Mental Health

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Social Anxiety Disorder and Alcohol Use: I’m SAD! I need a drink!

Being sad is one thing, but suffering from social anxiety disorder (SAD) is a totally different ball game. This is the same way that “wanting” a drink differs from “needing” a drink. When joined with problem drinking, this forms a lethal combination.  For a long time, experts have witnessed that people with anxiety disorders are susceptible to substance abuse and vice versa, but determining which one is the preceding problem has been a stumbling block for diagnosis.

More than just shyness

An individual suffering from social phobia, also known as social anxiety disorder (SAD), has a distinct and sometime irrational fear or anxiety about specific circumstances. According to WebMD, some of these situations include:

  • Speaking in public
  • Eating or drinking in front of others
  • Writing or working in front of others
  • Being the center of attention
  • Interacting with people (i.e. dating, attending parties, etc.)
  • Asking questions or giving reports in groups
  • Using public toilets
  • Talking on the telephone[1]

What causes SAD? Many researchers believe that it might be related to the abnormal functions of the brain circuits that regulate fear and anxiety. Genetics is also thought to play a part in its roots, since social phobia occasionally runs in a family. Other factors include stress and environment.[2]

The fear of making a mistake or humiliating oneself in front of others can be debilitating to a person with SAD. Taking a drink to calm one’s nerves is often used as a coping mechanism.

More common and costly than you think

Anxiety disorders, which affect over 40 million adults (or approximately 18 percent of the population), are the common mental illnesses in the United States.[3] According to the Anxiety and Depression Association of America, an estimated 15 million Americans suffer from SAD.

The disorder often surfaces during the teenage years or early adulthood and is more prevalent in women than men. Although highly treatable, sadly, only one-third of those suffering seek professional treatment.[4]

The economic costs associated with anxiety disorders in the United States are overwhelming. In the 1990, the costs were estimated to be around $46.6 billion. The majority of the expenditures was tied to the loss and reduction of productivity and other indirect costs, instead of treatment.[5]

Symptoms and signs

The symptoms that a person who is suffering with SAD experiences can vary and be difficult to distinguish from other health issues, such as depression and obsessive compulsive disorder. These individuals tends to have negative thoughts about themselves and what will happen to them in social situations. According to the National Institute of Mental Health, some of the common signs are:

  • Anxiousness – especially about being with other people
  • Self-consciousness – worried about how they are perceived by others
  • Extreme fear of embarrassment
  • Excessive worrying – sometimes for days and weeks before an activity
  • Avoidance of places where people hang out in crowds
  • Difficulty establishing and maintaining relationships

Physical signs, which include:

  • Blushing
  • Heavy sweating
  • Increased heart rate
  • Trembling
  • Nausea
  • Hard time talking[6]

Self-medicating

Even after diagnosis, individuals are often leery about seeking professional help. They underestimate the seriousness of their condition and believe that they can fix the problem themselves. Instead of seeking mental health treatment, alcohol and other substance are often used for self-medicating an anxiety disorder. Researchers are investigating just how frequently people are using and abusing self-destructive alternatives to deal with SAD and other anxiety-based disorders.

Individuals self-medicating an anxiety disorder are two to five times more likely to develop an alcohol or drug problem within three years.

A 2011 longitudinal study that includes almost 35,000 U. S. adults revealed that 13 percent of those who had consumed alcohol or drugs during the previous year had done so in order to relieve anxiety, fear or panic. It also found that individuals with a diagnosed anxiety disorder who were self-medicating at the beginning of the research were two to five times more likely to develop an alcohol or drug problem within three years than people who did not self-medicate.[7]

Other results from the three-year study showed that the number of people with an anxiety disorder who developed a substance problem varied depending on the self-medicating substance:

  • With alcohol use – 13 percent developed an alcohol problem
  • With recreational drugs use -“ 10 percent developed a drug problem

A drink won’t help

One of the most frequent self-medicating techniques is alcohol consumption. Individuals turn to alcohol because it help them feel more in control of a given situation or encounter. It also lowers inhibitions and reduces self-consciousness.  In some social gatherings, such as parties and mixers, alcohol is available in abundance.

