Category Archives: substance abuse

Set-Ups, Near Occasions & Solution-Focused Brief Therapy

Haven’t we all had times we felt set up for failure?

Near occasions. Think of them as set-ups. Human beings are spectacularly good at setting ourselves up, for good choices and for the not-so-good, too.

We Catholics refer to near-occasions of sin – the people, places, things and behaviors that we might see as “set ups” for us to make poor choices. There’s nothing inherently “bad” about gathering at a bar and grill with friends, but if you are trying hard to maintain your recovery as an alcoholic, it is a “near occasion.” It’s a set-up to make good choices even tougher. Likewise, the trip to the mall to “just walk around” when you’re trying to work your way out of debt. Why set yourself up for failure?

In the same way, there are what may be called “near occasions of Grace,” the people, places, things and behaviors that increase our odds of making good choices. The friends who are uplifting and don’t gossip; the entertainment that doesn’t feed envy or anger; the activities that make the rest of the day better. We “set up” the likelihood of good choices, too.

Solution Focused Brief Therapy (SFBT) similarly looks at people, places, things and behaviors. You may be thinking, well, duh, what sort of therapy does NOT focus on solutions? Different forms of therapy have different emphases in terms of finding solutions. For example, psychodynamic therapy emphasizes developing insight that leads to new choices; behavior modification focuses on step-by-step actions to guide the client towards reaching goals. In SFBT, there is a particular emphasis on the clues (factors that set up outcomes) in people’s lives and using these clues and the client’s strengths to develop solutions. In many ways, it is looking for near occasions of the goals the client has for therapy. When has the goal in question already happened, or part of it happened?  What was going on then? What was happening right before that? What were you doing? What were others doing? As a team, we investigate the near occasions of success so the client can use the clues to develop solutions that make sense for that client’s life.

Just as a quick example, let’s consider the person who realizes that getting the morning off on the right foot tends to lead to a better day, all-around. We look at examples of those “better days.” What did happen in the morning? What happened the day before that might have contributed to that morning? There are usually plenty of clues and examples of times when the person has been successful in doing things that either led to a “better day” or set the stage to some degree.  Some clues might be eating a reasonably healthy dinner, getting to bed “on time” and not using the phone or other screened device, getting up on time and getting out of bed right away instead of starting the phone-scroll. The person identifies the factors and then we look at how to increase the incidence or likelihood of those recurring. Breaking it down further, let’s take the dilemma of the phone next to the bed and its appeal as a way to deal with insomnia, or its interference with just getting out of bed on time. “I can’t leave it in the kitchen. It’s my alarm clock,” people will assert. Yes, I understand- and I understand that I bought a little travel alarm clock – a couple of AA batteries that have thus far worked for years – that wakes me reliably every morning whether there’s a power outage or not, and I do not have my phone over there, flashing lights and buzzing every time an artist friend posts a painting. It seems many other artists are night owls. The solution, if what is wanted is actually a reliable alarm clock function, can be had for less than fifteen dollars.  If the phone is off in another room, you’ll have to get out of bed to get to it. And by then you will probably have done something besides scroll – brushed your teeth or started the coffee or fed the dog. You will be vertical, approximately on time, and therefore have “set up” a more likely success story about getting into your day “on time.” The phone by the bed is a “near occasion” of extra time awake during the night, more time in bed, and then being rushed, grumpy and unprepared for the day. Nothing is inherently bad about the phone – but it might be part of a “set up.”

We all have “near occasions” – of sin, grace, good choices, bad choices. The negative ones have less power when we know what they are, and the good ones can exert their power when we focus on them.

7 Things to do When Life Is Crazy

Sometimes, life just goes horribly sidewise.  This week, like most weeks, I spent time with people who have lost their homes to natural disasters, lost their job, had loved ones die, and sometimes are grappling with multiple serious problems.  The world seems crazy, you can feel like you’re going mad, and it is oh-so-easy to slide into attempts to numb the pain that are ultimately harmful.

It’s easy to advise people on what NOT to do – don’t drink alcohol. Don’t use drugs. Don’t eat a lot of junk food. Don’t let yourself scroll through social media and/or your newsfeed for extended periods of times. It’s easier, though, to “do” than to “not do.”  Anyone who has tried to break a bad habit knows that; it’s easier to “eat an apple” than to “not smoke/drink/eat a bag of cheesy poofs the size of a pillow.”

