(a)unch party? oh, that’s so much work. i totally don’t feel like organizing ANYTHING right now. but you know what, that book is darn good. it was fun to look at it four years later and to spruce it up a bit.

stuff #4 – i am reading – i am reading – i am reading – ok, i’m gonna say it, i am reading eat pray love right now. yup. i finally did it, grabbed the book off my sister-in-law’s shelf and went to it. it’s actually not that bad – there are a few neat ideas in there so far. for example the petition to god. will it make my “best books of 2011″ list? no.

stuff #5 – oh, but HERE is a book that will make the list – alistair mchoag’s rollercoaster memoir invisible driving about his life with bipolar disorder. holy razmatazz! no need to be interested in mental illness to read that book, all you need is a love of reading. a review is coming up, and i’ll have to gather all my half and quarter wits to come up with something interesting after all the rave reviews he already has.

stuff #6 – resolutions. resolutions? i don’t know. i engaged in a bit of a rant against the typical approach to them in an interview with CBC parenting columnist michelle eliot the other day. more and more, i prefer themes rather than resolutions – ideas or actions i wouldn’t mind pursuing in the coming year, without going crazy about it for three weeks and then slacking off (“i will exercise of 60 minutes every day!”, “i’ll stop smoking forever!”). so two themes i’m proposing for this year is to slow down, and then to slow down some more. and extermination. of guilt.

aaah. slowing down. maybe i should stop now and go to bed.

and you?

one “checkpoint” in addictions counselling is to consider “set, setting, dose”. “set” refers to mindset, “setting” refers to the physical and social setting, and “dose” refers to the type and amount of a substance used or behaviour practiced, and considerations of how set and setting affect dose. for example, if sue, who just had a fight with her parents and is upset over it (“set”), is going to a party with her friends where there is much drinking (“setting”), then before going to the party, she could think about setting a limit on how much she is going to smoke and drink (“dose”), because she knows that alcohol has a stronger effect on her when she is upset.

an interesting question here is, what is the equivalent of drinking in job search? excessive drinking is harmful. what are harmful/unhelpful behaviours in job search? possible candidates:

• using only the computer for job search
• doing many non-job search related activities on the computer during the job search
• avoidance: excessive TV watching, eating, sleeping, etc.
• distraction: cleaning, shopping, etc.

examples of helpful behaviours:

• knocking on doors
• staying in regular contact with networks
• actively limiting non-job related internet use
• learning about writing effective cover letters

mindsets – examples:

• happy, serene, hopeful, positive, etc.
• neutral, realistic, up-and-down, etc.
• negative, depressed, hopeless, angry

settings – examples:

• home (bedroom? office?)
• knocking on doors
• employment resource centre
• coffee shop

an example might be: joe is sitting in a coffee shop where he reads that job openings in his industry are rising and feels hopeful. this prompts him to phone up an ex co-worker and invite him to have coffee.

questions for career practitioners:

• would it be helpful for clients to know about set, setting, dose and how they influence each other?
• we do a lot of work around positive behaviour, a little less about positive mindset, and very little about setting. what would it look like if we turned that on its head?
• how about an exercise where we ask clients to physically visit a place that makes them feel happy?
• at the most, our clients’ lives are 12% about job search (if they spend 20 hours a week on it); the rest is other things (at least overtly; they may spend quite a bit more time thinking about it). how are the remaining 88% influencing them? what would it be like if we thought about helping there in addition to with their job search, just like sue might be helped with her drinking if she had a better handle on how to approach conflicts with her parents?

#1  thanks for sharing this. i believe too much alcohol can’t help you better to stop it, you have to love your health and love your life. do something better, you can do physical activities instead of drinking too much.