A 2012 study at Emory University investigated the relationship between SAD and the motives for drinking. The researchers believed that the reasons for drinking are based on the fact that people drink in order to achieve an outcome that is of value to them. The motives can be categorized as:

  • Social: Drinking to aid camaraderie
  • Enhancement: Drinking to have more confidence or to enhance the impact of another drug
  • Coping: Drinking to cope with or escape from stress

The results showed that 13 percent of the participants met criteria for SAD at some point during their lives. It was determined that SAD was a predictor of coping drinking motives, but was not a predictor for social or enhancement motives. The research also revealed that other mood disorders (i.e. depression, panic disorder, and generalized anxiety disorder) also lead to coping drinking motives. [8]

Short-term solution, long-term problems

Self-medicating anxiety with alcohol makes things worse in the long term.Drinking alcohol is only a short-term solution for suppressing anxiety. Initially, drinking may make an individual suffering from SAD have less tension and feel more confident in social situations. However, once the “buzz” wears off, the old anxiety returns. Dr. James M. Bolton, lead researcher in a 2011 study about the effectiveness of alcohol in treating anxiety, stated: “People probably believe that self-medication works. What people do not realize is that this quick-fix method actually makes things worse in the long term.” [9]

Alcohol is a depressant and has an overall detrimental effect on the central nervous system. According to the National Institute on Alcohol Abuse and Alcoholism, regular alcohol use can lead to long-term health problems such as:

  • Stretching and drooping of heart muscles (cardiomyopathy)
  • Irregular heartbeats (arrhythmias)
  • High blood pressure
  • Liver disease/inflammations
  • Certain cancers (mouth, esophagus, throat, liver and breast)
  • Weaken immune system [10]

Additionally, alcohol can interfere with the thinking process. Drinking a couple of glasses wine before a presentation may seem like a way to lessen tension. However, that consumption can lead to making errors and possibly fumbling through the talk, which could increase the anxiety for any future communications. Thus, this compels the anxiously-minded individual to drink even more alcohol and starts a vicious cycle that is difficult to break.

Alcohol is not the answer

If you suffer from SAD, don’t make the mistake of trying to eliminate your problems with alcohol SAD is a psychological disorder and should be treated by medical professionals.  Treating SAD with alcohol leads to additional problems that can destroy relationships with families and friends.

If you or a loved one has already started self-medicating with alcohol, the experts at Behavioral Health of the Palm Beaches can help. With nearly 20 years of experience, our doctors can develop a treatment program that gives you better options to deal with your anxiety issues. Alcohol is not a safe and healthy way to deal with anxiety. Call us at (888) 432-2467 for healthier possibilities.

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SMART/12-Step: It’s not a contest.

A few months ago we began to offer a weekly meeting of SMART (Self-Management and Recovery Training) at Seaside Palm Beach as another tool in the arsenal that a person in recovery can use to maintain abstinence from addictive behaviors.  Twelve-step recovery meetings continue as they always have. The weekly Smart meeting has become popular. I can say that a number of people have integrated SMART into their long range plan for continued abstinence.

I was a little bit surprised at the impression a few people had of SMART even before we offered to first meeting. One person said “when I get to the point that I really want to drink I’m not going to do a cost-benefit analysis.” He’s probably correct. However, as I pointed out, “you’re not likely to call your sponsor either.” It doesn’t matter if a person is using 12-step recovery, SMART, or some combination, the reason we use meetings for support is so we don’t get to that point.

It is true that where 12-step recovery is based on spiritual principles SMART is based on Cognitive Behavioral Therapy (CBT). A SMART facilitator may tell the group that “spirituality is not part of the SMART program.”

I’m a SMART facilitator and a long time believer in 12-step recovery. I’m good at manipulating. So, if a person brings up “spirituality’ at one of my SMART meetings I will ask “what are the needs you are looking to fulfill?” I will then gladly put items such as belongingness,” “rootedness,”  “the desire to be a part of something bigger than oneself” on the agenda for the evening.

