Professionals working in the field of mental health are often asked how they separate, or manage, their own emotions from the people and situations they encounter regularly. Some questions I’ve been asked; “Don’t you get sad? How can you just listen to people talk about their problems every day? Do you think about work at home?” The answer isn’t so black and white. Hearing people vocalize and explore both their pain and progress certainly evokes sometimes heavy emotions in the listener or supporter. Supervision, collaborative treatment, and self-care are a few examples of healthy ways we actively work to process such emotions, receive support to maintain quality of care, and remain mindful of our own position in these meaningful therapeutic roles and relationships.
What does that look like for me? I’ll call a friend or colleague for support or feedback, go to the gym, or indulge in some comfort food. Recognizing the need to process these emotions as they come up is the important step, similar to our clients taking the initial step to seek support and engage in treatment.
I can’t speak for everyone in the field, but I feel confident in stating that many of us were brought to this field because of our ability and passion to empathize with people in order to provide support during challenging times. Also, there’s often an inherent mindset held by professionals in this field which helps us to view such “problems” as an opportunity for change. This is a way to positively reframe what could be identified by some as an emotionally taxing job, and instead recognize the rewarding opportunity to work with people who are initiating change by seeking support.
Ultimately, as humans we all experience emotions. It’s important that we acknowledge that it’s ok to feel sad, or to have an emotional response to our own, or others, personal struggles. It’s ok to say “today was really hard” and recognize our need as professionals to utilize our own healthy outlets to take care of ourselves. Certainly, easier said than done at times to “practice what we preach” but it’s an acquired and necessary practice to prioritize our needs as we simultaneously support others. Erik Erikson, a developmental psychologist and psychoanalyst known for his theory on psychosocial development of human beings, said “the more you know yourself, the more patience you have for what you see in others.” As we care for ourselves and continue making our own personal and professional growth, we’re able to continue doing what we love and offer the compassion and support we came to this field to provide.
As parents, we try to prepare our children for the real world the best that we can and we hope to excite them for all the wonderful possibilities that lie ahead. For instance, as we prepare to put our kindergartner the bus for the first time we say encouraging things like, “You’re going to love school”, and, “You’re going to make so many new friends!” It isn’t uncommon for parents to also say things like, “School is a place where you will learn so many new and exciting things!” We describe teachers as people they can always go to no matter what and that school itself is a “safe place”. When issues with friends arise we might tell them, “You don’t need to be friends with everyone but you need to include everyone when you play”. Overall, we describe school as a happy and comforting place to be.
Sadly, as our children grow we are seeing more and more adolescents battle with increased stress and anxiety surrounding their scholastic achievements, social environments, and self-identity. These stressors include the pressures of college, achieving good grades, excelling at athletics, and dealing with social pressures. As a result, the school-life balance becomes reality that many adolescents struggle with. Consequently, it is not a coincidence that anxiety and depression among children and teens have become more prevalent than ever before causing many teens to fail classes, miss school, use substances and engaged in self-destructive behaviors.
As a therapist, I constantly hear statements like “I will never get into a good enough college for my parents” or “B grades aren’t good enough…. I might as well give up.” Even in the realm of after school activities I have heard statements such as “Sports isn’t about the fun, but if I am good enough for a scholarship to play.” Even more disheartening is the notion that many adolescents attribute their marijuana or substance use as their main source for coping with their stress/anxiety.
Then of course there is our new digital age, filled with social media and all the pressure that comes along with growing up in a technologically advanced world. Traditionally adolescences has been a difficult time for many individuals. However, in today’s world our children are subjected to realities that we as parents just do not understand. A world whereby validation is not so much about the person you are but more so about how many likes you receive on an Instagram picture. Additionally, issues such as bullying, harassment, substance use, sexual activity, and so on have been exacerbated by social media.