So, here are seven things to do – and keep doing – when life is crazy

  1. Say grace. Say grace when you get to sit at a table and say grace – together – when you eating a granola bar in the shade after another few hours of trying to make sense of the debris that used to be your home.  Say grace when you are out on a hike, just about out of water, and have miles to go. G.K. Chesterton famously noted he said grace when he sat down to write, to draw, etc.  A moment of gratitude shifts the focus from the mud to the mountaintop.
  2. Put the social media/news scrolling down and, instead, watch something that will make you laugh, preferably either an episode of a sitcom or a funny movie. Why? These require sustained attention, will bring a focus on characters who have ups and downs, and have the potential to make you laugh. Laughter releases dopamine – that feel-good chemistry that helps you heal.  Make it better and share that humor break with someone else. Sharing laughter with the person you love helps that sense of connection that seems strained, or even lost, when life has gone crazy.
  3. Eat food that is good for you. Ongoing extreme stress causes havoc in your body, including your brain, and getting decent nutrition is essential to your well-being, now and later.  I did the price comparison:  a precooked chicken, a bag of salad, some fruit and a little something else healthy, for example, feeds two or four people far cheaper than most or all fast food. Your brain will thank you.
  4. Listen to music that is soothing: piano or guitar, instrumental jazz, classical, baroque:  as tempting as it may be to listen to “angry” music because you feel so angry about what’s become of your life, that will only reinforce your distress.  Let peace soak into you, however slowly it may come.
  5. Check in with other people every day. Reach out to someone to see how s/he is doing. It helps us get out of our own heads, our experiences, and feel less alone.
  6. Get outside, preferably in the morning, for natural light exposure. You don’t need to bake in the sun; just get out there. Take a walk if you can.  Early natural light helps the brain regulate the sleep/wake cycle, setting you up for a healthy rhythm of melatonin production over the course of the day.
  7. Ask God to show you where He is at work in the events of your life, because when life goes crazy, the fog can make God’s loving presence hard to detect. Ask for the grace to notice the helping hands, the kind words, the moments of clarity.

I’m sorry if life has gone crazy. It is scary, and lonely, and disorienting when disaster strikes. If you find that you are sinking, reach out for help:  call your local helpline (in Pinellas County, FL the number is 1-888-431-1998, for the new Care About Me program that helps match those in crisis with an appropriate mental health provider).  Call a friend, a family member, or, if you are feeling unsafe and considering suicide or plan to harm yourself or others, go seek immediate help via 911 or go to an emergency service location.  When life has gone crazy, it is natural to feel frightened, confused and even helpless, but remember that none of us were designed to “handle it all.” We are, in fact, designed so that our strengths are distributed so that each has something to offer but none has every gift and ability.  Please reach out for help if you feel you are sinking.

An Alcohol Dilemma

Alcohol can be a touchy subject. Addictions, generally, are frequently considered to be only something other addicts, including those in recovery, can help with.  Someone like me, who never drank regularly and now, since surgery a few years ago that included a bad anesthesia reaction, can’t drink any alcohol except, oddly, 3 or 4 ounces of Guinness on a couple of holidays each year, is automatically considered ineligible to be helpful. Despite my ineligible status, in a previous post, I included the life lesson that, for many, alcohol is not a friend.

This assertion flies in the face of much research, perhaps most famously Blue Zones data, which includes moderate alcohol use as a generally positive factor for long life. On the other hand, avoiding alcohol is well-supported by substantial research in the medical field.  Shake or stir in my non-drinker status and, well, it seems like I am a fun-killing fuddy-duddy looking for an excuse to ruin my clients’ good time.

What are the benefits of alcohol? Much research has focused in particular on resveratrol and relaxation.  There ways to get antioxidants and relaxation that don’t carry the risks of cancer, liver and brain damage, and some of the regrettable behaviors that alcohol can carry along. This might be a worthwhile topic of discussion with your healthcare provider. Eating grapes, prayer and meditation, physical activity and laughing might hit all the right keys on this.

If you are misusing alcohol – relying on it to “unwind” after the day, to “help you sleep” (it doesn’t, actually), or to get through social situations (there are ways to deal with social anxiety that don’t interfere with functioning) – please seek help. Other signs your relationship with alcohol is unhealthy? Using more than the recommended amount – 1 serving max per day for females, 2 for males. Feeling anxious if you run out, or worrying you will run out. If you worried more about stocking up with booze than water, batteries and nonperishable food for the past two hurricanes, that’s a bad sign, too. Any binge drinking is a danger sign. Binge drinking raises your blood alcohol to .08 in two hours or less, usually four or five single drinks. Any changes in your functioning at home, work, or socially are likewise danger signs. Pretending that these signs don’t apply to you is itself a sign.