It also occurs to me that if there’s no need for a Higher Power, what do you call a group of people supporting each other?

On the other hand, “came to believe….” seems fairly cognitive to me.

There are clearly people who object to 12-step’s religiosity. Probably the worst thing someone can do is tell another that 12-Step is not religious.” It is! I’ve often wanted to tell non-believers to “get over it.”  Most of the time they don’t. So for some people SMART may be the only social support for recovery. That would be great if SMART was as geographically available as is 12-step recovery. It’s not even close.  Fortunately, SMART has a great website (www.smartrecovery.org).

Great websites are also available to support 12-step recovery (www.intherooms.com ).

Bottom line is that SMART is not something that is offered instead of 12-step recovery. It’s “in addition to.”

Is an addiction a disease? SMART recovery does not take a position. Alcoholics Anonymous (AA) makes reference to an allergy to alcohol. Does it make a difference when it comes to maintaining abstinence? Probably not. In any case, it’s unlikely that a group of recovering people is going to settle an issue. It takes a lot of energy to maintain abstinence. Leave the argument to scientists.

The goal of SMART recovery is abstinence from addictive behaviors. It does not advocate moderation. It is true that SMART meetings are open to people who have not yet decided to abstain from addictive behaviors. People who have yet to make that decision are welcome providing they are not disruptive.

AA is open to anyone with a “desire not to drink.”AA is open to anyone with a “desire not to drink.” AA is likely to attract some people still engaged in the addictive behavior. They need to have the desire. That’d not a stipulation of SMART recovery.

Point is that both SMART and 12-step recovery may attract people who are still using. I think that SMART attracts a few more. Whether that’s a positive or a negative is debatable.

What’s not debatable is that SMART is less shaming. People who find labeling (“my name is …….., I’m a…..”) will feel much more comfortable at SMART.

In 12-step recovery there’s an emphasis on “powerlessness.”  SMART emphasizes being “empowered.” The difference may not be as great as it seems. It can be argued that accepting “powerlessness” over an addictive behavior actually frees you up. A good number of people will reject this argument.

I see pluses and minuses regarding SMART’s use of trained facilitators. The thirty hour on-line certification process is very well done. My experience has been that SMART facilitators are very professional. I’m not sure that the thirty hour process screens out people who shouldn’t be facilitating groups.

I believe that participants in a SMART group attribute skills to a facilitator that go beyond what the facilitator is trained to perform.

However, sponsors in 12-step programs are frequently seen as having magical powers.

The thing to remember about 12-step and SMART is that they are both support groups, not professional help.

So what does it come down to? My belief is that when a person is ready to give up an addiction petty arguments about whether one support group being spiritual and another cognitive will go away. That being said, a person has to start somewhere. Whether it’s 12-step or SMART it really doesn’t mater. A person working a strong recovery will find comfort in both.

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The Myth of Drugs and Creativity: Mental Illness’ Role in the Using Artist

Drugs and CreativityThe writer sits at his table, a drink in hand and ready for the downing. The painter stands at her canvas, having recently smoked a bliff, and contemplates the pigments on the surface of her latest work. The musician runs on stage, revved up on coke and ready to wow the crowd.

Whether touted as an emblem of counter-cultural freedom from the restrictive thinking of mainstream society or reputed to stimulate the imagination, drugs and alcohol have been linked with the artistic process for some time now. Both celebrated and aspiring creatives often dabble in drugs at one point or another in their lives. Though emerging from different walks of life, many artists fall into a tradition that began well before the 20th century and that has been maintained by legends like Pablo Picasso, The Beatles, and most recently Prince. Cocaine, methamphetamines, marijuana, alcohol – these are all part of the artist’s toolkit, right?

Not exactly.

A Myth That Enables Addiction

This common trope of drugs as elixirs of creativity is misleading and, when taken too far, irrevocably harmful. America’s favorite horror author Stephen King, who famously struggled with alcoholism and a number of drug addictions throughout his life, has no patience for those who claim that drugs inspire creativity.[1] As he states in On Writing: A Memoir of the Craft, “The idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.” The mystique that drugs hold in society is just that — an illusion.

the idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.