All of the aforementioned makes us wonder: What can we do to make school exciting again? How can we bring back the kindergartener who is excited to show you the art project that he/she made, or, the little boy who scored his first goal who runs over for a hug? How can we encourage our children to continue using their teachers as a resource? How can we make school a “safe place” again? As a parent and therapist, I ask myself these questions all the time. Below are a few resources to help…
We live in an age where we are subjected to the newest technological advances and gadgets, where information is only a swipe or search away- Just Google It! It is certainly a time that has led to the digital globalization of our planet, helped bridge divides and created exciting, innovative discoveries in the medical and communication fields. That being said, some wonder if the digital age has caused more harm in certain aspects than good? Think about the last time you went to your favorite restaurant for a bite to eat. Take a look around. How many people, many of whom are sitting right next to each other, are on some sort of electronic device?
The art of socializing and verbally communicating with one another seems to have been lost in the era of the white-picket fences and radio flyers. Forget how to be nostalgic? Fear not, your mobile device has all of your memories captured in one application or another. All kidding aside, we may be doing our children a disservice by inundating them with the newest version of the iPhone or the next best video game. According to the Kaiser Family Foundation, children between the ages of 8-18 spend 7.5 hours a day in front of an electronic device; that is 114 full days a year of watching a screen. It is not surprising, then, that so many families have communication breakdowns. If we take the time to actually speak to one another, then perhaps we may cultivate healthier relationships and, ultimately, the ability to make better, more informed decisions regarding health, peer pressure, etc.
One possible tool in creating these open lines of communication may be as simple as bringing back the traditional family dinner. Besides leading to better social adjustment and even higher GPAs, Brad Sachs, a psychologist and author believes that, “Eating is a fundamental way of creating closeness in a family...it is nourishing and restorative, both physically and emotionally.” If families can turn back the clock, turn off the devices, and sit down to eat and converse with one another, then maybe some of the dangers of too much screen time can be averted. Yolanda Reid Chassiakos, author of Children and Adolescents and Digital Media Technical Report, urges that such times at the dinner table may be critical in talking to kids about the risk of “cyber-bullying, engaging in sexting, and being accessible to advertisements and online predators.” Although these dangers may seem foreign or not pressing for some of us, the reality is that these dangers do exist.
 Screen Time vs. Lean Time Infographic. Centers for Disease Control and Prevention. Aug. 12, 2016. May 31, 2017. On-line. http://www.cdc.gov.
 Family Dinners: Tips for Better Communication. Griffin, R. Morgan. WebMD. 2012. May 31, 2017. On-line. http://www.webmd.com.
 New Screen Time Rules for Kids. Middlebrook, Hailey. CNN. Oct. 21, 2016. May 31, 2017. On-line. http://www.cnn.com.
Many studies have suggested that adding exercise to addiction treatment, which can include counseling, self-help support groups and/or medication, can strengthen the effects of recovery. In the early stages of recovery, individuals have reported feeling physically ill, weak, and unmotivated. There is no “right amount” of physical activity when it comes to exercising, but the benefits of engaging your body in the process of recovery are substantial and consistent.
It’s important to understand the similarities between how our bodies respond to substance use and how our bodies respond to exercise. Two words you should be familiar with are dopamine and endorphins. Dopamine is the feel-good chemical that plays an important role in mood, energy, attitude, and motivation. Endorphins are chemicals naturally released in the brain to reduce pain, that in large amounts can make you feel relaxed or full of energy. Individuals struggling with addiction experience mind and body cravings for endorphins that lead to the high he or she is used to. Substances flood the brain with dopamine and condition us to expect artificially high levels of the neurotransmitter. In this case, the brain begins to associate the drug with an enormous neurochemical reward. Exercise can cause the release of those same endorphins which helps to produce dopamine. Therefore, exercise can provide individuals with a similar, though less intense, pleasurable and rewarding experience.
In addition, exercise can help to combat the many withdrawal symptoms that come from substance dependence. Other helpful changes exercise can produce include providing individuals with a productive way to fill your time, helps regulate sleeping patterns, helps with stress reduction and improves overall health. There are many ways to activate the reward circuitry in the brain outside of using drugs or alcohol, and it’s important that we continue to implement full mind and body approaches in addiction treatment.
Project Courage firmly believes in the benefits that physical activity provides clients. That is why our services include adventure based counseling, fitness training, and yoga. To learn more about our services visit us here.