#2 taking alcohol occasionally is okay but being addicted to it is not healthy anymore. health is wealth, so better start doing something about it. stop it and enjoy life.

both of these comments illustrate the typical mindsets of people who either know nothing about addiction or who are afraid of addiction (or both).

truisms
people who don’t know much about addiction don’t understand that people who are struggling with addiction already know things like “too much alcohol can’t help” or “health is wealth”. in fact, at least half of them beat themselves up with that knowledge a hundred times a day. once you’ve been using for a little while, guess what, you’ve figured out that it’s unhealthy and that it would be a pretty darn good idea to stop or at least decrease it.

advice
it’s the same with advice. let’s take “stop it and enjoy life”. once again, the thought of stopping it has occurred to the person a thousand times.

and enjoying life? what if it feels like enjoying life seems impossible without the alcohol (or drug, or gambling, or whatever the person is dealing with). what if the person couldn’t enjoy life to begin with, and stopping the addiction would just bring her back to an unbearably bleak and painful life?

words such as “you can do physical activities instead of drinking too much” are supremely unhelpful for a number of reasons, e.g.

• as said before, the person who is addicted already knows that
• at least at the beginning, you don’t get nearly as much a kick out of the physical activity as the addictive activity (that goes for other activities as well)
• substitutions only work under certain circumstances. how’d you like it if i said, “you’re boyfriend just died? don’t worry, just get yourself another one – here, take john, he’s got a moustache, too”

attitude
the most troublesome part is the attitude, and the unthinkingness (nice word, huh?) if the person offering these comments thought for a moment, they could realize that the person with the addiction already knows that stopping would be a good idea. implicit in truisms like the ones above is the message, “you’re too stupid/naïve to have figured this out on your own, so now i’m telling you something that everyone else but you knows.”

the above and the lack of thoughtfulness portray disregard. the message is “this person i’m talking to is not worth thinking about; what i have to say is more important”.

what comes with all of this is a lack of empathy. “i’m not going to stop and reflect on how i would feel if someone gave me unsolicited advice about something painful in my life.”

fear
and why? most of the time it comes down to fear. fear of having my life entangled with the difficulties of another when my own may already be difficult to bear. and fear that by getting closer to the addiction, i might get “infected”. humans have a deep-seated fear of “catching” diseases not only of the body but also of the mind. the fact that this is irrational drives the fear even more underground, which just makes it more potent because it gets to roam around uncontrolled. (now there’s an interesting thought – the parallel between that suppressed fear and the underground, uncontrolled drug trade).

thoughts?

self medication to deal with life’s stressors
1:02 am floridlymad: [addiction is a] coping mechanism to life’s stressors gone wrong…
1:03 am floridlymad: @JoyFull_deb YES. a girl i know w/crack addiction once told me it’s her only joy left in life…
1:04 am GermanInAlabama: From my uneducated view I would say oftentimes attempt at self-’medicating’ and means of forgetting about probloems
1:48 am twitertwotter: If addicts r using drugs 2 self-medicate we need to find out why and help them learn to cope with it and move forward from past trauma
1:06 am NAMIMass: Sometimes people don’t want to take prescribed medications but think it’s ok to drink or take illicit drugs to feel better
1:18 am twitertwotter: I think an important thing that gets missed in addiction is in many cases the underlying trauma

self medication to deal with mental health issues
1:02 am JoyFull_deb: Yes !! Addiction (whatever kind) can be used to self medicate mental illness.
1:04 am petequily: @moritherapy society often doesn’t take mental health seriously & pays the cost in self medication / addictions & other MH conditions
1:05 am EatsShootsEdits: I used to self medicate before I came to understand my illness and get stable on meds
1:08 am hollymclennan: @moritherapy i see the conx btwn mental health + addiction when ppl don’t get the help they need + self-medicate.
1:08 am floridlymad: addiction to certain substances can trigger (or worsen preexisting) psychosis, which may or may not persist even after *quitting*.
1:17 am perthtones: We now know cannabis is effective on a range of depressive disorders, ketamine being trialled for bipolar – legal/illegal is abritrary
1:47 am icantican: My hx of drinking problem w/ alcohol was directly related to self medicating my symptoms of depression, blips of mania, anxiety, ADHD
1:08 am EatsShootsEdits: at lot of people self medicate long before they know they have a mental illness. our minds seek comfort sometimes it is drugs first
1:23 am twitertwotter: Many addicts use marijuana and other drugs to medicate their hyperarousal, that can be a result of PTSD or overactive flight/fight