When it comes down to it, King goes on to argue, artists who claim to use illicit substances to stir their creative juices are more-or-less trying to justify their inclination toward such self-destructive behavior. “But I need it to write!” or “I can’t express myself artistically without it” are not valid excuses but are instead symptomatic of a larger problem at hand: abuse and/or addiction. Drugs don’t make artists — they break them.

Stress and its Many Sources

Connection between drugs, alcohol and creativityThough those who abuse and become addicted to drugs are not one in the same and range in socioeconomic status, race, gender and other qualities, what they often do share is stress. Unstable households, physical pain or the pressures from school or work are stressors that can drive individuals to self-medicate through available drugs.

However, mental illness is one of the most prominent sources of stress that pulls people toward abusing substances in attempt to relieve or cope with their conditions. In fact, approximately a third of all individuals who experience a mental illness and about half of people living with severe mental illnesses also have substance abuse issues, according to the National Alliance on Mental Illness (NAMI).[2]

For reasons not yet fully understood, rates of mental illness are also high among artists, and understanding this link may help explain why so many artists are drawn toward drugs.

Mentally Ill or Creatively Inclined? The Two Often Go Hand-in-Hand

bipolar disorder and creativityWhile the belief that creativity is dependent on drugs is, as King put it, just a “pop-intellectual myth,” the stereotype of the tortured artist does have some credence (though is certainly not all-defining). A body of research suggests that there is a strong link between mental illness and creativity. In 2012, Sweden’s Karolinska Institute found that, “People in creative professions are treated more often for mental illness than the general population.” [3]

In one of the most comprehensive studies conducted in this field, the researchers used a registry of psychiatric patients listed for over the past 40 years, containing data on nearly 1.2 million Swedes and their relatives. Analyzing patients with a variety of diagnoses, ranging from schizophrenia and depression to ADHD and anxiety syndromes, they saw that bipolar disorder was the most prevalent among people with artistic and scientific professions, including dancers, researchers, photographers and authors.

The creative figure of the author, however, seemed to be especially burdened by mental disorders more-so than other individuals, artistic or otherwise. The study stated that ‘authors suffered from schizophrenia and bipolar disorder more than twice as often as the general population.’ [4] They were also more likely to be diagnosed with depression and anxiety disorders, and they also had a greater tendency to commit suicide.

Abusing Drugs to Cope with Mental Illness

emotional pain and artSo, we know the facts: a considerable number of artists experience mental illness. Since those who are mentally ill often abuse substances or have substance use disorders, according to the NAMI statistics, it stands to reason that many artists also have drug problems. Though some try to convince themselves that their lingering, preoccupying desire for another hit is a testament to their creative genius, the real story is that many artists cling to substances for a false sense of stability. They want to relieve the distress of their mental disorder left untreated, and too often they turn to drugs as a way of coping. But this only harms them in the long run.

What starts out as a casual experiment can quickly turn into abuse when an illicit substance temporarily dulls emotional pain or provokes euphoric feelings of delight in the user. Eventually, the body and mind can become so dependent on the drug that the user continues to abuse it in order just to function. This is when addiction sets in.

Case Study: Eminem’s Descent into Drug Addiction and His Sober Awakening

Take Eminem, one of the most versatile and provocative artists of the rap and hip-hop world. Though only revealed later in his career in 2008 that he has been grappling with bi-polar disorder for most of his life, his feelings of raw anger and emotional instability were exceedingly clear in his lyrics.[5] He also suffered from prescription pill addiction and even nearly died from an overdose at one point, according to MTV News.[6]

“It’s no secret I had a drug problem,” he was quoted admitting. “If I was to give you a number of Vicodin I would actually take in a day? Anywhere between 10 to 20. Valium, Ambien, the numbers got so high I don’t even know what I was taking.”

