“If you feel overwhelmed right now, this is normal.”
Jen Hofmann starts her latest inspired message with these words. Who ISN’T feeling overwhelmed these days? Politics are a real minefield on top of Covid-19 and economic meltdowns and peaceful protesters being shot by other protesters. No matter what your political persuasion might be, these are trying times.
Enter Jen. She is a pretty inspiring person and, as you may know, following the lead of people who inspire you can help cut down on your sense of overwhelm. Jen makes it easy to follow her lead. Take a look. You can read about Americans of Conscience Checklist here and you can subscribe to her checklist here. She started Americans of Conscience Checklist in 2018 and has faithfully followed through with her Facebook posts, checklists, inspired messages, Zoom meetings and emails, week after week. She provides a way to help you take action to help reduce the anxiety and stress we might be feeling and reminds us that those actions have a much greater impact when multiplied.
In her latest message, she comments on when she stood underneath some 1,000-year old sequoias and has this to say (and yes, those are sequoias in the image above) –
“…The strength of these mighty trees allows them to withstand fire, drought, and frigid cold. I learned that they manage to grow on nearly soil-less mountaintops yet do not fall over in high wind. I mistakenly believed it was their deep roots that make them strong.
But that’s not true. Beneath the soil, sequoias reach out in every direction to entwine their roots with their neighbors. They merge their fates together. While one sequoia is powerful alone, they are nearly invincible in solidarity.“
I think it’s fair to say that Jen speaks for Americans who are troubled by our country’s current leadership but her accomplishments, commitment, and leadership are inspiring no matter what political views you hold. I know I am inspired by her actions to hold fast to my faith in America and the solidarity of her citizens. Thank you, Jen.
I am certain that, just like the sequoias, it will take ALL of us, whatever our age, race, nationality, gender, or political or religious beliefs, holding tight to our shared roots to make it through this time as a cohesive, unified country.
Louise Fletcher’s blog post from 11/5/2018 is so good! This is just a piece of the whole. It’s so worth the full read.
“…We believe ‘real’ artists are whatever we are not. We see our idiosyncracies as flaws to be managed, rather than unique traits to be celebrated and amplified.
That’s all rubbish. Whatever you are is perfect. If you are colour blind, that’s perfect for the kind of art you’ll be making. If you can’t draw, that’s perfect because you won’t need to for the kind of art you’ll be making. If you have no arms, that’s perfect for the toe painting you’ll become famous for….”
Nikita Gill wrote a piece in November 2015 for Thought Catalog about being gentle with your body. The last paragraph is just lovely. The entire piece can be found here and you can find just the last paragraph here.
The last paragraph starts this way:
“Please be gentle with your body. It loves you more than anyone or anything in this world…”
And it goes on from there. I’d quote more if it didn’t violate copyright laws. So, seriously, click to read the entire piece or just the last paragraph.
The entire piece is one that supports self-compassion and self-awareness but the final paragraph is a beautiful admonition. For those of us who tend to take our bodies just a tiny bit for granted, it’s a timely reminder to love on ourselves just a little.
Speaking of poetry…have you heard of poetry, therapeutic expressive writing, or bibliopoetry therapy? Poetry therapy is an expressive arts therapy that can be used with therapeutic and non-therapeutic populations. The National Association for Poetry Therapy website provides information about poetry therapy and its uses (and they are running their annual membership drive right now). Poetry is a wonderfully effective way to reach people in a non-confrontational, non-aggressive way and can result in profound insight. It’s pretty amazing, actually.
I started reading Concepts of Chemical Dependency (10th ed.) (Doweiko, 2018) today. The book is required reading for my new health psychology class and I am curiously excited to take the class. Substance use disorders, or SUDs, include misuse of alcohol, tobacco, opiates, stimulants, cannabis, and hallucinogens. SUDs, most notably alcohol and tobacco use disorders, have quite a history in my family. So, I am interested in this! I know from personal experience that families dealing with SUDS suffer long-term physical and emotional consequences. Extensive research supports my own experience (Center for the Application of Prevention Technologies, 2018; Centers for Disease Control and Prevention, n.d.-a; Centers for Disease Control and Prevention, n.d.-b; Daley, 2013; Felitti et al., 1998; Lipari & Van Horn, 2017).