Substance use treatment is continuing to evolve to better meet the needs of struggling individuals and families. Once substance use treatment is initiated, it can be implied that an individual has already begun to face the many challenges of addiction. While treatment is highly beneficial and necessary, it is a response to an existing problem. What if we addressed these struggles and challenges preventatively, before they transform from a concern or fear to a difficult reality? It is important that people, particularly adolescents and young adults, are educated about the risk factors for developing a Substance Use Disorder (SUD). At Project Courage there are five core indicators that we look at to determine risk for a potential SUD: family history, adverse experiences, impaired control, age of initiation, and readiness to change. Educating our youth about these risk factors can serve as a tool for early intervention while it’s still a risk and not yet a reality.
First, it is important to gather information about an individual’s family history. Many people think genetics is the all-determining risk factor, but that isn’t necessarily true. Actually, we all have the genetic predisposition for addiction. Looking at addiction from a brain perspective, there is a rise in dopamine whenever we are reminded of something we enjoy such as sex or food. Therefore, as our dopamine levels increase so does our desire to act on such cravings. While everyone has the potential to develop an addiction, some people are more predisposed to SUD than others, bringing us back to family genetics. According to the National Council on Alcoholism and Drug Dependence, genetics make up 50% of the risk for developing alcohol and drug dependence. While there is no identified “addiction gene”, we’re looking at patterns of behavior and addiction that are inherited over generations. In addition to genetics, family history also sheds light on how family members view the possible problem. Favorable or ambivalent parental attitudes influence a young individual’s risk for developing a SUD as well.
Next, we explore an individual’s adverse experiences. Adverse experiences include stressors such as family conflict, loss, changes in the family composition, social stress, bullying, troubles in school, behavioral issues, and the presence of mental health issues or co-occurring disorders. The more stressors present over the course of an individual’s life span, the higher the risk is regardless of how long ago each stressor took place. Childhood through young adulthood are years of cognitive, physical, and emotional development. Adverse experiences have the potential to negatively impact one’s development resulting in a variety of consequences including increased risk of developing a SUD. For example, if an individual reports his or her parents divorced in the third grade and he or she was the victim of bullying in high school, the risk level increases. Further, if someone reports four or five adverse experiences, the risk level can be even more severe.
Third, we determine the extent of an individual’s impaired control. It is important to assess whether an individual has tried to cut down or stop use unsuccessfully. Alternatively, has the client desired to cut down or stop use for a prolonged period, but never taken steps towards change? According to research, either one of these increase risk more than family history. Questions asked during biopsychosocial assessments can help to determine one’s impaired control. Questions include: Have you tried to quit, or cut down your use and if so when and why? Do you use substances alone? How critical is it to you that you change your substance use? How confident are you that if you wanted to change your substance use you could? These questions give the clinician conducting the assessment insight into whether an individual has considered change before, and for what reasons, which may include both internal and external motivations. If an individual has tried to change their substance use multiple times without success, or has never attempted to change identified problematic behaviors, they are at an increased risk.
The fourth risk factor we look at is age of initiation. This is rather straightforward in that the younger an individual starts using alcohol or drugs the more their risk increases for being diagnosed with a SUD. Someone who started using alcohol or drugs at age thirteen is at a higher risk than someone who started at age sixteen.
Lastly, utilizing the Change Theory, we work to identify which stage of change an individual is in. The Change Theory assumes that all change in human behavior progresses through clear stages, and that it is significant to identify which stage of change an individual is in so that appropriate interventions can be selected. There are five stages of change: precontemplative, contemplative, preparation, action and maintenance. Precontemplative individuals may not view their use as problematic, feel others are overreacting or they may be in denial. Individuals in the contemplative stage of change are often still highly ambivalent but may be more willing to consider the possibility that they have a problem and weigh the pros and cons of changing their substance use. If an individual falls under one of these two identified stages, meaning they have not yet fully acknowledged the presence of an active problem or initiated change, they are at an increased risk. The more risk factors that are present, and the more precontemplative an individual is, the more at risk they may be.