self soothing
1:26 am twitertwotter: Treatment definitely needs to address mental health issues, coping mechanisms, affect regulation and self-soothing techniques
1:51 am twitertwotter: People who drugs to feel better, or to forget, or to escape. That is self-medication. They do not know how to self-soothe.
1:53 am NAMIMass: @twitertwotter Not all addiction is about self soothing. We’ve talked about self-medicating substance abuse for #mentalhealth issues
1:46 am moritherapy: if addiction is about self soothing, then it doesn’t matter that much what the substance/behaviour is
1:57 am NAMIMass: @moritherapy I’m not sure I do agree. I’m not thinking of them at same level. I think of self soothing as less than self medicating
1:54 am moritherapy: @NAMIMass self soothing and self medicating very similar, wouldn’t you say?
1:56 am moritherapy: @NAMIMass but if you talk to health care ppl, self soothing/medication will NOT be #1 for them

self medication and ADHD
1:08 am petequily: Smallest # of addicts with #ADHD in clinical journals I’ve seen is 20%. But only 5% of pop. has ADHD http://bit.ly/7cXP8
1:10 am petequily: Study 35% of Cocaine Abusers had #ADHD http://bit.ly/4vRuoi #selfmedicate #mentalhealth
1:25 am petequily: I know of people who had undiagnosed #ADHD & self medicated w/ one addiction, stopped it & started & stopped multiple other addictions
1:44 am petequily: Study 33% of Alcoholics had #ADHD 65% of Drug Users Had ADHD http://bit.ly/b4EwqG #addiction
1:47 am petequily: @unxpctdblessing well by telling other people about how he self medicated his #ADHD w/ pot you may save others from same exp.
1:54 am asdquefty: With ADHD or depression, substance abuse can be obtaining artificial motivation.

stories of self medication
1:03 am JoyFull_deb: I watched my sister “self medicate” for many, many years….
1:16 am MelissaMashburn: my brother is a vet and almost lost his license because he was self medicating with xanex and writing his own scrips.
1:39 am MelissaMashburn: I used internet games to self medicate
1:40 am unxpctdblessing: @petequily I agree. He had been self medicating since he was 14 years old. I knew he used when I met him but had no idea the extent.
1:44 am MelissaMashburn: For me the addiction to an internet browser game, was away for me to self isolate, and self medicate

the topic of the chat will be mental health and addiction. #mhsm typically uses between 5 and 8 questions to stimulate conversation. here are a few i’ve come up with – any more suggestions?

• where do you see the connection between mental health and addiction?
• how do you define addiction?
• how do you see the two are different? are they?
• some say that addiction is a form of self medication for mental health issues. what are your thoughts on this?
• what are your thoughts on addiction to prescription medication?
• the term “recovery” is used in mental health as well as in addiction circles. do you see a similarity between the meaning in both contexts? is it different?
• what is your experience with treatment specifically aimed at concurrent disorders?
• do mental health and addiction stigmatize each other? is it “better” or “worse” to have one or the other?

please let me know what you would like to discuss in the chat – whether the questions above or anything else!

to join us in the chat, sign in or sign up with twitter and then go to http://tweetchat.com/room/mhsm.

to show you what you can expect in such a chat, here is an excerpt from last week:

12:59 am mhsmchat: welcome to tonight’s chat!

1:01 am mhsmchat: tonight we will discuss our passion for #mentalhealth issues.