Where to go for help?  Go to an AA meeting. Call a therapist. Call 866-210-1303, or 211, or another helpline. See your physician. Tell someone you trust you’re ready to make a change. Just take that first bold step towards help. There are good people eager to help you change the course of your life for the better, preferably before it becomes unmanageable.  

Are we now voting on mental health?

Here in Florida, we have a process in which citizens can gather enough signatures and put an initiative on the ballot to alter the state constitution.

I vote no, even if in principle the idea seems good, because I don’t think that a majority vote is the way to treat a constitution. I would vote no, even if the amendment proposed to preserve, in perpetuity, the tax-exempt status of dark chocolate due to its obvious necessity to life. The whole idea of a constitution is that it sets forth basic principles: natural law, the essentials. All other laws and rules get held up to it to see if they fit within the boundaries of that constitution.  

In the upcoming election, Floridians will be asked to vote on a proposed amendment that would legalize non-medical marijuana for adults age 21 and over in Florida.  My libertarian side doesn’t much care what people do until it impacts other people. People who mess up their brains with drugs often seem to feel entitled to drive; ultimately, they demand their healthcare be paid for by other people; they clutter up emergency rooms, and do all sorts of other things that do impact others, making drug use a social, not a merely personal, issue.

Professionally, this deserves a resounding “no.” Not just because popular votes are not the way to treat a constitution; but because there is so much information not being openly and clearly presented on this.

To begin with, it is fairly laughable that there is so much so-called medical use of marijuana, when the research is sketchy for even the handful of possibly legitimate uses.  Anxiety? Insomnia? Marijuana is practically a recipe for anxiety, and in fact, can lead to very severe anxiety, especially among younger users.

Secondly, most people have been effectively shielded from information on the impact of marijuana on mental health, physical health, and crime. Why? Whose interest is served by hiding the number of ER visits for psychosis, panic, and/or hideously violent vomiting due to marijuana or other forms of THC use? Whose interest is served when the impact of THC in criminal activities is hidden? There is evidence that use of the modern, stronger forms of marijuana is leading to substantial increases in psychosis, self-destructive behavior and violence against others. Most people seem quite unaware of this. Did you know that the emergency room visits due to marijuana use – psychosis, panic and/or “scromiting” (screaming and vomiting) increased 53 to 400% in the first few years, from city to city? Or that even in Europe, the rate of marijuana psychosis slipping into schizophrenia has increased between 300 and 400% in the past twenty years?  In Colorado, a tragic experiment in progress on pot legalization, emergency room visits related to marijuana use increased 500% in the 5 years post-legalization, with severe psychiatric symptoms including psychosis and panic attacks. Then there is the pain and terrifying projectile vomiting typical of cannabinoid hyperemesis syndrome.

Critically, marijuana is not safe. It is prescribed medically (despite the evidence being rather variable and inconclusive) with a shrug: “well, the possibility of benefits outweighs the risks.” Fair enough; no reasonable person is worried about someone who needs appetite support or help with pain while in treatment for cancer or AIDS having long-term effects from marijuana; the possibility of benefit outweighs the risks.

That doesn’t make it safe. In 2021, about one-third of high school seniors were using marijuana in some form. We ought to be very worried about the effects on teenagers and young adults, whose brains are still in development and whom, evidence shows, will have long-term impacts years after they have stopped using marijuana. That, of course, assumes that they stop. About 17% – 1 in 6 – of people who start using marijuana in their teens will become addicted. The addiction rate is about 9% for adults, and that is old data from 2015, and thus trails the upticks in use and in potency.

The increased risks, especially for young males, for unremitting anxiety, psychosis, and a lingering apathy and lack of initiative ought not be brushed off or laughed off with stories of the late 1960s. Then, the available marijuana caused hallucinations for many people and was far less potent that modern varieties. In the past 40 years or so, the potency has increased about 4-fold.  For adolescents, the rate of suicidal ideation triples in those with cannabis use disorder; the rate of depression nearly triples; truancy, fighting, poor concentration all increase markedly with regular cannabis use.

Interestingly, we are urged to accept psychiatry when it comes to destigmatizing mental disorders and treatment, but this enthusiasm for psychiatric expertise melts away when it comes to legalizing weed in all its forms. The American Psychiatric Association still officially opposes the use of marijuana, noting it is not research-supported for psychiatric diagnoses and bears substantial risks for psychiatric side effects. The experts are discounted on this one thing. What could possibly drive that behavior?