You may wonder why I am referring to an alcohol use disorder, rather than alcoholism. Keyes et al. (2010) studied the impact of stigma on securing treatment for alcohol-related issues. They found that men were more sensitive than women to the perceived stigma associated with alcohol-related problems. They also found that individuals sensitive to the stigma were less likely to seek help with problems related to alcohol. Dweiko (2018) and the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, both refer to alcohol use disorder, not alcoholism, so I have officially adopted the term.
One interesting topic in the book (Doweiko, 2018) was the discussion about what Dr. Doweiko called “the continuum of recreational chemical use” (p. 12). This five-stage continuum reflects a progression in substance use from total abstinence to addiction. Merriam-Webster (n.d.) defines a continuum as “a coherent whole characterized as a collection, sequence, or progression of values or elements varying by minute degrees”. An image can be helpful to imagine the SUDs continuum. A tree’s seasonal growth is a type of a continuum. A tree has no leaves as spring begins but as the season progresses, the leaves suddenly burst forth. It always surprises me when trees are barely green one week and fully enveloped in leaves the next week!
Art by Kudryashka on GL Stock.com
Of course, the tree’s continuum continues into the fall as the leaves fall and then into winter as the branches again become bare. Aging is another type of continuum. The changes are barely noticeable from day to day but are readily apparent over time. Another common image reflects the progressive stages of alcohol use disorder (although the artist labeled it as alcoholism):
Art from GoGraph.com
I agreed with Doweiko’s (2018) idea of a continuum, but I also appreciated the discussion by Piazza and Deroche-Gamonet (2013). They use a three-stage progression that starts with light, irregular recreational use that brings pleasure. The search for pleasure shifts to a desire and then to a need, or a habit, in the second stage. The person engages in more frequent substance use activity and focuses more heavily on the drug use. The third stage involves a complete inability to control the substance use and shows all the signs of addiction. These stages are consecutive but not automatic for everyone because a person’s brain must have specific vulnerabilities to the drug’s pleasure rewards to move into the second and third stages. The first neurobiological vulnerability leads to the needs of the second stage, which are stabilized by increased use. The third stage only occurs because of a second neurobiological vulnerability that leads to the individual’s loss of control and full addiction. The requirement of neurobiological vulnerabilities firmly establishes SUDs to be psychiatric diseases. This raised additional questions for me about whether adverse childhood experiences lead to such neurobiological vulnerabilities. Perhaps I will revisit this topic in the future!
Doweiko (2018) also spoke of the high costs of substance use in the United States. In 2018, substance use disorders cost the United States over $820 billion (Buddy T., 2018). That is a lot of money. Doweiko (2018) states that more than 70 health conditions are worsened by substance use disorders! We know individuals with serious mental illness have a high rate of problematic substance use and usually have multiple medical conditions (Ward & Druss, 2015). The complications caused by SUDs help explain that reality. SUDs lead to significant increases in medical costs, especially when combined with serious mental illness (Doweiko, 2018; Ward & Druss, 2015). Significant additional healthcare costs are also associated with the increased rates of disability and spread of infectious diseases such as HIV/AIDS and hepatitis C that accompany SUDs (Buddy T., 2018; Doweiko, 2018). SUDs result in significant economic costs because of increased work absences and accidental injuries, and reduced work productivity. There are increased costs for law enforcement, litigation, and criminal justice systems. There are both economic and social costs from increased violence, crime, housing instability and homelessness, unemployment, suicide, and welfare costs (Buddy T,, 2018; Daley, 2013; Doweiko, 2018). There are also extensive social costs from increased emotional harm, infant mortality, and domestic violence within families (Buddy T., 2018; Daley, 2013; Felitti et al., 1998). Racial and ethnic minorities are more likely to be in the lower socioeconomic groups, which tend to cluster in at-risk neighborhoods. Multiple social determinants of health lead to decreased health and well-being in these neighborhoods, with SUDs being a common problem experienced by the residents (Fiscella & Sanders, 2016; Smrekar, n.d.). These problems further damage social networks and connections and contribute to the decay of the country’s social fabric.