Eminem drug addictionAnd how did he get so hooked? Through the psychological and physical relief that the substances instilled in him, countering the near-constant emotional instability that he experienced from his mental illness. “When I took my first Vicodin, it was like this feeling of ‘Ahh.’ Like everything was not only mellow, but [I] didn’t feel any pain,” Eminem says in the documentary How To Make Money Selling Drugs, quoted by MTV News.[7]

“I don’t know at what point exactly it started to be a problem. I just remember liking it more and more. People tried to tell me that I had a problem. I would say, “Get that f____g person outta here. I can’t believe they said that sh_t to me.”

As Eminem’s addiction worsened, his motivation, physical health, and even his ability to string words together deteriorated. MTV News writes that at his lowest the drugs shut off his brain and made him so lazy he preferred watching TV to making new tracks.[8]

After seeking treatment and remaining sober for a year, Eminem came back to the recording studio. In 2009, he released Relapse: an album that openly discussed his struggle with addiction. But he comments that during Recovery, an album released a year later, is when he really began to repair the damage that the drugs took on him despite how impossible it felt at times.

“I had to learn to write and rap again, and I had to do it sober and 100 percent clean,” Eminem told MTV News. “That didn’t feel good at first. I mean it in the literal sense. I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them. I was relearning basic motor skills. I couldn’t control my hand shakes. I’d get in the [recording] booth and tried to rap, and none of it was clever, none was witty and I wasn’t saying it right.”

Yet he did it, creating an award-winning album that stands as a testament to how only sobriety can unlock the true potential of an artist.

Let Our Treatment Help You Find Your Creative Flow Again

Eminem\’s Recovery is dedicated, “Anyone who’s in a dark place tryin’ to 2 get out. Keep your head up… It does get better!”[9] We couldn’t have said it better ourselves.

I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them.

Though the confusion, frustration and emotional agony that can come along with an untreated mental illness and drug addiction can seem insurmountable, there is a way out. Behavioral Health of the Palm Beaches’ dual diagnosis program is sensitive to the hardships unique to both mental health and substance use disorders, and our professionals are experienced in treating both conditions simultaneously.

At our facilities, artists can also continue creatively expressing themselves as a way of working through their conditions. We offer art therapy, music therapy, and expressive writing therapy for those who want to discover what it means to be creative while sober.

Don’t let drug addiction get in the way of what’s important in your life. Contact us at 888-432-2467 to learn more about our addiction help and mental health treatment options and how we can help you or a loved one find the courage to recover.

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Are Depression and Social Media Usage Linked?

The rise of social media sites like Facebook, Twitter, Instagram, Pinterest and others has changed the world we live in forever. People are now more connected than ever before and can personalize an online presence, conveying a digital persona of sorts. Social media has certainly led to a lot of very good things, but it’s undeniable that there have been some negatives associated with it as well.

A new study published in the journal of Depression and Anxiety found a link between high usage of social media sites and increased depression. The research, which was funded by the U.S. National Institutes of Health (NIH), involved nearly 1,800 individuals and tracked their usage of 11 well-known social media platforms:

  • Facebook
  • Instagram
  • YouTube
  • Twitter
  • Reddit
  • Google Plus
  • Snapchat
  • Tumblr
  • Pinterest
  • Vine
  • LinkedIn

The researchers found that the participants checked into social media an average of 30 times per week for just over an hour per day. Depression testing revealed that approximately one-quarter of the participants were at a high risk of depression. When social media patterns were compared with depression status, it was determined that those who used social media the most were about 2.7 times more likely to be depressed than participants who used social media the least. [1]

“One strong possibility is that people who are already having depressive symptoms start to use social media more, perhaps because they do not feel the energy or drive to engage as many in direct social relationships,” said senior study author, Dr. Brian Primack in a Health.com article. “However, there are also a few reasons why increased social media use may lead to more depressive thoughts. For example, people who engage in a lot of social media use may feel they are not living up to the idealized portraits of life that other people tend to present in their profiles. This phenomenon has sometimes been called ‘Facebook depression’.” [2]

The authors of the article, however, were careful to point out that they only discovered a connection, not a definite cause and effect relationship.