Substance abuse can be a debilitating issue impacting individuals, families, schools, and communities. There are treatment options available to meet the unique needs of each affected individual, but there are also options available to potentially interrupt patterns or change the path of those at a higher risk for developing a SUD through education, early intervention, and support. Some of you may be familiar with the name Chris Herren; a former professional basketball player who is now a well-known public speaker, traveling to share his personal struggles with addiction, and to educate youth on the importance of healthy lifestyles and good decision-making. Speaking at over one hundred high schools annually, Chris Herren has said:
“I ask them: Why? I say this at every school – why do you feel the need to change who you are by putting substances in your body? It’s as simple as it gets. And it’s as deep as it gets. I don’t preach moderation, and I don’t preach abstinence. I tell them that in high school I wasn’t the worst kid, and I ended up a heroin addict. Don’t think it can’t happen to you. I grew up with two parents, middle class. And this was the result. Kids can take that and do what they want with it.” –Chris Herren.
I’ve seen firsthand the impact this speech has had on our youth. It raises questions, started conversations, evoked emotions, and for some it certainly hit home. These are positive outcomes. We want our youth to feel comfortable confronting their questions and their concerns. Risk factors do not define the path of an individual, but by raising awareness on what these core risk factors are for developing a SUD, we can help to positively influence young individuals to make one different choice; one that could change their path through their own self-determination.
There has been a lot of controversy in the media recently over the use and distribution of e-cigarettes, more specifically, the growing number of adolescents “vaping.” The social acceptability of e-cigarettes among adolescents has far exceeded traditional cigarettes. This acceptability has lead to an increase in the use of e-cigarettes among young people. According to the CDC there was a significant increase in high school students that use e-cigarettes from 4.5% in 2013 to 13.4% in 2015. Since the 1990’s there has been a steady decline in adolescent tobacco use, but e-cigarettes appear to be an entirely new monster which is demonstrated by the overall nicotine use for adolescents to be similar to the rates in 1995 (1). It has also been found that adolescents that vape are more likely to smoke tobacco cigarettes than those that do not use e-cigarettes (2).
Many people say that there is no way the health effects of e-cigarettes compare to those of regular cigarettes, which may or may not be true. Harm reduction, right? But the reality is that we really don’t know what the long term adverse effects of e-cigarettes are.
The FDA has acknowledged this significant increase and in 2016 made changes that will significantly limit the amount of e-cigarette products available for consumption. These federal changes make any product that is on the market undergo a lengthy and expensive approval by the FDA. Also, starting August 8, 2016 no new e-cigarette products can be released unless they have undergone the lengthy application process. This includes any minor changes to already released products. Many small smoke shops that create their own products will close as a result of the high cost of the application process. The cost of the application process varies by product, but Forbes estimated that each application costs from $182,000 to $2.6 million depending on what is getting evaluated (3). E-cigarette manufacturers are able to sell their non-evaluated products until August of 2018, but after that their products must be taken off of the market until they are approved by the FDA.
The FDA hopes that by regulating the use of e-cigarettes fewer adolescents will have access to them. However, these can potentially cause smokers to return to tobacco cigarettes if they do not have access to e-cigarettes (3). Only time will tell what will happen to e-cigarettes and nicotine use once these regulations are in full swing.
1. Peachman, Rachel. “More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping.” New York Times. July 11, 2016. Retrieved on 10/25/16 from http://well.blogs.nytimes.com/2016/07/11/e-cigarettes-expand-teenage-nicotine-use-rather-than-replacing-it/
2. Mangan, Dan. “Are e-cigs the new 'gateway' drug to ... real cigarettes?” CNBC. September 8, 2015. Retrieved on 10/23/16 from http://www.cnbc.com/2015/09/08/are-e-cigs-the-new-gateway-drug-to-real-cigarettes.html
3. Sullum, Jacob. “FDA Assigns Zero Value To Smokers Who Die Because Of Its E-Cigarette Regulations.” Forbes. August 11, 2016. Retrieved on 10/23/16 from http://www.forbes.com/sites/jacobsullum/2016/08/11/fda-assigns-zero-value-to-smokers-who-die-because-of-its-e-cigarette-regulations/2/#1fd9000e2e42