Media coverage about the opioid crisis has increased in the past two years. Patients have been impacted by the 2016 opioid prescribing guidelines issued by the Centers for Disease Control (Dowell, Haegerich, & Chou, 2016), the 2017 report issued by the President’s Commission on Combating Drug Addiction and the Opioid Crisis (Christie et al., 2017), and the resulting changes made by insurance companies and pharmacies (CIGNA, 2017; CVS Caremark, 2018). The U. S. government has likened the problem to an epidemic (U.S. Department of Health and Human Services, 2018) and the President declared the opioid crisis to be a public health national emergency (Allen & Kelly, 2017; Trump, 2017). The media has reported on the struggles of opioid addiction and has demonized those who use opioids (Farberov, 2016; Seelye, 2018). This type of coverage presents an incomplete picture of the problem. My friends and family members who use prescribed medications for chronic pain are not alone in feeling unfairly singled out for medication reductions that have occurred due to mandates instead of thoughtful consideration of medication needs (Stone, 2018). They feel like they are the easy pickings for the insurance companies to meet their opioid prescription reduction goals (CIGNA, 2017) and are lumped in with the people using illicit opioids. The media reports often lack nuance, whether the reports are of White House announcements, struggling recovering addicts, or sweeping mandates. They often fail to address the needs of patients who live in excruciating pain and whose opioid prescriptions enable them to live relatively normal lives. This is true even in more private, professional communications. I recently received an email thread written with varying levels of compassion by clinical psychologists that discussed the issues of chronic pain patients expressing suicidal comments and whether those comments were valid threats or manipulative ploys to secure their medications (DIV38, personal communication, September 11, 2018). Media articles require some sensationalism to sell and stories that discuss the deep societal wounds caused by SUDs may not sell newspapers or internet ads. It can be easy to miss seeing those wounds, especially when they are unfamiliar and unseen.
It is easy to gloss over the SUDs problems. My worries about cannabis use lightened with glowing media reports about medical marijuana. Concerns about alcohol and tobacco faded although the costs of both disorders remain high (Doweiko, 2018). My personal doubts about the validity of the opioid crisis deepened with our current political divide and even with the news that a pharmaceutical company tied to creating the opioid crisis has patented a new anti-addiction drug that will make it millions of dollars. It was not until I researched the problem myself that it became clear that there are real problems with the over-prescribing of opioids, but it remains unclear whether the proposed resolutions will get to the root of the SUDs problems.
What do you think? Is the path to addiction a continuum? What are the costs of SUDs? How can America come to terms with its SUDs problems? Let me know your thoughts! Thanks for reading.
Daley, D. C. (2013). Family and social aspects of substance use disorders and treatment. Journal of Food and Drug Analysis, 21(4), S73-S76. https://doi.org/10.1016/j.jfda.2013.09.038
Doweiko, Harold E. (2018). Concepts of chemical dependency (10th ed.). Boston, MA: Cengage Learning, Inc.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recommendations and Reports, 65, (No. RR-1), 1–49. https://doi.org/10.15585/mmwr.rr6501e1
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8
Keyes, K. M., Hatzenbuehler, M. L., McLaughlin, K. A., Link, B., Olfson, M., Grant, B. F., & Hasin, D. (2010). Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology, 172, 1364–1372. https://doi.org/10.1093/aje/kwq304
Ward, M. C., & Druss, B. G. (2015). The case for primary care in public mental health settings. In L. E. Raney (Ed.), Integrated care: Working at the interface of primary care and behavioral health (pp. 141-167). Arlington, VA: American Psychiatric Publishing.
Reflections of a Tangled Kind of Life 