What we found were just overall tendencies for the entire population.

“What we found were just overall tendencies for the entire population. These findings do not suggest that every person who engages with more social media use is depressed,” Primack stressed. “In fact, there certainly are many groups of people who actually find solace and lessening of their depression through social media. However, the overall findings suggest that, on a population level, more social media use and more depression are correlated.”

Is Social Media Use a Danger to Mental Health?

Nearly everyone is familiar with some aspect of social media. Worldwide, there are over 1.96 billion users. Over three-quarters of the U.S. population currently has at least one social media profile, and 29 percent of U.S. social media users admit to logging on several times per day. [3]

Part of the potential negative impact of social media stems from the amount of time spent on various channels, which is time that could be spent exercising, meeting with friends and engaging in other activities that could benefit your mental health.

Individuals spend a staggering 4.7 hours per day on their smart phone checking social media sites. In the U.S., individuals check Facebook and other sites on their smartphones an average of 17 times per day and spend a staggering 4.7 hours per day using their phones. Considering that most of us are only awake for about 15 hours per day, this means that the average person spends a third of his or her time on the phone and checks social media at least once per hour. [4]

People spend hours at a time looking at other people’s lives; vacations, weddings, family updates and many other things that could incite envy. While social media can help people network for their careers and connect with distant friends and family members, it can also exacerbate negative feelings in individuals who are not happy with their lives.

The Problem of Bullying

cyberbullyingChildren have had to deal with bullying long before the advent and popularization of social media. The difference in years past is that kids could escape the bullying when they weren’t in school. With smartphones, tablets and laptops enabling adolescents to remain connected virtually 24/7, escaping from bullying is no longer possible. Children can be harassed at any time, day or night.

Cyberbullying is a growing problem that continues to receive attention in the mainstream media. In 2011, it was estimated that 2.2 million American students experienced some form of cyberbullying. [5] Other studies indicated that 7 percent of students from grades 6-12 experienced cyberbullying during the 2013-2014 school year, [6] and that 15 percent of high school students in 2013 were bullied electronically during the previous year. [7]

Potential Side Effects of Cyberbullying in Children

  • Substance abuse
  • Skipping school
  • More likely to be bullied in person
  • Unwilling to attend school
  • Experiencing mental health difficulties
  • Low self-esteem
  • Poor academic performance

Balancing Real and Virtual Relationships

addicted to the internetToday’s technological climate makes it nearly impossible for a person to avoid virtual or digital relationships. The vast majority of American teens and adults use social media and engage in blogging, texting and email regularly. There are many advantages to these types of communications and, when used correctly, they will not likely lead to any mental health difficulties. The problem comes when digital relationships exclusively take the place of personal ones.

Digital relationships may feel real, but they are limited and mediated by the technology we use. There is always something in between two people in a digital relationship and something is often lost in translation. Also, while all of the options available in electronic forms of communication may appear to give an individual more freedom, it actually may limit creativity and imagination. Never underestimate the value and effectiveness of face-to-face interaction.

There is also the very real issue of Internet addiction. Though there is no diagnostic criteria for identifying Internet addiction, a growing body of research surrounds the topic. Surveys estimate that up to 8.2 percent of U.S. citizens are currently addicted to the Internet, meaning they spend many hours in non-work technology-related computer/Internet/video game activities. Some research has shown prevalence rates as high as 18.5 percent. [8]

Help for Mental Health Difficulties

When people struggle with depression, anxiety, bipolar disorder, post-traumatic stress syndrome or any other psychological conditions, it can greatly diminish their quality of life. Living with these mental health issues can impact work, school, relationships and everything else in a person’s life, if they don’t receive proper mental health treatment.

If you are concerned about an older friend or family member, Behavioral Health of the Palm Beaches is ready to help. With nearly 20 years of experience, our doctors and other medical professionals can develop a treatment program that encompasses baby boomers’ needs. When you are ready to get back those good feelings without misusing alcohol and drugs, call us at (888) 432-2467.

 

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