1:02 am mhsmchat: can join in the chat here: http://tweetchat.com/room/mhsm =)

1:04 am mhsmchat: q1: how did you get involved with #mentalhealth activism, professional roles, or discussing #mentalhealth topics? what drives you?

1:05 am icantican: q1 my interest started as a curiosity when i was a teenager and a bigger mess than i am now and my mother had schizophrenia.

1:05 am partimefabulous: @mhsmchat after dealing with my own challenges with #depression, i decided to try and understand it better by creating a truthful film

1:06 am namimass: @mhsmchat i’m involved because i care about mental health. i’m a family member with a sibling with mental health issues.

1:07 am partimefabulous: #mentalhealth issues are so poorly represented in today’s media and entertainment. it’s time that the stigma is unveiled.

1:07 am perthtones: @icantican helped mum study 4 psych nurse exams at 14 advocated 4 decades, then hit by ptsd 10 yrs ago. now an even beter advocate

1:08 am icantican: vulnerability of the human mind, resilence, and adversity due to mental illness or causing it is interesting to me.

1:09 am mhsmchat: i became involved because of my own personal mental health issues predominantly.

1:10 am voiceinrecovery: q1 advocacy was a natural progression in my recovery from ed & alcohol abuse. felt i had a story 2 share 2 help others feel less alone

1:10 am perthtones: totally agreed on #stigma – the biggest barrier to proper treatment, media coverage & positive community awareness

i can’t
god can
i better let god

these pithy words come from the first three steps:

1. we admitted we were powerless over alcohol, and that our lives had become unmanageable
2. we came to believe that a power greater than ourselves would restore us to sanity.
3. we made a decision to turn our will and our lives over to the care of god as we understood him.

depending on one’s interpretation, that can sound quite defeatist (“i can’t / i’m powerless”) and cultish (“i better let god / turn over our will”).

in my occasional musings on how the 12 steps can be used outside of traditional addiction recovery (for example, here are some thoughts on step 3) i’d like to propose that these seven pithy words and these three steps can be useful for anyone as a guide in their lives.

we admitted we were powerless over alcohol, and that our lives had become unmanageable.

it may not be alcohol, it may not be drugs, food, work, cigarettes or caffeine – but the truth is that there are a lot of things inside and outside of ourselves that we are powerless over, and that feel totally overwhelming. i have no power over the traffic, you have no power over your boss, joe has no power over politics. but it goes deeper than that – it is our reactions to these things that truly trouble us – the feelings of helplessness, the endless worry, the anger. we hate these feelings, so we run to do something about them – TV, romance novels, potato chips, blackjack chips. at the root of that are fear and pain and avoidance of fear and pain through escape into instant gratification. so how about:

step 1: we are run by fear and pain and avoidance of them, and that the endless cycling between those two is exhausting and overwhelming – it is insanity.

we came to believe that a power greater than ourselves would restore us to sanity.

is there something greater than fear and avoidance of fear? god? maybe for some. how about for those uncomfortable with or plainly disinterested in the idea of god? the 12 steps are informed by underlying principles such as honesty, hope, courage, integrity, love, justice and service – all positive, life-affirming, values that are greater than our little egos and ids, our inner factories that constantly crank out more fear and fear avoidance. here is my proposition, then:

step 2: we remind ourselves that by holding on to our values, we can rise above fear and instant gratification and leave insanity behind.

we made a decision to turn our will and our lives over to the care of god as we understood him.

the awareness that there is an alternative to fear, pain and instant gratification is a good start but it is not enough. a lot of us are aware that there are problems. we need to make a decision to do something with that awareness. this decision, by the way, needs to happen on a daily, hourly, sometimes minute-by-minute basis. fear and pain and our desire to escape them are incredibly strong; if we want to let go of them as prime motivators for our lives, we need to counter them with our values, virtues and beliefs on an almost constant basis. one of my favourite quotes is freud’s about us having but a “thin veneer of civilization”. i firmly believe if we are to keep this world going, maybe even make it a better place, we need to do everything we can to make this veneer stronger and thicker. we literally need to become more civil. isn’t that one of the main goals of democracry (a concept deeply informed by civility): to create and nurture an environment where citizens need not be governed by fear? just as we need to keep working on and fighting for democracy, we need to keep building our own personal virtues and values. here is my suggestion for step 3:

step 3: we decided to lead our lives by our virtues and values.