Stepping back and gazing at these points – and I am sure there are others – I ponder why there is so much interest in promoting this particular amendment.  Is it because, as the old Judas Priest song goes, “Out there is a fortune, waiting to be had”? Is it really the case that so many people who are enthusiastic about bossy rules about the size of people’s American flags, house colors or the time people roll out their trash cans are libertarian on this one thing? How will they feel when it is their son or daughter who slips away into depression, relentless anxiety or psychosis?

The argument is made that legal marijuana will be pure – not laced with fentanyl or other deadly substances. Assuming this is the case, and that there arises no underground market to avoid taxes – moonshiners versus revenuers, remember? – the question remains as to whether the risk is worth it in terms of psychiatric and gastric impacts.

Who will pretend, later, to not have known how dangerous what will no doubt be called something like “Big Weed” really was, and rush to sue because of brain damage, the loss of loved ones to suicide or cancer? What about those whose death is due to initiating violence while “high” and being killed by someone in self-defense? What class action suits will emerge to right the wrongs of mass hospitalizations for psychosis and its long-term medical management? Will it in fact be the same ruse of not-knowing used against tobacco, despite its having been referred to as “coffin nails” even in the 1800s? And beyond these major effects, what about the many lives and talents wasted by indifference and ennui as the years-long lingering apathy steals young adulthood and early middle age?

What would make sense:  this proposition as a possible law, not as an amendment, with publicly available hearings and testimonies from all sides: those incarcerated for years for petty possession charges and those whose loved ones spiraled into psychosis and suicide.  Let’s hear sworn testimony and evidence from medical experts on both sides and statisticians who can break down the data on crime and medical impacts.  Then, having heard the information, we can, through the legislative process, pass a law that adheres to the principles of the state constitution and best suits the facts of the situation.

(Un)Social Drinking

4th in a series: I could tell you but you’re not going to like it: Social Drinking often isn’t.

Yet again, I am stepping into the fray to offer the kind of information that can be helpful but feel quite unwelcome. In this case, it’s the raw fact that, for many people, Social Drinking…isn’t.

Social drinking is one of the terms for the use of alcoholic beverages in disciplined moderation, with others: the glass of wine at dinner, the single drink at happy hour.  It means the person is not an alcoholic, and everything’s under control…but as the term is used, perhaps not.  The American Psychiatric Association has established a low bar to meet the criteria for mild Alcohol Use Disorder: these are two of the many criteria, and perhaps these two will resonate with some social drinkers:

“Alcohol is often taken in larger amounts or over a longer period than was intended” and

“Continued alcohol use despite persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of alcohol.”

In other words, if someone often drinks three glasses of wine when they meant to have just one, or plans to have “a drink” with a friend that turns into a three-hour hangout with multiple drinks, that is a marker of a potential problem. If someone uses alcohol, and then becomes argumentative with friends and/or family, or zones out in front of the television and, yet again, neglects chores or short-changes the dog’s evening walk, the so-called social drinking isn’t just social drinking. Stir in failing to get up on time for work due to a hangover, or having the alcohol cause headaches, belly aches, acid reflux or blood sugar issues, and there is a storm coming.

So, perhaps, unless your physician advises otherwise, you might do a bit of an experiment if you are a social drinker. The experiment is, no alcohol for a month; six weeks would be better. Fighting a habit takes time. Then see what happens.  If you discuss alcohol with your physician, please be honest: the health professionals’ unofficial guideline when people tell us about alcohol use is, double it, or perhaps even triple what the person tells you.

Evening alcohol use disrupts sleep; people may fall asleep more quickly but will often have sleep problems a few hours into the night.  Alcohol impacts the brain in a host of ways: it impairs balance and spatial judgment, slows physical reaction time, weakens impulse control, and interferes with cognitive functioning. It also interacts dangerously with a host of common medications, including but not limited to medications for pain, anxiety, depression, OCD, ADHD, allergies, and more; if you are on any medications, over the counter or prescription, check with your pharmacist about using alcohol with these medications.  Mixing alcohol and medication can be deadly. Perhaps during your alcohol-free weeks, you will find yourself more motivated to get up and get that morning walk or workout in; perhaps you will have fewer unproductive arguments with the people you love. At that point, it may seem that social drinking may not be social, after all.