i would be very interested in hearing your thoughts about this.

military mental health: sign of strength from militaryhealth on vimeo.

it’s a sign of strength to seek help. for  an anonymous mental health or alcohol assessment try www.militarymentalhealth.org.

changing the game at work by christine barnes

don’t wait for the CEO to build a culture of engagement but begin by creating heaven on earth for your employees now. ask questions such as

• do you know what’s expected of you at work?
• do you have the materials you need to do your work?
• do you have the opportunity to do what you’re best at, every day?
• in the past seven days, have you received recognition or praise for doing good work?

i’m very happy to say that my part time work at mcc gives me all of this. what about you?

maida rogerson, who talks about many mothers

imagine. you’ve just had your first baby. your husband is in a new job and doesn’t have a lot of time for you. you’ve moved away from your extended family. suddenly, there you are, you and your beautiful baby, home, alone. your baby starts to cry, and you’re dead tired and all you want to do is cry yourself, and you have no one to turn to.

the idea behind many mothers is that it takes a community to raise a child well. a great idea, presented with lovely words.

perfectly broken by mark lundholm

i have a chemically challenged anatomy, a drug-resistant soul and a penchant for guessing incorrectly when it comes to the betterment of others. … because i am terminally self-centered, i am spiritually retarted, emotionally invisible, financially irresponsible, socially phobic and almost pathological when it comes to lying. … i have been liberated by the knowledge that my liabiliities as a practicing addict can now become finely tuned assets that allow to deftly navigate the foreign terrain of relationships, employment, success and excellence.

this is a language i understand.

would i buy this book?  probably not, for the above reasons.  but it’s a nice gift idea for someone who likes to be inspired by people who do something, rather than sit around complaining.

unhealthy habits and demographic changes are combining to place an unprecedented burden on the health-care system that may not be manageable, the heart and stroke foundation said in its 2010 annual report on canadians’ health.

so says the CBC about an alarming increase in heart disease and the potential for heart disease, adding `most of this is preventable.” the solution is

encouraging canadians to be more physically active, eat a healthy diet and be aware of their risk factors for heart disease.

“we all eat from stress, or because we don’t have time to prepare things,” said cheryl shapiro, a heart patient in toronto who was diagnosed with high blood pressure eight years ago.

she encourages people to read labels. “we don’t realize what we’re putting in our bodies.”

it is difficult to fit in the recommended minimum of 30 minutes of moderate-intensity exercise at least three times a week, shapiro said, but she does walk her dog regularly.

part of the solution is to create infrastructure to make it easier for people to walk to the store rather than driving everywhere to avoid exercise, abramson said.

“it’s easy to take shortcuts,” abramson said. “but in the long run, those shortcuts will be disastrous for our health.

there was a bit more about this on the radio but the gist was the same. what i found interesting – always find interesting about such news stories – is that obesity and being overweight is almost exclusively seen as a lifestyle choice. the equation of overweight = fat = out of control, unattractive, lazy, weak-willed etc. is not made explicitly but it’s really just three letters away. indeed, when i looked at the first five or six pages of the comments, i saw the word “lazy” six times. neither in the story nor in the comment pages did i see the word “eating disorder” or “addiction”.

i often get the feeling that in the world of psychiatric diagnoses, anorexia is much more noble than overeating. the overly thin person who uses her will power to deny herself a piece of broccoli is so much more appealing in our culture than the slob who sits in front of his TV, gobbling ice cream. of course both are caricatures and tell only a very, very thin slice of reality (for example, you could have two very similar looking people side by side, one of them struggling with undereating, the other with overeating. it doesn’t always show in the body size.)

there is controversy in the psych community over whether overeating is an addiction. i must say that i find NEDIC’s approach in can i be addicted to food? just as naive as the above article. it ends up saying “once we begin eating in a normal, healthy way again, we won’t have the same desire to eat as much high-calorie, high-carbohydrate food, or foods we think are “bad”.” that sounds really easy, doesn’t it?

now of course “addiction” is just a label, so let’s not split hairs here (although personally i am firmly on the side of gabor mate’s definition of addiction, which would agree with the use of the word in connection with overeating). rather, let’s be clear on this:

there are many people who eat much more than they want to and are unhappy about it. they try and try and try and nothing seems to work. they experience things like this: they cry during binges because they hate that they are eating non-stop. they go to bed night after night with terrible stomach pains because they have eaten too much. they eat out of garbage bins, eat frozen and spoiled food. they go to great pains to hide their eating from others, often ordering nothing but a little salad when they go out with others. they go from macdonald’s to burger king to wendy’s, pretending they are buying for a family. they spend thousands of dollars on diets that work for a while and then go back to bingeing. they commit suicide over the shame they feel over their out-of-control eating.

this is not a little lifestyle problem that will go away with a bit of education and an admonishment to use more willpower. many people who overeat know a lot about nutrition already and know they should exercise more, just like many people who smoke know what their lungs look like. they are deeply unhappy that willpower doesn’t seem to work. my best friend’s mother, an astonishingly intelligent woman, died of lung cancer, greedily sucking on a cigarette just before she went into her last coma. while not every person who is overweight suffers with such intensity, there are nevertheless similarities. overeating, for many, is a disfiguring, depressing, despairing dis-ease that is difficult to fight. i wish that this will be acknowledged more in the coming years. come to think of it, MentalHealthCamp, our second conference on the intersection between social media and mental health, will be a great way to address this.

(this is another post for national eating disorders week)

today i gave a hefty amount of money to the guy who always sits in front of my neighbourhood supermarket. the parking sign pole against which he was leaning was shaking because he was shivering so hard. i made him promise to leave for the night and watched him go.

while i completely believe that it’s everyone’s decision whether and what they give, i thought i’d tell you the reasons why i give money:

1. it’s respectful. they don’t sit there to ask for food, they ask for money. most panhandlers are savvy; they know where the food banks and soup kitchens are. for one reason or another, they don’t want to go there. there’s something rude about someone asking for one thing and then giving her or him something else. when i ask to borrow your pen, you don’t give me a lighter either, do you?
2. i don’t know whether the person is using it for drugs. having working with very poor people for a number of years, i’ve met numerous panhandlers who didn’t use it for drugs.
3. even if they’re using it for drugs, they’re not going to stop using if i don’t give them money. even if nobody gave them money, they’d still not stop using. it’s like hoping that removing wine glasses will stop someone from being an alcoholic.
4. even if they use it for alcohol or drugs – guess what, i (and you) support a lot of peoples’ bad habits. of the bankers, politicians and multinationals that make money from me, how many do you think spend money on cocaine? gas-guzzling SUVs? booze?
5. panhandlers are micro entrepreneurs. i like the spirit of independence.
6. panhandling is hard work. if you don’t think so, try it yourself. i respect hard work.
7. there’s something honest about panhandling. the panhandler who just sits there quietly or asks politely for change doesn’t try to sell me a dream of a slimmer body, a happier child or better sex. it’s a straightforward kind of business. (btw, i can’t stand those frauds who try get money by telling me that they just arrived from calgary and all they need is a few bucks to call their ailing mother – i never give a cent to those scammers, only a growl)
8. above all, agreeing to the exchange as it is proposed – the panhandler asks for money, i give it – gives the person and me a chance to interact as humans. the panhandler asks, i give, we both smile and exchange a few words.  we connect, and we feel good.

what do you do?